Dr. Bernert is Director of the Suicide Prevention Research Laboratory within the Stanford Mood Disorders Center. She is a suicidologist, with subspecialty expertise in suicide prevention clinical trials and evidence-based standardized suicide risk assessment and best practice management. She has subspecialty training in behavioral sleep medicine, with a background in sleep and circadian physiology. Her program utilizes cognitive, biologic (e.g., fMRI), and behavioral testing paradigms, with an emphasis on translational therapeutics. Dr. Bernert has collaborated with NIH, DOD, DARPA, SAMHSA, and the White House on suicide prevention initiatives; and recently contributed to the 2014 VACO Mental Health Innovations for Suicide Prevention Workgroup and the 2013 VA/DOD Clinical Practice Guidelines (CPG) for the Assessment and Management of Patients at Risk for Suicide. Her research focuses on the development of novel therapeutic targets for suicide prevention across the lifespan, particularly those aiming to reduce stigma and enhance access to care. A specific focus of this work emphasizes the use of low-risk intervention approaches for the prevention of suicide. Dr. Bernert has several suicide prevention trials currently underway, funded by NIH and DOD, testing the preliminary efficacy of a non pharmacological insomnia treatment on suicidal behaviors. Within this framework, we are interested in the investigation of transdiagnostic risk factors and candidate biomarkers that may inform the pathogenesis of risk and treatment innovation. Advisory and advocacy work, focused on the way in which such research guides public health policy, dissemination, and national strategies for suicide prevention, has been an extension of this work. Most recently, this includes local initiatives to establish guidelines for lethal means restriction advocacy and implementation on a broad scale.

Academic Appointments

Administrative Appointments

  • Instructor, Psychiatry and Behavioral Sciences, Stanford University School of Medicine (2011 - 2015)
  • Director, Stanford Suicide Prevention Research Laboratory, Psychiatry and Behavioral Sciences (2012 - Present)
  • Investigator, Mental Illness Research, Education and Clinical Centers (MIRECC), VA Palo Alto Health Care System (2013 - Present)
  • Co-Chair, Project Catalyst, Psychiatry and Behavioral Sciences, Stanford University School of Medicine (2015 - Present)

Boards, Advisory Committees, Professional Organizations

  • Board Member, Bridge Rail Foundation (BRF) (2013 - Present)
  • Co-Chair, Lethal Means Restriction Workgroup, The City of Palo Alto and Project Safety Net (2016 - Present)

Professional Education

  • Undergraduate Education, University of Oregon, English and Psychology (2000)
  • Graduate Education, Florida State University, Clinical Psychology (2009)
  • Predoctoral Fellowship, NIH/NHGRI, Intramural Research Training Award in Biomedical Sciences (2006)
  • Predoctoral Fellowship, NIH/NIMH, Florida State University, National Research Service Award (F31) (2007)
  • Clinical Internship, VA Palo Alto Health Care System (VAPAHCS), Clinical Psychology (2009)
  • Postdoctoral Fellowship, NIH/NIMH, Stanford University, National Research Service Award (T32) (2011)

Research & Scholarship

Clinical Trials

  • A Brief Behavioral Sleep Intervention for Depression Among Military Veterans Recruiting

    This study investigates the impact of brief behavioral insomnia treatment on depressive symptoms among military veterans.

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  • A Sleep-Oriented Intervention for Suicidal Behaviors Recruiting

    An open-label trial to investigate the use of a behavioral insomnia treatment for suicidal ideation.

