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Cogan CM, Lee JY, Cranston CC, Pruiksma KE, Rhudy JL, Davis JL. The impact of exposure, relaxation, and rescripting therapy for post-trauma nightmares on suicidal ideation. J Clin Psychol 2019; 75:2095-2105. [PMID: 31468547 DOI: 10.1002/jclp.22852] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE This study investigated whether a brief psychotherapy for post-trauma nightmares (exposure, relaxation, and rescripting therapy [ERRT]), reduced suicidal ideation (SI). We hypothesized that: (a) nightmare frequency and severity, post-traumatic stress disorder (PTSD), depression, and sleep quality would be related to SI at pretreatment; (b) SI would decrease from pre- to post-treatment; and (c) the decrease in SI would remain after controlling for change in PTSD and depression. METHOD Seventy-five individuals exposed to a traumatic event and who experienced frequent nightmares (minimum one per week) participated in ERRT. Participants were not required to have a psychological diagnosis. Thirty percent endorsed SI at pretreatment. RESULTS Depression and PTSD were related to SI at pretreatment. SI decreased following treatment; however, the third hypothesis was not supported. CONCLUSION Results suggest brief psychotherapy targeting post-trauma nightmares may decrease SI. More research is necessary to determine what factors contribute to decreases in SI.
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Affiliation(s)
- Chelsea M Cogan
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
| | - Jenny Y Lee
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
| | - Christopher C Cranston
- Department of Psychiatry & Behavioral Sciences, Division of Medical Psychology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kristi E Pruiksma
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Jamie L Rhudy
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
| | - Joanne L Davis
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
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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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Owen-Smith AA, Ahmedani BK, Peterson E, Simon GE, Rossom RC, Lynch FL, Lu CY, Waitzfelder BE, Beck A, DeBar LL, Sanon V, Maaz Y, Khan S, Miller-Matero LR, Prabhakar D, Frank C, Drake CL, Braciszewski JM. The Mediating Effect of Sleep Disturbance on the Relationship Between Nonmalignant Chronic Pain and Suicide Death. Pain Pract 2019; 19:382-389. [PMID: 30462885 DOI: 10.1111/papr.12750] [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: 09/07/2018] [Revised: 11/08/2018] [Accepted: 11/14/2018] [Indexed: 11/30/2022]
Abstract
IMPORTANCE Few studies have examined the relationship between nonmalignant chronic pain (NMCP) and suicide death, and even fewer have specifically explored what role sleep disturbance might play in the association between NMCP and suicide death. OBJECTIVE To assess whether sleep disturbance mediates the relationship between NMCP and suicide death. DESIGN This case-control study included 2,674 individuals who died by suicide between 2000 and 2013 (cases) and 267,400 matched individuals (controls). SETTING Eight Mental Health Research Network (MHRN)-affiliated healthcare systems. PARTICIPANTS All cases and matched controls were health plan members for at least 10 months during the year prior to the index date. MAIN OUTCOMES AND MEASURES Sociodemographic data and diagnosis codes for NMCP and sleep disorders were extracted from the MHRN's Virtual Data Warehouse. Suicide mortality was identified using International Statistical Classification of Diseases and Related Health Problems (ICD)-10 codes from official government mortality records matched to health system records. RESULTS After accounting for covariates, there was a significant relationship between NMCP and sleep disturbance; those who were diagnosed with NMCP were more likely to develop subsequent sleep disturbance. Similarly, sleep disturbance was significantly associated with suicide death. Finally, a significant indirect effect of NMCP on suicide death, through sleep disturbance, and a nonsignificant direct effect of NMCP on suicide death provide support for a fully mediated model. CONCLUSIONS AND RELEVANCE There is a need for clinicians to screen for both sleep disturbance and suicidal ideation in NMCP patients and for health systems to implement more widespread behavioral treatments that address comorbid sleep problems and NMCP.
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Affiliation(s)
- Ashli A Owen-Smith
- School of Public Health, Georgia State University, Atlanta, Georgia, U.S.A.,Kaiser Permanente Georgia, Center for Research and Evaluation, Atlanta, Georgia
| | - Brian K Ahmedani
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan, U.S.A.,Behavioral Health Services, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Ed Peterson
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Gregory E Simon
- Kaiser Permanente Washington, Health Research Institute, Seattle, Washington, U.S.A
| | | | - Frances L Lynch
- Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon, U.S.A
| | - Christine Y Lu
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts, U.S.A
| | - Beth E Waitzfelder
- Kaiser Permanente Hawaii, Center for Health Research, Honolulu, Hawaii, U.S.A
| | - Arne Beck
- Kaiser Permanente Colorado, Institute for Health Research, Aurora, Colorado, U.S.A
| | - Lynn L DeBar
- Kaiser Permanente Washington, Health Research Institute, Seattle, Washington, U.S.A
| | - Victoria Sanon
- School of Public Health, Georgia State University, Atlanta, Georgia, U.S.A
| | - Yousef Maaz
- Behavioral Health Services, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Shehryar Khan
- Behavioral Health Services, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Lisa R Miller-Matero
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan, U.S.A.,Behavioral Health Services, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Deepak Prabhakar
- Behavioral Health Services, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Cathy Frank
- Behavioral Health Services, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Christopher L Drake
- Sleep Disorders and Research Center, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Jordan M Braciszewski
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan, U.S.A
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Huang Y, Li P, Lai Z, Jia X, Xiao D, Wang T, Guo L, Lu C. Role of sleep quality in mediating the relationship between sexual minority status and suicidal behavior among Chinese adolescents. Psychol Res Behav Manag 2018; 11:607-615. [PMID: 30573996 PMCID: PMC6292244 DOI: 10.2147/prbm.s186586] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Studies suggest that sexual minority adolescents experience higher rates of sleep disturbance than their heterosexual peers, and disturbed sleep is a well-known risk factor for suicidality. This study aimed to explore whether sleep quality had mediating effects on the relationship between sexual minority status and suicidal behavior in Chinese adolescents. Methods We analyzed data collected from 7th to 12th graders from seven randomly selected provinces of People’s Republic of China in the 2015 School-Based Chinese Adolescents Health Survey. The 123,459 students who completed questionnaires regarding sexual attraction, the Pittsburgh Sleep Quality Index, past-year suicidal ideation, and past-year suicide attempts were included in our study (response rate: 95.9%). Results After adjustment for covariates, sexual minority status was associated with suicidal ideation (adjusted odds ratio =1.82, 95% CI=1.69–1.95) and suicide attempts (adjusted odds ratio =2.16, 95% CI=1.82–2.56). Sleep quality partially mediated the effects of sexual minority status on suicidal ideation (standardized β estimate=0.009, 95% CI=0.007–0.012) and suicide attempts (standardized β estimate=0.004, 95% CI=0.003–0.005). Conclusion Poor sleep quality partially explained the increased risk of suicidality for Chinese sexual minority adolescents. To prevent subsequent suicidality, suicide interventions targeting sexual minorities should be made, with a focus on their disparities in sleep disturbance and sleep health promotion.
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Affiliation(s)
- Yeen Huang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China,
| | - Pengsheng Li
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China,
| | - Zhisheng Lai
- Department of HIV/AIDS Prevention and Control, Yuexiu District Center for Disease Control and Prevention, Guangzhou, Guangdong, People's Republic of China
| | - Xiaofei Jia
- Department of HIV/AIDS Prevention and Control, Tianhe District Center for Disease Control and Prevention, Guangzhou, Guangdong, People's Republic of China
| | - Di Xiao
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China,
| | - Tian Wang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China,
| | - Lan Guo
- Department of HIV/AIDS Prevention and Control, Yuexiu District Center for Disease Control and Prevention, Guangzhou, Guangdong, People's Republic of China
| | - Ciyong Lu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China, .,Guangdong Provincial Key Laboratory of Food, Guangdong Engineering Technology Research Center of Nutrition Translation, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China,
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55
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Guo L, Luo M, Wang WX, Huang GL, Xu Y, Gao X, Lu CY, Zhang WH. Association between problematic Internet use, sleep disturbance, and suicidal behavior in Chinese adolescents. J Behav Addict 2018; 7:965-975. [PMID: 30474380 PMCID: PMC6376369 DOI: 10.1556/2006.7.2018.115] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIMS This large-scale study aimed to test (a) associations of problematic Internet use (PIU) and sleep disturbance with suicidal ideation and suicide attempts among Chinese adolescents and (b) whether sleep disturbance mediates the association between PIU and suicidal behavior. METHODS Data were drawn from the 2017 National School-based Chinese Adolescents Health Survey. A total of 20,895 students' questionnaires were qualified for analysis. The Young's Internet Addiction Test was used to assess PIU, and level of sleep disturbance was measured by the Pittsburgh Sleep Quality Index. Multilevel logistic regression models and path models were utilized in analyses. RESULTS Of the total sample, 2,864 (13.7%) reported having suicidal ideation, and 537 (2.6%) reported having suicide attempts. After adjusting for control variables and sleep disturbance, PIU was associated with an increased risk of suicidal ideation (AOR = 1.04, 95% CI = 1.03-1.04) and suicide attempts (AOR = 1.03, 95% CI = 1.02-1.04). Findings of the path models showed that the standardized indirect effects of PIU on suicidal ideation (standardized β estimate = 0.092, 95% CI = 0.082-0.102) and on suicide attempts (standardized β estimate = 0.082, 95% CI = 0.068-0.096) through sleep disturbance were significant. Conversely, sleep disturbance significantly mediated the association of suicidal behavior on PIU. DISCUSSION AND CONCLUSIONS There may be a complex transactional association between PIU, sleep disturbance, and suicidal behavior. The estimates of the mediator role of sleep disturbance provide evidence for the current understanding of the mechanism of the association between PIU and suicidal behavior. Possible concomitant treatment services for PIU, sleep disturbance, and suicidal behavior were recommended.
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Affiliation(s)
- Lan Guo
- Department of Medical statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People’s Republic of China,Department of Nutrition, Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, People’s Republic of China
| | - Min Luo
- Department of Medical statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People’s Republic of China,Department of Nutrition, Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, People’s Republic of China
| | - Wan-Xin Wang
- Department of Medical statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People’s Republic of China,Department of Nutrition, Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, People’s Republic of China
| | - Guo-Liang Huang
- Department of Drug Abuse Control, Center for ADR monitoring of Guangdong, Guangzhou, People’s Republic of China
| | - Yan Xu
- Department of Drug Abuse Control, Center for ADR monitoring of Guangdong, Guangzhou, People’s Republic of China
| | - Xue Gao
- Department of Drug Abuse Control, Center for ADR monitoring of Guangdong, Guangzhou, People’s Republic of China
| | - Ci-Yong Lu
- Department of Medical statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People’s Republic of China,Department of Nutrition, Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, People’s Republic of China,Corresponding author: Ci-Yong Lu, MD, PhD; Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, Guangzhou 510080, People’s Republic of China; Phone: +86 20 87332477; Fax: +86 20 87331882; E-mail:
| | - Wei-Hong Zhang
- School of Public Health, Université Libre de Bruxelles (ULB), Bruxelles, Belgium,Research Center for Public Health, Tsinghua University, Beijing, People’s Republic of China
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56
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Um SB, Yeom H, Kim NH, Kim HC, Lee HK, Suh I. Association between dry eye symptoms and suicidal ideation in a Korean adult population. PLoS One 2018; 13:e0199131. [PMID: 29924835 PMCID: PMC6010274 DOI: 10.1371/journal.pone.0199131] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 06/03/2018] [Indexed: 12/31/2022] Open
Abstract
Purpose This study assessed the association of dry eyes with depression and suicidal ideation in a Korean adult population. Methods Data from 16408 participants (6972 men and 9436 women) aged ≥ 19 years included in the fifth Korea National Health and Nutrition Examination Survey, conducted from 2010–2012, were analyzed. For dry eyes, surveys of previous diagnosis of dry eye disease (DED) by an ophthalmologist and experience of subjective dry eye symptoms were separately used. Diagnosis of depression and suicidal ideation were obtained via responses to an interviewer-assisted questionnaire, and questions were asked in a closed-ended response format. Logistic regression was used to examine the associations between dry eyes, depression, and suicidal ideation. Results DED diagnosis exhibited an odds ratio (OR) of 1.32 (95% confidence interval [CI] 1.11–1.57) for depression and 1.24 (95% CI 1.05–1.48) for suicidal ideation compared to those without DED, after adjusting for sex, age, education, occupation, household income, body mass index, smoking behavior, alcohol consumption, physical activity, hypertension, diabetes, dyslipidemia, thyroid diseases, major cardiovascular disease, and cancer. Similarly, the adjusted OR (95% CI) of dry eye symptoms was 1.50 (95% CI 1.30–1.73) for depression and 1.47 (95% CI 1.27–1.70) for suicidal ideation. Conclusion Our findings suggest that dry eyes (either DED diagnosis or dry eye symptoms) may be associated with the prevalence of depression and suicidal ideation in the Korean adult population.
