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Hochard KD, Ashcroft S, Carroll J, Heym N, Townsend E. Exploring Thematic Nightmare Content and Associated Self-Harm Risk. Suicide Life Threat Behav 2019; 49:64-75. [PMID: 28960406 DOI: 10.1111/sltb.12402] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 07/25/2017] [Indexed: 01/17/2023]
Abstract
Nightmares have been shown to be robust predictors of self-harm risk, beyond depressive symptoms and hopelessness at times. However, few studies have investigated associations between nightmare content and increased self-harm risk. This study explored associations of thematic nightmare content with history of self-harm, and risk of self-harm phenomena the morning following a nightmare. A mixed-method diary study was performed. Prospective nightmare reports were obtained from 72 participants. A total of 47 nightmare reports met inclusion criteria and were analyzed for themes using inductive thematic analysis. Chi-square and bootstrap Pearson's correlation tests were performed to assess the associations between nightmare themes and self-harm history, and risk of self-harm phenomena following a nightmare. "Powerlessness to Change Behavior" was associated with a history of self-harm engagement, whereas "Financial Hardship" indicated reduced risk. Themes were not significantly associated with increased risk of self-harm phenomena following a nightmare. Content may be of use in detecting lifetime history of self-harm engagement, particularly in populations where disclosure is seen as taboo. However, nightmare symptom severity remains a better indicator of risk. Evidence for the utility of nightmare content in assessing immediate self-harm risk is presently lacking. Replication with increased power is recommended.
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Affiliation(s)
- Kevin D Hochard
- Department of Psychology, University of Chester, Chester, UK
| | - Sam Ashcroft
- Department of Psychology, University of Chester, Chester, UK
| | - Janine Carroll
- Department of Psychology, University of Chester, Chester, UK
| | - Nadja Heym
- Division of Psychology, Nottingham Trent University, Nottingham, UK
| | - Ellen Townsend
- School of Psychology, University of Nottingham, University Park, Nottingham, UK
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102
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Borderline personality disorder traits and suicide risk: The mediating role of insomnia and nightmares. J Affect Disord 2019; 244:85-91. [PMID: 30326346 DOI: 10.1016/j.jad.2018.10.097] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/10/2018] [Accepted: 10/08/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Borderline personality disorder (BPD) is associated with high rates of suicide risk and problems related to sleep, including insomnia and nightmares. The purpose of the current study was to assess the potential indirect effect of BPD traits on suicide risk through both/either insomnia and nightmares. METHODS Participants (N = 281) were recruited via Amazon's Mechanical Turk to complete the study remotely online. Participants completed measures of BPD traits and symptoms, suicide risk (history of suicidal thoughts and behaviors), insomnia symptoms, and distress and impairment related to nightmares. RESULTS BPD traits and symptoms were moderately to highly correlated to suicide risk, insomnia, and nightmares. In parallel mediation models, BPD traits had a significant indirect effect on suicide risk through insomnia symptoms but not nightmares. LIMITATIONS The current study assessed problems within the general population and not in a clinical sample. Second, the study relied solely on self-report measures. Futures studies would benefit from investigating these relations in clinical samples utilizing observer-report and interview methods. CONCLUSIONS BPD traits appear to relate to increased risk for suicide through the relation with sleep concerns, particularly insomnia symptoms. Therefore, assessing and treating sleep problems within individuals with BPD may result in a lower risk for suicide.