    View full details


2016-17 Courses

Graduate and Fellowship Programs


All Publications

  • Suicide and sleep: Is it a bad thing to be awake when reason sleeps? Sleep medicine reviews Perlis, M. L., Grandner, M. A., Chakravorty, S., Bernert, R. A., Brown, G. K., Thase, M. E. 2016; 29: 101-107


    Suicide is the second leading cause of death, worldwide, for those between the ages of 24 and 44 y old. In 2013, more than 41,000 suicides occurred in the United States. These statistics underscore the need to 1) understand why people die by suicide and 2) identify risk factors that are potentially modifiable. While it has been posited that sleep disturbance may represent one such factor, systematic research in this arena did not begin until the 2000s. Since that time, sleep disturbance has been reliably identified as a risk factor for suicidal ideation, suicide attempts, and suicide. While insomnia, nightmares, and other sleep disorders have each been found to contribute to the risk for suicidal ideation and behavior, it is also possible that these factors share some common variance. One possibility is that sleep disturbance results in being awake at night, and being awake at night also confers risk. The hypothesis proffered here is that being awake when one is not biologically prepared to be so results in "hypofrontality" and diminished executive function, and that this represents a common pathway to suicidal ideation and behavior. Such a proposition is highly testable under a variety of possible protocols. The current review summarizes the extant literature on suicide rates by time-of-day, and discusses circadian, psychosocial, and neurocognitive explanations of risk. Such a focus promises to enhance our understanding of how sleep disturbance may confer risk, allows for the identification of future lines of research, and further justifies the need for interventions that promote good sleep continuity among at-risk individuals.

    View details for DOI 10.1016/j.smrv.2015.10.003

    View details for PubMedID 26706755

  • Limitations of a single-item assessment of suicide attempt history: Implications for standardized suicide risk assessment. Psychological assessment Hom, M. A., Joiner, T. E., Bernert, R. A. 2016; 28 (8): 1026-1030


    Although a suicide attempt history is among the single best predictors of risk for eventual death by suicide, little is known about the extent to which reporting of suicide attempts may vary by assessment type. The current study aimed to investigate the correspondence between suicide attempt history information obtained via a single-item self-report survey, multi-item self-report survey, and face-to-face clinical interview. Data were collected among a high-risk sample of undergraduates (N = 100) who endorsed a past attempt on a single-item prescreening survey. Participants subsequently completed a multi-item self-report survey, which was followed by a face-to-face clinical interview, both of which included additional questions regarding the timing and nature of previous attempts. Even though 100% of participants (n = 100) endorsed a suicide attempt history on the single-item prescreening survey, only 67% (n = 67) reported having made a suicide attempt on the multi-item follow-up survey. After incorporating ancillary information from the in-person interview, 60% of participants qualified for a Centers for Disease Control and Prevention (CDC)-defined suicide attempt. Of the 40% who did not qualify for a CDC-defined suicide attempt, 30% instead qualified for no attempt, 7% an aborted attempt, and 3% an interrupted attempt. These findings suggest that single-item assessments of suicide attempt history may result in the misclassification of prior suicidal behaviors. Given that such assessments are commonly used in research and clinical practice, these results emphasize the importance of utilizing follow-up questions and assessments to improve precision in the characterization and assessment of suicide risk. (PsycINFO Database Record

    View details for DOI 10.1037/pas0000241

    View details for PubMedID 26502202

  • Nocturnal Wakefulness Is Associated With Next-Day Suicidal Ideation in Major Depressive Disorder and Bipolar Disorder JOURNAL OF CLINICAL PSYCHIATRY Ballard, E. D., Voort, J. L., Bernert, R. A., Luckenbaugh, D. A., Richards, E. M., Niciu, M. J., Furey, M. L., Duncan, W. C., Zarate, C. A. 2016; 77 (6): 825-831