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Affiliation(s)
- Sun-Bi Um
- Department of Public Health, Yonsei University Graduate School, Seoul, Republic of Korea
| | - Hyungseon Yeom
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Na Hyun Kim
- Department of Public Health, Yonsei University Graduate School, Seoul, Republic of Korea
| | - Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- * E-mail:
| | - Hyung Keun Lee
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Il Suh
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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Don Richardson J, King L, St. Cyr K, Shnaider P, Roth ML, Ketcheson F, Balderson K, Elhai JD. Depression and the relationship between sleep disturbances, nightmares, and suicidal ideation in treatment-seeking Canadian Armed Forces members and veterans. BMC Psychiatry 2018; 18:204. [PMID: 29921268 PMCID: PMC6011186 DOI: 10.1186/s12888-018-1782-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 06/11/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Research on the relationship between insomnia and nightmares, and suicidal ideation (SI) has produced variable findings, especially with regard to military samples. This study investigates whether depression mediated the relationship between: 1) sleep disturbances and SI, and 2) trauma-related nightmares and SI, in a sample of treatment-seeking Canadian Armed Forces (CAF) personnel and veterans (N = 663). METHOD Regression analyses were used to investigate associations between sleep disturbances or trauma-related nightmares and SI while controlling for depressive symptom severity, posttraumatic stress disorder (PTSD) symptom severity, anxiety symptom severity, and alcohol use severity. Bootstrapped resampling analyses were used to investigate the mediating effect of depression. RESULTS Approximately two-thirds of the sample (68%; N = 400) endorsed sleep disturbances and 88% (N = 516) reported experiencing trauma-related nightmares. Although sleep disturbances and trauma-related nightmares were both significantly associated with SI on their own, these relationships were no longer significant when other psychiatric conditions were included in the models. Instead, depressive symptom severity emerged as the only variable significantly associated with SI in both equations. Bootstrap resampling analyses confirmed a significant mediating role of depression for sleep disturbances. CONCLUSIONS The findings suggest that sleep disturbances and trauma-related nightmares are associated with SI as a function of depressive symptoms in treatment-seeking CAF personnel and veterans. Treating depression in patients who present with sleep difficulties may subsequently help mitigate suicide risk.
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Affiliation(s)
- J. Don Richardson
- Parkwood Institute Operational Stress Injury Clinic, London, ON Canada
- Department of Psychiatry, Western University, London, ON Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON Canada
| | - Lisa King
- Parkwood Institute Operational Stress Injury Clinic, London, ON Canada
| | - Kate St. Cyr
- Parkwood Institute Operational Stress Injury Clinic, London, ON Canada
| | - Philippe Shnaider
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON Canada
- Anxiety Treatment and Research Centre, St. Joseph’s Healthcare Hamilton, Hamilton, ON Canada
| | - Maya L. Roth
- Parkwood Institute Operational Stress Injury Clinic, London, ON Canada
- Department of Graduate Studies, Ryerson University, Toronto, ON Canada
| | - Felicia Ketcheson
- Parkwood Institute Operational Stress Injury Clinic, London, ON Canada
| | - Ken Balderson
- Parkwood Institute Operational Stress Injury Clinic, London, ON Canada
- Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | - Jon D. Elhai
- Departments of Psychology and Psychiatry, University of Toledo, Toledo, OH USA
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Lamis DA, Innamorati M, Erbuto D, Berardelli I, Montebovi F, Serafini G, Amore M, Krakow B, Girardi P, Pompili M. Nightmares and suicide risk in psychiatric patients: The roles of hopelessness and male depressive symptoms. Psychiatry Res 2018; 264:20-25. [PMID: 29626827 DOI: 10.1016/j.psychres.2018.03.053] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 03/13/2018] [Accepted: 03/22/2018] [Indexed: 12/29/2022]
Abstract
Although nightmares have been shown to increase the risk for suicide, less is known about the mechanisms underlying this relationship. In order to address this gap and guided by the hopelessness theory of suicide risk, we examined hopelessness and male depressive symptoms as risk factors for suicide while considering the frequency of and impairment due to nightmares. Data were collected from 172 psychiatrically hospitalized, adult patients (91 women, 81 men) with an average age of 39.15 (SD = 13.48) years. Patients were administered self-report measures of nightmare frequency/impairment, hopelessness, and male depressive symptoms, as well as undergoing a fully structured diagnostic clinical interview to determine diagnoses and suicide risk. Compared to patients with yearly or no nightmares, those with monthly or weekly nightmares reported nightmares reported higher levels of hopelessness, male depressive symptoms, and suicide risk. Male depressive symptoms significantly mediated the relation between hopelessness and suicide risk in patients who reported monthly to weekly nightmares, but not in those who reported yearly or no nightmares. Moreover, impairment due to nightmares was significantly and positively associated with male depression, but not hopelessness or suicide risk. The results also provide evidence and further understanding about possible mechanisms of emerging suicide.
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Affiliation(s)
- Dorian A Lamis
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA; Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Centre, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Marco Innamorati
- Department of Human Sciences, European University of Rome, Rome, Italy
| | - Denise Erbuto
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Centre, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Isabella Berardelli
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Centre, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Franco Montebovi
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Centre, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Barry Krakow
- Sleep & Human Health Institute, Albuquerque, NM, USA; Maimonides Sleep Arts & Sciences, Ltd., Albuquerque, NM, USA
| | - Paolo Girardi
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Centre, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Centre, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
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Russell K, Rasmussen S, Hunter SC. Insomnia and Nightmares as Markers of Risk for Suicidal Ideation in Young People: Investigating the Role of Defeat and Entrapment. J Clin Sleep Med 2018; 14:775-784. [PMID: 29734987 DOI: 10.5664/jcsm.7104] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 01/26/2018] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Although converging evidence has identified sleep problems as robust predictors of suicidal ideation in young people, the psychological processes driving these associations are not yet known. The current study aimed to test predictions, informed by the Integrated Motivational-Volitional (IMV) Model of Suicidal Behavior, concerning the role of feelings of defeat and entrapment within the sleep-suicide relationship. METHODS Volunteers aged 15 to 17 years (n = 1,045) from Scottish secondary schools completed an anonymous self-report survey assessing insomnia symptoms, nightmares, suicidal ideation, depressive symptomology, and feelings of defeat and entrapment. RESULTS Both insomnia symptoms and nightmares were associated with an increased likelihood of reporting suicidal ideation (independent of depression). Perceptions of both defeat and entrapment were elevated in young people who reported clinically salient insomnia and/or nightmares, relative to those who did not. The relationship between insomnia and suicidal ideation was fully mediated by perceptions of defeat and entrapment, whereas nightmares were indirectly associated with suicidal ideation through perceptions of defeat and entrapment. CONCLUSIONS Taken together, these findings provide novel insights into the psychological mechanisms linking sleep disturbance and suicidality by highlighting the role of defeat and entrapment. Clinically, these findings have the potential to improve suicide risk assessment and prevention in young people experiencing difficulties with their sleep.
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Affiliation(s)
- Kirsten Russell
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
| | - Susan Rasmussen
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
| | - Simon C Hunter
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom.,Faculty of Education, University of Western Australia, Crawley, Western Australia, Australia
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Abstract
OBJECTIVES To test, among older Chinese adolescents, the associations of childhood maltreatment with single and multiple suicide attempts and whether these associations vary in relation to the presence of sleep disturbance. STUDY DESIGN We analyzed data collected from 10th to 12th graders from 7 randomly selected provinces of China in the 2015 School-based Chinese Adolescents Health Survey. There were 83 200 students who were invited to participate, and 75 715 students' questionnaires were completed and qualified for the survey. Adjusted multinomial logistic regression models were conducted to evaluate the associations of childhood maltreatment with suicide attempts. RESULTS Compared with no suicide attempts, each type of adjusted childhood maltreatment (physical abuse, emotional abuse, sexual abuse, physical neglect, or emotional neglect) was associated with an increased risk of single and multiple suicide attempts (P < .05). The magnitude of the aORs in multiple suicide attempters was greater than those in single suicide attempters. Moreover, the adjusted interaction effects for a single suicide attempt between each type of childhood maltreatment and sleep disturbance were all statistically significant in the multivariable multinomial logistic regression models (P < .001). However, the adjusted interaction effects for multiple suicide attempts were not significant (P > .05). CONCLUSIONS Maltreatment during one's childhood is associated with an increased risk of single and multiple suicide attempts among older Chinese adolescents. Sleep disturbances play a moderating role in these associations for a single suicide attempt.
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Rumble ME, Dickson D, McCall WV, Krystal AD, Case D, Rosenquist PB, Benca RM. The relationship of person-specific eveningness chronotype, greater seasonality, and less rhythmicity to suicidal behavior: A literature review. J Affect Disord 2018; 227:721-730. [PMID: 29179142 PMCID: PMC5805608 DOI: 10.1016/j.jad.2017.11.078] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 09/11/2017] [Accepted: 11/11/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Epidemiological data have demonstrated seasonal and circadian patterns of suicidal deaths. Several reviews and meta-analyses have confirmed the relationship between sleep disturbance and suicidality. However, these reviews/meta-analyses have not focused on seasonal and circadian dysfunction in relation to suicidality, despite the common presence of this dysfunction in patients with mood disorders. Thus, the current literature review analyzed studies investigating person-specific chronotype, seasonality, and rhythmicity in relation to suicidal thoughts and behaviors. METHODS Study authors reviewed articles related to individual-level chronotype, seasonality, and rhythmicity and suicidality that were written in English and not case reports or reviews. RESULTS This review supports a relationship between an eveningness chronotype, greater seasonality, and decreased rhythmicity with suicidal thoughts and behaviors in those with unipolar depression, as well as in other psychiatric disorders and in children/adolescents. LIMITATIONS These findings need to be explored more fully in mood disordered populations and other psychiatric populations, in both adults and children, with objective measurement such as actigraphy, and with chronotype, seasonality, and rhythmicity as well as broader sleep disturbance measurement all included so the construct(s) most strongly linked to suicidality can be best identified. CONCLUSIONS Eveningness, greater seasonality, and less rhythmicity should be considered in individuals who may be at risk for suicidal thoughts and behaviors and may be helpful in further tailoring assessment and treatment to improve patient outcome.
