Affective lability and pre-sleep social-media engagement each independently predicted suicide-attempt history among adolescents, with sexual-minority status further elevating risk, and the full model demonstrating strong discrimination (AUC = 0.861).
Key Findings
Results
Adolescents with a suicide-attempt history showed significantly higher affective lability than controls.
Sample included 159 adolescents aged 10-17 years: 66 with a suicide-attempt history and 93 controls.
Affective lability was measured using the Children's Affective Lability Scale.
Median affective lability score was 36.5 in the suicide-attempt group versus 12 in controls.
In regression analysis, affective lability independently predicted suicide-attempt history (OR = 1.05, 95% CI [1.03–1.08], p < .001).
Results
Adolescents with a suicide-attempt history spent more time on social media before sleep than controls.
Pre-sleep social-media duration was assessed with investigator-developed items.
Median pre-sleep social-media use was 60 minutes in the suicide-attempt group versus 30 minutes in controls (p = .016).
Difficulty disengaging from social media at bedtime was also greater in the suicide-attempt group (median = 5 vs. 4, p = .004).
Pre-sleep social-media engagement independently predicted suicide-attempt history in adjusted regression (OR = 1.71, 95% CI [1.06–2.76], p = .029).
Results
Sexual-minority status was a strong independent predictor of suicide-attempt history.
Sexual-minority status was included as a covariate in binary logistic regression models adjusted for age, sex, and sexual-minority status.
Sexual-minority status was associated with markedly elevated odds of suicide-attempt history (OR = 9.33, 95% CI [3.95–22.01], p < .001).
This finding held after adjusting for affective lability and pre-sleep social-media engagement.
Results
The full logistic regression model demonstrated strong discrimination and good calibration for predicting suicide-attempt history.
The full model included affective lability, pre-sleep social-media engagement, age, sex, and sexual-minority status.
Area under the curve (AUC) was 0.861 (95% CI [0.802–0.920]).
The model also showed good calibration.
Cross-sectional design limits causal inference.
Conclusions
Both affective lability and pre-sleep social-media engagement each uniquely predicted suicide-attempt vulnerability among adolescents, underscoring their relevance as potential markers of suicide risk.
Each predictor independently contributed to the model after adjustment for age, sex, and sexual-minority status.
Pre-sleep social-media engagement was assessed with two investigator-developed items measuring duration and difficulty disengaging.
The study used Mann-Whitney U tests for group comparisons and binary logistic regression for predictive modeling.
The cross-sectional design was identified as a study limitation.
What This Means
This research suggests that two factors — emotional instability (called 'affective lability') and heavy social media use right before bedtime — are each independently linked to a history of suicide attempts in teenagers aged 10 to 17. In a study of 159 adolescents, those who had previously attempted suicide tended to have much higher emotional instability scores and spent about twice as long on social media before sleep (60 minutes vs. 30 minutes) compared to teens with no such history. They also reported greater difficulty stopping social media use at bedtime. When researchers built a statistical model combining these factors along with age, sex, and whether teens identified as a sexual minority, the model was highly accurate at distinguishing between the two groups.
The study also found that identifying as a sexual minority was associated with over nine times higher odds of having a suicide-attempt history, even after accounting for the other factors. This highlights sexual-minority adolescents as a particularly vulnerable group. Importantly, both emotional lability and pre-sleep social media use contributed to the prediction independently — meaning neither one fully explained the other's effect.
This research suggests that pre-sleep social media engagement and emotional instability could serve as useful markers to help identify teenagers at higher risk for suicide attempts. Because pre-sleep social media use is a potentially modifiable behavior, these findings point toward possible targets for intervention — though the cross-sectional design of the study means it cannot establish whether these factors cause suicide attempts or are simply associated with them.
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Manzour R, Sereika S, Zelazny J. (2026). Affective lability and pre-sleep social-media use in relation to adolescent suicide attempts.. Archives of psychiatric nursing. https://doi.org/10.1016/j.apnu.2026.152123