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103
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Johnson LL, O'Connor SS, Kaminer B, Gutierrez PM, Carney E, Groh B, Jobes DA. Evaluation of Structured Assessment and Mediating Factors of Suicide-Focused Group Therapy for Veterans Recently Discharged from Inpatient Psychiatry. Arch Suicide Res 2019; 23:15-33. [PMID: 29220609 DOI: 10.1080/13811118.2017.1402722] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The current study investigated the impact of adding the Suicide Status Form (SSF) to a suicide-focused group therapy for veterans recently discharged from an inpatient psychiatry setting. A sample of 141 veterans was enrolled and randomized into a Usual Assessment Group Therapy or SSF-Assessment Group Therapy. Participants completed interviews at baseline, 1, and 3 months. No significant differences were observed between groups regarding group attendance (IRR = 1.01, Std. Err = 0.08, 95% CI = 0.87, 1.18) or client satisfaction (β = 0.23, Std. Err = 0.66, p = 0.73, d = -.25). No main effects were observed across the study on secondary outcomes of interest for suicidal ideation and overall symptom distress, although participants in both treatment conditions reported significant improvements on these outcomes over the course of the study. Patients in the Usual Assessment Group Therapy demonstrated greater reductions in overall symptom distress across the 3-month follow-up window (β = 6.08, Std. Err = 2.04, p = 0.003; f2 = 0.05). Follow-up path analyses revealed that more frequent session attendance was significantly related to less suicidal ideation at 1-month, higher working alliance between individual members and group facilitators was associated with greater suicidal ideation at 1-month, and higher group cohesion among group members at 1-month was significantly associated with less thwarted belongingness at 1-month. Although the SSF did not improve the impact of an existing suicide-focused group therapy, the study findings support future research on group treatments for suicidal veterans.
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104
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McKernan LC, Clayton EW, Walsh CG. Protecting Life While Preserving Liberty: Ethical Recommendations for Suicide Prevention With Artificial Intelligence. Front Psychiatry 2018; 9:650. [PMID: 30559686 PMCID: PMC6287030 DOI: 10.3389/fpsyt.2018.00650] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 11/16/2018] [Indexed: 01/05/2023] Open
Abstract
In the United States, suicide increased by 24% in the past 20 years, and suicide risk identification at point-of-care remains a cornerstone of the effort to curb this epidemic (1). As risk identification is difficult because of symptom under-reporting, timing, or lack of screening, healthcare systems rely increasingly on risk scoring and now artificial intelligence (AI) to assess risk. AI remains the science of solving problems and accomplishing tasks, through automated or computational means, that normally require human intelligence. This science is decades-old and includes traditional predictive statistics and machine learning. Only in the last few years has it been applied rigorously in suicide risk prediction and prevention. Applying AI in this context raises significant ethical concern, particularly in balancing beneficence and respecting personal autonomy. To navigate the ethical issues raised by suicide risk prediction, we provide recommendations in three areas-communication, consent, and controls-for both providers and researchers (2).
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Affiliation(s)
- Lindsey C. McKernan
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Ellen W. Clayton
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, United States
- Law School, Vanderbilt University, Nashville, TN, United States
| | - Colin G. Walsh
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
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105
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Colic S, J Richardson D, James Reilly P, Gary Hasey M. Using Machine Learning Algorithms to Enhance the Management of Suicide Ideation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:4936-4939. [PMID: 30441450 DOI: 10.1109/embc.2018.8513200] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Combat veterans; especially those with mental health conditions are an at risk group for suicidal ideation and behaviour. This study attempts to use machine learning algorithm to predict suicidal ideation (SI) in a treatment seeking veteran population. Questionnaire data from 738 patients consisting of veterans, still serving members of the Canadian Forces (CF) and Royal Canadian Mountain Police (RCMP) were examined to determine the likelihood of suicide ideation and to identify key variables for tracking the risk of suicide. Unlike conventional approaches we use pattern recognition methods, known collectively as machine learning (ML), to examine multivariate data and identify patterns associate with suicidal ideation. Our findings show that accurate prediction of SI of over 84.4% can be obtained with 25 variables, and 81% using as little as 10 variables primarily obtained from the patient health questionnaire (PHQ). Surprisingly the best identifiers for SI did not come from occupational experiences but rather the patient quality of health, signifying that these findings could be applied to the general population. Our results suggest that ML could assist clinicians to develop a better screening aid for suicidal ideation and behaviour.