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Affiliation(s)
- Meredith E Rumble
- Department of Psychiatry, University of Wisconsin, Madison, United States.
| | - Daniel Dickson
- Department of Psychiatry, University of Wisconsin, Madison, United States
| | - W Vaughn McCall
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, United States
| | - Andrew D Krystal
- Department of Psychiatry, University of California, San Francisco, United States; Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States
| | - Doug Case
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Peter B Rosenquist
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, United States
| | - Ruth M Benca
- Department of Psychiatry and Human Behavior, University of California, Irvine, United States
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Rössler W, Angst J, Ajdacic-Gross V, Haker H, Berrouiguet S, Ujeyl M, Glozier N, Hengartner MP. Sleep Disturbances and Suicidality-A Longitudinal Analysis From a Representative Community Study Over 30 Years. Front Psychiatry 2018; 9:320. [PMID: 30061849 PMCID: PMC6054984 DOI: 10.3389/fpsyt.2018.00320] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 06/26/2018] [Indexed: 11/16/2022] Open
Abstract
Study objectives: Associations between sleep problems and suicidality are increasingly acknowledged, but prospective data from well-controlled long-term community studies are lacking. Methods: We analyzed data from a longitudinal cohort study with n = 591 young adults from Zurich, Switzerland, prospectively followed from 1979 (age 20/21 years) to 2008 (age 49/50 years). Twelve-month prevalence of various mental disorders, socio-environmental confounders and sleep problems were carefully assessed with semi-structured interviews at 7 assessment waves spanning overall a 30-year observation period. Interviews were conducted with the "Structured Psychopathological Interview and Rating of the Social Consequences of Psychological Disturbances for Epidemiology" (SPIKE). The 12-month prevalence of sleep problems was graded according to frequency and associated distress of reported symptoms. 12-month prevalence of suicidality was classified as either mild (transient suicidal ideation) or severe (self-harm, suicide attempts). Results: Concurrently, and fully adjusted for several covariates, including mental disorders, relative to no sleep problems there was an odds ratio (OR) of OR = 1.9 (95% confidence interval 1.4-2.5), OR = 3.3 (2.5-4.4), and OR = 1.9 (1.3-2.8) for mild, moderate and severe sleep problems in association with suicidality. There was no evidence for a prospective effect of broad sleep problems on subsequent suicidality. Mild suicidality, but not severe suicidality, prospectively predicted subsequent broad sleep problems in the fully adjusted multivariate model (adjusted OR = 1.5; 1.1-1.9). Disturbed sleep initiation, a proxy for insomnia, significantly predicted subsequent suicidality (OR = 1.5; 1.1-1.9), whereas mild suicidality, but not severe suicidality, significantly predicted subsequent insomnia (OR = 1.5; 1.1-2.0). Conclusions: Sleep problems and suicidality are longitudinally inter-related, which has important implications for clinical practice. Most importantly, the causal pathways appear to be bi-directional and independent of socio-demographics and concomitant mental disorders. More research is needed to examine the possible biopsychosocial etiological mechanisms linking suicidality to sleep problems.
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Affiliation(s)
- Wulf Rössler
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Universität Zurich, Zurich, Switzerland.,Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin, Berlin, Germany.,Laboratory of Neuroscience, Institute of Psychiatry, Universidade de São Paulo, São Paulo, Brazil
| | - Jules Angst
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Universität Zurich, Zurich, Switzerland
| | - Vladeta Ajdacic-Gross
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Universität Zurich, Zurich, Switzerland
| | - Helene Haker
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Universität Zurich, Zurich, Switzerland
| | - Sofian Berrouiguet
- 5IMT Atlantique, Lab-STICC, UBL, EA 7479 SPURBO, Université de Bretagne Occidentale, Brest, France
| | - Mariam Ujeyl
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin, Berlin, Germany
| | - Nicholas Glozier
- Brain and Mind Centre, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Michael P Hengartner
- Department of Applied Psychology, Zurich University of Applied Sciences, Winterthur, Switzerland
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Hamilton JL, Brindle RC, Alloy LB, Liu RT. Childhood Trauma and Sleep Among Young Adults With a History of Depression: A Daily Diary Study. Front Psychiatry 2018; 9:673. [PMID: 30564159 PMCID: PMC6288170 DOI: 10.3389/fpsyt.2018.00673] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 11/21/2018] [Indexed: 01/05/2023] Open
Abstract
Child maltreatment and sleep disturbances are particularly prevalent among individuals with a history of depression. However, the precise relation between child maltreatment and sleep within this population is unclear. The present study evaluated childhood maltreatment and trauma as a predictor of sleep duration and insomnia symptoms among young adults with prior depression. A total of 102 young adults (18-22; 78% female) with a history of clinical or subclinical depression completed an in-person visit with diagnostic interviews and questionnaires of childhood trauma (maltreatment and general trauma), and 2 weeks of daily assessments of sleep and depressive symptoms using internet-capable devices. Using multilevel modeling, we found that only childhood emotional neglect significantly predicted higher levels of insomnia symptoms over the 2 weeks, controlling for daily depression. Neither childhood maltreatment nor trauma predicted sleep duration. Our findings highlight a unique relationship between emotional neglect and insomnia symptoms among individuals with a depression history that, given prior research, may potentially play a role in depression recurrence and represent a potential treatment target.
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Affiliation(s)
- Jessica L Hamilton
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Ryan C Brindle
- Department of Psychology and Neuroscience Program, Washington and Lee University, Lexington, VA, United States
| | - Lauren B Alloy
- Department of Psychology, Temple University, Philadelphia, PA, United States
| | - Richard T Liu
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States
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Stanley IH, Hom MA, Luby JL, Joshi PT, Wagner KD, Emslie GJ, Walkup JT, Axelson DA, Joiner TE. Comorbid sleep disorders and suicide risk among children and adolescents with bipolar disorder. J Psychiatr Res 2017; 95:54-59. [PMID: 28777984 PMCID: PMC5653415 DOI: 10.1016/j.jpsychires.2017.07.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/27/2017] [Accepted: 07/27/2017] [Indexed: 01/27/2023]
Abstract
Children and adolescents with bipolar disorder are at increased risk for suicide. Sleep disturbances are common among youth with bipolar disorder and are also independently implicated in suicide risk; thus, comorbid sleep disorders may amplify suicide risk in this clinical population. This study examined the effects of comorbid sleep disorders on suicide risk among youth with bipolar disorder. We conducted secondary analyses of baseline data from the Treatment of Early Age Mania (TEAM) study, a randomized controlled trial of individuals aged 6-15 years (mean ± SD = 10.2 ± 2.7 years) with DSM-IV bipolar I disorder (N = 379). Sleep disorders (i.e., nightmare, sleep terror, and sleepwalking disorders) and suicide risk were assessed via the WASH-U-KSADS and the CDRS-R, respectively. We constructed uncontrolled logistic regression models as well as models controlling for trauma history, a generalized anxiety disorder (GAD) diagnosis, and depression symptoms. Participants with a current comorbid nightmare disorder versus those without were nearly twice as likely to screen positive for suicide risk in an uncontrolled model and models controlling for trauma history, a GAD diagnosis, and depression symptoms. Neither a current comorbid sleep terror disorder nor a sleepwalking disorder was significantly associated with suicide risk. This pattern of findings remained consistent for both current and lifetime sleep disorder diagnoses. Youth with bipolar I disorder and a comorbid nightmare disorder appear to be at heightened suicide risk. Implications for assessment and treatment are discussed.
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Affiliation(s)
- Ian H Stanley
- Department of Psychology, Florida State University, Tallahassee, FL, USA.
| | - Melanie A Hom
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Joan L Luby
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Paramjit T Joshi
- Division of Psychiatry and Behavioral Sciences, Children's National Health System, Washington, DC, USA
| | - Karen D Wagner
- Department of Psychiatry, University of Texas Medical Branch, Galveston, TX, USA
| | - Graham J Emslie
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA; Division of Child and Adolescent Psychiatry, Children's Medical Center, Dallas, TX, USA
| | - John T Walkup
- Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA
| | - David A Axelson
- Nationwide Children's Hospital Research Institute, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Thomas E Joiner
- Department of Psychology, Florida State University, Tallahassee, FL, USA
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Vande Voort JL, Ballard ED, Luckenbaugh DA, Bernert RA, Richards EM, Niciu MJ, Park LT, Machado-Vieira R, Duncan WC, Zarate CA. Antisuicidal Response Following Ketamine Infusion Is Associated With Decreased Nighttime Wakefulness in Major Depressive Disorder and Bipolar Disorder. J Clin Psychiatry 2017; 78:1068-1074. [PMID: 27929610 PMCID: PMC5641476 DOI: 10.4088/jcp.15m10440] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 02/11/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Insomnia and disrupted sleep are associated with increased risk of suicide. The N-methyl-d-aspartate antagonist ketamine has been associated with reduced suicidal thoughts, but the mechanism of action is unknown. This study sought to evaluate differences in nocturnal wakefulness in depressed individuals who did and did not have an antisuicidal response to ketamine. METHODS Thirty-four participants with baseline suicidal ideation diagnosed with either DSM-IV major depressive disorder (n = 23) or bipolar depression (n = 11) between 2006 and 2013 completed nighttime electroencephalography (EEG) the night before and the night after a single ketamine infusion (0.5 mg/kg over 40 minutes). Suicidal ideation was assessed at baseline and the morning after ketamine infusion via several measures, including the Hamilton Depression Rating Scale suicide item, the suicide item of the Montgomery-Asberg Depression Rating Scale, and the first 5 items of the Scale for Suicide Ideation. A generalized linear mixed model evaluated differences in nocturnal wakefulness, as verified by EEG, between those who had an antisuicidal response to ketamine and those who did not, controlling for baseline nocturnal wakefulness. Results were also compared to the sleep of healthy controls (n = 22). RESULTS After analyses adjusted for baseline sleep, participants with an antisuicidal response to ketamine showed significantly reduced nocturnal wakefulness the night after ketamine infusion compared to those without an antisuicidal response (F₁,₂₂ = 5.04, P = .04). Level of nocturnal wakefulness after antisuicidal response to ketamine did not differ significantly from nocturnal wakefulness in the control sample but did differ at a trend level (F₁,₄₀ = 3.15, P = .08). CONCLUSIONS Reductions in wakefulness following ketamine may point to a biological mechanism underlying the effect of ketamine on suicidal ideation. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00088699.
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Affiliation(s)
- Jennifer L Vande Voort
- Mayo Clinic, 200 First St SW, Rochester, MN 55902.
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
- Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Elizabeth D Ballard
- Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - David A Luckenbaugh
- Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Rebecca A Bernert
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - Erica M Richards
- Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Mark J Niciu
- Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Lawrence T Park
- Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Rodrigo Machado-Vieira
- Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Wallace C Duncan
- Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Carlos A Zarate
- Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
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O’Rourke N, Heisel MJ, Canham SL, Sixsmith A. Predictors of suicide ideation among older adults with bipolar disorder. PLoS One 2017; 12:e0187632. [PMID: 29145409 PMCID: PMC5690620 DOI: 10.1371/journal.pone.0187632] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 10/23/2017] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Bipolar disorder (BD) carries the greatest risk of death by suicide of all psychiatric conditions as 25%-50% of those with BD will make one or more suicide attempt, and about 15% will intentionally end their lives. Among young adults with BD, substance misuse, medication non-adherence, age at onset, and comorbid psychiatric conditions each predict self-harm. It is currently unclear if these same factors or others predict suicide ideation among older adults with BD. METHODS We recruited a global sample of 220 older adults with BD over 19 days using socio-demographically targeted, social media advertising and online data collection (Mean = 58.50, SD = 5.42; range 50 to 81 years). Path analyses allowed us to identify direct and indirect predictors of suicide ideation among older adults with BD. RESULTS Cognitive failures (perception, memory, and motor function), depressive symptoms, alcohol misuse, and dissatisfaction with life as direct predictors of suicide ideation; duration of BD symptoms and medication non-adherence emerged as indirect predictors. Of note, the significant impact of sleep on suicide ideation is indirect via depressive symptoms, cognitive failures, medication non-adherence and life dissatisfaction. CONCLUSIONS As with young adults with BD, alcohol misuse and medication non-adherence emerged as significant predictors of suicide ideation. In addition, cognitive failures directly and indirectly predict suicide ideation in this sample of older adults with BD. Population aging and treatment efficacy are leading to ever growing numbers of older adults with BD. Both direct and indirect predictors of suicide ideation need to be considered in future BD research and treatment planning.
