Sleep Problems and Self-Harm at University
- 02 April 2024
- Posted in: Healthcare, Management & Leadership, Education
We spend approximately one third of our life sleeping, or at least trying to (Aminoff et al., 2011), however little is understood about the functions of sleep. What is known is that sleep difficulties are associated with mental health problems across all ages (Baglioni et al., 2016) , and that more and more individuals worldwide are getting insufficient sleep (Roenneberg, 2013), particularly adolescents (Chattu et al., 2018). Adolescence is the most common developmental phase for the onset of mental health problems (Jones, 2013) and increased rates of this are evident within this age group (Roach, 2018). Self-harm is a complex, multidimensional construct encompassing self-injurious behaviours (Long et al., 2013) and previous research has demonstrated strong links between sleep problems and self-harm (Khazaie et al., 2021). Given that adolescence is a particularly vulnerable to the onset of mental health problems (Galván, 2017), and have the highest prevalence of self-harm behaviour (Brager-Larsen et al., 2022), it is critical that researchers and practitioners identify and understand how key risk factors, like sleep, contribute to this expression of psychological distress in order to effectively prevent it.
Adolescence is a transitional period accompanying significant changes in physiology, identity, and social roles (Dahl et al., 2018), and instability within this potentially influences this age group’s vulnerability to poor mental health. In the 2014 Health Behaviour in School-Aged Children Report, it was found that approximately 49% of girls and 30% of boys reported sleep difficulties (Bruce et al., 2017). Concerningly, a third of adolescents who experience sleep problems at 16 continue having difficulty at 23 years (Dregan & Armstrong, 2010), highlighting the chronicity of sleep problems into adulthood. This continuation of challenges to sleep is further reflected in 62% of university students reporting poor sleep quality, getting insufficient sleep, or taking too long to fall asleep (Becker et al., 2018).
Transitioning to university is another period characterised by major adjustment. Those attending higher education naturally experience delayed circadian preference (Roenneberg et al., 2004), which may be defined as a biologically driven sleep pattern involving later sleeping and waking times. This combined with early-morning lectures and seminars, and the influence of various psychosocial factors such as drink-culture and technology usage, getting enough good quality sleep can be the unachievable dream. The prevalence of depression amongst undergraduate students ranges from 10-58%, and suicidality is as high as 14% (Sheldon et al., 2021). Given the interwoven relationship between sleep and mental health, recognising the relevance of sleep difficulties, and tackling this modifiable behaviour is imperative when preventing and treating mental health problems, particularly self-harm.
Self-harm may be conceptualised as an umbrella term to a variety of self-injurious behaviours that may be separated based on intention of death: non-suicidal self-injury (NSSI), and suicide (Halicka & Kiejna, 2018). Suicide is a leading cause of death amongst adolescents and young people worldwide (Glenn et al., 2020), and roughly 17.2% of adolescents report NSSI (Swannell et al., 2014). Engaging in NSSI has shown to increase the likelihood of attempting suicide the following year by 30- to 100-fold (Chan et al., 2016). Several factors can act as a preventative buffer to the development of self-harm behaviour, meanwhile the absence of mitigating factors can be the tipping point, with sleep playing a key role (Short et al., 2020). Nevertheless, our understanding of the mechanisms and contributing factors in this relationship between sleep and self-harm is poor, especially amongst this demographic (Fuligni et al., 2018).
My research seeks to provide detailed insight into the longitudinal effects of poor sleep on self-harm during adolescence by untangling the complex web of factors in these associations, such as decision-making, risk-taking, and self-esteem. Investigating how physical, socio-emotional, behavioural, and cognitive development processes contribute to this enables the mapping of factors to provide practitioners and other academics critical time points for when interventions may be best suited for maximum effectiveness. Understanding the factors and the nature of their associations that contribute to the development of self-harm will allow the field of youth mental health the needed step-up to curb this major public health concern and the knowledge to support those most at risk.
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