(PS3-B39) Prevalence of Specific Dysfunctional Beliefs and Attitudes About Sleep Constructs in a Population of Suicidal Adolescents at Entry and Discharge to Treatment: An Exploratory Investigation

Dysfunctional beliefs and attitudes about sleep (DBAS) are indicated as a potential mechanism underlying the association between insomnia and internalizing difficulties (e.g., depression, anxiety), and even suicidality in children and adolescents (Blake et al., 2018; Littlewood et al., 2017; McCall et al., 2013). Reducing maladaptive sleep-related cognitions, such as DBAS, are an essential outcome variable for behavioral sleep interventions (e.g., CBT-Insomnia). DBAS are often conceptualized as multiple constructs, such as dysfunctional beliefs and attitudes regarding expectations for sleep requirements, control and predictability of one’s sleep, and consequences for sleep loss (Morin 1993, 1994; Morin et al., 2007). However, few to no studies have examined DBAS constructs as related to outcomes, let alone in high-risk populations (e.g., sleep quality, suicidality; Chan et al., 2022; Gregory et al., 2008).

This study investigated the prevalence of DBAS constructs in a population of suicidal adolescents (aged 12-18; M = 14.8 years; 72% female) in a suicidality treatment program at admission (N = 186) and discharge (N = 92). To examine dysfunctional beliefs and attitudes about sleep, we selected the well-validated DBAS-16 scale (Morin et al., 2007). Items are rated on a Likert scale (1 - “strongly disagree” to 10 - “strongly agree”; higher score meaning more erroneous beliefs). The scale has four derived constructs/subscales: 1) consequences of insomnia; 2) helplessness/worry about sleep; 3) expectations for sleep; and 4) medication. We utilized descriptive statistics and paired samples t-tests to examine prevalence rates and change over time.

At admission, adolescents endorsed the most difficulties with subscales of helplessness (M = 4.53, SD = 2.57) and expectations (M = 5.19, SD = 2.76). At discharge, adolescents indicated decreases in difficulties with consequences and medication subscales, but only statistically significant decreases with helplessness (p< .001). Interestingly, findings indicate increased difficulties with expectations, though this was not statistically significant. When examining this subscale, DBAS related to quantity of sleep increased, whereas those about “catching up” on sleep decreased, at discharge.

Though not causal, we suggest that standard suicidality treatment interventions are helpful in improving some, but not all, constructs of DBAS. Understanding and targeting the nuanced constructs of DBAS in this high-risk population are imperative to better informing and tailoring suicidality and sleep-related interventions (such as CBT-I), as there may be considerable differences in sleep-related cognitions between this high-risk population and the non-suicidal adult populations on which those interventions were developed. Larger scale examinations of DBAS and their relationships with outcome variables (e.g., sleep quality, suicidality) in suicidal adolescent populations are essential in improving treatment outcomes.