Short Sleep Tied to Next-Day Depression in Suicidal Youth, With Delainey Wescott, PhD

Sleeping less than usual may contribute to greater next-day depression among adolescents and young adults receiving intensive treatment for depression and suicidality, according to data presented at the 2026 Anxiety and Depression Association of American (ADAA) in Chicago from April 9 – 11. Findings from an intensive longitudinal study suggest that heightened emotional reactivity to negative interpersonal events may help explain the relationship.

“What's even more important is that for folks who have more moderate to severe depression, that sleep loss to depression relationship is amplified, and so folks with more severe depression may be more vulnerable to the effects of sleep loss on next day depression,” Delainey Wescott, PhD, of the University of Pittsburgh School of Medicine, said in an interview with HCPLive.

The longitudinal study included 198 adolescents and young adults aged 13-23 years (82% white participants; 76% female) undergoing intensive outpatient treatment for depression and suicide risk. Participants wore actigraphy devices and completed daily diaries assessing sleep duration, depression symptoms, and emotional responses to interpersonal events over an average of 60 days. Clinician-rated depression severity was also collected weekly. Multilevel models examined day-to-day associations between sleep and next-day depressive symptoms, and mediation analyses evaluated affective reactivity as a potential mechanism.

Over the course of treatment, self-reported sleep duration increased modestly (P <.001), while daily self-reported depression decreased (P =.02). However, actigraphy-measured sleep duration did not significantly change (P = .16). The study ultimately showed that sleeping less than usual based on self-report was associated with greater next-day depression (P =.02), whereas actigraphy-based sleep duration was not significantly associated after covariate adjustment (P =.18).

Baseline depression severity moderated the relationship between sleep and next-day depression. Greater clinician-rated depression amplified the impact of short sleep duration on next-day depressive symptoms for both diary-based (P =.03) and actigraphy-based sleep estimates P =.01). These findings suggest that youth with more severe depression may be particularly sensitive to sleep disruption.

The analysis also identified a potential mechanism linking sleep loss to worsening mood. Sleeping less than usual predicted increased negative emotional reactivity to interpersonal events, such as conflicts, perceived rejection, or feelings of exclusion. This heightened reactivity, in turn, was associated with greater next-day depression. Mediation models confirmed that increased negative affectivity statistically mediated the relationship between short sleep and depressive symptoms (P <.001).

The findings have implications for clinical care, particularly in intensive outpatient settings, where sleep may be under-addressed. Wescott suggested that integrating sleep-focused strategies into higher-acuity treatment programs could improve outcomes. Potential approaches include promoting regular sleep-wake schedules, increasing sleep duration, and incorporating elements of cognitive behavioral therapy for insomnia or transdiagnostic sleep and circadian interventions.

Future research will evaluate whether directly targeting sleep in intensive outpatient programs improves clinical outcomes. Ongoing work aims to integrate sleep-focused interventions into treatment curricula and assess effects on depression and suicidality in high-risk youth.

“What's really unique about this data set is we were able to not only look at high risk youth…engaged in intensive outpatient treatment, but we're also able to follow them for up to 3 months, and so we're able to track the progression of treatment over time, but really understand those day-to-day relationships of sleep, of negative affectivity, of depression severity, to disentangle what might be happening on a day-to-day basis that may be maintaining some depression symptomatology,” Wescott said. “The unique study design and the unique sample of this study really allowed us to ask some interesting questions, which I think have some important clinical implications of the importance of treating sleep in high risk youth.”

References

Wescott D. Sleeping Less Than Usual Is Associated with Greater Next Day Depression and Higher Reactivity to Negative Interpersonal Events Among Suicidal Adolescents. Poster presented at ADAA in Chicago from April 9 – 11, 2026.