    Self-reported sleep disturbances may confer elevated risk for suicidal ideation, suicide attempts, and death. However, limited research has evaluated polysomnographically determined sleep disturbance as an acute physiologic risk factor for suicidal thoughts. This study sought to investigate the relationship between nocturnal wakefulness in association with next-day suicidal ideation using overnight polysomnography assessment from data collected between 2006 and 2013.Sixty-five participants with DSM-IV-diagnosed major depressive disorder or bipolar depression underwent overnight polysomnography monitoring in a sleep laboratory. The Hamilton Depression Rating Scale (HDRS) was administered the morning after polysomnography recording to assess next-day suicidal ideation, severity of depressive symptoms, and subjective sleep disturbances.Using a generalized linear mixed model, a significant time-by-ideation interaction was found indicating greater nocturnal wakefulness at 4:00 am among participants with suicidal ideation (F4,136 = 3.65, P = .007). Increased time awake during the 4:00 am hour (4:00 to 4:59) was significantly associated with elevated suicidal thoughts the next day (standardized ? = 0.31, P = .008). This relationship persisted after controlling for age, gender, diagnosis, and severity of depressive symptoms.Greater nocturnal wakefulness, particularly in the early morning hours, was significantly associated with next-day suicidal thoughts. Polysomnographically documented sleep disruption at specific times of night may represent an acute risk factor of suicidal ideation that warrants additional identifier: NCT00024635.

    View details for DOI 10.4088/JCP.15m09943

    View details for Web of Science ID 000379302500021

    View details for PubMedID 27337418

  • The Association between Sleep Disturbances and Depression among Firefighters: Emotion Dysregulation as an Explanatory Factor. Journal of clinical sleep medicine Hom, M. A., Stanley, I. H., Rogers, M. L., Tzoneva, M., Bernert, R. A., Joiner, T. E. 2016; 12 (2): 235-245


    To investigate emotion regulation difficulties in association with self-reported insomnia symptoms, nightmares, and depression symptoms in a sample of current and retired firefighters.A total of 880 current and retired United States firefighters completed a web-based survey of firefighter behavioral health. Self-report measures included the Center for Epidemiologic Studies Depression Scale, Insomnia Severity Index, PTSD Checklist, and Difficulties in Emotion Regulation Scale.A notable portion of participants reported clinically significant depression symptoms (39.6%) and insomnia symptoms (52.7%), as well as nightmare problems (19.2%), each of which demonstrated a strong association with emotion regulation difficulties (rs = 0.56-0.80). Bootstrapped mediation analyses revealed that the indirect effects of overall emotion regulation difficulties were significant both for the relationship between insomnia and depression (95% CI: 0.385-0.566) and nightmares and depression (95% CI: 1.445-2.365). Limited access to emotion regulation strategies emerged as the strongest, significant indirect effect for both relationships (insomnia 95% CI: 0.136-0.335; nightmares 95% CI: 0.887-1.931).Findings extend previous affective neuroscience research by providing evidence that insomnia and nightmares may influence depression symptoms specifically through the pathway of explicit emotion regulation difficulties. Sleep disturbances may impair the ability to access and leverage emotion regulation strategies effectively, thus conferring risk for negative affect and depression.

    View details for DOI 10.5664/jcsm.5492

    View details for PubMedID 26350604

  • The Association between Sleep Disturbances and Depression among Firefighters: Emotion Dysregulation as an Explanatory Factor JOURNAL OF CLINICAL SLEEP MEDICINE Hom, M. A., Stanley, I. H., Rogers, M. L., Tzoneva, M., Bernert, R. A., Joiner, T. E. 2016; 12 (2): 235-245

    View details for DOI 10.5664/jcsm.5492

    View details for Web of Science ID 000374138900012

  • Sleep Disturbances and Suicide Risk. Sleep medicine clinics Bernert, R. A., Nadorff, M. R. 2015; 10 (1): 35-39


    Suicide occurs in the presence of psychiatric illness, and is associated with biological, psychological, and social risk factors. Insomnia symptoms and nightmares appear to present elevated risk for suicidal ideation, attempts, and death by suicide. Failure to account for the presence of psychopathology and frequent use of single item assessments of sleep and suicidal ideation are common methodological problems in this literature. Preliminary research, addressing these issues, suggests that subjective sleep complaints may confer independent risk for suicidal behaviors.