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Affiliation(s)
- Norm O’Rourke
- Department of Public Health and Center for Multidisciplinary Research in Aging, Ben-Gurion University of the Negev, Be’er Sheva, Israel
- * E-mail:
| | - Marnin J. Heisel
- Department of Psychiatry University of Western Ontario and Lawson Health Research Institute, London, Ontario, Canada
| | - Sarah L. Canham
- Gerontology Research Centre, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Andrew Sixsmith
- STAR Institute, Simon Fraser University, Surrey, British Columbia, Canada
| | - BADAS Study Team
- IRMACS Centre, Simon Fraser University, Burnaby, British Columbia, Canada
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Abstract
Sleep disturbances are associated with suicide-related thoughts and behaviors, and the incidence of sleep concerns and suicide has increased recently in the US. Most published research exploring the sleep-suicidality relation is focused on select sleep disorders, with few reviews offering a comprehensive overview of the sleep-suicidality literature. This narrative review broadly investigates the growing research literature on sleep disorders and suicidality, noting the prevalence of suicide ideation and nonfatal and fatal suicide attempts, the impact of several sleep disorders on suicide risk, and potential sleep-disorder management strategies for mitigating suicide risk. Aside from insomnia symptoms and nightmares, there exist opportunities to learn more about suicide risk across many sleep conditions, including whether sleep disorders are associated with suicide risk independently of other psychiatric conditions or symptoms. Generally, there is a lack of randomized controlled trials examining the modification of suicide risk via evidence-based sleep interventions for individuals with sleep disorders.
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Affiliation(s)
| | - Michael R Nadorff
- Department of Psychology, Mississippi State University, Mississippi State, MS, USA
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Batterham PJ, Christensen H, Mackinnon AJ, Gosling JA, Thorndike FP, Ritterband LM, Glozier N, Griffiths KM. Trajectories of change and long-term outcomes in a randomised controlled trial of internet-based insomnia treatment to prevent depression. BJPsych Open 2017; 3:228-235. [PMID: 28959453 PMCID: PMC5611538 DOI: 10.1192/bjpo.bp.117.005231] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 07/10/2017] [Accepted: 08/14/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Insomnia treatment using an internet-based cognitive-behavioural therapy for insomnia (CBT-I) program reduces depression symptoms, anxiety symptoms and suicidal ideation. However, the speed, longevity and consistency of these effects are unknown. AIMS To test the following: whether the efficacy of online CBT-I was sustained over 18 months; how rapidly the effects of CBT-I emerged; evidence for distinct trajectories of change in depressive symptoms; and predictors of these trajectories. METHOD A randomised controlled trial compared the 6-week Sleep Healthy Using the Internet (SHUTi) CBT-I program to an attention control program. Adults (N=1149) with clinical insomnia and subclinical depression symptoms were recruited online from the Australian community. RESULTS Depression, anxiety and insomnia decreased significantly by week 4 of the intervention period and remained significantly lower relative to control for >18 months (between-group Cohen's d=0.63, 0.47, 0.55, respectively, at 18 months). Effects on suicidal ideation were only short term. Two depression trajectories were identified using growth mixture models: improving (95%) and stable/deteriorating (5%) symptoms. More severe baseline depression, younger age and limited comfort with the internet were associated with reduced odds of improvement. CONCLUSIONS Online CBT-I produced rapid and long-term symptom reduction in people with subclinical depressive symptoms, although the initial effect on suicidal ideation was not sustained. DECLARATION OF INTEREST P.J.B. has received grants from the National Health and Medical Research Council (NHMRC) during the conduct of the study. H.C. has received grants from the NHMRC and the Australian Research Council during the conduct of the study. L.M.R. receives research funding from the National Institutes of Health (NIH) that, in part, focuses on insomnia. F.P.T. and L.M.R. have equity ownership in BeHealth Solutions (Charlottesville, VA, USA), a company that develops and makes available products related to the research reported in this manuscript. BeHealth Solutions has licensed the SHUTi program and the software platform on which it was built from the University of Virginia. The terms of this arrangement have been reviewed and approved by the University of Virginia in accordance with its conflict of interest policy. N.G. has received grants from the NHMRC during the conduct of the study and personal fees from Lundbeck, Servier and Janssen outside the submitted work. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.
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Affiliation(s)
- Philip J Batterham
- , PhD, Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, ACT, Australia
| | - Helen Christensen
- , PhD, Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Andrew J Mackinnon
- , PhD, Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - John A Gosling
- , BSc (Hons), Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, ACT, Australia
| | | | - Lee M Ritterband
- , PhD, Behavioural Health and Technology Lab, Department of Psychiatry and Neurobehavioural Sciences, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Nick Glozier
- , PhD, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Kathleen M Griffiths
- , PhD, Research School of Psychology, The Australian National University, Canberra, ACT, Australia
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Grove JL, Smith TW, Crowell SE, Ellis JH. Preliminary Evidence for Emotion Dysregulation as a Mechanism Underlying Poor Sleep Quality in Borderline Personality Disorder. J Pers Disord 2017; 31:542-552. [PMID: 27617649 DOI: 10.1521/pedi_2016_30_261] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Sleep disturbance is common in borderline personality disorder (BPD), yet the reasons for this association are not clear. The present study sought to extend prior studies by testing emotion dysregulation as a mechanism underlying this association. We administered self-report measures of sleep quality (SQ), emotion dysregulation, and borderline features to two cross-sectional samples of undergraduates (sample 1: N = 293; sample 2: N = 188). In addition to replicating prior studies linking BPD features to poor SQ, analyses indicated that BPD features related to emotion dysregulation were most strongly correlated with poorer global SQ across both samples. Further, bootstrapping techniques revealed indirect associations by total score on the Difficulties in Emotion Regulation Scale (DERS), as well as for several of its facets (lack of strategies, lack of emotional clarity, lack of awareness). We discuss the potential clinical relevance of emotion dysregulation in the treatment of co-occurring sleep problems in BPD.
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Richardson JD, Thompson A, King L, Corbett B, Shnaider P, St. Cyr K, Nelson C, Sareen J, Elhai J, Zamorski M. Insomnia, psychiatric disorders and suicidal ideation in a National Representative Sample of active Canadian Forces members. BMC Psychiatry 2017; 17:211. [PMID: 28583100 PMCID: PMC5460415 DOI: 10.1186/s12888-017-1372-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 05/26/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Past research on the association between insomnia and suicidal ideation (SI) has produced mixed findings. The current study explored the relationship between insomnia, SI, and past-year mental health status among a large Canadian Forces (CF) sample. METHOD Data was obtained from the 2013 Canadian Forces Mental Health Survey (CFMHS), and included a large representative sample of Canadian Regular Forces personnel (N = 6700). A series of univariate logistic regressions were conducted to test individual associations between past-year mental health status, insomnia, and potential confounds and SI. Mental health status included three groups: 0, 1, or two or more probable diagnoses of posttraumatic stress disorder (PTSD), major depressive disorder (MDD), generalized anxiety disorder (GAD), panic disorder (PD) and alcohol abuse/dependence. Stepwise multivariate logistic regression was used to assess the relationship between insomnia and SI with mental health status as a moderator. RESULTS 40.8% of respondents reported experiencing insomnia. Both insomnia and number of mental health conditions incrementally increased the risk of SI. However, past-year mental health status was a significant moderator of this relationship, such that for CF personnel with either no (AOR = 1.61, 1.37-1.89) or only one past-year mental health condition (AOR = 1.39, 1.12-1.73), an incremental increase in insomnia was associated with an increased likelihood of SI. However, in personnel with two or more past-year mental health disorders, insomnia was no longer significantly associated with SI (AOR = 1.04, 0.81-1.33). CONCLUSIONS Insomnia significantly increased the odds of SI, but only among individuals with no or one mental health condition. Findings highlight the importance of assessing insomnia among CF members in order to further suicide prevention efforts.
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Affiliation(s)
- J. D. Richardson
- Western University, 1151 Richmond St, London, ON N6A 3K7 Canada
- McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8 Canada
- Parkwood Operational Stress Injury Clinic-Parkwood Institute-St. Joseph’s Health Care London, 550 Wellington Rd, London, ON N6C 0A7 Canada
- Canadian Forces Health Services Group and Department of Family Medicine, University of Ottawa, 75 Laurier Ave E, Ottawa, ON K1N 6N5 Canada
| | - A. Thompson
- Canadian Forces Health Services Group and Department of Family Medicine, University of Ottawa, 75 Laurier Ave E, Ottawa, ON K1N 6N5 Canada
| | - L. King
- Parkwood Operational Stress Injury Clinic-Parkwood Institute-St. Joseph’s Health Care London, 550 Wellington Rd, London, ON N6C 0A7 Canada
| | - B. Corbett
- Western University, 1151 Richmond St, London, ON N6A 3K7 Canada
- Canadian Forces Health Services Group and Department of Family Medicine, University of Ottawa, 75 Laurier Ave E, Ottawa, ON K1N 6N5 Canada
- Stamford International University, Prawet, Bangkok, 10250 Thailand
| | - P. Shnaider
- McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8 Canada
- St. Joseph’s Healthcare Hamilton, 2757 King Street East, Hamilton, ON L8G 5E4 Canada
- Ryerson University, 350 Victoria St, Toronto, ON M5B 2K3 Canada
| | - K. St. Cyr
- Parkwood Operational Stress Injury Clinic-Parkwood Institute-St. Joseph’s Health Care London, 550 Wellington Rd, London, ON N6C 0A7 Canada
| | - C. Nelson
- Western University, 1151 Richmond St, London, ON N6A 3K7 Canada
- Parkwood Operational Stress Injury Clinic-Parkwood Institute-St. Joseph’s Health Care London, 550 Wellington Rd, London, ON N6C 0A7 Canada
| | - J. Sareen
- University of Manitoba, 66 Chancellors Cir, Winnipeg, MB R3T 2N2 Canada
- Deer Lodge Centre Operational Stress Injury Clinic, 2109 Portage Avenue, Winnipeg, MB R3J 0L3 Canada
| | - J. Elhai
- University of Toledo, 2801 W Bancroft St, Toledo, OH 43606 USA
| | - M. Zamorski
- Canadian Forces Health Services Group and Department of Family Medicine, University of Ottawa, 75 Laurier Ave E, Ottawa, ON K1N 6N5 Canada
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Hochard KD, Heym N, Townsend E. Investigating the Interaction Between Sleep Symptoms of Arousal and Acquired Capability in Predicting Suicidality. Suicide Life Threat Behav 2017; 47:370-381. [PMID: 27481231 DOI: 10.1111/sltb.12285] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 05/09/2016] [Indexed: 11/27/2022]
Abstract
Heightened arousal significantly interacts with acquired capability to predict suicidality. We explore this interaction with insomnia and nightmares independently of waking state arousal symptoms, and test predictions of the Interpersonal Theory of Suicide (IPTS) and Escape Theory in relation to these sleep arousal symptoms. Findings from our e-survey (n = 540) supported the IPTS over models of Suicide as Escape. Sleep-specific measurements of arousal (insomnia and nightmares) showed no main effect, yet interacted with acquired capability to predict increased suicidality. The explained variance in suicidality by the interaction (1%-2%) using sleep-specific measures was comparable to variance explained by interactions previously reported in the literature using measurements composed of a mix of waking and sleep state arousal symptoms. Similarly, when entrapment (inability to escape) was included in models, main effects of sleep symptoms arousal were not detected yet interacted with entrapment to predict suicidality. We discuss findings in relation to treatment options suggesting that sleep-specific interventions be considered for the long-term management of at-risk individuals.