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106
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Berzins TL, Van Dulmen MHM, Deluca H. Alcohol use affects sleep duration among military couples. MILITARY PSYCHOLOGY 2018. [DOI: 10.1080/08995605.2018.1521684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | | | - Haylee Deluca
- Department of Psychological Sciences, Kent State University, Kent, Ohio
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107
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Sami H, Danielle L, Lihi D, Elena S. The effect of sleep disturbances and internet addiction on suicidal ideation among adolescents in the presence of depressive symptoms. Psychiatry Res 2018; 267:327-332. [PMID: 29957549 DOI: 10.1016/j.psychres.2018.03.067] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 03/10/2018] [Accepted: 03/22/2018] [Indexed: 11/18/2022]
Abstract
Maladaptive use of internet and sleep problems is a significant health concern among adolescents. We aimed to understand better how sleep problems are related to suicidal ideation taking into account the presence of depression and internet addiction. 631 adolescents aged between 12 and 18 randomly recruited from different middle and high schools to complete self-report questionnaires assessing sleep disturbances, addictive use of the internet, depressive symptoms, and suicidal ideation. 22.9% of the sample reported on suicidal ideation during the month before the study, 42% of the sample suffer from sleep disturbances, 30.2% reported on the addictive use of the internet, and 26.5% exhibited severe symptoms of depression. Adolescents with suicidal ideation had higher rates of sleep disturbances, addictive use of internet and depressive symptoms. A confirmatory path analysis suggests that the effect of sleep disturbances on suicidal ideation moderated by the impact of internet addiction and mediated by the sleep effects on depressive symptoms. These results emphasize the importance to address the above risk behaviors in prevention curriculums programs. Future longitudinal studies are needed to determine the temporal order and to validate causal pathways.
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Affiliation(s)
- Hamdan Sami
- School of Behavioral Sciences, The Academic College of Tel-Aviv Jaffa (MTA), Israel.
| | - Levi Danielle
- School of Behavioral Sciences, The Academic College of Tel-Aviv Jaffa (MTA), Israel
| | - Dahan Lihi
- School of Behavioral Sciences, The Academic College of Tel-Aviv Jaffa (MTA), Israel
| | - Stukalin Elena
- School of Behavioral Sciences, The Academic College of Tel-Aviv Jaffa (MTA), Israel.
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108
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Ribeiro SP, LaCroix JM, De Oliveira F, Novak LA, Lee-Tauler SY, Darmour CA, Perera KU, Goldston DB, Weaver J, Soumoff A, Ghahramanlou-Holloway M. The Link between Posttraumatic Stress Disorder and Functionality among United States Military Service Members Psychiatrically Hospitalized Following a Suicide Crisis. Healthcare (Basel) 2018; 6:E95. [PMID: 30087239 PMCID: PMC6164520 DOI: 10.3390/healthcare6030095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 07/18/2018] [Accepted: 07/30/2018] [Indexed: 11/25/2022] Open
Abstract
Posttraumatic stress disorder (PTSD) is one of the most commonly diagnosed psychiatric disorders in the United States and has been linked to suicidal thoughts and behaviors, yet the role of a PTSD diagnosis on functional impairment among suicidal individuals remains unknown. This study examined the association between PTSD status and functional impairment among military psychiatric inpatients admitted for acute suicide risk (N = 166) with a lifetime history of at least one suicide attempt. Measures of functionality included: (1) alcohol use; (2) sleep quality; (3) social problem-solving; and (4) work and social adjustment. Thirty-eight percent of the sample met criteria for PTSD. Women were more likely than men to meet criteria for PTSD (p = 0.007), and participants who met PTSD criteria had significantly more psychiatric diagnoses (p < 0.001). Service members who met PTSD criteria reported more disturbed sleep (p = 0.003) and greater difficulties with work and social adjustment (p = 0.004) than those who did not meet PTSD criteria. However, functionality measures were not significantly associated with PTSD status after controlling for gender and psychiatric comorbidity. Gender and number of psychiatric comorbidities other than PTSD were significant predictors of PTSD in logistic regression models across four functionality measures. Future studies should assess the additive or mediating effect of psychiatric comorbidities in the association between impaired functioning and PTSD. Clinicians are encouraged to assess and address functionality during treatment with suicidal individuals, paying particular attention to individuals with multiple psychiatric diagnoses.