    View details for DOI 10.1016/j.jsmc.2014.11.004

    View details for PubMedID 26055671

  • Sleep Disturbances as an Evidence-Based Suicide Risk Factor CURRENT PSYCHIATRY REPORTS Bernert, R. A., Kim, J. S., Iwata, N. G., Perlis, M. L. 2015; 17 (3)


    Increasing research indicates that sleep disturbances may confer increased risk for suicidal behaviors, including suicidal ideation, suicide attempts, and death by suicide. Despite increased investigation, a number of methodological problems present important limitations to the validity and generalizability of findings in this area, which warrant additional focus. To evaluate and delineate sleep disturbances as an evidence-based suicide risk factor, a systematic review of the extant literature was conducted with methodological considerations as a central focus. The following methodologic criteria were required for inclusion: the report (1) evaluated an index of sleep disturbance; (2) examined an outcome measure for suicidal behavior; (3) adjusted for presence of a depression diagnosis or depression severity, as a covariate; and (4) represented an original investigation as opposed to a chart review. Reports meeting inclusion criteria were further classified and reviewed according to: study design and timeframe; sample type and size; sleep disturbance, suicide risk, and depression covariate assessment measure(s); and presence of positive versus negative findings. Based on keyword search, the following search engines were used: PubMed and PsycINFO. Search criteria generated N?=?82 articles representing original investigations focused on sleep disturbances and suicide outcomes. Of these, N?=?18 met inclusion criteria for review based on systematic analysis. Of the reports identified, N?=?18 evaluated insomnia or poor sleep quality symptoms, whereas N?=?8 assessed nightmares in association with suicide risk. Despite considerable differences in study designs, samples, and assessment techniques, the comparison of such reports indicates preliminary, converging evidence for sleep disturbances as an empirical risk factor for suicidal behaviors, while highlighting important, future directions for increased investigation.

    View details for DOI 10.1007/s11920-015-0554-4

    View details for Web of Science ID 000351232900006

    View details for PubMedID 25698339

  • The prediction of study-emergent suicidal ideation in bipolar disorder: a pilot study using ecological momentary assessment data BIPOLAR DISORDERS Thompson, W. K., Gershon, A., O'Hara, R., Bernert, R. A., Depp, C. A. 2014; 16 (7): 669-677

    View details for DOI 10.1111/bdi.12218

    View details for Web of Science ID 000344373100001

  • Association of poor subjective sleep quality with risk for death by suicide during a 10-year period: a longitudinal, population-based study of late life. JAMA psychiatry Bernert, R. A., Turvey, C. L., Conwell, Y., Joiner, T. E. 2014; 71 (10): 1129-1137


    Older adults have high rates of sleep disturbance, die by suicide at disproportionately higher rates compared with other age groups, and tend to visit their physician in the weeks preceding suicide death. To our knowledge, to date, no study has examined disturbed sleep as an independent risk factor for late-life suicide.To examine the relative independent risk for suicide associated with poor subjective sleep quality in a population-based study of older adults during a 10-year observation period.A longitudinal case-control cohort study of late-life suicide among a multisite, population-based community sample of older adults participating in the Established Populations for Epidemiologic Studies of the Elderly. Of 14?456 community older adults sampled, 400 control subjects were matched (on age, sex, and study site) to 20 suicide decedents.Primary measures included the Sleep Quality Index, the Center for Epidemiologic Studies-Depression Scale, and vital statistics.Hierarchical logistic regressions revealed that poor sleep quality at baseline was significantly associated with increased risk for suicide (odds ratio [OR], 1.39; 95% CI, 1.14-1.69; P?

    View details for DOI 10.1001/jamapsychiatry.2014.1126

    View details for PubMedID 25133759

  • A Review of Multidisciplinary Clinical Practice Guidelines in Suicide Prevention: Toward an Emerging Standard in Suicide Risk Assessment and Management, Training and Practice ACADEMIC PSYCHIATRY Bernert, R. A., Hom, M. A., Roberts, L. W. 2014; 38 (5): 585-592
  • Association of Poor Subjective Sleep Quality With Risk for Death by Suicide During a 10-Year Period A Longitudinal, Population-Based Study of Late Life JAMA PSYCHIATRY Bernert, R. A., Turvey, C. L., Conwell, Y., Joiner, T. E. 2014; 71 (10): 1129-1137
  • Obsessive compulsive symptoms and sleep difficulties: Exploring the unique relationship between insomnia and obsessions JOURNAL OF PSYCHIATRIC RESEARCH Timpano, K. R., Carbonella, J. Y., Bernert, R. A., Schmidt, N. B. 2014; 57: 101-107


