Nighttime Sensory–Behavioral Activation and Admission Suicidality in Young Inpatients With Major Depressive Disorder: A Retrospective Clinical‐Record Study

Abstract

INTRODUCTION: Suicide risk assessment during psychiatric admission may benefit from clinically observable information beyond overall depressive symptom severity. This study examined whether clinician-documented nighttime sensory-behavioral activation was associated with admission suicidality in young inpatients with major depressive disorder (MDD). METHODS: This retrospective study included 406 inpatients aged 15-35 years with moderate-to-severe MDD. Nighttime sensory-behavioral activation was coded as none, recurrent, or marked. The primary outcome was admission suicidality, defined as suicidal ideation or behavior during the index depressive episode. Logistic regression models adjusted for age, sex, HAMD-17 score excluding suicide and insomnia items (Items 3-6), and documented precipitating stressor type. Severe social role impairment and thyroid indicators were secondary and exploratory outcomes. RESULTS: After adjustment, recurrent activation (OR = 2.00, 95% CI 1.17-3.43) and marked activation (OR = 1.96, 95% CI 1.12-3.43) were associated with higher odds of admission suicidality. Marked activation was associated with severe social role impairment (OR = 2.47, 95% CI 1.42-4.30). Thyroid indicators did not account for these associations. CONCLUSION: Nighttime sensory-behavioral activation was associated with admission suicidality and, at the marked level, severe social role impairment. These findings are preliminary and warrant prospective validation using standardized measures.