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Dolsen EA, Prather AA, Lamers F, Penninx BWJH. Suicidal ideation and suicide attempts: associations with sleep duration, insomnia, and inflammation. Psychol Med 2021; 51:2094-2103. [PMID: 32321599 DOI: 10.1017/s0033291720000860] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Sleep disturbance has been consistently identified as an independent contributor to suicide risk. Inflammation has emerged as a potential mechanism linked to both sleep disturbance and suicide risk. This study tested associations between sleep duration, insomnia, and inflammation on suicidal ideation (SI) and history of a suicide attempt (SA). METHODS Participants included 2329 adults with current or remitted depression and/or anxiety enrolled in the Netherlands Study of Depression and Anxiety. Sleep duration, insomnia, past week SI, and SA were assessed with self-report measures. Plasma levels of C-reactive protein, interleukin-6, and tumor necrosis factor-α were obtained. RESULTS Short sleep duration (⩽6 h) compared to normal sleep duration (7-9 h) was associated with reporting a prior SA, adjusting for covariates [adjusted odds ratio (AOR) 1.68, 95% CI 1.13-2.51]. A higher likelihood of SI during the past week was observed for participants with long sleep duration (⩾10 h) compared to normal sleep duration (AOR 2.22, 95% CI 1.02-4.82), more insomnia symptoms (AOR 1.44, 95% CI 1.14-1.83), and higher IL-6 (AOR 1.31, 95% CI 1.02-1.68). Mediation analyses indicated that the association between long sleep duration and SI was partially explained by IL-6 (AOR 1.02, 95% CI 1.00-1.05). CONCLUSIONS These findings from a large sample of adults with depression and/or anxiety provide evidence that both short and long sleep duration, insomnia symptoms, and IL-6 are associated with the indicators of suicide risk. Furthermore, the association between long sleep duration and SI may operate through IL-6.
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Affiliation(s)
- Emily A Dolsen
- Department of Psychology, University of California, Berkeley, 2121 Berkeley Way, Berkeley, CA94720, USA
| | - Aric A Prather
- Department of Psychiatry, University of California San Francisco, San Francisco, CA94118, USA
| | - Femke Lamers
- Department of Psychiatry, Amsterdam Neuroscience and Amsterdam Public Health Research Institutes, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam Neuroscience and Amsterdam Public Health Research Institutes, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
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Grove JL, Carlson SE, Parkhurst KA, Smith TW. The role of pre-sleep arousal in the connection between insomnia and suicide risk. DEATH STUDIES 2021; 46:2523-2529. [PMID: 34403294 PMCID: PMC9815160 DOI: 10.1080/07481187.2021.1964109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Insomnia is a risk factor for suicidal thoughts and behaviors. The present study examined the role of pre-sleep arousal in this association. Seventy-eight adults (Mage = 24.28, 56% had recent history of suicidal thoughts and behaviors) attended two lab visits over four consecutive days. We tested if generally experienced self-reported pre-sleep arousal explained the association between self-report insomnia symptoms experienced over the past two weeks and past week-suicidal ideation. Results indicated full mediation for pre-sleep cognitive arousal, but not somatic arousal. Pre-sleep cognitive arousal could be a key variable linking insomnia symptoms to suicide risk.
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53
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Tubbs AS, Harrison-Monroe P, Fernandez FX, Perlis ML, Grandner MA. When reason sleeps: attempted suicide during the circadian night. J Clin Sleep Med 2021; 16:1809-1810. [PMID: 32621577 DOI: 10.5664/jcsm.8662] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
None Disrupted sleep and nocturnal wakefulness are evidence-based risk factors for suicidal thoughts and behaviors. We present a suicide attempt following a rapid increase in nocturnal wakefulness. This case illustrates how nocturnal wakefulness may drive suicide risk through circadian misalignment.
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Affiliation(s)
- Andrew S Tubbs
- Department of Psychiatry, University of Arizona College of Medicine, Tucson, Arizona
| | | | | | - Michael L Perlis
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Michael A Grandner
- Department of Psychiatry, University of Arizona College of Medicine, Tucson, Arizona
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54
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Dutta R, Gkotsis G, Velupillai S, Bakolis I, Stewart R. Temporal and diurnal variation in social media posts to a suicide support forum. BMC Psychiatry 2021; 21:259. [PMID: 34011346 PMCID: PMC8136175 DOI: 10.1186/s12888-021-03268-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 05/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rates of suicide attempts and deaths are highest on Mondays and these occur more frequently in the morning or early afternoon, suggesting weekly temporal and diurnal variation in suicidal behaviour. It is unknown whether there are similar time trends on social media, of posts relevant to suicide. We aimed to determine temporal and diurnal variation in posting patterns on the Reddit forum SuicideWatch, an online community for individuals who might be at risk of, or who know someone at risk of suicide. METHODS We used time series analysis to compare date and time stamps of 90,518 SuicideWatch posts from 1st December 2008 to 31st August 2015 to (i) 6,616,431 posts on the most commonly subscribed general subreddit, AskReddit and (ii) 66,934 of these AskReddit posts, which were posted by the SuicideWatch authors. RESULTS Mondays showed the highest proportion of posts on SuicideWatch. Clear diurnal variation was observed, with a peak in the early morning (2:00-5:00 h), and a subsequent decrease to a trough in late morning/early afternoon (11:00-14:00 h). Conversely, the highest volume of posts in the control data was between 20:00-23:00 h. CONCLUSIONS Posts on SuicideWatch occurred most frequently on Mondays: the day most associated with suicide risk. The early morning peak in SuicideWatch posts precedes the time of day during which suicide attempts and deaths most commonly occur. Further research of these weekly and diurnal rhythms should help target populations with support and suicide prevention interventions when needed most.
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Affiliation(s)
- Rina Dutta
- Department of Psychological Medicine, School of Academic Psychiatry, King’s College London, IoPPN, PO Box 84, 3rd Floor East Wing, Room E3.07, De Crespigny Park, London, SE5 8AF UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - George Gkotsis
- Department of Psychological Medicine, School of Academic Psychiatry, King’s College London, IoPPN, PO Box 84, 3rd Floor East Wing, Room E3.07, De Crespigny Park, London, SE5 8AF UK
| | - Sumithra Velupillai
- Department of Psychological Medicine, School of Academic Psychiatry, King’s College London, IoPPN, PO Box 84, 3rd Floor East Wing, Room E3.07, De Crespigny Park, London, SE5 8AF UK
- School of Electrical Engineering and Computer Science, KTH, Stockholm, Sweden
| | - Ioannis Bakolis
- Department of Psychological Medicine, School of Academic Psychiatry, King’s College London, IoPPN, PO Box 84, 3rd Floor East Wing, Room E3.07, De Crespigny Park, London, SE5 8AF UK
| | - Robert Stewart
- Department of Psychological Medicine, School of Academic Psychiatry, King’s College London, IoPPN, PO Box 84, 3rd Floor East Wing, Room E3.07, De Crespigny Park, London, SE5 8AF UK
- South London and Maudsley NHS Foundation Trust, London, UK
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55
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Poor sleep quality and suicidal ideation among Chinese community adults: A moderated mediation model of mental distress and family functioning. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01845-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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56
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Onoya ED, Makwakwa NL, Motloba DP. Temporal variation in suicide in peri-urban Pretoria. S Afr Fam Pract (2004) 2021; 63:e1-e7. [PMID: 34082560 PMCID: PMC8377945 DOI: 10.4102/safp.v63i1.5260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/08/2021] [Accepted: 03/07/2021] [Indexed: 12/03/2022] Open
Abstract
Background Suicide is a public health problem, and the third major cause of death in Indian, black and mixed race groups. In whites suicide is the second cause of death. The patterns of suicide vary by time of day, day of the week, month of the year and seasons. As a result of limited and inaccurate data, these variations have not been fully examined in the developing world. This study investigated the diurnality and seasonality of suicide in peri-urban Pretoria, as opposed to studies conducted previously in the country’s metropolitan. Methods A retrospective analysis of suicides recorded between 2007 and 2019 was undertaken. Data were extracted from the forensic pathology department’s database (university mortuary). Results Of the 1515 cases of suicides examined, majority were black Africans (95.9%), male (83.9%), aged 21–40 years (50.5%). Hanging was the most common method of suicide irrespective of demographics (72.8%). Diurnal suicide variations were distinct for men and women, occurring at (16:00–20:00) and (08:00–12:00), respectively. Suicide peaked on days preceding and after the weekend (Mondays and Fridays) and in warmer seasons (summer and spring) Conclusion The overall patterns of suicide in peri-urban Pretoria, mimic local and global trends with regard to methods, demographics and temporal characteristics. The underlying mechanism for these trends is unclear requiring in-depth investigation in order to develop appropriate interventions.
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Affiliation(s)
- Eric D Onoya
- Department of Forensic Pathology, School of Medicine, Faculty of Health Sciences, Sefako Makgatho Health Sciences University, Pretoria.
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Zeoli I, Lanquart JP, Wacquier B, Mungo A, Loas G, Hein M. Polysomnographic markers of suicidal ideation in untreated unipolar major depressed individuals. Int J Psychophysiol 2021; 166:19-24. [PMID: 33965422 DOI: 10.1016/j.ijpsycho.2021.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 04/19/2021] [Accepted: 05/05/2021] [Indexed: 11/18/2022]
Abstract
Given the major role played by sleep in the particular relationship between suicidality and major depression, the aim of this study was to empirically identify polysomnographic markers specific to suicidal ideation in major depressed individuals in order to allow better suicide prevention in this high-risk subpopulation. Demographic and polysomnographic data from 190 individuals (34 healthy controls and 156 untreated unipolar major depressed individuals) recruited from the sleep laboratory database were analysed. Suicidal ideation were considered present if the score in item G of the Beck Depression Inventory was ≥1 and/or if they were highlighted during the systematic psychiatric assessment conducted on admission to the sleep laboratory. Independently of depression severity, major depressed individuals with suicidal ideation present a decrease in deep NREM sleep (slow-wave sleep) and an increase in light NREM sleep (stage 1 + stage 2) compared to those without suicidal ideation. There are no significant differences for the other polysomnographic parameters. In our study, we highlighted the existence of potential polysomnographic markers of suicidal ideation in untreated unipolar major depressed individuals, which seems to open up new perspectives for the identification and management of individuals at high-risk of suicide in this particular subpopulation.
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Affiliation(s)
- Ileana Zeoli
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université libre de Bruxelles, ULB, Brussels, Belgium
| | - Jean-Pol Lanquart
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université libre de Bruxelles, ULB, Brussels, Belgium
| | - Benjamin Wacquier
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université libre de Bruxelles, ULB, Brussels, Belgium
| | - Anaïs Mungo
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université libre de Bruxelles, ULB, Brussels, Belgium
| | - Gwenolé Loas
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université libre de Bruxelles, ULB, Brussels, Belgium
| | - Matthieu Hein
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université libre de Bruxelles, ULB, Brussels, Belgium.