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Affiliation(s)
- Kevin D Hochard
- Department of Psychology, University of Chester, Chester, UK
| | - Nadja Heym
- Department of Psychology, Nottingham Trent University, Nottingham, UK
| | - Ellen Townsend
- Department of Psychology, University of Nottingham, Nottingham, UK
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Kaufmann CN, Susukida R, Depp CA. Sleep apnea, psychopathology, and mental health care. Sleep Health 2017; 3:244-249. [PMID: 28709510 DOI: 10.1016/j.sleh.2017.04.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 04/08/2017] [Accepted: 04/14/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Sleep apnea has been shown to be associated with mental health conditions. This study examined the association between sleep apnea and psychopathology and mental health service utilization in a US nationally-representative sample. DESIGN National Survey on Drug Use and Health (NSDUH). SETTING United States. PARTICIPANTS We used data on 264,653 individuals who participated in the 2008-2014 waves of the NSDUH, of which 5498 (3.3%) reported having sleep apnea within the past year. INTERVENTION Not applicable. MEASUREMENTS Based on NSDUH responses, participants were categorized as having depression, suicidal ideation, anxiety, and serious psychological distress within the past year. Analyses consisted of using logistic regression models with sleep apnea as the main predictor and mental health conditions as the outcomes of interest, controlling for potential confounding variables. RESULTS Compared with those without sleep apnea, those reporting past-year sleep apnea had 3.11 (95% confidence interval [CI], 2.77-3.50) times increased odds of having depression, 2.75 (95% CI, 2.34-3.23) times increased odds of suicidal ideation, 3.68 (95% CI, 3.30-4.10) times increased odds of anxiety, and 2.88 (95% CI, 2.61-3.17) times increased odds of severe psychological distress, after controlling for confounders. Among those with each psychiatric outcome, individuals with sleep apnea were substantially more likely to report unmet need for mental health care, despite reporting greater mental health service use. CONCLUSIONS Individuals with sleep apnea have increased risk for psychopathology, including suicidal ideation. Efforts to address the mental health care needs of those with sleep apnea are needed.
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Affiliation(s)
- Christopher N Kaufmann
- Department of Psychiatry, UC San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; Stein Institute for Research on Aging, UC San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA.
| | - Ryoko Susukida
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205, USA
| | - Colin A Depp
- Department of Psychiatry, UC San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; Stein Institute for Research on Aging, UC San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
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Abstract
How does a lack of sleep affect our brains? In contrast to the benefits of sleep, frameworks exploring the impact of sleep loss are relatively lacking. Importantly, the effects of sleep deprivation (SD) do not simply reflect the absence of sleep and the benefits attributed to it; rather, they reflect the consequences of several additional factors, including extended wakefulness. With a focus on neuroimaging studies, we review the consequences of SD on attention and working memory, positive and negative emotion, and hippocampal learning. We explore how this evidence informs our mechanistic understanding of the known changes in cognition and emotion associated with SD, and the insights it provides regarding clinical conditions associated with sleep disruption.
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74
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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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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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Examining the role of psychological factors in the relationship between sleep problems and suicide. Clin Psychol Rev 2017; 54:1-16. [PMID: 28371648 PMCID: PMC5434037 DOI: 10.1016/j.cpr.2017.03.009] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 11/29/2016] [Accepted: 03/27/2017] [Indexed: 01/08/2023]
Abstract
We sought to conduct the first systematic review of empirical evidence investigating the role of psychological factors in the relationship between sleep problems and suicidal thoughts and behaviours. Twelve studies were identified which examined psychological factors grouped into four categories of cognitive appraisals, psychosocial factors, emotion regulation strategies, and risk behaviours. Although there was substantial heterogeneity across studies with respect to measurement, sampling, and analysis, preliminary evidence indicated that negative cognitive appraisals, perceived social isolation, and unhelpful emotion regulation strategies may contribute to the association between sleep problems and suicidal thoughts and behaviours. Given that findings in this area are currently restricted to studies with cross-sectional designs, the directionality of the interrelationships between these psychological factors, sleep problems and suicidality, remains unclear. We integrate the findings of our review with contemporary psychological models of suicidal behaviour to develop a clear research agenda. Identified pathways should now be tested with longitudinal and experimental designs. In addition, a more thorough investigation of the complexities of sleep, psychological factors, and suicidal thoughts and behaviours is crucial for the development of targeted psychological interventions. Systematic review of the role of psychological factors in sleep/suicide relationships Review findings integrated with suicide theory to define a clear research agenda. Reliance on cross-sectional designs limits interpretation of directionality of pathways. Identified pathways should be investigated with longitudinal and experimental designs.
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Sandman N, Valli K, Kronholm E, Vartiainen E, Laatikainen T, Paunio T. Nightmares as predictors of suicide: an extension study including war veterans. Sci Rep 2017; 7:44756. [PMID: 28294195 PMCID: PMC5353666 DOI: 10.1038/srep44756] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 02/13/2017] [Indexed: 12/16/2022] Open
Abstract
Nightmares are intensive dreams with negative emotional tone. Frequent nightmares can pose a serious clinical problem and in 2001, Tanskanen et al. found that nightmares increase the risk of suicide. However, the dataset used by these authors included war veterans in whom nightmare frequency - and possibly also suicide risk - is elevated. Therefore, re-examination of the association between nightmares and suicide in these data is warranted. We investigated the relationship between nightmares and suicide both in the general population and war veterans in Finnish National FINRISK Study from the years 1972 to 2012, a dataset overlapping with the one used in the study by Tanskanen et al. Our data comprise 71,068 participants of whom 3139 are war veterans. Participants were followed from their survey participation until the end of 2014 or death. Suicides (N = 398) were identified from the National Causes of Death Register. Frequent nightmares increase the risk of suicide: The result of Tanskanen et al. holds even when war experiences are controlled for. Actually nightmares are not significantly associated with suicides among war veterans. These results support the role of nightmares as an independent risk factor for suicide instead of just being proxy for history of traumatic experiences.
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Affiliation(s)
- Nils Sandman
- Center for Cognitive Neuroscience, Turku Brain and Mind Center, Department of Psychology and Speech-Language Pathology, University of Turku, Turku, Finland
- Genomics and Biomarkers Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Katja Valli
- Center for Cognitive Neuroscience, Turku Brain and Mind Center, Department of Psychology and Speech-Language Pathology, University of Turku, Turku, Finland
- Department of Cognitive Neuroscience and Philosophy, School of Bioscience, University of Skövde, Skövde, Sweden
| | - Erkki Kronholm
- Department of Health, National Institute for Health and Welfare, Turku, Finland
| | - Erkki Vartiainen
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
| | - Tiina Laatikainen
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Hospital District of North Karelia, Joensuu, Finland
| | - Tiina Paunio
- Genomics and Biomarkers Unit, National Institute for Health and Welfare, Helsinki, Finland
- Department of Psychiatry, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
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Chu C, Hom MA, Rogers ML, Stanley IH, Ringer-Moberg FB, Podlogar MC, Hirsch JK, Joiner TE. Insomnia and suicide-related behaviors: A multi-study investigation of thwarted belongingness as a distinct explanatory factor. J Affect Disord 2017; 208:153-162. [PMID: 27770645 PMCID: PMC5154904 DOI: 10.1016/j.jad.2016.08.065] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 08/25/2016] [Accepted: 08/25/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Insomnia is a robust correlate of suicidal ideation and behavior. Preliminary research has identified thwarted belongingness (c.f. social disconnection) as an explanatory link between insomnia and suicidal ideation. OBJECTIVES This study replicates and extends previous findings using both cross-sectional and longitudinal designs in four demographically diverse samples. Additionally, the specificity of thwarted belongingness was evaluated by testing anxiety as a rival mediator. METHOD Self-report measures of insomnia symptoms, thwarted belongingness, suicidal ideation and behavior, and anxiety were administered in four adult samples: 469 undergraduate students, 352 psychiatric outpatients, 858 firefighters, and 217 primary care patients. RESULTS More severe insomnia was associated with more severe thwarted belongingness and suicidality. Thwarted belongingness significantly accounted for the association between insomnia and suicidality, cross-sectionally and longitudinally, beyond anxiety. Notably, findings supported the specificity of thwarted belongingness: anxiety did not significantly mediate the association between insomnia and suicidality, and insomnia did not mediate the relation between thwarted belongingness and suicidality. LIMITATIONS This study relied solely on self-report measures. Future studies incorporating objective sleep measurements are needed. CONCLUSION Findings underscore the utility of assessing and addressing sleep disturbances and social disconnection to reduce suicide risk.
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Affiliation(s)
- Carol Chu
- Florida State University, Department of Psychology, 1107 West Call St., Tallahassee, FL 32306, USA.
| | - Melanie A Hom
- Florida State University, Department of Psychology, 1107 West Call St., Tallahassee, FL 32306, USA
| | - Megan L Rogers
- Florida State University, Department of Psychology, 1107 West Call St., Tallahassee, FL 32306, USA
| | - Ian H Stanley
- Florida State University, Department of Psychology, 1107 West Call St., Tallahassee, FL 32306, USA
| | - Fallon B Ringer-Moberg
- Florida State University, Department of Psychology, 1107 West Call St., Tallahassee, FL 32306, USA
| | - Matthew C Podlogar
- Florida State University, Department of Psychology, 1107 West Call St., Tallahassee, FL 32306, USA
| | - Jameson K Hirsch
- East Tennessee State University, Department of Psychology, 420 Rogers-Stout Hall, Johnson City, TN 37614, USA
| | - Thomas E Joiner
- Florida State University, Department of Psychology, 1107 West Call St., Tallahassee, FL 32306, USA
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Bernert RA, Luckenbaugh DA, Duncan WC, Iwata N, Ballard ED, Zarate CA. Sleep architecture parameters as a putative biomarker of suicidal ideation in treatment-resistant depression. J Affect Disord 2017; 208:309-315. [PMID: 27810712 PMCID: PMC6502232 DOI: 10.1016/j.jad.2016.08.050] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 08/11/2016] [Accepted: 08/27/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Disturbed sleep may confer risk for suicidal behaviors. Polysomnographic (PSG) sleep parameters have not been systematically evaluated in association with suicidal ideation (SI) among individuals with treatment-resistant depression (TRD). METHODS This secondary data analysis included 54 TRD individuals (N=30 with major depressive disorder (MDD) and N=24 with bipolar depression (BD)). PSG sleep parameters included Sleep Efficiency (SE), Total Sleep Time (TST), Wakefulness After Sleep Onset (WASO), REM percent/latency, and non-REM (NREM) Sleep Stages 1-4. The Hamilton Depression Rating Scale (HAM-D) was used to group participants according to presence or absence of SI. Sleep abnormalities were hypothesized among those with current SI. ANOVA analyses were conducted before (Model 1) and after adjusting for depression (Model 2) and diagnostic variables (Model 3). RESULTS Significant differences in PSG parameters were observed in Model 1; those with SI had less NREM Stage 4 sleep (p<.05). After adjusting for central covariates, Models 2 and 3 revealed significantly less NREM Stage 4 sleep, lower SE (P<.05), and higher WASO (P<.05) among those with SI. BD participants with SI also had less NREM Stage 4 and more NREM Stage 1 sleep. LIMITATIONS 1) a predominantly white sample; 2) exclusion of imminent suicide risk; 3) concomitant mood stabilizer use among BD patients; and 4) single-item SI assessment. CONCLUSIONS Independent of depression severity, SI was associated with less NREM Stage 4 sleep, and higher nocturnal wakefulness across diagnostic groups. Sleep may warrant further investigation in the pathogenesis of suicide risk, particularly in TRD, where risk may be heightened.
