JMIR Publications

ABSTRACT

Background:

Patients are at high risk of suicidal behaviour and death by suicide immediately following discharge from an inpatient psychiatric hospital. Furthermore, there is a high prevalence of sleep problems in inpatient settings which is associated with worse outcomes following hospitalisation. However, it is unknown whether poor sleep is associated with suicidality following initial hospital discharge. Our study aim is to examine the relationship between sleep and suicidality in discharged patients using ecological momentary assessment (EMA).

Objective:

To examine the relationship between subjective and objective sleep parameters and suicidality in young psychiatric inpatients transitioning to the community, and to explore the underlying mechanisms of this relationship using an adapted Integrated Motivational-Volitional (IMV) model.

Methods:

Our study will be the first co-produced prospective EMA using a wearable device to examine the sleep-suicide relationship during the transition from acute inpatient care to the community. Prospectively discharged inpatients aged 18-35 with a mental disorder (n>50) will be assessed for eligibility and recruited across two sites. Data on suicidal ideation, behaviour and imagery, non-suicidal self-harm and imagery, defeat, entrapment, and hopelessness, affect and sleep will be collected on the Pro-Diary V wrist-worn electronic watch for up to 14 days. Objective sleep and daytime activity will be measured using the inbuilt MotionWare software. Questionnaires will be administered face-to-face at baseline and follow-up while data will also be collected on the acceptability and feasibility of using the Pro-Diary V watch to monitor the transition following discharge. The study has been, and will continue to be, co-produced with young people with experience of being in an inpatient setting and suicidality.

Results:

South Birmingham Research Ethics Committee (Ref: 21/WM/0128) approved the study on June 28th 2021. We expect to see a relationship between poor sleep and post-discharge suicidality. Results will be available in 2022.

Conclusions:

This will be the first EMA study to examine the relationship between sleep and suicidality, and to apply the IMV model in young patients transitioning from psychiatric hospital to community. We expect findings will directly influence policy and clinical practice, including the introduction of digital monitoring of suicidality and/or sleep before and after initial hospital discharge.