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Chang LY, Chang YH, Wu CC, Chang JJ, Yen LL, Chang HY. Resilience buffers the effects of sleep problems on the trajectory of suicidal ideation from adolescence through young adulthood. Soc Sci Med 2021; 279:114020. [PMID: 34004572 DOI: 10.1016/j.socscimed.2021.114020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/28/2021] [Accepted: 05/06/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To examine both the between-person and within-person effects of sleep problems on the trajectory of suicidal ideation from ages 14 to 22 and investigate whether resilience moderates the effects. Age and sex differences were explored in the main and interaction effects of sleep problems and resilience on suicidal ideation. METHODS The study sample included 2491 adolescents (1260 males and 1231 females) who participated in a prospective study spanning 2009 through 2016 in northern Taiwan. Sex-stratified multilevel models were used to examine the between-person and within-person effects of sleep problems and the moderating effects of resilience on the trajectory of suicidal ideation in males and females. RESULTS Across adolescents, higher levels of sleep problems contributed to an elevated risk of suicidal ideation for both sexes. Within individuals, a higher risk of suicidal ideation was observed when an adolescent's sleep problems exceeded their typical levels. The within-person effects of sleep problems were further determined to vary by age in males, with the effects gradually decreasing throughout late adolescence but increasing again in young adulthood. The buffering effects of resilience were only observed in females. The relationships between the within-person effects of sleep problems and suicidal ideation were only significant in female adolescents with low levels of resilience. CONCLUSIONS Our findings extend the research by demonstrating both the between-person and within-person association between sleep problems and suicidal ideation. We further revealed age and sex differences in the within-person effects of sleep problems and the buffering effects of resilience. Prevention and intervention programs that target sleep problems could be tailored based on individuals' age, sex, and levels of resilience to prevent suicidal ideation.
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Affiliation(s)
- Ling-Yin Chang
- Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan.
| | - Yi-Han Chang
- Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan; Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chi-Chen Wu
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan Town, Miaoli County, Taiwan
| | - Jen Jen Chang
- Department of Epidemiology and Biostatistics, College of Public Health and Social Justice, Saint Louis University, USA
| | - Lee-Lan Yen
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan Town, Miaoli County, Taiwan; Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Hsing-Yi Chang
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan Town, Miaoli County, Taiwan
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Tubbs AS, Fernandez FX, Perlis ML, Hale L, Branas CC, Barrett M, Chakravorty S, Khader W, Grandner MA. Suicidal ideation is associated with nighttime wakefulness in a community sample. Sleep 2021; 44:5866613. [PMID: 32614967 DOI: 10.1093/sleep/zsaa128] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 06/19/2020] [Indexed: 12/20/2022] Open
Abstract
STUDY OBJECTIVES Nocturnal wakefulness is a risk factor for suicide and suicidal ideation in clinical populations. However, these results have not been demonstrated in general community samples or compared to sleep duration or sleep quality. The present study explored how the timing of wakefulness was associated with suicidal ideation for weekdays and weekends. METHODS Data were collected from 888 adults aged 22-60 as part of the Sleep and Healthy Activity, Diet, Environment, and Socialization study. Suicidal ideation was measured by the Patient Health Questionnaire-9, while timing of wakefulness was estimated from the Sleep Timing Questionnaire. Binomial logistic regressions estimated the association between nocturnal (11 pm-5 am) and morning (5 am-11 am) wakefulness and suicidal ideation. RESULTS Nocturnal wakefulness was positively associated with suicidal ideation on weekdays (OR: 1.44 [1.28-1.64] per hour awake between 11:00 pm and 05:00 am, p < 0.0001) and weekends (OR: 1.22 [1.08-1.39], p = 0.0018). Morning wakefulness was negatively associated with suicidal ideation on weekdays (OR: 0.82 [0.72-0.92] per hour awake between 05:00 am and 11:00 am, p = 0.0008) and weekends (OR: 0.84 [0.75-0.94], p = 0.0035). These associations remained significant when adjusting for sociodemographic factors. Additionally, nocturnal wakefulness on weekdays was associated with suicidal ideation when accounting for insomnia, sleep duration, sleep quality, and chronotype (OR 1.25 [1.09-1.44] per hour awake, p = 0.002). CONCLUSION Wakefulness at night was consistently associated with suicidal ideation. Additionally, morning wakefulness was negatively associated with suicidal ideation in some models. Although these findings are drawn from a non-clinical sample, larger longitudinal studies in the general population are needed to confirm these results.
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Affiliation(s)
- Andrew S Tubbs
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona, Tucson, AZ
| | - Fabian-Xosé Fernandez
- Department of Psychology, BIO5 and McKnight Brain Research Institutes, University of Arizona, Tucson, AZ
| | - Michael L Perlis
- Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - Lauren Hale
- Program in Public Health, Department of Family, Population, and Preventative Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY
| | | | - Marna Barrett
- Mood and Anxiety Disorders Treatment Research Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - Subhajit Chakravorty
- Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - Waliuddin Khader
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona, Tucson, AZ
| | - Michael A Grandner
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona, Tucson, AZ
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Alter S, Wilson C, Sun S, Harris RE, Wang Z, Vitale A, Hazlett EA, Goodman M, Ge Y, Yehuda R, Galfalvy H, Haghighi F. The association of childhood trauma with sleep disturbances and risk of suicide in US veterans. J Psychiatr Res 2021; 136:54-62. [PMID: 33561736 DOI: 10.1016/j.jpsychires.2021.01.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 12/14/2020] [Accepted: 01/16/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Sleep dysregulation is prevalent among veterans and is associated with increased risk of suicidal ideation and behaviors. A confluence of risk factors have been identified to date that contribute to increase risk for suicidal behavior. How these risk factors including childhood trauma, comorbid psychopathology, impulsivity, and hostility together with sleep disturbance contribute to suicide risk remains an open question. These factors have never been examined simultaneously in a unified mediation model, as investigated in the present study, to determine their relative contribution to suicide risk. METHODS Veterans (N = 105) were recruited across 3-groups, including Major Depressive Disorder (MDD) with/without a history of a suicide attempt (n = 35 and n = 37, respectively), and non-psychiatric controls, who had no history of mental illness or suicidal behavior (n = 33). The participants were assessed using validated self-report assessments with in-depth phenotyping for relevant risk factors associated with suicidal behavior including childhood adversity, depression severity, impulsivity, hostility, and sleep quality. These factors were included in mediation models using path analysis. RESULTS Across all subjects including those with MDD and non-psychiatric controls, mediation analysis showed that higher levels of childhood trauma had an indirect effect on poor sleep quality (p = 0.001). This effect was orthogonal, being independently mediated by both MDD psychopathology (p = 0.003), and higher traits of impulsivity (p = 0.001) and hostility (p = 0.015). Amongst MDD veterans, childhood trauma was directly associated with increased suicide risk (p = 0.034), irrespective of their severity of depression, or their degree of hostility and impulsivity. LIMITATIONS include use of self-report data, and the inability to establish causal inferences with cross-sectional design. CONCLUSION Childhood adversity as a significant pre-deployment risk factor for disturbed sleep and elevated suicide risk, potentially important for incorporation in clinical practice for suicide.
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Affiliation(s)
| | | | - Shengnan Sun
- Icahn School of Medicine at Mount Sinai, New York, USA
| | | | - Zhaoyu Wang
- Icahn School of Medicine at Mount Sinai, New York, USA
| | - Amanda Vitale
- Icahn School of Medicine at Mount Sinai, New York, USA
| | - Erin A Hazlett
- James J. Peters VA Medical Center, Bronx, USA; Icahn School of Medicine at Mount Sinai, New York, USA
| | - Marianne Goodman
- James J. Peters VA Medical Center, Bronx, USA; Icahn School of Medicine at Mount Sinai, New York, USA
| | - Yongchao Ge
- Icahn School of Medicine at Mount Sinai, New York, USA
| | - Rachel Yehuda
- James J. Peters VA Medical Center, Bronx, USA; Icahn School of Medicine at Mount Sinai, New York, USA
| | | | - Fatemeh Haghighi
- James J. Peters VA Medical Center, Bronx, USA; Icahn School of Medicine at Mount Sinai, New York, USA.
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Zhao J, Liu H, Wu Z, Wang Y, Cao T, Lyu D, Huang Q, Wu Z, Zhu Y, Wu X, Chen J, Wang Y, Su Y, Zhang C, Peng D, Li Z, Rong H, Liu T, Xia Y, Hong W, Fang Y. Clinical features of the patients with major depressive disorder co-occurring insomnia and hypersomnia symptoms: a report of NSSD study. Sleep Med 2021; 81:375-381. [PMID: 33813234 DOI: 10.1016/j.sleep.2021.03.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/24/2021] [Accepted: 03/05/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The co-occurrence of insomnia and hypersomnia symptoms in patients with major depressive disorder (MDD) is associated with suicidal ideation and functional impairment. The relationship between sleep disturbances and clinical features and outcomes may not be adequately studied. In this study, we measured the functional impairments and clinical features of co-occurring insomnia and hypersomnia symptoms in Chinese patients with MDD. METHODS A post-hoc analysis was performed on data from the National Survey on Symptomatology of Depression (NSSD), which assessed the MDD patients in 32 hospitals by a clinician-rating questionnaire. The clinical features and outcomes were compared among the following four groups: insomnia symptom only, hypersomnia symptom only, both insomnia and hypersomnia symptoms, no sleep disturbance, respectively. RESULTS Totally, 234 (7.15%) of 3275 participants with MDD co-occurred insomnia and hypersomnia symptoms. They had more depressive symptoms (27.41 ± 9.123), higher rate of suicide ideation (39.7%), more severe impairment in physical (58.1%), economic (32.9%), work (55.1%), and relationship with families (29.5%). Patients with both sleep disturbances were more likely to excessive worry about sleep, have suicidal ideation, the distress of social disharmony, more somatic symptoms, lack of energy, hyperphagia, loss of mood reactivity, and diurnal change, whereas less likely to have anxious mood. LIMITATIONS Sleep disorders were not diagnosed by current standard diagnostic criteria. CONCLUSIONS Patients co-occurring with both sleep disturbances are associated with a higher rate of suicide risk and poorer social function. Our study could provide implications for suicidal risk evaluation and the development of therapeutic strategies for depression.
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Affiliation(s)
- Jie Zhao
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; Huangpu District Mental Health Center, Shanghai 200001, China
| | - Hongmei Liu
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Zhiguo Wu
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; Department of Psychiatry and Neuropsychology, Shanghai Deji Hospital, Qingdao University, Shanghai 200331, China.
| | - Yun Wang
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Tongdan Cao
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; Huangpu District Mental Health Center, Shanghai 200001, China
| | - Dongbin Lyu
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Qinte Huang
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Zhenling Wu
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Yuncheng Zhu
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Xiaohui Wu
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Jun Chen
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Yong Wang
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Yousong Su
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Chen Zhang
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Daihui Peng
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Zezhi Li
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Han Rong
- Shenzhen Mental Health Center, Shenzhen 518020, China
| | - Tiebang Liu
- Shenzhen Mental Health Center, Shenzhen 518020, China
| | - Yong Xia
- Hangzhou Seventh People's Hospital, Mental Health Center Zhejiang University School of Medicine, Hangzhou 310013, China
| | - Wu Hong
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai 201108, China.
| | - Yiru Fang
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai 201108, China; CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai 200031, China.