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Affiliation(s)
- Rebecca A. Bernert
- Suicide Prevention Research Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford CA, USA,Corresponding author. Rebecca Bernert, Ph.D. Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, MC 5797, Stanford, California 94304, USA, Phone: 650-724-9381, Fax: 650-498-5294.
| | - David A. Luckenbaugh
- Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland USA
| | - Wallace C. Duncan
- Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland USA
| | - Naomi Iwata
- Suicide Prevention Research Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford CA, USA
| | - Elizabeth D. Ballard
- Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland USA
| | - Carlos A. Zarate
- Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland USA
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Hom MA, Stanley IH, Rogers ML, Tzoneva M, Bernert RA, Joiner TE. The Association between Sleep Disturbances and Depression among Firefighters: Emotion Dysregulation as an Explanatory Factor. J Clin Sleep Med 2017; 12:235-45. [PMID: 26350604 DOI: 10.5664/jcsm.5492] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 08/14/2015] [Indexed: 12/25/2022]
Abstract
STUDY OBJECTIVES To investigate emotion regulation difficulties in association with self-reported insomnia symptoms, nightmares, and depression symptoms in a sample of current and retired firefighters. METHODS A total of 880 current and retired United States firefighters completed a web-based survey of firefighter behavioral health. Self-report measures included the Center for Epidemiologic Studies Depression Scale, Insomnia Severity Index, PTSD Checklist, and Difficulties in Emotion Regulation Scale. RESULTS A notable portion of participants reported clinically significant depression symptoms (39.6%) and insomnia symptoms (52.7%), as well as nightmare problems (19.2%), each of which demonstrated a strong association with emotion regulation difficulties (rs = 0.56-0.80). Bootstrapped mediation analyses revealed that the indirect effects of overall emotion regulation difficulties were significant both for the relationship between insomnia and depression (95% CI: 0.385-0.566) and nightmares and depression (95% CI: 1.445-2.365). Limited access to emotion regulation strategies emerged as the strongest, significant indirect effect for both relationships (insomnia 95% CI: 0.136-0.335; nightmares 95% CI: 0.887-1.931). CONCLUSIONS Findings extend previous affective neuroscience research by providing evidence that insomnia and nightmares may influence depression symptoms specifically through the pathway of explicit emotion regulation difficulties. Sleep disturbances may impair the ability to access and leverage emotion regulation strategies effectively, thus conferring risk for negative affect and depression.
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Affiliation(s)
- Melanie A Hom
- Department of Psychology, Florida State University, Tallahassee, FL
| | - Ian H Stanley
- Department of Psychology, Florida State University, Tallahassee, FL
| | - Megan L Rogers
- Department of Psychology, Florida State University, Tallahassee, FL
| | - Mirela Tzoneva
- Department of Psychology, Florida State University, Tallahassee, FL
| | - Rebecca A Bernert
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Thomas E Joiner
- Department of Psychology, Florida State University, Tallahassee, FL
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82
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Suh S, Schneider M, Lee R, Joiner T. Perceived Interpersonal Burdensomeness as a Mediator between Nightmare Distress and Suicidal Ideation in Nightmare Sufferers. Front Psychol 2016; 7:1805. [PMID: 27917142 PMCID: PMC5114297 DOI: 10.3389/fpsyg.2016.01805] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 11/01/2016] [Indexed: 11/28/2022] Open
Abstract
Previous studies have supported the significant association between nightmares and suicidal ideation, but the underlying mechanisms are largely unknown. The purpose of the present study was to investigate perceived burdensomeness and thwarted belongingness as mediators in the relationship between nightmare distress and suicidal ideation. This sample consisted of 301 undergraduate students who endorsed experiencing nightmares (mean age 21.87 ± 2.17, 78.1% female). All participants completed questionnaires on nightmare distress (Nightmare Distress Questionnaire), unmet interpersonal needs (Interpersonal Needs Questionnaire), and suicidal ideation (Depressive Symptom Inventory – Suicidality Subscale). Analyses were performed using multiple mediation regression. Results indicated that nightmare distress was associated with perceived burdensomeness (r = 0.17, p < 0.001) and suicidal ideation (r = 0.24, p < 0.001), but was not related to thwarted belongingness (r = 0.10, p = 0.06). Multiple mediation analyses revealed that perceived burdensomeness partially mediated the relationship between nightmares and suicidal ideation, but thwarted belongingness did not. Additionally, this mediating relationship for perceived burdensomeness was moderated by gender, being significant only for females. These findings highlight the important role of interpersonal factors in the relationship between nightmares and suicidal ideation.
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Affiliation(s)
- Sooyeon Suh
- Department of Psychology, Sungshin Women's UniversitySeoul, South Korea; Department of Psychiatry, Stanford UniversityPalo Alto, CA, USA
| | - Matthew Schneider
- Department of Psychology, Florida State University Tallahassee, FL, USA
| | - Ruda Lee
- Department of Psychology, Sungshin Women's University Seoul, South Korea
| | - Thomas Joiner
- Department of Psychology, Florida State University Tallahassee, FL, USA
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The Relationship of Suicidal Thoughts and Behaviors to Sleep Disturbance: a Review of Recent Findings. CURRENT SLEEP MEDICINE REPORTS 2016. [DOI: 10.1007/s40675-016-0054-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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84
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Benard V, Geoffroy PA, Bellivier F. [Seasons, circadian rhythms, sleep and suicidal behaviors vulnerability]. Encephale 2016; 41:S29-37. [PMID: 26746320 DOI: 10.1016/s0013-7006(15)30004-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Suicidal behaviors are common in the general population and are so a major public health problem. In order to improve suicide prevention and to reduce the mortality by suicide, it appears essential to better identify suicide risk factors. Seasonality, circadian rhythms and sleep abnormalities have been already associated with numerous psychiatric disorders. This review aimed to characterize the associations between seasonality, circadian rhythms, sleep and suicidal behaviors including suicide attempts and completed suicides. METHODS We conducted a literature search between 1973 and 2015 in PubMed databases using the following terms: ("suicide" OR "suicidality" OR "suicide attempts" OR "suicidal behavior") AND ("circadian rhythms" OR "seasons" OR "sleep"). RESULTS Many studies confirm a specific seasonality for suicide with a higher peak of suicides in spring for both sex and a lower peak in autumn especially for women. This distribution seems to correlate with depressive symptoms (especially for the autumn peak), gender and different types of suicide. Regarding gender and type of suicide differences, males more commonly commit violent suicide with a higher rate of suicides in spring. Suicide behaviors appear to be influenced by climatic and biological factors like sunshine, daylight cycles, temperature, air pollutants, viruses, parasites and aeroallergens. Circadian variations exist in suicide rates depending on age with a morning peak for elder and an evening peak for youth. In addition, completed suicide peak in early morning whereas suicide attempts peak rather in later afternoon. Several biomarkers dysregulation like melatonin, serotonin and cortisol may be implicated in suicide circadian variations. Furthermore, specific sleep disorders like insomnia, nightmares and sleep deprivation are common risk factors of suicide and possibly independently of the presence of depressive symptoms. Finally, the efficacy of chronotherapeutics (such as luminotherapy, dark therapy, sleep deprivation and melatonin drugs) has been suggested in the reduction of suicidal behaviors. CONCLUSION The suicide seasonality is very well documented showing a main peak in spring and another one in autumn. A suicide circadian distribution also exists depending of the suicidal behavior intensity and of the age. Numerous sleep disorders are also suicide risk factors and can be treated with chronotherapeutics. A better identification of seasonality, circadian rhythms and sleep abnormalities in suicidal behaviors could allow a better prevention in suicidal attempts and a reduction in death by suicide.
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Affiliation(s)
- V Benard
- Centre Hospitalier Universitaire de Lille (CHRU), Lille, F-59000, France; Université de Lille, Lille, F-59000, France
| | - P A Geoffroy
- Inserm, U1144, Paris, F-75006, France; Université Paris Descartes, UMR-S 1144, Paris, F-75006, France; Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris, F-75013, France; AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, 75475 Paris cedex 10, France; Fondation FondaMental, Créteil, 94000, France
| | - F Bellivier
- Inserm, U1144, Paris, F-75006, France; Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris, F-75013, France; AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, 75475 Paris cedex 10, France; Fondation FondaMental, Créteil, 94000, France.
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85
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Stanley IH, Rufino KA, Rogers ML, Ellis TE, Joiner TE. Acute Suicidal Affective Disturbance (ASAD): A confirmatory factor analysis with 1442 psychiatric inpatients. J Psychiatr Res 2016; 80:97-104. [PMID: 27344228 DOI: 10.1016/j.jpsychires.2016.06.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 06/02/2016] [Accepted: 06/10/2016] [Indexed: 11/26/2022]
Abstract
Acute Suicidal Affective Disturbance (ASAD) is a newly proposed diagnostic entity that characterizes rapid onset suicidal intent. This study aims to confirm the factor structure of ASAD among psychiatric inpatients, and to determine the clinical utility of ASAD in predicting suicide attempt status. Overall, 1442 psychiatric inpatients completed a battery of self-report questionnaires assessing symptoms theorized to comprise the ASAD construct. Utilizing these data, a confirmatory factor analysis with a one-factor solution was performed. Regression analyses were employed to determine if the ASAD construct predicted past suicide attempts, and analyses of variance (ANOVAs) were employed to determine if ASAD symptoms differed by the presence and number of past suicide attempts. The one-factor solution indicated good fit: χ(2)(77) = 309.1, p < 0.001, Tucker-Lewis Index (TLI) = 0.96, comparative fit index (CFI) = 0.97, root-mean-square error of approximation (RMSEA) = 0.05. Controlling for depressive disorders and current symptoms, the ASAD construct significantly predicted the presence of a past suicide attempt. Moreover, ASAD differentiated in the expected directions between individuals with a history of multiple suicide attempts, individuals with a single suicide attempt, and individuals with no history of a suicide attempt. Acute Suicidal Affective Disturbance (ASAD) appears to be a unified construct that predicts suicidal behavior and is distinct from an already-defined mood disorder.
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Affiliation(s)
- Ian H Stanley
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL 32306, USA.
| | - Katrina A Rufino
- The Menninger Clinic, 12301 S. Main St., Houston, TX 77035, USA; Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd., Houston, TX 77030, USA; Department of Social Sciences, University of Houston-Downtown, One Main Street, Houston, TX 77002, USA
| | - Megan L Rogers
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL 32306, USA
| | - Thomas E Ellis
- The Menninger Clinic, 12301 S. Main St., Houston, TX 77035, USA; Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd., Houston, TX 77030, USA
| | - Thomas E Joiner
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL 32306, USA
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86
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Abstract
OBJECTIVE Sleep problems are associated with increased risk of suicide, independent of depression. This analysis explores narrative accounts of the role of sleep in relation to suicidal thoughts and behaviours. DESIGN Qualitative study, based on in-depth semistructured interviews which were analysed with an inductive, latent thematic analysis. PARTICIPANTS A maximum variation sample of 18 people with experience of a major depressive episode, and suicidal thoughts and behaviours. SETTING Primary care, North West England. RESULTS Respondents emphasised the importance of sleep for recovery and management of their mental well-being. Moreover, three inter-related pathways were identified, whereby beliefs about sleep contributed to suicidal thoughts and behaviours. First, being awake during the biological night heightened risk of suicidal behaviours, as this was perceived to be an opportune time for a suicide attempt due to the decreased chances that a friend of family member would intervene during a suicide attempt. Additionally, the reduction in available support at night added to suicide risk. Second, failure to achieve good sleep was perceived to make life harder through contributing to core features of depression, such as negative thinking, attention difficulties and inactivity. Third, sleep acted as an alternative to suicide, by providing an escape from problems, including mental health problems, in waking life. However, this desire to sleep to escape was associated with excessive daytime sleeping, which subsequently may reinforce disturbed sleeping patterns. CONCLUSIONS Sleep problems should be an important treatment target when working with suicidal clients. More broadly, night-time service provision should be considered when developing suicide prevention initiatives.