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Affiliation(s)
- Sissi Palma Ribeiro
- Suicide Care, Prevention, and Research Initiative, Department of Medical & Clinical Psychology, Uniformed Services University, Bethesda, MD 20814, USA.
| | - Jessica M LaCroix
- Suicide Care, Prevention, and Research Initiative, Department of Medical & Clinical Psychology, Uniformed Services University, Bethesda, MD 20814, USA.
| | - Fernanda De Oliveira
- Suicide Care, Prevention, and Research Initiative, Department of Medical & Clinical Psychology, Uniformed Services University, Bethesda, MD 20814, USA.
| | - Laura A Novak
- Suicide Care, Prevention, and Research Initiative, Department of Medical & Clinical Psychology, Uniformed Services University, Bethesda, MD 20814, USA.
| | - Su Yeon Lee-Tauler
- Suicide Care, Prevention, and Research Initiative, Department of Medical & Clinical Psychology, Uniformed Services University, Bethesda, MD 20814, USA.
| | - Charles A Darmour
- Suicide Care, Prevention, and Research Initiative, Department of Medical & Clinical Psychology, Uniformed Services University, Bethesda, MD 20814, USA.
| | - Kanchana U Perera
- Suicide Care, Prevention, and Research Initiative, Department of Medical & Clinical Psychology, Uniformed Services University, Bethesda, MD 20814, USA.
| | - David B Goldston
- Department of Psychiatry, Duke University, Durham, NC 27708, USA.
| | - Jennifer Weaver
- Inpatient Psychiatry, Fort Belvoir Community Hospital, VA 22060, USA.
| | - Alyssa Soumoff
- Department of Psychiatry, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA.
| | - Marjan Ghahramanlou-Holloway
- Suicide Care, Prevention, and Research Initiative, Department of Medical & Clinical Psychology, Uniformed Services University, Bethesda, MD 20814, USA.
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109
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Using optimal combined moderators to define heterogeneity in neural responses to randomized conditions: Application to the effect of sleep loss on fear learning. Neuroimage 2018; 181:718-727. [PMID: 30041060 DOI: 10.1016/j.neuroimage.2018.07.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 07/18/2018] [Accepted: 07/21/2018] [Indexed: 12/24/2022] Open
Abstract
Comparing the neural outcomes of two randomized experimental groups is a primary aim of many functional neuroimaging studies. However, between-group effects can be obscured by heterogeneity in neural responses. Optimal Combined Moderator (OCM) approaches have previously been used to clarify heterogeneity in clinical outcomes following treatment randomization. We show that OCMs can also be used to clarify heterogeneity in the effect of a randomized experimental condition on neural responses. In 78 healthy adults aged 18-30 from the Effects of Dose-Dependent Sleep Disruption on Fear and Reward (SFeRe) study, we used demographic, clinical, genetic, and polysomnographic characteristics to develop OCMs for the effect of a randomized sleep restriction (SR) versus normal sleep (NS) condition on blood-oxygen-level dependent responses in the right amygdala (RAmyg) and subgenual anterior cingulate cortex (sgACC) during fear conditioning (FC) and extinction (FE) paradigms. The OCM for the RAmyg during FE was strongest [r (95% CI) = 0.52 (0.42, 0.68)], withstood cross-validation, and divided the sample into two subgroups with opposing experimental effects. Among N = 48 participants ("SR < NS"), those with SR exhibited less RAmyg activation during FE than those with NS [d (95%CI) = -1.10 (-1.86, -0.77)]. Among the remaining N = 30 participants ("SR > NS"), those with SR exhibited greater RAmyg activation during FE following SR than those with NS [d (95%CI) = 0.87 (0.37,1.78)]. SR > NS participants were more likely to be female, white, l/l genotype carriers, and have a psychiatric history. They had less sleep (overall and in REM), lower REM density, and lower spindle activity (12-16 Hz). Applying OCMs to randomized studies with neural outcomes can clarify neural heterogeneity and jumpstart mechanistic research; with further validation they also offer promise for personalized brain-based treatments and interventions.