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Vitale A, Byma L, Sun S, Podolak E, Wang Z, Alter S, Galfalvy H, Geraci J, Langhoff E, Klingbeil H, Yehuda R, Haghighi F, Feder A. Effectiveness of Complementary and Integrative Approaches in Promoting Engagement and Overall Wellness Toward Suicide Prevention in Veterans. J Altern Complement Med 2021; 27:S14-S27. [PMID: 33788604 PMCID: PMC8035924 DOI: 10.1089/acm.2020.0245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objective: Suicide is a major public health problem, specifically among U.S. veterans, who do not consistently engage in mental health services, often citing stigma as a barrier. Complementary and Integrative Health (CIH) interventions are promising alternatives in promoting patient engagement and further, they may play a critical role in transitioning people into mental health care. Toward this goal, the Resilience and Wellness Center (RWC) was developed to break through the stigma barrier by addressing risk factors of suicide through multimodal CIH interventions via cohort design, promoting social connectedness and accountability among participants. Design: This is a program evaluation study at a large urban VA medical center, where assessments were evaluated from pre- to post-program completion to determine the effectiveness of an intensive multimodal CIH 4-week group outpatient intervention for suicide prevention. Outcome measures: Primary outcomes measured included group connectedness, severity of depression and hopelessness symptoms, suicidal ideation, sleep quality, and diet. Secondary outcomes included measures of post-traumatic stress disorder (PTSD), generalized anxiety severity stress/coping skills, pain, and fatigue. Results: The RWC showed high participant engagement, with an 84%-95% attendance engagement rate depending on suicide risk history. Data from 15 cohorts (N = 126) demonstrate favorable outcomes associated with participation in this comprehensive program, as evidenced by a reduction in suicidal ideation, depression, and hopelessness, but not sleep quality and diet. In addition, in a subset of veterans with a history of suicidal ideation or attempt, significant improvements were noted in pain, PTSD/anxiety symptoms, and stress coping measures. Conclusions: The RWC shows that an intensive complement of CIH interventions is associated with a significant improvement with high veteran engagement. Findings from this program evaluation study can be used to aid health care systems and their providers in determining whether or not to utilize such multimodal CIH integrated interventions as an effective treatment for at-risk populations as a part of suicide prevention efforts.
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Affiliation(s)
| | - Lauren Byma
- James J. Peters VA Medical Center, Bronx, NY, USA
| | - Shengnan Sun
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Evan Podolak
- James J. Peters VA Medical Center, Bronx, NY, USA
| | - Zhaoyu Wang
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sharon Alter
- James J. Peters VA Medical Center, Bronx, NY, USA
| | - Hanga Galfalvy
- Department of Psychiatry, Columbia University, New York, NY, USA
| | | | - Erik Langhoff
- James J. Peters VA Medical Center, Bronx, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Rachel Yehuda
- James J. Peters VA Medical Center, Bronx, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Fatemeh Haghighi
- James J. Peters VA Medical Center, Bronx, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ann Feder
- James J. Peters VA Medical Center, Bronx, NY, USA
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63
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Batterham PJ, Werner-Seidler A, Calear AL, McCallum S, Gulliver A. Specific aspects of sleep disturbance associated with suicidal thoughts and attempts. J Affect Disord 2021; 282:574-579. [PMID: 33440302 DOI: 10.1016/j.jad.2020.12.150] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/08/2020] [Accepted: 12/24/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Previous research suggests that sleep disturbance is associated with suicidal ideation and suicide attempt. However, few studies have accounted for the presence of multiple mental disorders and interpersonal factors associated with suicide risk. Furthermore, limited research has examined which aspects of sleep disturbance are most strongly associated with suicidal thoughts and attempts. METHOD A large community-based sample of Australian adults (n = 3,618; 81% female; 37% reporting ideation) completed a comprehensive survey assessing suicidal thoughts and behaviours, sleep disturbance, common mental disorders and interpersonal risk factors. Sleep disturbance was assessed using the 6-item PROMIS sleep disturbance scale and suicidality was measured using the Psychiatric Symptom Frequency Scale. Analyses were adjusted for age, sex, perceived burdensomeness, thwarted belongingness, and clinical caseness for six mental disorders, including major depression. RESULTS After accounting for mental health, demographic and interpersonal characteristics, increasing sleep disturbance was significantly associated with higher odds of both suicidal ideation (OR=1.17 for one-SD increase in PROMIS-SD), and suicide attempt (OR=1.33 for one-SD increase in PROMIS-SD). Of the specific indicators of sleep disturbance, only sleep onset (difficulties falling asleep) had a significant independent association with both suicidal ideation (p < 0.001) and suicide attempt (p = 0.047). CONCLUSIONS Sleep disturbance is independently associated with greater risk of suicidal thoughts and behaviours. Sleep disturbance is highly modifiable, so sleep interventions for people with suicide risk and sleep problems may provide an effective and efficient approach to suicide prevention in the community.
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Affiliation(s)
- Philip J Batterham
- Centre for Mental Health Research, The Australian National University, Canberra, Australia.
| | | | - Alison L Calear
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
| | - Sonia McCallum
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
| | - Amelia Gulliver
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
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64
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Veselsky SL, Poirier MV, Tracy BM, Castater CA, Mehta C, Minihan AK, Williams KN, Gelbard RB, Faloye AO, Smith RN. Mechanisms of Self-Inflicted Injuries at an Urban City Hospital. Am Surg 2021; 88:1669-1674. [PMID: 33629879 DOI: 10.1177/0003134821998681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Suicide is a major public health issue with root causes including psychological, economical, and societal factors. METHODS Retrospective review identified self-inflicted traumatic injuries (SITIs) at Grady Health System between 2009 and 2017. Patients were categorized by penetrating or blunt mechanism of injury (MOI). Outcomes included hospital length of stay (HLOS) and ventilator duration, mortality, and location of death. RESULTS 678 patients in total were identified. Penetrating MOI was most prevalent (n = 474). Patients with a blunt MOI were significantly younger (32 Y vs. 37 Y; P < .0001). Psychiatric illness was equally common between MOI at more than 50%. Penetrating traumas required longer ventilator times (1 D vs. 0 D; P < .0001) but shorter overall HLOS (4 D vs. 6 D; P = .0013). Mortality was twice as high in the penetrating group (29.8% vs. 11.8%; P < .0001). CONCLUSION Self-inflicted traumatic injuries occurred most often among younger adults and those with history of psychiatric illness. Penetrating traumas result in worse outcomes. Self-inflicted traumatic injuries carry high morbidity and mortality. Improved prevention strategies targeting high-risk groups are needed.
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Affiliation(s)
- Steven L Veselsky
- 12239Emory University School of Medicine, Atlanta, GA, USA.,Division of Surgery, Emory University, Grady Health System, Atlanta, GA, USA.,4518West Virginia School of Osteopathic Medicine, Lewisburg, WV, USA
| | - Marie-Veronique Poirier
- 12239Emory University School of Medicine, Atlanta, GA, USA.,25798Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Brett M Tracy
- 12239Emory University School of Medicine, Atlanta, GA, USA.,Division of Surgery, Emory University, Grady Health System, Atlanta, GA, USA
| | - Christine A Castater
- 12239Emory University School of Medicine, Atlanta, GA, USA.,Division of Surgery, Emory University, Grady Health System, Atlanta, GA, USA
| | - Christina Mehta
- 25798Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Adair K Minihan
- 25798Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Keneeshia N Williams
- 12239Emory University School of Medicine, Atlanta, GA, USA.,Division of Surgery, Emory University, Grady Health System, Atlanta, GA, USA
| | - Rondi B Gelbard
- 12239Emory University School of Medicine, Atlanta, GA, USA.,Division of Surgery, Emory University, Grady Health System, Atlanta, GA, USA
| | - Abimbola O Faloye
- 12239Emory University School of Medicine, Atlanta, GA, USA.,Division of Anesthesiology, Emory University, Grady Health System, Atlanta, GA, USA
| | - Randi N Smith
- 12239Emory University School of Medicine, Atlanta, GA, USA.,Division of Surgery, Emory University, Grady Health System, Atlanta, GA, USA.,25798Rollins School of Public Health, Emory University, Atlanta, GA, USA
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65
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Yeung WF, Yu BYM, Yuen JWM, Ho JYS, Chung KF, Zhang ZJ, Mak DSY, Suen LKP, Ho LM. Semi-Individualized Acupuncture for Insomnia Disorder and Oxidative Stress: A Randomized, Double-Blind, Sham-Controlled Trial. Nat Sci Sleep 2021; 13:1195-1207. [PMID: 34321944 PMCID: PMC8310926 DOI: 10.2147/nss.s318874] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/09/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Acupuncture is an alternative treatment for improving sleep, and it may attenuate oxidative stress, which is a possible pathophysiological factor in insomnia. The aim of this study was to examine the efficacy and safety of a semi-individualized acupuncture in improving sleep and explore its effect on oxidative stress parameters in adults with insomnia disorder. METHODS In this randomized sham-controlled trial, 140 participants were randomly assigned to either a 4-week semi-individualized traditional acupuncture (TA) or noninvasive sham acupuncture (SA). The primary outcome measure was the sleep-diary-derived sleep efficiency. Other outcomes included sleep diary and actigraphy, Insomnia Severity Index, anxiety and depressive symptoms, and quality of life. Blood samples were taken to measure oxidative stress parameters (malondialdehyde, glutathione peroxidase, paraoxonase, and arylesterase). RESULTS Although no significant difference was found in the primary outcome measure, both sleep-diary-derived and actigraphy-derived total sleep time (TST) were significantly increased in the TA group at 1-week posttreatment (mean difference in sleep diary = 22.0 min, p = 0.01, actigraphy = 18.8 min, p = 0.02). At 5-week posttreatment follow-up, a significantly higher proportion of participants in the TA group showed sleep-diary-derived sleep efficiency (SE) ≥ 85% than in the SA group (55.6% versus 36.4%, p = 0.03). CONCLUSION TA and SA did not significantly differ in improving subjective sleep efficiency in individuals with insomnia disorder. However, the TA group showed a short-term effect on improving TST as measured by both sleep diary and actigraphy at 1-week posttreatment, but there were no differences in the oxidative stress parameters. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Title: Acupuncture in the Modulation of Peripheral Oxidative Stress Insomnia; Identifier NCT03447587; URL: https://clinicaltrials.gov/ct2/show/NCT03447587.
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Affiliation(s)
- Wing-Fai Yeung
- School of Nursing, The Hong Kong Polytechnic University, The Hong Kong SAR, People's Republic of China
| | - Branda Yee-Man Yu
- Department of Psychology, The University of Hong Kong, The Hong Kong SAR, People's Republic of China
| | - John Wai-Man Yuen
- School of Nursing, The Hong Kong Polytechnic University, The Hong Kong SAR, People's Republic of China
| | - Janice Yuen Shan Ho
- School of Nursing, The Hong Kong Polytechnic University, The Hong Kong SAR, People's Republic of China
| | - Ka-Fai Chung
- Department of Psychiatry, The University of Hong Kong, The Hong Kong SAR, People's Republic of China
| | - Zhang-Jin Zhang
- School of Chinese Medicine, The University of Hong Kong, The Hong Kong SAR, People's Republic of China
| | - Deejay Suen Yui Mak
- School of Medical and Health Sciences, Tung Wah College, The Hong Kong SAR, People's Republic of China
| | - Lorna Kwai-Ping Suen
- School of Nursing, Tung Wah College, The Hong Kong SAR, People's Republic of China
| | - Lai-Ming Ho
- School of Public Health, The University of Hong Kong, The Hong Kong SAR, People's Republic of China
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Xiao S, Liu S, Zhang P, Yu J, A H, Wu H, Zhang F, Xiao Y, Ma N, Zhang X, Ma X, Li J, Wang X, Shao X, Liu W, Zhang X, Wu W, Wang L, Wu R, He Y, Xu Z, Chi L, Du S, Zhang B. The Association Between Depressive Symptoms and Insomnia in College Students in Qinghai Province: The Mediating Effect of Rumination. Front Psychiatry 2021; 12:751411. [PMID: 34744840 PMCID: PMC8563788 DOI: 10.3389/fpsyt.2021.751411] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 09/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background: This study investigates the mediating effect of rumination on the associations between depressive symptoms and insomnia. Methods: This is a cross-sectional study. Insomnia Severity Index (ISI), Ruminant Response Scale (RRS) and Beck Depression Inventory (BDI) were determined in 12,178 college students in Qinghai province by a questionnaire network platform. Results: The prevalence of insomnia was 38.6% in the participants. Insomnia symptoms [interquartile range: 6 (3, 9)], depressive symptoms [interquartile range: 5 (1, 9)], and rumination [interquartile range: 22 (20, 26)] were positively correlated (r = 0.25-0.46, p < 0.01). Mediation effect analysis showed that the depressive symptoms affected insomnia directly and indirectly. The direct effect and the indirect effect through rumination account for 92.4 and 7.6% of the total effect, respectively. Conclusion: The study shows that insomnia, depressive symptoms, and rumination are related constructs in college students in Qinghai province. It demonstrates the direct effects and the rumination-mediated indirect effects between depressive symptoms and insomnia; the direct effects seem to be dominant.