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Affiliation(s)
| | - Patricia Gooding
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Simon D Kyle
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Daniel Pratt
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Sarah Peters
- School of Health Sciences, University of Manchester, Manchester, UK
- Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
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87
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Lopes MC, Boronat AC, Wang YP, Fu-I L. Sleep Complaints as Risk Factor for Suicidal Behavior in Severely Depressed Children and Adolescents. CNS Neurosci Ther 2016; 22:915-920. [PMID: 27534369 PMCID: PMC5096249 DOI: 10.1111/cns.12597] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Revised: 07/19/2016] [Accepted: 07/21/2016] [Indexed: 11/27/2022] Open
Abstract
Objectives To investigate the association between sleep complaints and suicidal behaviors among severely depressed children and adolescents. Methods The sample was 214 youths (56.1% males, mean age 12.5 years) with diagnosis of DSM‐IV major depressive disorder consecutively recruited from a university‐based outpatient clinic specialized in mood disorders. The structured interview for children and adolescents was applied to participants. The Children's Depression Rating Scale—revised version—scored the severity of depression, and the Children's Global Assessment Scale assessed the global functioning. Subgroups of patients were compared for psychopathological association by means of logistic regression, in accordance with presence and absence of sleep complaints and suicidality. Results The frequency of sleep complaints and suicidal behaviors was, respectively, 66.4% and 52.3%, and both symptoms were observed in 37.9% of patients. Initial insomnia was the most frequent manifestation (58%), followed by night awakening (36%), daytime sleepiness (31%), and early awakening (29.9%). Significant association between sleep disturbance and suicidal behavior was found (odds ratio range of 2.3–10.8). Conclusion Sleep disturbances are potential warning manifestations of suicidal behaviors in depressed youth. Possibly, the severity of the active affective episode likely underlies in both sleep complaints and suicidal behaviors among depressed underage patients.
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Affiliation(s)
- Maria-Cecilia Lopes
- Childhood and Adolescence Affective Disorders Program at Institute and Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.
| | - Alexandre C Boronat
- Childhood and Adolescence Affective Disorders Program at Institute and Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Yuan-Pang Wang
- Section of Psychiatric Epidemiology LIM-23, Institute and Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Lee Fu-I
- Childhood and Adolescence Affective Disorders Program at Institute and Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
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88
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Abstract
INTRODUCTION A growing empirical literature has examined insomnia symptoms as a possible risk factor for a range of suicidal behavior. Not much literature is available in normal adolescent population. AIMS The aim is to find insomnia prevalence, studying various dream factors, and suicidality prevalence among students of various courses. To check if there is a relation between insomnia and suicidal behavior and dreams, particularly nightmares and suicide. MATERIALS AND METHODS A total of 400 students of various courses were assessed using Insomnia Severity Index and The Mannheim Dream Questionnaire and Suicide Behaviour Questionnaire. RESULTS Insomnia was present in 11%, 23%, 19%, and 19% and suicide behavior in 16%, 17%, 12%, and 22%, respectively, in medical, commerce, engineering, and arts students. Statistically significant correlation was found between suicide and insomnia severity and various dream factors. CONCLUSIONS Insomnia and dreams had relation with suicidality in normal adolescent population.
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Affiliation(s)
- Sagar B Karia
- Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, India
| | - Nirali Mehta
- Lokmanya Tilak Municipal Medical College, Mumbai, India
| | - Devavrat Harshe
- Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, India
| | - Avinash De Sousa
- Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, India
| | - Nilesh Shah
- Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, India
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89
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Giannaccini G, Masala I, Palego L, Betti L, Pacciardi B, Palagini L, Luchini F, Belli S, Lucacchini A, Mauri M. Melatonin and pro-hypnotic effectiveness of the antidepressant Trazodone: A preliminary evaluation in insomniac mood-disorder patients. Clin Biochem 2016; 49:1152-1158. [PMID: 27374436 DOI: 10.1016/j.clinbiochem.2016.06.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 06/07/2016] [Accepted: 06/28/2016] [Indexed: 12/16/2022]
Affiliation(s)
- Gino Giannaccini
- Department of Pharmacy, University of Pisa, Via Boannno 6, 56126 Pisa, Italy.
| | - Irene Masala
- Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126 Pisa, Italy.
| | - Lionella Palego
- Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126 Pisa, Italy.
| | - Laura Betti
- Department of Pharmacy, University of Pisa, Via Boannno 6, 56126 Pisa, Italy.
| | - Bruno Pacciardi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126 Pisa, Italy.
| | - Laura Palagini
- Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126 Pisa, Italy.
| | - Federica Luchini
- Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126 Pisa, Italy.
| | - Simone Belli
- Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126 Pisa, Italy.
| | - Antonio Lucacchini
- Department of Pharmacy, University of Pisa, Via Boannno 6, 56126 Pisa, Italy.
| | - Mauro Mauri
- Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126 Pisa, Italy.
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90
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Mallick F, McCullumsmith CB. Ketamine for Treatment of Suicidal Ideation and Reduction of Risk for Suicidal Behavior. Curr Psychiatry Rep 2016; 18:61. [PMID: 27194043 DOI: 10.1007/s11920-016-0680-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Ketamine, an NMDA receptor antagonist with efficacy as a rapid anti-depressant, has early evidence for action to reduce suicidal ideation. This review will explore several important questions that arise from these studies. First, how do we measure reductions in suicidal ideation that occur over minutes to hours? Second, are the reductions in suicidal ideation after ketamine treatment solely a result of its rapid anti-depressant effect? Third, is ketamine only effective in reducing suicidal ideation in patients with mood disorders? Fourth, could ketamine's action lead us to a greater understanding of the neurobiology of suicidal processes? Last, do the reductions in depression and suicidal ideation after ketamine treatment translate into decreased risk for suicidal behavior? Our review concludes that ketamine treatment can be seen as a double-edged sword, clinically to help provide treatment for acutely suicidal patients and experimentally to explore the neurobiological nature of suicidal ideation and suicidal behavior.
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Affiliation(s)
- Faryal Mallick
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH, USA
| | - Cheryl B McCullumsmith
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH, USA.
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91
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Chu C, Hom MA, Rogers ML, Ringer FB, Hames JL, Suh S, Joiner TE. Is Insomnia Lonely? Exploring Thwarted Belongingness as an Explanatory Link between Insomnia and Suicidal Ideation in a Sample of South Korean University Students. J Clin Sleep Med 2016; 12:647-52. [PMID: 26857060 DOI: 10.5664/jcsm.5784] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 01/03/2016] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Suicide is a serious public health problem, and suicide rates are particularly high in South Korea. Insomnia has been identified as a risk factor for suicidal ideation; however, little is known about the mechanisms accounting for this relationship in this population. Based on the premise that insomnia can be lonely (e.g., being awake when everyone else is asleep), the purpose of this study was to examine whether greater insomnia severity would be associated with higher levels of thwarted belongingness and suicidal ideation, and whether thwarted belongingness would mediate the relationship between insomnia and suicidal ideation. METHODS Predictions were tested in a sample of 552 South Korean young adults who completed self-report measures of insomnia severity, suicidal ideation, and thwarted belongingness. RESULTS Greater insomnia symptom severity was significantly and positively associated with thwarted belongingness and suicidal ideation. Mediation analyses revealed that thwarted belongingness significantly accounted for the relationship between insomnia severity and suicidal ideation. CONCLUSIONS These findings highlight the potential importance of monitoring and therapeutically impacting insomnia and thwarted belongingness to help reduce suicide risk.
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Affiliation(s)
- Carol Chu
- Florida State University, Department of Psychology, Tallahassee, FL
| | - Melanie A Hom
- Florida State University, Department of Psychology, Tallahassee, FL
| | - Megan L Rogers
- Florida State University, Department of Psychology, Tallahassee, FL
| | - Fallon B Ringer
- Florida State University, Department of Psychology, Tallahassee, FL
| | - Jennifer L Hames
- Florida State University, Department of Psychology, Tallahassee, FL.,Minneapolis Veterans Affairs Medical Center, Minneapolis, MN
| | - Sooyeon Suh
- Sungshin Women's University, Department of Psychology, Seoul, South Korea.,Stanford University, Department of Psychiatry and Behavioral Sciences, Stanford, CA
| | - Thomas E Joiner
- Florida State University, Department of Psychology, Tallahassee, FL
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92
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Rogers ML, Tucker RP, Law KC, Michaels MS, Anestis MD, Joiner TE. Manifestations of overarousal account for the association between cognitive anxiety sensitivity and suicidal ideation. J Affect Disord 2016; 192:116-24. [PMID: 26720010 DOI: 10.1016/j.jad.2015.12.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 11/07/2015] [Accepted: 12/11/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Recent evidence suggests an association between cognitive anxiety sensitivity and suicidal ideation. Cognitive anxiety sensitivity has also been implicated as a precursor to various forms of overarousal. These manifestations of overarousal (i.e., agitation, insomnia, nightmares, and anger) may account for the association between cognitive anxiety sensitivity and suicidal ideation. METHODS In Study 1, undergraduate students selectively sampled for recent suicidal ideation completed all measures online. In Study 2, clinical outpatients completed all measures prior to their initial intake appointments at a psychology clinic. RESULTS Study 1 demonstrated that agitation and insomnia individually and jointly accounted for the association between cognitive anxiety sensitivity and suicidal ideation, controlling for general anxiety and demographic variables. Study 2 replicated and extended these findings, such that, controlling for demographics, general anxiety, and physical and social anxiety sensitivity, agitation and anger each independently and together accounted for the association between cognitive anxiety sensitivity and suicidal ideation, whereas insomnia and nightmares did not. LIMITATIONS This study utilized a cross-sectional design and self-report measures in both samples as well as a sample of undergraduate students in Study 1. CONCLUSIONS Together, these findings suggest that agitation and anger may explain the previously established relationship between cognitive anxiety sensitivity and suicidal ideation. Targeting cognitive anxiety sensitivity in treatment may in turn reduce these forms of overarousal and thereby suicide risk.
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Affiliation(s)
| | | | - Keyne C Law
- University of Southern Mississippi, United States
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93
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Gelaye B, Barrios YV, Zhong QY, Rondon MB, Borba CPC, Sánchez SE, Henderson DC, Williams MA. Association of poor subjective sleep quality with suicidal ideation among pregnant Peruvian women. Gen Hosp Psychiatry 2015; 37:441-7. [PMID: 25983188 PMCID: PMC4558240 DOI: 10.1016/j.genhosppsych.2015.04.014] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 04/22/2015] [Accepted: 04/30/2015] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To examine the independent and joint relationships of poor subjective sleep quality and antepartum depression with suicidal ideation among pregnant women. METHODS A cross-sectional study was conducted among 641 pregnant women attending prenatal care clinics in Lima, Peru. Antepartum depression and suicidal ideation were assessed using the Patient Health Questionnaire-9 scale. Antepartum subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Logistic regression procedures were performed to estimate odds ratios (aOR) and 95% confidence intervals (95% CI) adjusted for confounders. RESULTS Overall, the prevalence of suicidal ideation in this cohort was 16.8% and poor subjective sleep quality was more common among women endorsing suicidal ideation as compared to their counterparts who did not (47.2% vs. 24.8%, P<.001). After adjustment for confounders including maternal depression, poor subjective sleep quality (defined using the recommended criteria of PSQI global score of >5 vs. ≤5) was associated with a 1.7-fold increased odds of suicidal ideation (aOR=1.67; 95% CI 1.02-2.71). When assessed as a continuous variable, each 1-unit increase in the global PSQI score resulted in an 18% increase in odds for suicidal ideation, even after adjusting for depression (aOR=1.18; 95% CI 1.08-1.28). Women with both poor subjective sleep quality and depression had a 3.5-fold increased odds of suicidal ideation (aOR=3.48; 95% CI 1.96-6.18) as compared with those who had neither risk factor. CONCLUSION Poor subjective sleep quality was associated with increased odds of suicidal ideation. Replication of these findings may promote investments in studies designed to examine the efficacy of sleep-focused interventions to treat pregnant women with sleep disorders and suicidal ideation.