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111
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LaCroix JM, Colborn VA, Hassen HO, Perera KU, Weaver J, Soumoff A, Novak LA, Ghahramanlou-Holloway M. Intimate partner relationship stress and suicidality in a psychiatrically hospitalized military sample. Compr Psychiatry 2018; 84:106-111. [PMID: 29747068 DOI: 10.1016/j.comppsych.2018.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 04/16/2018] [Accepted: 04/18/2018] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE Suicide among United States service members is a significant public health concern. Intimate partner relationship stress may contribute to suicide risk, as a failed or failing relationship is the most commonly documented stressor preceding military suicide attempts and deaths. However, little is known about the manner by which relationship stressors are associated with the experience of military suicidality. METHODS A sample of 190 psychiatrically hospitalized military personnel and adult dependents enrolled in an ongoing randomized controlled trial evaluating the efficacy of an inpatient cognitive behavioral treatment for suicidality were included in this study. Analyses examined depression, hopelessness, and suicidality among participants with (n = 105) and without (n = 85) self-reported romantic relationship stress. RESULTS Over half (55%) of the sample reported current romantic relationship stress. Compared to participants without current romantic relationship stress, results indicated that individuals reporting current romantic relationship stress were more hopeless (AOR = 1.07 (95% CI: 1.01-1.12), p = 0.020), more likely to endorse multiple suicide attempts (AOR = 1.96 (95% CI: 1.01-3.79), p = 0.046), had higher overall suicide risk (AOR = 2.49, (95% CI: 1.03-6.06), p = 0.044), and were more likely to report that the reason for their suicidality was at least in part to get a reaction from others. CONCLUSIONS Findings suggest romantic relationship stress is associated with greater suicide risk, and have clinical implications for suicide prevention and intervention. Future research may examine mechanisms and pathways between romantic relationship stress, suicidality, and prevention and intervention strategies.
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Affiliation(s)
- Jessica M LaCroix
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Victoria A Colborn
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Helena O Hassen
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Kanchana U Perera
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Jennifer Weaver
- Fort Belvoir Community Hospital, 9300 DeWitt Loop, Fort Belvoir, VA 22060, USA
| | - Alyssa Soumoff
- Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889, USA
| | - Laura A Novak
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
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112
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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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Lin HT, Lai CH, Perng HJ, Chung CH, Wang CC, Chen WL, Chien WC. Insomnia as an independent predictor of suicide attempts: a nationwide population-based retrospective cohort study. BMC Psychiatry 2018; 18:117. [PMID: 29716570 PMCID: PMC5930777 DOI: 10.1186/s12888-018-1702-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 04/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Numerous studies have verified that insomnia is associated with suicidal ideation, suicide attempts, and death by suicide. Limited population-based cohort studies have been conducted to examine the association. The present study aimed to analyze whether insomnia increases the risk of suicide attempts and verify the effects of insomnia on suicide risk. METHODS This study is a cohort study using 2000-2013 hospitalization data from the National