0975 Mediators of the Insomnia-Suicidality Association

Abstract Introduction Insomnia severity is a significant risk factor for heightened suicidality, including ideation, attempts, and death by suicide. As a modifiable risk factor, insomnia is a potential target for suicide prevention; however, the models explaining the association between insomnia and suicidality remain unclear. Our model posits that insomnia hinders sleep’s regional recuperative brain functions, contributing to daytime impairments, including emotional dysregulations. Another model links insomnia to suicidality through additional factors including perceived burdensomeness and thwarted belongingness. Each of these potential factors are associated with both insomnia and suicidality. This study aimed to investigate potential psychological mechanisms in the insomnia-suicidality association, using validated measures in a nationally representative sample. Methods Through a Qualtrics survey, participants (N=428) completed the Difficulties in Emotion Regulation Scale to assess emotional dysregulation, Interpersonal Needs Questionnaire to measure perceived burdensomeness and thwarted belongingness, Frequency of Suicidal Ideation Inventory to assess suicidality severity, Insomnia Severity Index, and PROMIS–Depression, and -Anxiety short forms. We used regression analyses to investigate the association between insomnia, suicidality severity, and demographic variables. Structural equation modeling was used to determine whether emotional dysregulation, perceived burdensomeness, or thwarted belongingness mediated the insomnia-suicidality severity association, even when accounting for depression. Results Insomnia severity was related to greater suicidality (p 0.001, CI=0.19–0.31). This association was mediated by depression severity (p=0.836, CI=-0.06–0.08). Emotion dysregulation and perceived burdensomeness partially mediated the insomnia-suicidality severity association (β=0.06, p=0.001; β=0.18, p 0.001), and when accounting for depression severity, fully mediated the insomnia-suicidality severity association (β=0.04, p=0.045; β=0.24, p 0.001). Thwarted belongingness did not mediate the association before (β=0.02, p=0.142) or after accounting for depression (β=0.01, p=0.412). Conclusion This study replicates considerable evidence that insomnia is an important marker and risk factor for suicidality. The mechanisms through which insomnia may confer risk for suicidality include depression, emotion dysregulation, and perceived burdensomeness. Insomnia may be an ideal upstream target for reducing suicidality and its risk factors including depression, emotion dysregulation, and perceived burdensomeness. Support (if any)