Sleep Duration Moderates the Association Between Bullying and Suicide Attempts Among US Adolescents

Suicide attempts, bullying, and insufficient sleep duration are significant public health concerns among US adolescents. While research has identified sleep as a modifiable factor linked to both bullying and suicidality, it remains unclear whether sleep duration influences the relationship between bullying and suicide attempts. This study examined whether sleep duration moderates the association between bullying (school and electronic) and suicide attempts among US adolescents. Data were drawn from the 2021 National Youth Risk Behavior Surveillance System, a nationally representative survey of US students in grades 9–12. Primary exposure was self-reported school/electronic bullying. Suicide attempts were the outcome. Self-reported sleep duration was the moderating variable. Multivariable log-binomial models and interaction effects were examined on both multiplicative and additive scales. Among 17,134 students, bullying was associated with a greater risk of suicide attempts, with the highest risk among those experiencing school and electronic bullying RR = 2.13, 95% CI, 1.75–5.89. Sleep duration moderated this association, with lowest risk observed at 7–8 hours and greater risks at ≤ 4 and ≥ 9 hours. Additive interaction analysis revealed the proportion of suicide attempt risk attributable to the interaction of school bullying with a sleep duration of ≥ 9 hours was 68%. Sleep duration moderates the relationship between bullying and suicide attempts in US adolescents. Reducing bullying and promoting optimal sleep duration in adolescents could substantially lower suicide risk.