Health Insurance Research Database (NHIRD) to track the rate of suicide attempts among insomnia patients aged 15 years or older. In addition, a 1:2 pairing based on sex, age, and date of hospitalization was conducted to identify the reference cohort (patients without insomnia). Cox proportional hazard model was used to assess the effects of insomnia on suicide risk. RESULTS The total number of hospitalized patients aged 15 years or older was 479,967 between 2000 and 2013 (159,989 patients with insomnia and 319,978 patients without insomnia). After adjusting for confounders, suicide risk in insomnia patients was 3.533-fold that of patients without insomnia (adjusted hazard ratio [HR] = 3.533, 95% confidence interval [CI] = 3.059-4.080, P < 0.001). Suicide risk in low-income patients was 1.434-fold (adjusted HR = 1.434, 95% CI = 1.184-1.736, P < 0.001) that of non-low-income patients. Suicide risk in patients with drug dependence and with mental disorders was 1.592-fold (adjusted HR = 1.592, 95% CI = 1.220-2.077, P < 0.001) and 4.483-fold (adjusted HR = 4.483, 95% CI = 3.934-5.109, P < 0.001) that of patients without drug dependence and without mental disorders, respectively. In the female population, suicide risk in insomnia patients was 4.186-fold (adjusted HR = 4.186, 95% CI = 3.429-5.111, P < 0.001) that of patients without insomnia. Among patients aged 25-44 years, suicide risk in insomnia patients was 5.546-fold (adjusted HR = 5.546, 95% CI = 4.236-7.262, P < 0.001) that of patients without insomnia. Furthermore, the suicide risk of insomnia patients with mental disorders was 18.322-fold that of patients without insomnia and mental disorders (P < 0.001). CONCLUSION Insomnia, low income, drug dependence, and mental disorders are independent risk factors for suicide attempts. Female patients and those aged 25-44 years are at high risk of suicide due to insomnia. Insomnia, mental disorders, and low income exhibit a synergistic effect on suicide attempts. Clinicians should pay attention to mental status and income level of insomnia patients.
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Affiliation(s)
- Han-Ting Lin
- National Defense Medical Center, School of Public Health 4325R, No. 161, Section 6, Min-Chuan East Road, Neihu District, Taipei City, 11490 Taiwan, Republic of China
| | - Chi-Huang Lai
- National Defense Medical Center, School of Public Health 4325R, No. 161, Section 6, Min-Chuan East Road, Neihu District, Taipei City, 11490 Taiwan, Republic of China
| | - Huey-Jen Perng
- National Defense Medical Center, Graduate Institute of Life Sciences 7115R, No. 161, Section 6, Min-Chuan East Road, Neihu District, Taipei City, 11490 Taiwan, Republic of China
| | - Chi-Hsiang Chung
- National Defense Medical Center, Graduate Institute of Life Sciences 7115R, No. 161, Section 6, Min-Chuan East Road, Neihu District, Taipei City, 11490 Taiwan, Republic of China
| | - Chung-Ching Wang
- Department of Family and Community Medicine, National Defense Medical Center, Tri-Service General Hospital Taipei, No. 325, Section 2, Cheng-Kung Road, Taipei City, 11490 Taiwan, Republic of China
| | - Wei-Liang Chen
- Department of Family and Community Medicine, National Defense Medical Center, Tri-Service General Hospital Taipei, No. 325, Section 2, Cheng-Kung Road, Taipei City, 11490 Taiwan, Republic of China
| | - Wu-Chien Chien
- National Defense Medical Center, School of Public Health 4325R, No. 161, Section 6, Min-Chuan East Road, Neihu District, Taipei City, 11490, Taiwan, Republic of China. .,National Defense Medical Center, Graduate Institute of Life Sciences 7115R, No. 161, Section 6, Min-Chuan East Road, Neihu District, Taipei City, 11490, Taiwan, Republic of China. .,Department of Medical Research 7115R, National Defense Medical Center, Tri-Service General Hospital Taipei, No. 325, Section 2, Cheng-Kung Road, Taipei City, 11490, Taiwan, Republic of China.
