Excessive daytime sleepiness as a predictor of suicidal behavior in first-episode youth major depressive disorder.

BACKGROUND

Excessive daytime sleepiness (EDS) is common in youth with major depressive disorder (MDD), and it may have some serious consequences, such as suicidal behavior. However, little is known about the pathways linking EDS to suicidal behavior in this population.

METHOD: This cross-sectional analysis comprising a sample of N = 427 youth with first-episode MDD. The assessment battery captured sociodemographic details, clinical profiles, and responses to standardized questionnaires, including the Epworth Sleepiness Scale (ESS), Athens Insomnia Scale (AIS), Hamilton Anxiety Rating Scale (HAMA), Hamilton Depression Rating Scale (HAMD), and Columbia-Suicide Severity Rating Scale (C-SSRS). A multiple linear regression analysis was used to explore association between risk predictors of suicidal behavior. Suicidal behavior, the dependent variable, was assessed using the C-SSRS. Additionally, an exploratory mediation analysis was conducted to examine the potential mediating role of depressive symptoms in the association between daytime sleepiness and suicidal behavior.

RESULT: The prevalence of EDS was 39.1 % in our sample of youth. Regression analysis identified several independent predictors, including age (β = -0.19, p < 0.001), depressive symptoms (β = 0.28, p < 0.001), insomnia (β = 0.11, p = 0.031), and EDS (β = 0.16, p = 0.002). Mediation analyses revealed that depressive symptoms (β = 0.37, p < 0.001) significantly mediated the relationship between EDS (β = 0.35, p < 0.001) and suicidal behavior, even after adjusting for insomnia.

LIMITATION: Nevertheless, the cross-sectional design precludes causal inference.

CONCLUSION

EDS represents a significant and independent risk factor for suicidal behavior in youth with MDD. Furthermore, the association between EDS and suicidal behavior was partially mediated by depressive symptoms. Collectively, these findings underscore the critical importance of assessing and addressing daytime sleepiness in suicide risk prevention strategies for this vulnerable population.