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Affiliation(s)
- Shuheng Xiao
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shuai Liu
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China.,The Third People's Hospital of Qinghai Province, Xining, China
| | - Puxiao Zhang
- First Clinical Medical College, Xinjiang Medical University, Urumqi, China
| | - Jia Yu
- The Third People's Hospital of Panzhihua, Panzhihua, China
| | - Huaihong A
- The Third People's Hospital of Qinghai Province, Xining, China
| | - Hui Wu
- The Third People's Hospital of Qinghai Province, Xining, China
| | - Fabin Zhang
- Department of Student Affairs, Qinghai University, Xining, China
| | - Yulan Xiao
- Office of the President, Qinghai Nationalities University, Xining, China
| | - Naiben Ma
- Department of Student Affairs, Qinghai Nationalities University, Xining, China
| | - Xiuqin Zhang
- Department of Student Affairs, Qinghai Nationalities University, Xining, China.,Mental Health Education Center, Qinghai Nationalities University, Xining, China
| | - Xiaoxia Ma
- Mental Health Education Center, Qinghai Nationalities University, Xining, China
| | - Junfeng Li
- School of Economics and Trade, Hebei GEO University, Shijiazhuang, China.,School of Economics and Management, Qinghai Nationalities University, Xining, China
| | - Xiaodun Wang
- School of Civil Engineering, Tianjin University, Tianjin, China.,School of Civil and Traffic Engineering, Qinghai Nationalities University, Xining, China
| | - Xin Shao
- School of Physics Science and Information Technology, Liaocheng University, Liaocheng, China.,School of Physics and Electronic Information Engineering, Qinghai Normal University, Xining, China
| | - Wenjing Liu
- The Third People's Hospital of Qinghai Province, Xining, China
| | - Xiaolin Zhang
- The Third People's Hospital of Qinghai Province, Xining, China
| | - Wei Wu
- The Third People's Hospital of Qinghai Province, Xining, China
| | - Lihua Wang
- The Third People's Hospital of Qinghai Province, Xining, China
| | - Rihan Wu
- The Third People's Hospital of Qinghai Province, Xining, China
| | - Yinglian He
- The Third People's Hospital of Qinghai Province, Xining, China
| | - Zeyu Xu
- Institute of Health Management, Southern Medical University, Guangzhou, China
| | - Luhao Chi
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shixu Du
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Bin Zhang
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Abstract
Sleep disturbances, particularly insomnia, nightmares, and excessive daytime sleepiness (EDS), are significant, proximal, and modifiable risk factors for suicidal ideation and behaviors (SIB) and could be targeted for preventative interventions. In this chapter, we review the evidence supporting the association of insomnia, nightmares, and EDS with SIB. We also describe these sleep disturbances in the general population, as well as their association with psychiatric disorders. A PubMed search was conducted to identify the relevant literature. Insomnia is very frequent across mental disorders, but SIB patients are particularly exposed. Specific interventions focused on insomnia are useful in contending suicidal ideation. Nightmares seem to constitute an independent risk factor for SIB, beyond insomnia, particularly in young people and when experienced frequently. The evidence regarding the association of EDS and SIB is less clear and probably explained by the reduction of health-related quality of life and comorbid depression. The mechanisms underlying the relationship between sleep disturbances and SIB as well as the role of potential confounders and future perspectives in this field are also discussed.
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Affiliation(s)
- Jorge Lopez-Castroman
- PSNREC, University of Montpellier, INSERM, Montpellier, France. .,Nimes University Hospital, Nimes, France. .,CIBERSAM, Madrid, Spain.
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68
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Gee BL, Han J, Benassi H, Batterham PJ. Suicidal thoughts, suicidal behaviours and self-harm in daily life: A systematic review of ecological momentary assessment studies. Digit Health 2020; 6:2055207620963958. [PMID: 33224516 PMCID: PMC7649887 DOI: 10.1177/2055207620963958] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 09/11/2020] [Indexed: 12/13/2022] Open
Abstract
Background Ecological Momentary Assessments (EMA) offer an approach to understand the daily risk factors of suicide and self-harm of individuals through the use of self-monitoring techniques using mobile technologies. Objectives This systematic review aimed to examine the results of studies on suicidality risk factors and self-harm that used Ecological Momentary Assessments. Methods Pubmed and PsycINFO databases were searched up to April 2020. Bibliographies of eligible studies were hand-searched, and 744 abstracts were screened and double-coded for inclusion. Results The 49 studies using EMA included in the review found associations between daily affect, rumination and interpersonal interactions and daily non-suicidal self-injury (NSSI). Studies also found associations between daily negative affect and positive affect, social support, sleep, and emotions and a person's history of suicide and self-harm. Associations between daily suicide thoughts and self-harm, and psychopathology factors measured at baseline were also observed. Conclusions Research using EMA has the potential to offer clinicians the ability to understand the daily predictors, or risk factors, of suicide and self-harm. However, there are no clear reporting standards for EMA studies on risk factors for suicide. Further research should utilise longitudinal study designs, harmonise datasets and use machine learning techniques to identify patterns of proximal risk factors for suicide behaviours.
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Affiliation(s)
- Brendan Loo Gee
- Centre for Mental Health Research, Australian National University, Acton, Australia.,Australasian Institute of Digital Health, Level 1, 85 Buckhurst Street, South Melbourne, Australia
| | - Jin Han
- Black Dog Institute, University of New South Wales, New South Wales, Australia
| | - Helen Benassi
- Centre for Mental Health Research, Australian National University, Acton, Australia
| | - Philip J Batterham
- Centre for Mental Health Research, Australian National University, Acton, Australia
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69
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Vargas I, Perlis ML, Grandner M, Gencarelli A, Khader W, Zandberg LJ, Klingaman EA, Goldschmied JR, Gehrman PR, Brown GK, Thase ME. Insomnia Symptoms and Suicide-Related Ideation in U.S. Army Service Members. Behav Sleep Med 2020; 18:820-836. [PMID: 31738588 DOI: 10.1080/15402002.2019.1693373] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Insomnia has been identified as a key risk factor for suicide, though most studies have been limited to global measures of these constructs. The aim of the present study was to evaluate the link between insomnia symptoms and five different aspects of suicide-related ideation. Participants: 1,160 active U.S. Army service members (719 male; Mage = 31.2; SDage = 8.62). Methods: As part of an archival analysis, retrospectively assessed insomnia, depression, anxiety symptoms, as well as suicide-related ideation, were evaluated. Suicide-related ideation was assessed in terms of: thoughts of death, thoughts of suicide, suicidal plan, suicidal intent, and suicidal communication. Results: Subjects with clinically significant insomnia symptoms were 3.5 times more likely to report any suicide-related ideation, and approximately 3 times more likely to report thoughts of death and thoughts of suicide. More frequent nocturnal awakenings (i.e., waking up three or more times during a single night) were associated with a greater likelihood of reporting thoughts of death or suicide, whereas greater middle insomnia (i.e., waking up and having difficulty getting back to sleep) was associated with lower odds of experiencing thoughts of suicide, suicidal plan, and suicidal intent. Conclusions: A more refined delineation of insomnia and suicide-related ideation may serve to clarify the nature of the association, and potentially offer some clues as to the underlying mechanisms. With regard to potential clinical implications, the results support that careful assessment of insomnia symptoms, suicide-related ideation, and their respective subtypes, is important and may influence how we estimate risk for suicide.
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Affiliation(s)
- Ivan Vargas
- Department of Psychological Sciences, University of Arkansas , Fayetteville, Arkansas
| | - Michael L Perlis
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Michael Grandner
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona , Tucson, Arizona
| | - Amy Gencarelli
- Department of Psychology, East Carolina University , Greenville, North Carolina
| | - Waliuddin Khader
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona , Tucson, Arizona
| | - Laura J Zandberg
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Elizabeth A Klingaman
- Mental Illness Research, Education, and Clinical Center, VA Capitol Health Care Network , Linthicum, Maryland.,Department of Psychiatry, University of Maryland School of Medicine , Baltimore, Maryland
| | - Jennifer R Goldschmied
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Philip R Gehrman
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania.,Corporal Michael J. Crescenz Veterans Affairs Medical Center , Philadelphia, Pennsylvania
| | - Gregory K Brown
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Michael E Thase
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania
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Rufino KA, Ward-Ciesielski EF, Webb CA, Nadorff MR. Emotion regulation difficulties are associated with nightmares and suicide attempts in an adult psychiatric inpatient sample. Psychiatry Res 2020; 293:113437. [PMID: 32916439 DOI: 10.1016/j.psychres.2020.113437] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/26/2020] [Accepted: 08/29/2020] [Indexed: 11/26/2022]
Abstract
Although many studies have examined potential moderators of the relation between nightmares and suicide, few have examined emotion regulation, particularly utilizing severe populations such as psychiatric inpatients. The present study sought to investigate whether emotion regulation difficulties are associated with nightmares and suicide attempts in an inpatient sample. We included 2,683 psychiatric inpatients ranging from 18 to 81 years (M = 34.35, SD = 14.70). Nightmare frequency, emotion regulation difficulties, and their interaction predicted previous suicide attempts. Limitations include the homogeneity and cross-sectional nature of the sample. Suggestions for future study are discussed.
