(PS6-B41) Sleep Difficulties as Mediators of the Relationship Between Mental Health Symptoms and Suicidal Ideation in College Student Athletes

Suicide is a major public health concern, especially among college students in which it is the second leading cause of death. Mental health disorders are prevalent in college students, and student athletes may be particularly at risk due to high demands from athletic training and competition. Previous literature generally shows a relationship between a variety of mental health symptoms (e.g., anxiety, depression, substance use, disordered eating, etc.) and suicidal thoughts and behaviors. Additionally, it is well-established that (1) sleep difficulties are associated with suicidal ideation and (2) mental health symptom severity is related to suicidal ideation and sleep difficulties. However, less is known about whether sleep difficulties may help to explain the relationship between mental health symptoms and suicidal thoughts in college student athletes. This study examined if sleep difficulties account for (mediate) the relationship between mental health symptoms and suicidal ideation in collegiate athletes. College student athletes (n = 993, mean age = 20 years, 47% women) from three universities in the Pacific Athletic Conference-12 completed mental health screeners as part of their routine health examination. Suicidal ideation was assessed using a single item from the Patient Health Questionnaire (PHQ)-9, which was dichotomized. Sleep difficulties were assessed using the Athlete Sleep Screening Questionnaire-Sleep Difficulty Score (ASSQ-SDS) total and item level scores. Mental health symptoms were assessed using the following scales: PHQ-9 (with the suicide item removed), GAD-7, APSQ, EDE-QS, AUDIT-C, CAGE-AID, ASRS, and PC-PTSD. Basic cross-sectional mediation analyses were conducted. Using bootstrapping with 5,000 resamples, the indirect effect of alcohol use on suicidal ideation through sleep difficulty was significantly different from zero (ab = .022, SE = .011, 95% CI [.003, .048]). Alcohol use was significantly associated with sleep difficulty (b = .123, SE = .046, p = .007), and sleep difficulty was in turn, significantly associated with suicidal ideation (b = .183, SE = .070, p = .009). The direct effect of alcohol use on suicidal ideation was also significant (b = .244, SE = .098, p = .013). These findings suggest that sleep difficulty mediated the association between alcohol use and suicidal ideation. Additional basic mediation analyses were conducted using individual items on the ASSQ-SDS. Analyses revealed that the indirect effects of alcohol use on suicidal ideation through trouble staying asleep and sleep medication use were significantly different from zero (ab = .031 SE = .014, 95% CI [.005, .060]; ab = .018, SE = .012, 95% CI [.0002, .040], respectively). Sleep difficulty did not significantly mediate the association between symptoms of depression, anxiety, psychological strain, disordered eating, drug use, ADHD, or posttraumatic stress and suicidal ideation. This study was limited by the use of cross-sectional mediation analyses and self-report measures. Future research using longitudinal mediation analyses and structured clinical interviews to further examine sleep problems as a mediator between mental health symptoms and suicidal thoughts in collegiate athlete populations is warranted.