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Ribeiro JD, Huang X, Fox KR, Franklin JC. Depression and hopelessness as risk factors for suicide ideation, attempts and death: meta-analysis of longitudinal studies. Br J Psychiatry 2018; 212:279-286. [PMID: 29587888 DOI: 10.1192/bjp.2018.27] [Citation(s) in RCA: 418] [Impact Index Per Article: 69.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Many studies have documented robust relationships between depression and hopelessness and subsequent suicidal thoughts and behaviours; however, much weaker and non-significant effects have also been reported. These inconsistencies raise questions about whether and to what degree these factors confer risk for suicidal thoughts and behaviours.AimsThis study aimed to evaluate the magnitude and clinical utility of depression and hopelessness as risk factors for suicide ideation, attempts and death. METHOD We conducted a meta-analysis of published studies from 1971 to 31 December 2014 that included at least one longitudinal analysis predicting suicide ideation, attempt or death using any depression or hopelessness variable. RESULTS Overall prediction was weaker than anticipated, with weighted mean odds ratios of 1.96 (1.81-2.13) for ideation, 1.63 (1.55-1.72) for attempt and 1.33 (1.18-1.49) for death. Adjusting for publication bias further reduced estimates. Effects generally persisted regardless of sample severity, sample age or follow-up length. CONCLUSIONS Several methodological constraints were prominent across studies; addressing these issues would likely be fruitful moving forward.Declaration of interestNone.
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Affiliation(s)
- Jessica D Ribeiro
- Department of Psychology,Florida State University,Tallahassee,Florida
| | - Xieyining Huang
- Department of Psychology,Florida State University,Tallahassee,Florida
| | - Kathryn R Fox
- Department of Psychology,Harvard University,Cambridge,Massachusetts
| | - Joseph C Franklin
- Department of Psychology,Florida State University,Tallahassee,Florida,USA
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115
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Becker SP, Dvorsky MR, Holdaway AS, Luebbe AM. Sleep problems and suicidal behaviors in college students. J Psychiatr Res 2018; 99:122-128. [PMID: 29448236 PMCID: PMC5962276 DOI: 10.1016/j.jpsychires.2018.01.009] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 12/04/2017] [Accepted: 01/11/2018] [Indexed: 11/19/2022]
Abstract
Using a large sample of college students, objectives were to examine (1) the overlap between poor sleep and suicide risk status, (2) whether poor sleep was associated with suicide behaviors above and beyond depression, (3) whether sleep problems and depression interacted to predict increased suicidal behaviors or risk, and (4) which specific components of sleep were uniquely associated with suicidal behaviors. Participants were 1700 college students (ages 18-29 years; 65% female) from two universities who completed measures assessing sleep, depressive symptoms, and suicidal behaviors (Suicidal Behaviors Questionnaire-Revised [SBQ-R], a composite measure including ideation, past attempt, disclosure to others, and future likelihood of suicide that includes a cutoff for determining participants with suicide risk). Approximately one-quarter (24%) of participants were classified with suicide risk. Four-fifths (82.7%) of participants classified with suicide risk also met cutoff criteria for sleep problems; conversely, almost one-third (31.3%) of the participants classified with sleep problems were also classified with suicide risk. Total sleep problems remained significantly associated with suicidal behaviors above and beyond depressive symptoms, though sleep and depression did not interact to predict suicidal behaviors or risk. When considered together and controlling for sex, the odds of being classified with suicide risk were 6.54 times greater for participants with elevated depressive symptoms and 2.70 times greater for participants with sleep problems. Analyses examining specific sleep domains found shorter sleep duration, having bad dreams, feeling too cold while sleeping, and sleep medication use to each be independently associated with suicidal behaviors. Findings add to a growing body of literature linking sleep and suicide in college students.