    Sleep complaints have been linked with Obsessive Compulsive Disorder (OCD), though there is a dearth of research exploring the association between a range of disturbed sleep indicators and obsessive compulsive symptoms (OCS). Two separate studies were conducted to rigorously investigate this relationship in further detail, considering a number of different sleep indices and also the heterogeneous nature of OCS.Study 1 (n = 167) examined the relationship between OCS and the gold standard self-report assessments for delayed bedtime, sleep quality, nightmares, and insomnia symptoms. Study 2 (n = 352) replicated the primary findings from Study 1 in an independent sample and with an alternative measure of OCD, which takes into account the different OCS dimensions.Results revealed a significant, independent link between obsessions and insomnia symptoms, but not between insomnia and compulsions. When examining the different OCS dimensions, insomnia was again found to bear a specific relationship to obsessions, above and beyond that with the other dimensions. Although depression is often highly comorbid with both OCD and sleep disturbances, depressive symptoms did not explain the OCS-sleep relationship in either study, suggesting a unique association between obsessions and insomnia.Findings indicate that high levels of intrusive thoughts exhibit a specific association with insomnia symptoms-one that is not observed with other OCS. Future research may help elucidate the mechanisms and causal nature of this relationship.

    View details for DOI 10.1016/j.jpsychires.2014.06.021

    View details for Web of Science ID 000341550100013

    View details for PubMedID 25038630

  • Eating disorder and obsessive-compulsive symptoms in a sample of bulimic women: Perfectionism as a mediating factor PERSONALITY AND INDIVIDUAL DIFFERENCES Bernert, R. A., Timpano, K. R., Peterson, C. B., Crow, S. J., Bardone-Cone, A. M., Le Grange, D., Klein, M., Crosby, R. D., Mitchell, J. E., Wonderlich, S. A., Joiner, T. E. 2013; 54 (2): 231-235
  • Clinical significance of night-to-night sleep variability in insomnia SLEEP MEDICINE Suh, S., Nowakowski, S., Bernert, R. A., Ong, J. C., Siebern, A. T., Dowdle, C. L., Manber, R. 2012; 13 (5): 469-475


    To evaluate the clinical relevance of night-to-night variability of sleep schedules and insomnia symptoms.The sample consisted of 455 patients (193 men, mean age=48) seeking treatment for insomnia in a sleep medicine clinic. All participants received group cognitive behavioral therapy for insomnia (CBTI). Variability in sleep parameters was assessed using sleep diary data. Two composite scores were computed, a behavioral schedule composite score (BCS) and insomnia symptom composite score (ICS). The Insomnia Severity Index, the Beck Depression Inventory, and the Morningness-Eveningness Composite Scale were administered at baseline and post-treatment.Results revealed that greater BCS scores were significantly associated with younger age, eveningness chronotype, and greater depression severity (p<0.001). Both depression severity and eveningness chronotype independently predicted variability in sleep schedules (p<0.001). Finally, CBTI resulted in reduced sleep variability for all sleep diary variables except bedtime. Post-treatment symptom reductions in depression severity were greater among those with high versus low baseline BCS scores (p<0.001).Results suggest that variability in sleep schedules predict reduction in insomnia and depressive severity following group CBTI. Schedule variability may be particularly important to assess and address among patients with high depression symptoms and those with the evening chronotype.