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Affiliation(s)
- Katrina A Rufino
- University of Houston Downtown, Department of Social Sciences, Houston, Texas, USA; The Menninger Clinic, Houston, Texas, USA.
| | - Erin F Ward-Ciesielski
- Boston University, Center for Anxiety and Related Disoders, Department of Psychological and Brain Sciences, Boston, Massachusetts, USA
| | | | - Michael R Nadorff
- Mississippi State University, Department of Psychology, Missippi State, Mississippi, USA
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71
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Chan NY, Zhang J, Tsang CC, Li AM, Chan JWY, Wing YK, Li SX. The associations of insomnia symptoms and chronotype with daytime sleepiness, mood symptoms and suicide risk in adolescents. Sleep Med 2020; 74:124-131. [DOI: 10.1016/j.sleep.2020.05.035] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 05/18/2020] [Accepted: 05/20/2020] [Indexed: 12/22/2022]
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72
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Vargas I, Perlis ML. Insomnia and depression: clinical associations and possible mechanistic links. Curr Opin Psychol 2020; 34:95-99. [DOI: 10.1016/j.copsyc.2019.11.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/06/2019] [Accepted: 11/19/2019] [Indexed: 02/08/2023]
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73
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Ogeil RP, Witt K, Scott D, Smith K, Lubman DI. Self-reported sleep disturbance in ambulance attendances for suicidal ideation and attempted suicide between 2012 and 2017. J Affect Disord 2020; 265:364-371. [PMID: 32090761 DOI: 10.1016/j.jad.2019.11.158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 10/28/2019] [Accepted: 11/30/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND Sleep disturbances are among the top-ten warning signs for suicide, however there has been limited investigation of the relationship between these variables in acute presentations, particularly community settings. We examined ambulance attendances for suicide ideation and attempt to explore the role of sleep and co-morbid factors (mental health symptoms, attendance time, and alcohol and benzodiazepine use). METHODS Coded clinical records from Ambulance Victoria for the period 1 January 2012 to 30 June 2017 were analysed. RESULTS Paramedics attended 97,198 cases of suicidal ideation or suicide attempt during the study period. Just over half (56.4%) of these were for suicidal ideation, and 43.6% were for attempted suicide. Depression symptomology-related attendances were more common than those for anxiety and despite a lower proportion of both sleep and current anxiety-related symptoms, benzodiazepine use was significantly more common in attendances for suicide attempts (25.9%) than for ideation (2.2%). Co-morbid benzodiazepine use was associated with attempted suicide (OR: 10.37 (10.04-10.72), in a hierarchical regression model. LIMITATIONS Data represent self-report/paramedic observation only, and do include validated measures of sleep or drug use. Sleep disturbance is likely under recorded in ambulance attendances given the primary role of paramedics is to stabilise patients, and minimise risk of harm during transport. CONCLUSION This study reports internationally unique data, and provides the first examination of ambulance coded clinical records for suicide ideation and attempt. Sleep disturbances had a unique role in these attendances, over and above common co-occurring factors including drug use and mental health diagnoses.
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Affiliation(s)
- Rowan P Ogeil
- Eastern Health Clinical School, Monash University, Box Hill, VIC 3128, Australia; Turning Point, Eastern Health, 110 Church St., Richmond, VIC 3121, Australia; Monash Addiction Research Centre, Frankston, VIC 3199, Australia.
| | - Katrina Witt
- Eastern Health Clinical School, Monash University, Box Hill, VIC 3128, Australia; Turning Point, Eastern Health, 110 Church St., Richmond, VIC 3121, Australia; Monash Addiction Research Centre, Frankston, VIC 3199, Australia
| | - Deborah Scott
- Eastern Health Clinical School, Monash University, Box Hill, VIC 3128, Australia; Turning Point, Eastern Health, 110 Church St., Richmond, VIC 3121, Australia; Monash Addiction Research Centre, Frankston, VIC 3199, Australia
| | - Karen Smith
- Ambulance Victoria, Doncaster, VIC 3108, Australia; Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, VIC 3199, Australia; Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Dan I Lubman
- Eastern Health Clinical School, Monash University, Box Hill, VIC 3128, Australia; Turning Point, Eastern Health, 110 Church St., Richmond, VIC 3121, Australia; Monash Addiction Research Centre, Frankston, VIC 3199, Australia
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74
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Kearns JC, Coppersmith DDL, Santee AC, Insel C, Pigeon WR, Glenn CR. Sleep problems and suicide risk in youth: A systematic review, developmental framework, and implications for hospital treatment. Gen Hosp Psychiatry 2020; 63:141-151. [PMID: 30301558 DOI: 10.1016/j.genhosppsych.2018.09.011] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 08/15/2018] [Accepted: 09/24/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Sleep problems are transdiagnostic symptoms that confer significant risk for suicidal thoughts and behaviors (STBs) in adults. However, less is known about the sleep-STB association in adolescence-a developmental period when rates of STBs increase drastically, and sleep problems may be particularly pernicious. This article provides a systematic review of research on the sleep-STB association in youth, an overview of changes in sleep regulation during adolescence that may make sleep problems particularly detrimental for youth, and a discussion of the clinical implications of the sleep-STB association for hospitalized youth. METHOD The systematic review included all longitudinal studies in which sleep problems were examined as prospective predictors of STBs in adolescents (aged 10-24 years). The search was conducted on December 1, 2017 using PsychINFO, PubMed, and Web of Science databases. RESULTS Ten studies qualified for inclusion in this review. Of these, seven studies found at least one type of sleep problem significantly predicted a STB outcome. CONCLUSIONS Although findings are mixed, growing research suggests that sleep problems may be a unique risk factor for STBs in youth. Sleep problems may be particularly important intervention target because they are easily assessed across healthcare settings and are amenable to treatment.
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Affiliation(s)
- Jaclyn C Kearns
- Department of Psychology, University of Rochester, Rochester, NY, USA
| | | | - Angela C Santee
- Department of Psychology, University of Rochester, Rochester, NY, USA
| | - Catherine Insel
- Department of Psychology, Harvard University, Cambridge, MA, USA; Center for Brain Science, Harvard University, Cambridge, MA, USA
| | - Wilfred R Pigeon
- VISN 2 Center for Excellence at Canandaigua VA Medical Center, Canandaigua, NY, USA; Sleep and Neurophysiology Research Lab, Department of Psychiatry, University of Rochester Medical Center Rochester, NY, USA; Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA
| | - Catherine R Glenn
- Department of Psychology, University of Rochester, Rochester, NY, USA.
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75
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Tubbs AS, Perlis ML, Basner M, Chakravorty S, Khader W, Fernandez F, Grandner MA. Relationship of Nocturnal Wakefulness to Suicide Risk Across Months and Methods of Suicide. J Clin Psychiatry 2020; 81:19m12964. [PMID: 32097547 PMCID: PMC8121668 DOI: 10.4088/jcp.19m12964] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 09/11/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Insomnia is a risk factor for suicide, and the risk of suicide after accounting for population wakefulness is disproportionately highest at night. This study investigated whether this risk varied across months and/or methods of suicide. METHODS Time, date, method (eg, firearm, poisoning), and demographic information for 35,338 suicides were collected from the National Violent Death Reporting System for the years 2003-2010. Time of fatal injury was grouped into 1-hour bins and compared to the estimated hourly proportion of the population awake from the American Time Use Survey for 2003-2010. Negative binomial modeling then generated hourly incidence risk ratios (IRRs) of suicide. Risks were then aggregated into 4 categories: morning (6:00 am to 11:59 am), afternoon (noon to 5:59 pm), evening (6:00 pm to 11:59 pm), and night (midnight to 5:59 am). RESULTS The risk of suicide was higher at night across all months (P < .001) and methods (P < .001). The mean nocturnal IRR across months was 3.18 (SD = 0.314), with the highest IRR in May (3.90) and the lowest in November (2.74). The mean (SD) nocturnal IRR across methods was 3.09 (0.472), with the highest IRR for fire (3.75) and the lowest for drowning (2.44). Additionally, nocturnal risk was elevated within all demographics (all P < .001). However, there were no month-by-time or method-by-time interactions across demographics (all P > .05). CONCLUSIONS Regardless of month or method, the incidence risk of suicide at night is higher than at any other time of day. Additionally, demographic subgroups did not differentially experience higher risks across months or mechanisms at night.
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Affiliation(s)
- Andrew S Tubbs
- Department of Psychiatry, University of Arizona, College of Medicine, PO Box 245002, Tucson, AZ 85724-5002. .,Sleep and Health Research Program, Department of Psychiatry, University of Arizona, Tucson, Arizona, USA
| | - Michael L Perlis
- University of Pennsylvania, Department of Psychiatry, Philadelphia, Pennsylvania, USA
| | - Mathias Basner
- University of Pennsylvania, Department of Psychiatry, Philadelphia, Pennsylvania, USA
| | - Subhajit Chakravorty
- University of Pennsylvania, Department of Psychiatry, Philadelphia, Pennsylvania, USA
| | - Waliuddin Khader
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona, Tucson, Arizona, USA,Department of Psychology, University of Arizona, Tucson, Arizona, USA
| | - Fabian Fernandez
- Department of Psychology, University of Arizona, Tucson, Arizona, USA
| | - Michael A Grandner
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona, Tucson, Arizona, USA
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76
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Affiliation(s)
- Leo Sher
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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77
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Hamilton JL, Buysse DJ. Reducing Suicidality Through Insomnia Treatment: Critical Next Steps in Suicide Prevention. Am J Psychiatry 2019; 176:897-899. [PMID: 31672043 DOI: 10.1176/appi.ajp.2019.19080888] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jessica L Hamilton
- Department of Psychiatry (Hamilton, Buysse) and Clinical and Translational Science Institute (Buysse), University of Pittsburgh School of Medicine, Pittsburgh
| | - Daniel J Buysse
- Department of Psychiatry (Hamilton, Buysse) and Clinical and Translational Science Institute (Buysse), University of Pittsburgh School of Medicine, Pittsburgh
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78
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Longitudinal course of suicidal ideation and predictors of its persistence - A NESDA study. J Affect Disord 2019; 257:365-375. [PMID: 31302526 DOI: 10.1016/j.jad.2019.07.042] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 06/17/2019] [Accepted: 07/04/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Prior research indicates that the factors that trigger suicidal ideation may differ from those that maintain it, but studies into the maintenance of suicidal ideation remain scarce. Our aim was to assess the longitudinal course of suicidal ideation, and to identify predictors of persistent suicidal ideation. METHODS We used data from the Netherlands Study of Depression and Anxiety (NESDA). We performed a linear mixed-effects growth model analysis (n = 230 with current suicidal ideation at baseline) to assess the course of suicidal ideation over time (baseline through 2-, 4-, 6- and 9-year follow-up). We used logistic regression analysis (n = 195) to test whether factors previously associated with the incidence of suicidal ideation in the literature (insomnia, hopelessness, loneliness, borderline personality traits, childhood trauma, negative life events) also predict persistence of suicidal ideation (i.e., reporting ideation at two consecutive assessment points, 6- and 9-years). We controlled for socio-demographics, clinical diagnosis and severity, medication use, and suicide attempt history. RESULTS Suicidal ideation decreased over time, and this decrease became slower with increasing time, with the majority of symptom reductions occurring in the first two years of follow-up. More severe insomnia and hopelessness were associated with increased odds of persistent suicidal ideation, and hopelessness was a significant mediator of the relationship between insomnia and persistent suicidal ideation. LIMITATIONS Findings may not generalize to those with more severe suicidal ideation due to dropout of those with the worst clinical profile. CONCLUSIONS Targeting insomnia and hopelessness in treatment may be particularly important to prevent the persistence of suicidal ideation.
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79
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Drapeau CW, Nadorff MR, McCall WV, Titus CE, Barclay N, Payne A. Screening for suicide risk in adult sleep patients. Sleep Med Rev 2019; 46:17-26. [DOI: 10.1016/j.smrv.2019.03.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 03/07/2019] [Accepted: 03/22/2019] [Indexed: 01/10/2023]
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80
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McCarthy MS, Hoffmire C, Brenner LA, Nazem S. Sleep and timing of death by suicide among U.S. Veterans 2006–2015: analysis of the American Time Use Survey and the National Violent Death Reporting System. Sleep 2019; 42:5513337. [DOI: 10.1093/sleep/zsz094] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 01/28/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study Objectives
Suicide is a top public health priority, and U.S. Veterans are recognized to be at particularly elevated risk. Sleep disturbances are an independent risk factor for suicide; recent empirical data suggest that nocturnal wakefulness may be a key mechanism underlying this association. Given higher rates of sleep disturbances among U.S. Veterans compared with civilians, we examined associations between nocturnal wakefulness and timing of death by suicide in U.S. Veterans and civilians to determine whether temporal suicide patterns differed.
