1000 Social Media Use And Actigraphic Measures Of Sleep Timing Among High-risk Adolescents

Introduction

Social media use is a risk factor for poor sleep among adolescents. It remains unclear whether social media use before bed impacts later sleep timing or whether youth turn to social media because of sleep problems, which impacts sleep timing. No study to date has examined this relationship using prospective designs and objective sleep measures among high-risk adolescents, who may be particularly vulnerable to social media use.

Methods

As a preliminary test of this relationship, 25 adolescents and young adults in an intensive outpatient program for depression and suicidality completed baseline measures of social media use and wore actiwatches for up to three months. Social media use included: 1) minutes of use within 2 hours of going to sleep, and 2) frequency of social media use due to difficulty falling or staying asleep. To examine social media as a predictor of sleep timing over the next month, actigraphic measures of sleep timing (i.e., onset) were used in the first month after baseline.

Results

Multilevel modeling indicated that higher levels of social media use in the 2 hours before bed (mean = 46.94 minutes) predicted later sleep timing (B = .02; SE = .01; p= .003). Similarly, higher frequency of social media use due to perceived sleep problems predicted later sleep timing (B = .22; SE = .11; p= .04). Models covaried for age, gender, and prior-day depressed mood. When simultaneously entered, only minutes of social media use in the 2 hours before bed significantly predicted later sleep timing.

Conclusion

Findings suggest that the relationship between social media use and sleep timing among adolescents with depression and suicidality may be driven by both social media use before bed and media use due to sleep problems. Research assessing objective social media use and daily relationships are needed to further disentangle this relationship.

Support

Jessica L Hamilton is supported by a T32 fellowship from NHLBI (HL082610; PI: Buysse). This research is supported by grants from the American Foundation for Suicide Prevention and University of Pittsburgh Clinical and Translational Science Institute.

0976 Temporal Associations Between Sleep And Suicidality In Ultra-high Risk Adolescents And College Students During An Intensive Longitudinal Study

Introduction

Studies consistently demonstrate a link between subjective sleep disturbances and the continuum of suicidality, although this evidence primarily comes from retrospective, cross-sectional studies using limited items to assess sleep. Longitudinal assessment of well-defined and measured sleep/wake behaviors with high-risk individuals are needed to enhance the specificity of near-term suicide risk detection and render concrete targets for suicide prevention.

Methods

Participants (N=46) included ultra-high-risk adolescents (N=29 ages 12-18) and college students (N=17 ages 18-24). For up to 12 weeks, participants wore an actigraph to yield objective data on sleep/wake, and concurrently completed daily cellphone-based ratings of subjective sleep and suicidality. Generalized estimating equations were used to examine the association between sleep parameters (subjective and objective) and the odds of next-day suicidal outcomes (i.e., passive death wish [PDW], suicidal ideation, suicidal intent) controlling for age, gender, and depression severity.

Results

Significant quadratic relationships were observed between actigraphy-derived total sleep time (TST) and probability of next-day PDW (Z=3.7, p=0.0002), suicidal ideation (Z=2.1, p=0.04), and suicidal intent (Z=2.78, p=0.006), with increasing suicidality at low and high values of TST. Low sleep efficiency (<75%) was associated with increased odds of next-day PDW (OR=1.24, Z=2.07, p=0.038). Subjectively (sleep diary measures), low sleep quality (<50 on 100-point scale) was associated with increased odds of next-day suicidal ideation (OR=1.57, Z=3.42, p<0.001), and longer sleep onset latency (>20 minutes) with next-day suicidal intent (OR=3.00, Z=2.37, p=0.018).

Conclusion

Poor sleep health may signal increasing suicide risk, and are modifiable risk factors. We document a significant temporal association whereby objectively-derived short and long TST and low sleep efficiency, as well as subjective sleep quality and sleep onset latency, predicts next day’s suicidality. Further understanding of the temporal association between sleep and suicidality may hold promise to inform real-time monitoring and preventive strategies. Interventions targeting these factors may therefore help reduce suicidality in high-risk youth.

Support

American Foundation for Suicide Prevention; University of Pittsburgh Clinical and Translational Science Institute

0359 The Moderating Role of Race in the Association of Adolescent Sleep Duration and Marijuana Use

Introduction

Insufficient sleep and marijuana use during adolescence vary by race and are associated with poor outcomes in various domains. Sleep difficulties predict drug-related problems, but not all adolescents with insufficient sleep go on to use substances. We examined whether race/ethnicity moderates the association of sleep duration and marijuana use among Black/African-American and White adolescents using a countywide probability-based survey of adolescents.