    View details for DOI 10.1016/j.sleep.2011.10.034

    View details for Web of Science ID 000303346800004

    View details for PubMedID 22357064

  • Sleep problems outperform depression and hopelessness as cross-sectional and longitudinal predictors of suicidal ideation and behavior in young adults in the military JOURNAL OF AFFECTIVE DISORDERS Ribeiro, J. D., Pease, J. L., Gutierrez, P. M., Silva, C., Bernert, R. A., Rudd, M. D., Joiner, T. E. 2012; 136 (3): 743-750


    Sleep problems appear to represent an underappreciated and important warning sign and risk factor for suicidal behaviors. Given past research indicating that disturbed sleep may confer such risk independent of depressed mood, in the present report we compared self-reported insomnia symptoms to several more traditional, well-established suicide risk factors: depression severity, hopelessness, PTSD diagnosis, as well as anxiety, drug abuse, and alcohol abuse symptoms.Using multiple regression, we examined the cross-sectional and longitudinal relationships between insomnia symptoms and suicidal ideation and behavior, controlling for depressive symptom severity, hopelessness, PTSD diagnosis, anxiety symptoms, and drug and alcohol abuse symptoms in a sample of military personnel (N=311).In support of a priori hypotheses, self-reported insomnia symptoms were cross-sectionally associated with suicidal ideation, even after accounting for symptoms of depression, hopelessness, PTSD diagnosis, anxiety symptoms and drug and alcohol abuse. Self-reported insomnia symptoms also predicted suicide attempts prospectively at one-month follow up at the level of a non-significant trend, when controlling for baseline self-reported insomnia symptoms, depression, hopelessness, PTSD diagnosis and anxiety, drug and alcohol abuse symptoms. Insomnia symptoms were unique predictors of suicide attempt longitudinally when only baseline self-reported insomnia symptoms, depressive symptoms and hopelessness were controlled.The assessment of insomnia symptoms consisted of only three self-report items. Findings may not generalize outside of populations at severe suicide risk.These findings suggest that insomnia symptoms may be an important target for suicide risk assessment and the treatment development of interventions to prevent suicide.

    View details for DOI 10.1016/j.jad.2011.09.049

    View details for Web of Science ID 000301996000071

    View details for PubMedID 22032872

  • CBT for Insomnia in Patients with High and Low Depressive Symptom Severity: Adherence and Clinical Outcomes JOURNAL OF CLINICAL SLEEP MEDICINE Manber, R., Bernert, R. A., Suh, S., Nowakowski, S., Siebern, A. T., Ong, J. C. 2011; 7 (6): 645-652


    To evaluate whether depressive symptom severity leads to poorer response and perceived adherence to cognitive behavioral therapy for insomnia (CBTI) and to examine the impact of CBTI on well-being, depressive symptom severity, and suicidal ideation.Pre- to posttreatment case replication series comparing low depression (LowDep) and high depression (HiDep) groups (based on a cutoff of 14 on the Beck Depression Inventory [BDI]).127 men and 174 women referred for the treatment of insomnia.Seven sessions of group CBTI.Improvement in the insomnia severity, perceived energy, productivity, self-esteem, other aspects of wellbeing, and overall treatment satisfaction did not differ between the HiDep and LowDep groups (p > 0.14). HiDep patients reported lower adherence to a fixed rise time, restricting time in bed, and changing expectations about sleep (p < 0.05). HiDep participants experienced significant reductions in BDI, after removing the sleep item. Levels of suicidal ideation dropped significantly among patients with pretreatment elevations (p < 0.0001).Results suggest that pre- to post CBTI improvements in insomnia symptoms, perceived energy, productivity, self-esteem, and other aspects of well-being were similar among patients with and without elevation in depressive symptom severity. Thus, the benefits of CBTI extend beyond insomnia and include improvements in non-sleep outcomes, such as overall well-being and depressive symptom severity, including suicidal ideation, among patients with baseline elevations. Results identify aspects of CBTI that may merit additional attention to further improve outcomes among patients with insomnia and elevated depressive symptom severity.

    View details for DOI 10.5664/jcsm.1472

    View details for Web of Science ID 000300161900012

    View details for PubMedID 22171204

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