Methods
The American Time Use Survey and the National Violent Death Reporting System were analyzed (2006–2015) to determine whether sleep and temporal suicide patterns differed between age-stratified groups (18–39, 40–64, and ≥65) of U.S. Veterans and civilians. Observed temporal suicide patterns were reported and standardized incidence ratios (SIRs) calculated to compare the percentage of suicides observed with those expected, given the proportion of the population awake, across clock hours.
Results
The raw proportion of Veteran suicides peaks between the hours of 1000–1200; however, the peak prevalence of suicide after accounting for the population awake is between 0000 and 0300 hr (p < .00001, ϕ = .88). The highest SIR was at midnight; U.S. Veterans were eight times more likely to die by suicide than expected given the population awake (SIR = 8.17; 95% CI = 7.45–8.94).
Conclusions
Nocturnal wakefulness is associated with increased risk for suicide in U.S. Veterans. Overall patterns of observed suicides by clock hour were similar between U.S. Veterans and civilians. However, Veteran-specific SIRs suggest differences in magnitude of risk by clock hour across age groups. Future research examining female and Post-9/11 U.S. Veterans is warranted.
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Affiliation(s)
| | - Claire Hoffmire
- Rocky Mountain Mental Illness Research Education and Clinical Center, Veterans Administration, Aurora, CO
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO
| | - Lisa A Brenner
- Rocky Mountain Mental Illness Research Education and Clinical Center, Veterans Administration, Aurora, CO
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO
| | - Sarra Nazem
- Rocky Mountain Mental Illness Research Education and Clinical Center, Veterans Administration, Aurora, CO
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO
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81
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Hartwig EM, Rufino KA, Palmer CA, Shepard C, Alfano CA, Schanzer B, Mathew SJ, Patriquin MA. Trajectories of self-reported sleep disturbance across inpatient psychiatric treatment predict clinical outcome in comorbid major depressive disorder and generalized anxiety disorder. J Affect Disord 2019; 251:248-255. [PMID: 30953891 DOI: 10.1016/j.jad.2019.03.069] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/14/2019] [Accepted: 03/21/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND As there has been a demonstrated link between sleep disturbance and suicide, the present study investigated the relationship between self-reported sleep disturbance during inpatient psychiatric treatment and clinical outcomes at discharge and six months post-discharge. METHODS Participants were 2,970 adults receiving care in a long-term inpatient psychiatric hospital. Greater than 90% of inpatients reported at least mild sleep disturbance throughout treatment. Group-based trajectory modeling was used to determine patterns of sleep disturbance changes over time. RESULTS Participants fit into distinct categories based on their trajectories of sleep problems across treatment: No Sleep Problems (10.3% of participants, no sleep problems endorsed over the course of inpatient psychiatric treatment), Resolvers (sleep problems completely resolved over the course of inpatient psychiatric treatment; 10.6%), Non-Responders (did not respond to inpatient psychiatric treatment; 35.7%) and Responders (sleep problems decreased but did not fully resolve over the course of inpatient psychiatric treatment; 43.4%). Individuals with comorbid major depressive disorder and generalized anxiety disorder were significantly more likely to demonstrate higher rates of sleep disturbance throughout inpatient psychiatric treatment and their sleep problems did not respond to treatment as usual (Non-Responders). Further, patients in the Non-Responder group had significantly more suicidal ideation and worse clinical outcomes (higher anxiety, more disability, and lower well-being) at discharge and six months post-discharge, as well as were on more medication including hypnotics throughout treatment. CONCLUSIONS Findings indicate the urgent need to design and implement inpatient psychiatry sleep protocols to not only improve sleep and clinical outcomes, but also reduce the risk for suicide post-discharge.
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Affiliation(s)
- Elizabeth M Hartwig
- The Menninger Clinic, Houston TX USA 77035; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston TX USA 77030
| | - Katrina A Rufino
- The Menninger Clinic, Houston TX USA 77035; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston TX USA 77030; The University of Houston Downtown, Houston TX USA 77002
| | - Cara A Palmer
- Sleep and Anxiety Center of Houston, University of Houston, Houston TX USA 77204
| | | | - Candice A Alfano
- Sleep and Anxiety Center of Houston, University of Houston, Houston TX USA 77204
| | - Bella Schanzer
- The Menninger Clinic, Houston TX USA 77035; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston TX USA 77030
| | - Sanjay J Mathew
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston TX USA 77030; Michael E. DeBakey VA Medical Center, Houston TX USA 77030
| | - Michelle A Patriquin
- The Menninger Clinic, Houston TX USA 77035; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston TX USA 77030; Michael E. DeBakey VA Medical Center, Houston TX USA 77030.
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82
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Porras-Segovia A, Pérez-Rodríguez MM, López-Esteban P, Courtet P, Barrigón M ML, López-Castromán J, Cervilla JA, Baca-García E. Contribution of sleep deprivation to suicidal behaviour: A systematic review. Sleep Med Rev 2019; 44:37-47. [DOI: 10.1016/j.smrv.2018.12.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/03/2018] [Accepted: 12/05/2018] [Indexed: 12/11/2022]
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83
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Tubbs AS, Perlis ML, Grandner MA. Surviving the long night: The potential of sleep health for suicide prevention. Sleep Med Rev 2019; 44:83-84. [PMID: 30797539 PMCID: PMC6530547 DOI: 10.1016/j.smrv.2019.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Andrew S Tubbs
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Michael L Perlis
- Behavioral Sleep Medicine Program, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Michael A Grandner
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona College of Medicine, Tucson, AZ, USA
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84
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Schennach R, Feige B, Riemann D, Heuser J, Voderholzer U. Pre- to post-inpatient treatment of subjective sleep quality in 5,481 patients with mental disorders: A longitudinal analysis. J Sleep Res 2019; 28:e12842. [PMID: 30907038 DOI: 10.1111/jsr.12842] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 09/20/2018] [Accepted: 02/12/2019] [Indexed: 01/26/2023]
Abstract
There is only limited evidence of the course of sleep quality and sleep disturbances during acute inpatient treatment and the prediction of/association with treatment outcome in mental disorders. Within this naturalistic study, 5,481 consecutively admitted inpatients completed the Pittsburgh Sleep Quality Index (PSQI) and the Beck Depression Inventory (BDI-II) at admission and at discharge. Treatment included both individual and group psychotherapy (but no specific interventions for sleep disturbances) and pharmacotherapy based on current national treatment guidelines. Correlation analyses, analyses of variance and linear models were calculated to analyse the datasets. The PSQI improved significantly (p < 0.001) from admission (mean score 9.51 [±4.11]) to discharge (mean score 8.08 [±4.20]) in all diagnostic subgroups. Despite this improvement, 47% of the patients still showed elevated PSQI scores (>5) at discharge. Patients with post-traumatic stress disorder showed the largest sleep disturbances at both time-points; patients with obsessive-compulsive disorder were the least impaired. An improvement of the PSQI was found to be significantly correlated (p < 0.001) to the change of BDI-II values (without the sleep item) during treatment. The likelihood of achieving remission of depressive symptoms (BDI-II total score <14) was significantly associated with less sleep disturbances at admission. The results suggest that almost half of inpatients with mental disorders treated successfully with state-of-the art specific psychotherapy and pharmacotherapy do not have remission of their sleep problems. Therefore, specific treatment programmes for insomnia should be evaluated and implemented in daily clinical routines.
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Affiliation(s)
- Rebecca Schennach
- Schoen Clinic Roseneck, Prien am Chiemsee, Germany.,Department of Psychiatry, LMU Munich, Munich, Germany
| | - Bernd Feige
- Department of Psychiatry and Psychotherapy, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dieter Riemann
- Department of Psychiatry and Psychotherapy, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jörg Heuser
- Schoen Clinic Roseneck, Prien am Chiemsee, Germany
| | - Ulrich Voderholzer
- Schoen Clinic Roseneck, Prien am Chiemsee, Germany.,Department of Psychiatry and Psychotherapy, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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85
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Liu JW, Tu YK, Lai YF, Lee HC, Tsai PS, Chen TJ, Huang HC, Chen YT, Chiu HY. Associations between sleep disturbances and suicidal ideation, plans, and attempts in adolescents: a systematic review and meta-analysis. Sleep 2019; 42:5370501. [DOI: 10.1093/sleep/zsz054] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 01/27/2019] [Indexed: 02/06/2023] Open
Affiliation(s)
- Jen-Wei Liu
- Department of Pharmacy, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
- Department of Pharmacy, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Yu-Kang Tu
- Department of Public Health, Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Ying-Fan Lai
- School of Nursing, College of Nursing, Taipei Medical University, Taipei City, Taiwan
| | - Hsin-Chien Lee
- Department of Psychiatry, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan
- Research Center of Sleep Medicine, School of Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Pei-Shan Tsai
- School of Nursing, College of Nursing, Taipei Medical University, Taipei City, Taiwan
| | - Ting-Jhen Chen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei City, Taiwan
| | - Hui-Chuan Huang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei City, Taiwan
| | - Yu-Ting Chen
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Department of Psychiatry, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan
| | - Hsiao-Yean Chiu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei City, Taiwan
- Research Center of Sleep Medicine, School of Medicine, Taipei Medical University, Taipei City, Taiwan
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86
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Fiedorowicz JG, Persons JE, Assari S, Ostacher MJ, Zandi P, Wang PW, Thase ME, Frye MA, Coryell W. Depressive symptoms carry an increased risk for suicidal ideation and behavior in bipolar disorder without any additional contribution of mixed symptoms. J Affect Disord 2019; 246:775-782. [PMID: 30623823 PMCID: PMC6914253 DOI: 10.1016/j.jad.2018.12.057] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 06/28/2018] [Accepted: 12/19/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To determine whether the risk of suicidal ideation or behavior during mixed states exceeds that attributable to the depressive components of these states alone in bipolar disorder. METHODS We utilized real-world, longitudinal clinical data collected on 290 patients with bipolar disorders (bipolar I, bipolar II, and bipolar not otherwise specified (NOS)) from the National Network of Depression Centers (NNDC) Clinical Care Registry (CCR) seen for 891 visits over a mean of 27.5 weeks. Depressive symptoms were measured with the Patient Health Questionnaire-9 (PHQ-9), manic symptoms with the Altman Self-Rating Mania (ASRM), and suicidal ideation and behavior with the Columbia-Suicide Severity Rating Scale (C-SSRS), obtained as part of the routine, measurement-based care provided across the NNDC. The relations between depressive symptoms, manic symptoms, and the interaction thereof (mixed symptoms) on coinciding suicidal ideation and behavior were modeled in generalized linear mixed models. RESULTS Depressive symptoms, as measured by the PHQ-9, were strongly associated with suicidal ideation and behavior (p < 0.0001), while there was no significant association with manic symptoms as measured by the ASRM or the interaction between depressive and manic symptoms. Similar results were observed when the outcome was restricted to suicidal behavior and when mood was modeled categorically. There was evidence of a gender by ASRM interaction (p = 0.011) and risk of suicidal ideation or behavior was significant for women, but not men with manic symptoms. LIMITATIONS Diagnoses were based on clinician assessment and not structured interview. Mood assessments were self-reported rather than clinician-administered. Suicidal ideation was more frequently observed than suicidal behavior (23/272 visits where outcome positive). CONCLUSIONS Depression represents the primary mood state accounting for suicide risk in bipolar disorder. Co-occurring symptoms of mania (mixed symptoms) do not appear to convey an elevated risk for suicidal ideation or behavior beyond that explained by the depressive symptoms alone.