Methods

Using cross-sectional data (n=1447), logistic regression examined whether race moderated the association of adolescent sleep duration and recent marijuana use alone and after controlling for covariates in both weighted and unweighted models.

Results

Hours of sleep was significantly negatively associated with recent marijuana use. Black/African-American youth in our sample had up to a 60% increased odds of marijuana use in the past 30 days compared to White youth, and they reported significantly shorter sleep duration than their White peers. In weighted models, Black/African-American youth had an increased probability of marijuana use with fewer hours of sleep as compared to White youth, even after accounting for covariates.

Conclusion

In our countywide survey of adolescents, we found racial differences in the association of sleep duration and marijuana use. Future work should replicate our analyses with a longitudinal sample of adolescents to better evaluate the direction of these effects. Future efforts should also focus on identifying contextual factors that may explain racial differences in the sleep duration—substance use relationship, as well as developing strategies to reduce disparities in this relationship.

Support

The Heinz Foundation, the Hillman Foundation, the Grable Foundation, and the FISA Foundation. Dr. Levenson’s effort was supported by NICHD.

Altered functioning of reward circuitry in youth offspring of parents with bipolar disorder

BACKGROUND

Offspring of parents with bipolar disorder (BD) (BO) are at higher risk of BD than offspring of parents with non-BD psychopathology (NBO), although both groups are at higher risk than offspring of psychiatrically healthy parents (HC) for other affective and psychiatric disorders. Abnormal functioning in reward circuitry has been demonstrated previously in individuals with BD. We aimed to determine whether activation and functional connectivity in this circuitry during risky decision-making differentiated BO, NBO and HC.

METHOD

BO (n = 29; mean age = 13.8 years; 14 female), NBO (n = 28; mean age = 13.9 years; 12 female) and HC (n = 23; mean age = 13.7 years; 11 female) were scanned while performing a number-guessing reward task. Of the participants, 11 BO and 12 NBO had current non-BD psychopathology; five BO and four NBO were taking psychotropic medications.

RESULTS

A 3 (group) × 2 (conditions: win-control/loss-control) analysis of variance revealed a main effect of group on right frontal pole activation: BO showed significantly greater activation than HC. There was a significant main effect of group on functional connectivity between the bilateral ventral striatum and the right ventrolateral prefrontal cortex (Z > 3.09, cluster-p < 0.05): BO showed significantly greater negative functional connectivity than other participants. These between-group differences remained after removing youth with psychiatric disorders and psychotropic medications from analyses.

CONCLUSIONS

This is the first study to demonstrate that reward circuitry activation and functional connectivity distinguish BO from NBO and HC. The fact that the pattern of findings remained when comparing healthy BO v. healthy NBO v. HC suggests that these neuroimaging measures may represent trait-level neurobiological markers conferring either risk for, or protection against, BD in youth.

Antidepressant discontinuation-related mania: critical prospective observation and theoretical implications in bipolar disorder

BACKGROUND

Development of manic symptoms on antidepressant discontinuation has primarily been reported in unipolar patients. This case series presents preliminary evidence for a similar phenomenon in bipolar patients.

METHOD

Prospectively obtained life chart ratings of 73 bipolar patients at the National Institute of Mental Health were reviewed for manic episodes that emerged during antidepressant taper or discontinuation. Medical records were utilized as a corroborative resource. Six cases of antidepressant discontinuation-related mania were identified and critically evaluated.

RESULTS

All patients were taking conventional mood stabilizers. The patients were on antidepressant treatment a mean of 6.5 months prior to taper, which lasted an average of 20 days (range, 1-43 days). First manic symptoms emerged, on average, 2 weeks into the taper (range, 1-23 days). These 6 cases of antidepressant discontinuation-related mania involved 3 selective serotonin reuptake inhibitors (SSRIs), 2 tricyclic antidepressants (TCAs), and 1 serotonin-norepinephrine reuptake inhibitor. Mean length of the ensuing manic episode was 27.8 days (range, 12-49 days). Potential confounds such as antidepressant induction, phenomenological misdiagnosis of agitated depression, physiologic drug withdrawal syndrome, and course of illness were carefully evaluated and determined to be noncontributory.

CONCLUSION

These 6 cases suggest a paradoxical effect whereby antidepressant discontinuation actually induces mania in spite of adequate concomitant mood-stabilizing treatment. These preliminary observations, if replicated in larger and controlled prospective studies, suggest the need for further consideration of the potential biochemical mechanisms involved so that new preventive treatment approaches can be assessed.