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Affiliation(s)
- Bizu Gelaye
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
| | - Yasmin V Barrios
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Qiu-Yue Zhong
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Marta B Rondon
- Department of Medicine, Cayetano Heredia Peruvian University, Lima, Peru
| | - Christina P C Borba
- Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Sixto E Sánchez
- Universidad Peruana de Ciencias Aplicadas, Lima, Peru; Asociación Civil PROESA, Lima, Peru
| | - David C Henderson
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Michelle A Williams
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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94
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Bryan CJ, Gonzales J, Rudd MD, Bryan AO, Clemans TA, Ray-Sannerud B, Wertenberger E, Leeson B, Heron EA, Morrow CE, Etienne N. DEPRESSION MEDIATES THE RELATION OF INSOMNIA SEVERITY WITH SUICIDE RISK IN THREE CLINICAL SAMPLES OF U.S. MILITARY PERSONNEL. Depress Anxiety 2015; 32:647-55. [PMID: 26047362 DOI: 10.1002/da.22383] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Revised: 04/08/2015] [Accepted: 05/01/2015] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND A growing body of empirical research suggests insomnia severity is directly related to suicide ideation, attempts, and death in nonmilitary samples, even when controlling for depression and other suicide risk factors. Few studies have explored this relationship in U.S. military personnel. METHODS The present study entailed secondary data analyses examining the associations of insomnia severity with suicide ideation and attempts in three clinical samples: Air Force psychiatric outpatients (n = 158), recently discharged Army psychiatric inpatients (n = 168), and Army psychiatric outpatients (n = 54). Participants completed the Beck Scale for Suicide Ideation, the Beck Depression Inventory-II or Patient Health Questionnaire-9, the Insomnia Severity Index, and the Posttraumatic Stress Disorder Checklist at baseline; two samples also completed these measures during follow-up. RESULTS Sleep disturbance was associated with concurrent (β's > 0.21; P's < 0.059) and prospective (β's > 0.39; P's < 0.001) suicide ideation in all three samples. When adjusting for age, gender, depression, and posttraumatic stress, insomnia severity was no longer directly associated with suicide ideation either concurrently (β's < 0.19; P's > 0.200) or prospectively (β's < 0.26; P's > 0.063), but depression was (β's > 0.22; P's < 0.012). Results of a latent difference score mediation model indicated that depression mediated the relation of insomnia severity with suicide ideation. CONCLUSIONS Across three clinical samples of military personnel, depression explained the relationship between insomnia severity and suicide risk.
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Affiliation(s)
- Craig J Bryan
- National Center for Veterans Studies, The University of Utah, Salt Lake City, Utah.,The University of Utah, Salt Lake City, Utah
| | - Jacqueline Gonzales
- National Center for Veterans Studies, The University of Utah, Salt Lake City, Utah.,The University of Utah, Salt Lake City, Utah
| | - M David Rudd
- National Center for Veterans Studies, The University of Utah, Salt Lake City, Utah.,The University of Memphis, Memphis, Tennessee
| | - AnnaBelle O Bryan
- National Center for Veterans Studies, The University of Utah, Salt Lake City, Utah.,The University of Utah, Salt Lake City, Utah
| | - Tracy A Clemans
- National Center for Veterans Studies, The University of Utah, Salt Lake City, Utah.,The University of Utah, Salt Lake City, Utah
| | - Bobbie Ray-Sannerud
- National Center for Veterans Studies, The University of Utah, Salt Lake City, Utah.,The University of Utah, Salt Lake City, Utah
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95
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Woznica AA, Carney CE, Kuo JR, Moss TG. The insomnia and suicide link: toward an enhanced understanding of this relationship. Sleep Med Rev 2015; 22:37-46. [DOI: 10.1016/j.smrv.2014.10.004] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 10/03/2014] [Accepted: 10/06/2014] [Indexed: 11/25/2022]
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96
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Norra C, Bremshey N. Die Bedeutung von Schlafstörungen für die Prävention von Suizidalität. SOMNOLOGIE 2015. [DOI: 10.1007/s11818-015-0009-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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97
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Sun L, Zhang J, Liu X. Insomnia Symptom, Mental Disorder and Suicide: A Case-Control Study in Chinese Rural Youths. Sleep Biol Rhythms 2015; 13:181-188. [PMID: 25914606 DOI: 10.1111/sbr.12105] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Insomnia has been reported as a risk factor of suicidal behaviors, but few studies have examined the association among insomnia, mental disorder and suicide, especially among Chinese populations. In this study, we examined the effect of insomnia symptoms on completed suicide in a large sample of suicides and their controls in Chinese rural youths. Subjects were 388 consecutively recruited suicides and 416 community living controls aged 15-34 years in the rural areas of three provinces in China. Established psychological autopsy method was used for the data collection. Insomnia symptoms were assessed with sleep questions in the Hamilton Depression Rating Scale (HAMD) about insomnia, including difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS) and early morning awakening (EMA). The results showed that DIS (OR=12.01, p<0.001), DMS (OR=12.82, p<0.001) or EMA (OR=12.08, p<0.001) was significantly associated with increased risk of suicide even after mental disorder was controlled for. Our study showed that insomnia can be an independent risk factor for suicide. Mental disorders mediated the association between insomnia and suicide. Insomnia should be assessed and treated for individuals at risk of suicide.
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Affiliation(s)
- Long Sun
- Shandong University School of Public Health, Center for Suicide Prevention Research, Jinan, China
| | - Jie Zhang
- Shandong University School of Public Health, Center for Suicide Prevention Research, Jinan, China, State University of New York Buffalo State Department of Sociology, Buffalo, USA
| | - Xianchen Liu
- Shandong University School of Public Health, Center for Suicide Prevention Research, Jinan, China, Department of Psychiatry, School of Medicine, Indiana University, Indianapolis, USA
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98
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Weis D, Rothenberg L, Moshe L, Brent DA, Hamdan S. The Effect of Sleep Problems on Suicidal Risk among Young Adults in the Presence of Depressive Symptoms and Cognitive Processes. Arch Suicide Res 2015; 19:321-34. [PMID: 25517910 DOI: 10.1080/13811118.2014.986697] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We aimed to investigate the effect of sleep problems, depression, and cognitive processes on suicidal risk among 460 young adults. They completed self-report questionnaires assessing suicidal behavior, sleep quality, depressive symptoms, emotion regulation, rumination, and impulsivity. Suicidal participants exhibited higher rates of depressive symptoms, sleep problems, expressive suppression, rumination, and impulsivity. A confirmatory factor analysis model revealed pathways to suicidal risk that showed no direct pathways between sleep problems and suicidal risk. Instead, sleep was related to suicidal risk via depression and rumination, which in turn increased suicidal risk. These results suggest that addressing sleep problems will be useful in either the treatment or prevention of depressive and rumination symptoms and reduction in suicidal risk.
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99
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Timpano KR, Carbonella JY, Bernert RA, Schmidt NB. Obsessive compulsive symptoms and sleep difficulties: exploring the unique relationship between insomnia and obsessions. J Psychiatr Res 2014; 57:101-7. [PMID: 25038630 DOI: 10.1016/j.jpsychires.2014.06.021] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 06/26/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Sleep complaints have been linked with Obsessive Compulsive Disorder (OCD), though there is a dearth of research exploring the association between a range of disturbed sleep indicators and obsessive compulsive symptoms (OCS). Two separate studies were conducted to rigorously investigate this relationship in further detail, considering a number of different sleep indices and also the heterogeneous nature of OCS. METHODS Study 1 (n = 167) examined the relationship between OCS and the gold standard self-report assessments for delayed bedtime, sleep quality, nightmares, and insomnia symptoms. Study 2 (n = 352) replicated the primary findings from Study 1 in an independent sample and with an alternative measure of OCD, which takes into account the different OCS dimensions. RESULTS Results revealed a significant, independent link between obsessions and insomnia symptoms, but not between insomnia and compulsions. When examining the different OCS dimensions, insomnia was again found to bear a specific relationship to obsessions, above and beyond that with the other dimensions. Although depression is often highly comorbid with both OCD and sleep disturbances, depressive symptoms did not explain the OCS-sleep relationship in either study, suggesting a unique association between obsessions and insomnia. CONCLUSIONS Findings indicate that high levels of intrusive thoughts exhibit a specific association with insomnia symptoms-one that is not observed with other OCS. Future research may help elucidate the mechanisms and causal nature of this relationship.
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Bernert RA, Turvey CL, Conwell Y, Joiner TE. Association of poor subjective sleep quality with risk for death by suicide during a 10-year period: a longitudinal, population-based study of late life. JAMA Psychiatry 2014; 71:1129-37. [PMID: 25133759 PMCID: PMC4283786 DOI: 10.1001/jamapsychiatry.2014.1126] [Citation(s) in RCA: 163] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
IMPORTANCE Older adults have high rates of sleep disturbance, die by suicide at disproportionately higher rates compared with other age groups, and tend to visit their physician in the weeks preceding suicide death. To our knowledge, to date, no study has examined disturbed sleep as an independent risk factor for late-life suicide. OBJECTIVE To examine the relative independent risk for suicide associated with poor subjective sleep quality in a population-based study of older adults during a 10-year observation period. DESIGN, SETTING, AND PARTICIPANTS A longitudinal case-control cohort study of late-life suicide among a multisite, population-based community sample of older adults participating in the Established Populations for Epidemiologic Studies of the Elderly. Of 14 456 community older adults sampled, 400 control subjects were matched (on age, sex, and study site) to 20 suicide decedents. MAIN OUTCOMES AND MEASURES Primary measures included the Sleep Quality Index, the Center for Epidemiologic Studies-Depression Scale, and vital statistics. RESULTS Hierarchical logistic regressions revealed that poor sleep quality at baseline was significantly associated with increased risk for suicide (odds ratio [OR], 1.39; 95% CI, 1.14-1.69; P < .001) by 10 follow-up years. In addition, 2 sleep items were individually associated with elevated risk for suicide at 10-year follow-up: difficulty falling asleep (OR, 2.24; 95% CI, 1.27-3.93; P < .01) and nonrestorative sleep (OR, 2.17; 95% CI, 1.28-3.67; P < .01). Controlling for depressive symptoms, baseline self-reported sleep quality was associated with increased risk for death by suicide (OR, 1.30; 95% CI, 1.04-1.63; P < .05). CONCLUSIONS AND RELEVANCE Our results indicate that poor subjective sleep quality is associated with increased risk for death by suicide 10 years later, even after adjustment for depressive symptoms. Disturbed sleep appears to confer considerable risk, independent of depressed mood, for the most severe suicidal behaviors and may warrant inclusion in suicide risk assessment frameworks to enhance detection of risk and intervention opportunity in late life.
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Affiliation(s)
- Rebecca A Bernert
- Stanford Mood Disorders Center, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | | | - Yeates Conwell
- Office for Aging Research and Health Services, University of Rochester Medical Center, Rochester, New York4Center for the Study and Prevention of Suicide, Department of Psychiatry, University of Rochester, Rochester, New York
| | - Thomas E Joiner
- Department of Psychology, Florida State University, Tallahassee
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