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Affiliation(s)
- Jess G. Fiedorowicz
- Departments of Psychiatry and Internal Medicine, 4François M. Abboud Cardiovascular Research Center, Iowa Neuroscience Institute, Obesity Research and Education Initiative, The University of Iowa, Iowa City, IA,Department of Epidemiology, College of Public Health, 4François M. Abboud Cardiovascular Research Center, Iowa Neuroscience Institute, Obesity Research and Education Initiative, The University of Iowa, Iowa City, IA,Department of Psychiatry, University of Michigan, Ann Arbor, MI
| | - Jane E. Persons
- Roy J. and Lucille A. Carver College of Medicine, 4François M. Abboud Cardiovascular Research Center, Iowa Neuroscience Institute, Obesity Research and Education Initiative, The University of Iowa, Iowa City, IA
| | - Shervin Assari
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States.
| | - Michael J. Ostacher
- Bipolar Disorder & Depression Research Program, VA Palo Alto Health System, Palo Alto, CA,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University, Palo Alto, CA
| | - Peter Zandi
- Department of Mental Health and Epidemiology, Johns Hopkins Bloomberg School of Public Health, Department of Psychiatry, Johns Hopkins Medicine, Baltimore, MD, United States.
| | - Po W. Wang
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University, Palo Alto, CA
| | - Michael E. Thase
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Mark A. Frye
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN
| | - William Coryell
- Departments of Psychiatry and Internal Medicine, Carver College of Medicine, The University of Iowa, Iowa City, IA, United States.
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87
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Sleep: suicide's tipping point? Time for menopausal practitioners to act. Menopause 2019; 26:123. [DOI: 10.1097/gme.0000000000001179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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88
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Associations between sleep duration and suicidality in adolescents: A systematic review and dose–response meta-analysis. Sleep Med Rev 2018; 42:119-126. [DOI: 10.1016/j.smrv.2018.07.003] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 07/04/2018] [Accepted: 07/05/2018] [Indexed: 02/05/2023]
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89
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Tang W, Xu D, Li B, Lu Y, Xu J. The relationship between the frequency of suicidal ideation and sleep disturbance factors among adolescent earthquake victims in China. Gen Hosp Psychiatry 2018; 55:90-97. [PMID: 30448743 DOI: 10.1016/j.genhosppsych.2018.09.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 09/27/2018] [Accepted: 09/27/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVE This study aimed to examine the frequency of suicidal ideation (SI) and identify exposure variables, mental health, and sleep-related risk factors of SI among adolescents following the 2013 Ya'an earthquake. METHODS Participants consisted of 5563 adolescent students selected through random sampling from 11 primary and high schools in the counties most severely affected by the earthquake. They were asked to complete the Pittsburgh Sleep Quality Index, Children's Revised Impact of Event Scale-13, Short Mood and Feelings Questionnaire, and Screen for Child Anxiety-Related Emotional Disorders. Multinomial logistic analysis was used to identify possible relationships between SI and psychopathology, sleep problems, earthquake exposures or demographic characteristics. The mediation analysis was used to identify direct and indirect effects among sleep problems, psychopathology, earthquake exposures and SI. RESULTS Our findings suggest that 29.5% of the sample experienced SI during the past year (12.9% once, 11.9% twice, 2.6% on 3-4 occasions and 2.1% on at least 5 occasions). Multiple sleeping problems, including trouble falling asleep, shorter sleep duration, and daytime dysfunction, showed independent associations with SI. The mediation analysis suggested that depression and anxiety mainly mediated the association of sleep with SI. LIMITATIONS This study was cross-sectional and did not include controls. No baseline data were collected prior to the earthquake. CONCLUSION SI can be a serious problem among adolescents following a major earthquake, especially those who are older, who live in one-child households, or who are female. Years after a disaster, we found that exposure severity, psychopathology and sleep impairment all contributed to SI, and that earthquake exposure may have disrupted sleep and worsened mood, which in turn may have impacted SI. By enhancing teenagers' sleep management and shaping their activities, post-disaster intervention programs may help prevent SI among Chinese adolescents.
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Affiliation(s)
- Wanjie Tang
- Institute of Emergency Management and Post-disaster Reconstruction, Sichuan University, Chengdu, China; Centre for Educational and Health Psychology, Sichuan University, Chengdu, China; Mental Health Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Dun Xu
- Institute of Emergency Management and Post-disaster Reconstruction, Sichuan University, Chengdu, China
| | - Bin Li
- Mental Health Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Lu
- Institute of Emergency Management and Post-disaster Reconstruction, Sichuan University, Chengdu, China
| | - Jiuping Xu
- Institute of Emergency Management and Post-disaster Reconstruction, Sichuan University, Chengdu, China.
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90
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Berrouiguet S, Le Moal V, Guillodo É, Le Floch A, Lenca P, Billot R, Walter M. Prévention du suicide et santé connectée. Med Sci (Paris) 2018; 34:730-734. [DOI: 10.1051/medsci/20183408021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
L’évaluation ponctuelle du risque suicidaire habituellement conduite aux urgences, après un geste suicidaire, ne rend pas compte de son évolution après la sortie des soins, alors même que le risque de récidive reste important plusieurs mois après. Dans ces conditions, les possibilités d’identification, et donc de prise en charge, des patients à risque suicidaire sont limitées. Le développement de la santé connectée (eHealth) donne désormais accès en temps réel à des informations sur l’état de santé d’un patient entre deux séjours en centre de soins. Cette extension de l’évaluation clinique à l’environnement du patient permet de développer des outils d’aide à la décision face à la gestion du risque suicidaire.
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91
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Grandner MA. The Cost of Sleep Lost: Implications for Health, Performance, and the Bottom Line. Am J Health Promot 2018; 32:1629-1634. [PMID: 30099900 PMCID: PMC6530553 DOI: 10.1177/0890117118790621a] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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92
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Blake MJ, Trinder JA, Allen NB. Mechanisms underlying the association between insomnia, anxiety, and depression in adolescence: Implications for behavioral sleep interventions. Clin Psychol Rev 2018; 63:25-40. [PMID: 29879564 DOI: 10.1016/j.cpr.2018.05.006] [Citation(s) in RCA: 220] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 05/05/2018] [Accepted: 05/26/2018] [Indexed: 11/27/2022]
Abstract
There is robust evidence of an association between insomnia, anxiety, and depression in adolescence. The aim of this review is to describe and synthesize potential mechanisms underlying this association and explore implications for the design of adolescent behavioral sleep interventions. Specifically, we examine whether insomnia symptoms are a mechanism for the development of internalizing symptoms in adolescence and whether sleep interventions are an effective treatment for both insomnia and internalizing symptoms in adolescence because they target the shared mechanisms underlying these disorders. Research using different methodologies points to the role of sequential, parallel, and interacting mechanisms. In this paper, we review a wide range of relevant biological (i.e., polymorphisms and dysregulation in serotonin, dopamine, and circadian clock genes; alterations in corticolimbic and mesolimbic brain circuits; cortisol reactivity to stress; inflammatory cytokine dysregulation; biased memory consolidation; changes in sleep architecture), psychological (i.e., cognitive inflexibility, interpretational biases, judgment biases, negative attribution styles, worry, rumination, biased attention to threat, dysfunctional beliefs and attitudes about sleep, misperception of sleep deficit), and social mechanisms (i.e., reduced and impaired social interactions, unhelpful parenting behaviors, family stress) and propose an integrative multilevel model of how these phenomena may interact to increase vulnerability to both insomnia and internalizing disorders. Several 'biopsychosocial' mechanisms hold promise as viable treatment targets for adolescent behavioral sleep interventions, which may reduce both insomnia and internalizing symptoms.
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Affiliation(s)
- Matthew J Blake
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Vic 3010, Australia.
| | - John A Trinder
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Vic 3010, Australia.
| | - Nicholas B Allen
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Vic 3010, Australia; Department of Psychology, University of Oregon, Eugene, OR 97403-1227, USA.
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93
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Schredl M, Göritz AS. Nightmare Themes: An Online Study of Most Recent Nightmares and Childhood Nightmares. J Clin Sleep Med 2018; 14:465-471. [PMID: 29458691 DOI: 10.5664/jcsm.7002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 12/13/2017] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Even though the common diagnostic criteria (ICSD-3, DSM-5) acknowledge that nightmares do not only contain anxiety/fear (definition of the ICD-10) but also other emotions such as grief, disgust, and anger, the definition of a nightmare still focuses on threats to survival, security, or physical integrity. However, empirical studies on nightmare content in larger samples are scarce. METHODS The current study elicited 1,216 of the most recent nightmares including childhood nightmares of a population-based sample. RESULTS The findings show that nightmares encompass a diversity of different topics, being chased, physical aggression, including death/injury of close persons. Infrequent themes like being the aggressor and suicide are of special interest as they might be related to waking-life psychopathology. CONCLUSIONS The variety of nightmare topics clearly indicate that current definitions of nightmare content are too narrow. Future studies should look into nightmare content of persons in whom nightmare disorder has been diagnosed.
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Affiliation(s)
- Michael Schredl
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Heidelberg, Germany
| | - Anja S Göritz
- Psychology Department, University of Freiburg, Freiburg, Germany
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94
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School start time effects on adolescent learning and academic performance, emotional health and behaviour. Curr Opin Psychiatry 2017; 30:485-490. [PMID: 28858008 DOI: 10.1097/yco.0000000000000368] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE OF REVIEW The investigation of the relationship between the time of day that school begins and the effects it could have on students began in the mid-1990s. Since that time, many articles have been written either for the medical literature or the educational literature. This review is intended to bridge that gap by examining together the findings for both academic and health outcomes, exploring what we know and what is needed in further investigation. RECENT FINDINGS Teens who are sleep deficient (defined as obtaining less than 8 h per night) because of early starting time for their school are much more likely to engage in risky behaviours, such as drug, cigarette and alcohol use, have significant feelings of depression, get lower grades and are at greater risk for car crashes. Many studies of academic performance and later school start time indicate benefits, although further research is needed to understand the related mechanisms that contribute to improvements in achievement. Recent research in adolescent sleep and outcomes is being shaped by not only measuring sleep duration, but also examining the timing in which sleep occurs. SUMMARY Early school starting time for middle and high students has a clear, deleterious effect on their health and well being. Most recently, sleep deficit in teens is being viewed as a public health issue that needs a wider discussion about its impact and it necessitates improved public education about the sleep phase shift that occurs during adolescence.
