# Sleep as a Mechanism of Premenstrual Exacerbation of Depression and Suicidality

> **NIH NIH F30** · UNIVERSITY OF ILLINOIS AT CHICAGO · 2024 · $53,974

## Abstract

Aligned with the NIMH 2023 Strategic Plan, which highlights suicide prevention and digital health as research
priorities, the proposed project is consistent with NIH’s strategic goal to examine mental illness trajectories across
the lifespan. The proposed project utilizes high-resolution digital health sleep data in a clinical trial to identify
periods of acute suicide risk and potential sleep-related treatment targets, while also examining the impact of
the menstrual cycle in these processes. Suicide is a leading cause of death, and it is important for ongoing
studies to focus on when patients may be at imminent risk. Emerging research suggests the menstrual cycle and
sleep disturbances are time-varying modulators of acute depression and suicidality. The primary mentor’s prior
work substantiates a link between cyclical changes in ovarian steroids and suicidality and confirms that most
patients recruited for recent suicidal ideation (SI) demonstrate perimenstrual worsening of SI. Further, the
laboratory’s two crossover RCTs demonstrate that natural perimenstrual steroid withdrawal serves as a recurring
trigger for worsened suicidality and depression that can be reversed with E2+P4 supplementation. However,
treatment of this kind is not feasible long-term due to clotting and hormone-dependent cancer risks, so it is critical
to identify physiological mediators of these effects which may be treatment targets. Sleep disturbances also
predict acute increases in suicidality/depression and there is within-person worsening in sleep perimenstrually
suggesting that sleep may be a time-varying physiological mediator for the relationship between the cyclical
hormones and suicidality in some people. The proposed study will utilize archival data from the primary mentor’s
recently completed R01-funded RCT, which the candidate was instrumental in collecting, in 150 AFAB
transdiagnostic patients with suicidality, including 1-3 months of daily surveys, hormonally confirmed cycle
phases, and wearable sleep data (Oura ring), to evaluate the role of sleep in perimenstrual exacerbation of
SI/depression. The proposed study has several novel aspects: 1) High temporal resolution sleep data across
long observation periods; 2) Analytic methods that consider individual differences in cyclical hormone sensitivity
and sleep patterns; 3) Experimental ovarian hormone manipulation to establish causality in the relationship
between sleep disturbances, cycling hormones, and suicidality/depression. The proposed project will provide
clinical trial research experience, training in nomothetic and idiographic statistical modeling, and collaborative
mentorship in methods and clinical exposure in sleep and reproductive psychiatry to help the candidate achieve
long-term career goals in academic medicine.

## Key facts

- **NIH application ID:** 10997175
- **Project number:** 1F30MH138058-01
- **Recipient organization:** UNIVERSITY OF ILLINOIS AT CHICAGO
- **Principal Investigator:** Anisha Nagpal
- **Activity code:** F30 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $53,974
- **Award type:** 1
- **Project period:** 2024-06-27 → 2028-06-26

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10997175

## Citation

> US National Institutes of Health, RePORTER application 10997175, Sleep as a Mechanism of Premenstrual Exacerbation of Depression and Suicidality (1F30MH138058-01). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10997175. Licensed CC0.

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