Insomnia and Suicide-Related Behaviors: A Multi-Study Investigation of Thwarted Belongingness as a Distinct Explanatory Factor

Abstract Background Insomnia is a robust correlate of suicidal ideation and behavior. Preliminary research has identified thwarted belongingness (c.f. social disconnection) as an explanatory link between insomnia and suicidal ideation. Objectives This study replicates and extends previous findings in four demographically diverse samples using both cross-sectional and longitudinal designs. Additionally, the specificity of thwarted belongingness was evaluated by testing anxiety as a rival mediator. Method Self-report measures of insomnia severity, thwarted belongingness, suicidal ideation and behavior, and anxiety were administered in four adult samples: 469 undergraduate students, 352 psychiatric outpatients, 858 firefighters, and 217 primary care patients. Results More severe insomnia was associated with more severe thwarted belongingness and suicidality. Thwarted belongingness significantly accounted for the association between insomnia and suicidality, cross-sectionally and longitudinally, beyond anxiety. Notably, findings supported the specificity of thwarted belongingness: anxiety did not significantly mediate the association between insomnia and suicidality, and insomnia did not mediate the relation between thwarted belongingness and suicidality. Limitations This study relied solely on self-report measures. Future studies incorporating objective sleep measurements are needed. Conclusion Findings underscore the utility of assessing and addressing sleep disturbances and social disconnection to reduce suicide risk.