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95
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Adolescent insomnia, suicide risk, and the interpersonal theory of suicide. Psychiatry Res 2017; 257:242-248. [PMID: 28780282 DOI: 10.1016/j.psychres.2017.07.054] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 07/01/2017] [Accepted: 07/29/2017] [Indexed: 11/21/2022]
Abstract
Although insomnia has been repeatedly linked with suicide ideation, the reason for the linkage is not clear. The Interpersonal Psychological Theory of Suicide (IPTS) proposes that three core variables (thwarted belongingness, perceived burdensomeness, and acquired capability) are the final common pathway for all risk factors for suicide ideation and behavior. Recent research has suggested that insomnia may be associated with suicide ideation independently of the IPTS. We examined cross-sectional data from 151 psychiatric inpatients (ages 12-17) to determine if the association between insomnia symptoms and a continuous measure of suicide risk (measured as increasingly severe ideation and plan) was explained by the framework of the IPTS. When all IPTS variables and depressive symptoms were included in the model, insomnia symptoms did not contribute unique variance to suicide risk. Perceived burdensomeness and depressive symptoms were found to explain the relationship between insomnia symptoms and suicide risk. Our findings suggest that improved sleep might reduce suicide risk, that management of interpersonal need cognitions might reduce risk in the presence of insomnia symptoms, and reinforce the independent role of depressive symptoms in suicide risk in clinical samples of adolescents.
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96
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Yeung WF, Ho FYY, Chung KF, Zhang ZJ, Yu BYM, Suen LKP, Chan LYT, Chen HY, Ho LM, Lao LX. Self-administered acupressure for insomnia disorder: a pilot randomized controlled trial. J Sleep Res 2017; 27:220-231. [DOI: 10.1111/jsr.12597] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Accepted: 07/25/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Wing-Fai Yeung
- School of Nursing; Hong Kong Polytechnic University; Hong Kong China
| | - Fiona Yan-Yee Ho
- Department of Psychology and Centre for Psychosocial Health; the Education University of Hong Kong; Hong Kong China
| | - Ka-Fai Chung
- Department of Psychiatry; the University of Hong Kong; Hong Kong China
| | - Zhang-Jin Zhang
- School of Chinese Medicine; the University of Hong Kong; Hong Kong China
| | - Branda Yee-Man Yu
- School of Nursing; Hong Kong Polytechnic University; Hong Kong China
| | | | | | - Hai-Yong Chen
- School of Chinese Medicine; the University of Hong Kong; Hong Kong China
| | - Lai-Ming Ho
- School of Public Health; The University of Hong Kong; Hong Kong, Pokfulam China
| | - Li-Xing Lao
- School of Chinese Medicine; the University of Hong Kong; Hong Kong China
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97
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Abstract
PURPOSE We aimed to systematically review recent publications (01/2014-03/2017) with longitudinal designs allowing for the assessment of the prospective risk of insomnia on new onset mental illness in key conditions: anxiety, depression, bipolar disorder, posttraumatic stress disorder, substance use disorders, and suicide. RECENT FINDINGS A literature yielded 1859 unique articles meeting search criteria were identified; 16 articles met all selection criteria and reviewed with some studies reporting on more than one mental health outcome. Overall, the review supports the hypothesis that insomnia is a predictor of subsequent mental illness. The evidence is strongest for an insomnia-depression relationship. The new studies identified and reviewed add to a modest number of publications supporting a prospective role of insomnia in new onset mental illness in three areas: anxiety disorders, bipolar disorder, and suicide. The few selected new studies focused on SUD were mixed, and no studies focused on PTSD were identified that met the selection criteria. Treatment of insomnia may also be a preventive mental health strategy.
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98
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Kim K, Lee H, Hong JP, Cho MJ, Fava M, Mischoulon D, Kim DJ, Jeon HJ. Poor sleep quality and suicide attempt among adults with internet addiction: A nationwide community sample of Korea. PLoS One 2017; 12:e0174619. [PMID: 28384238 PMCID: PMC5383038 DOI: 10.1371/journal.pone.0174619] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 03/12/2017] [Indexed: 11/30/2022] Open
Abstract
Purpose Internet addiction (IA) is defined as a psychological dependence on the internet, regardless of the type of activities once logged on, and previous studies have focused on adolescents and young adults. The aim of this study was to investigate the association between suicide attempts and sleep among community-dwelling adults with IA. Methods The Young’s Internet Addiction Test (IAT), the Korean version of the Composite International Diagnostic Interview (K-CIDI) and a suicide questionnaire were used in this cross-sectional multistage, cluster sampling population-based study. A total of 3212 adults aged 18–64 years were interviewed face-to-face, and they had been randomly selected through a one-person-per-household method. Results Of the 3212 adults, 204 were assessed as having IA (6.35%). Adults with IA were younger, and more frequently male, unmarried, and unemployed, and had poorer sleep quality than adults without IA (32.8% vs. 19.8%), whereas there was no significant difference in the absolute duration of sleep between the two groups. Adults with IA showed more frequent difficulty initiating and maintaining sleep, non-restorative sleep, daytime functional impairment, and duration of sleep more than 10 hours on weekdays than adults without IA. IA with poor sleep quality was significantly associated with lifetime suicide attempts (AOR = 3.34, 95% CI 1.38–8.05) after adjusting for demographic covariates. Adults with IA who had more sleep problems showed more severe IA, especially those who experienced a previous suicidal attempt. Among mental disorders, IA with poor sleep quality was significantly associated with anxiety disorder and overall psychiatric disorders. Conclusions Among adults with IA, poor sleep quality was found to be associated with more severe IA and lifetime suicide attempt.
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Affiliation(s)
- Kiwon Kim
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Haewoo Lee
- Department of Psychiatry, Seoul Medical Center, Seoul, Republic of Korea
| | - Jin Pyo Hong
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Maeng Je Cho
- Department of Psychiatry and Behavioral Sciences, Seoul National University College of Medicine, Seoul, Korea
| | - Maurizio Fava
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, United States of America
| | - David Mischoulon
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, United States of America
| | - Dong Jun Kim
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Health Sciences & Technology, Samsung Biomedical Research Institute (SAIHST), Sungkyunkwan University, Seoul, Korea
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, United States of America
- Department of Health Sciences & Technology, Samsung Biomedical Research Institute (SAIHST), Sungkyunkwan University, Seoul, Korea
- * E-mail:
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99
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Dewa LH, Hassan L, Shaw JJ, Senior J. Trouble sleeping inside: a cross-sectional study of the prevalence and associated risk factors of insomnia in adult prison populations in England. Sleep Med 2017; 32:129-136. [PMID: 28366324 PMCID: PMC5390769 DOI: 10.1016/j.sleep.2016.12.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 12/07/2016] [Accepted: 12/08/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate the prevalence of insomnia and identify associated demographic, clinical and forensic risk factors in adult prisoners in England. METHODS A cross-sectional study of 237 prisoners aged 18-72 years, across two male prisons and one female prison in North England. We used the Sleep Condition Indicator to measure probable DSM-V insomnia disorder (ID) and the Pittsburgh Sleep Quality Index to examine sleep quality. Multiple demographic, sleep, clinical and forensic self-reported measures were recorded to identify any associations with insomnia. RESULTS Overall, the prevalence of possible DSM-V ID was 61.6% (95% CI, 55.5%-67.8%). Subjective poor sleep quality was reported by 88.2% (95% CI, 84.1%-92.3%). Seven in ten (70.6%) female prisoners had possible DSM-V ID (95% CI, 64.8%-76.4%). Multivariable logistic regression analysis, adjusting for gender and age, indicated odds of having possible ID in prison were increased for the following factors: history of physical ill-health (OR = 3.62, 95% CI, 1.31-9.98); suicidality (OR = 2.79, 95% CI, 1.01.7.66), previously asked for help for insomnia (OR = 2.58, 95% CI, 1.21-5.47), depression (OR = 2.06, 95% CI 1.31-3.24), greater endorsement of dysfunctional beliefs about sleep (OR = 1.50, 95% CI, 1.21-1.87), poor sleep hygiene (OR = 1.11, 95% CI, 1.04-1.19), and problematic prison environment (eg, noise, light or temperature) (OR = 1.07, 95% CI, 1.02-1.12). CONCLUSIONS For the first time we have established the prevalence and associated factors of insomnia in a large sample of adult English prisoners. ID and poor sleep quality are common, especially in female prisoners. These findings emphasize/amplify the need for dedicated treatment pathways to improve screening, assessment and treatment of insomnia in prison.
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Affiliation(s)
- Lindsay H Dewa
- NIHR Imperial Patient Safety Translational Research Centre, Imperial College London, London, UK.
| | - Lamiece Hassan
- Division of Imaging, Informatics and Data Sciences, The University of Manchester, Manchester, UK
| | - Jenny J Shaw
- Division of Psychology and Mental Health, The University of Manchester, UK
| | - Jane Senior
- Division of Psychology and Mental Health, The University of Manchester, UK
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100
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Dolsen EA, Cheng P, Arnedt JT, Swanson L, Casement MD, Kim HS, Goldschmied JR, Hoffmann RF, Armitage R, Deldin PJ. Neurophysiological correlates of suicidal ideation in major depressive disorder: Hyperarousal during sleep. J Affect Disord 2017; 212:160-166. [PMID: 28192765 PMCID: PMC5361570 DOI: 10.1016/j.jad.2017.01.025] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 01/04/2017] [Accepted: 01/22/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND Suicide is a major public health concern, and a barrier to reducing the suicide rate is the lack of objective predictors of risk. The present study considers whether quantitative sleep electroencephalography (EEG) may be a neurobiological correlate of suicidal ideation. METHODS Participants included 84 (45 female, mean age=26.6) adults diagnosed with major depressive disorder (MDD). The item that measures thoughts of death or suicide on the Quick Inventory of Depressive Symptomatology (QIDS) was used to classify 47 participants as low suicidal ideation (24 females, mean age=26.1) and 37 as high suicidal ideation (21 females, mean age=27.3). Data were obtained from archival samples collected at the University of Michigan and University of Texas Southwestern Medical Center between 2004 and 2012. Sleep EEG was quantified using power spectral analysis, and focused on alpha, beta, and delta frequencies. RESULTS Results indicated that participants with high compared to low suicidal ideation experienced 1) increased fast frequency activity, 2) decreased delta activity, and 3) increased alpha-delta sleep after adjusting for age, sex, depression, and insomnia symptoms. LIMITATIONS Limitations include the exclusion of imminent suicidal intent, a single suicidal ideation item, and cross-sectional archival data. CONCLUSIONS This is one of the first studies to provide preliminary support that electrophysiological brain activity during sleep is associated with increased suicidal ideation in MDD, and may point toward central nervous system (CNS) hyperarousal during sleep as a neurobiological correlate of suicidal ideation.
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Affiliation(s)
- Emily A. Dolsen
- Department of Psychology, University of California, Berkeley, CA
94720, USA,Correspondence to: 2205 Tolman Hall, Berkeley, CA 94720
(E.A. Dolsen)
| | - Philip Cheng
- Sleep Disorders and Research Center, Henry Ford Hospital, Detroit,
MI 48202, USA
| | - J. Todd Arnedt
- Department of Psychiatry, University of Michigan, Ann Arbor, MI
48109, USA
| | - Leslie Swanson
- Department of Psychiatry, University of Michigan, Ann Arbor, MI
48109, USA
| | | | - Hyang Sook Kim
- Department of Psychology, Sogang University, Seoul 121-742,
Korea
| | | | - Robert F. Hoffmann
- Department of Psychiatry, University of Michigan, Ann Arbor, MI
48109, USA
| | - Roseanne Armitage
- Department of Psychiatry, University of Michigan, Ann Arbor, MI
48109, USA
| | - Patricia J. Deldin
- Department of Psychology, University of Michigan, Ann Arbor, MI
48109, USA
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