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Affiliation(s)
- Stephen P Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Melissa R Dvorsky
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Alex S Holdaway
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Aaron M Luebbe
- Department of Psychology, Miami University, Oxford, OH, USA
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Chu C, Hom MA, Stanley IH, Gai A, Nock MK, Gutierrez PM, Joiner TE. Non-suicidal self-injury and suicidal thoughts and behaviors: A study of the explanatory roles of the interpersonal theory variables among military service members and veterans. J Consult Clin Psychol 2018; 86:56-68. [PMID: 29172592 PMCID: PMC5754238 DOI: 10.1037/ccp0000262] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Research has identified non-suicidal self-injury (NSSI) as a robust correlate of suicidal thoughts and behaviors; however, little is known regarding why these constructs may be related. Consistent with the interpersonal theory of suicide, this study investigated thwarted belongingness (TB), perceived burdensomeness (PB), and capability for suicide (CS) as explanatory links in the association between NSSI, ideation, and suicide attempt history. METHOD Military service members and veterans (N = 973; agemean = 29.9 years, 78.8% male, 63.8% Caucasian/White) completed measures of lifetime NSSI and suicide attempts; current suicidal ideation; TB, PB, and CS; and related psychiatric symptoms. Bootstrap moderated mediation analyses were employed to examine whether (a) TB moderated the mediating effect of PB on NSSI and ideation, (b) PB moderated the mediating effect of TB on NSSI and ideation, and (c) CS moderated the mediating effect of TB and PB on NSSI and attempts. RESULTS TB and PB significantly accounted for the relationship between lifetime NSSI and current ideation. TB did not moderate the mediating effect of PB on NSSI and ideation, and PB did not moderate the mediating effect of TB. However, CS significantly moderated the mediating effects of TB and PB on NSSI and attempt history. CONCLUSIONS The interpersonal theory of suicide hypotheses were partially supported. Consistent with the theory, the interaction of TB and PB only explained NSSI and attempt history among service members with high levels of CS. TB and PB only individually explained the association between lifetime NSSI and recent suicidal ideation. Prospective studies are warranted to replicate these findings across other military samples. (PsycINFO Database Record
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Affiliation(s)
- Carol Chu
- Florida State University, Department of Psychology, Tallahassee, FL
- McLean Hospital, Belmont, MA
- Harvard Medical School, Department of Psychiatry, Cambridge, MA
| | - Melanie A. Hom
- Florida State University, Department of Psychology, Tallahassee, FL
| | - Ian H. Stanley
- Florida State University, Department of Psychology, Tallahassee, FL
| | - Anna Gai
- Florida State University, Department of Psychology, Tallahassee, FL
| | - Matthew K. Nock
- Harvard University, Department of Psychology, Cambridge, MA
- Massachusetts General Hospital, Boston, MA
| | - Peter M. Gutierrez
- Rocky Mountain Mental Illness Research, Education and Clinical Center, Denver Veterans Affairs Medical Center, Denver, CO
- University of Colorado School of Medicine, Department of Psychiatry, Aurora, CO
| | - Thomas E. Joiner
- Florida State University, Department of Psychology, Tallahassee, FL
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117
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Cvejic E, Huang S, Vollmer-Conna U. Can you snooze your way to an 'A'? Exploring the complex relationship between sleep, autonomic activity, wellbeing and performance in medical students. Aust N Z J Psychiatry 2018. [PMID: 28649873 DOI: 10.1177/0004867417716543] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Medical training brings with it multiple stressors, including demanding workloads in highly competitive environments, with well-documented impact on psychiatric morbidity. This study evaluated the impact of sleep-related factors on psychological wellbeing, cognitive task performance and academic standing in medical students. METHODS A total of 59 undergraduate medical students took part in this cross-sectional study over two consecutive days. Participants responded to questionnaires about their physical and psychological health, sleep, functioning and academic performance at the initial visit. Participants then wore an ambulatory bioharness overnight (to derive heart rate variability measures), before returning to complete a computerised battery of cognitive tasks. A sleep diary was completed for the next 7 days. RESULTS Poor sleep quality in the month preceding assessment correlated with psychological distress ( p < 0.001) and reduced nocturnal heart rate variability ( p = 0.007). Psychological distress also correlated with reduced nocturnal heart rate variability ( p = 0.031) and less refreshing sleep during the monitoring week ( p < 0.001), but not with sleep timing parameters. A greater increase in heart rate variability during the transition from awake to sleep significantly predicted better spontaneous cognitive performance ( p = 0.021). Better academic standing was predicted by consistently short, less refreshing sleep (all p < 0.001), along with earlier bedtimes ( p = 0.004) and greater psychological wellbeing ( p = 0.009). CONCLUSION Unrefreshing, short-duration sleep and psychological distress are prevalent in medical students during university training and were associated with reduced nocturnal parasympathetic autonomic activity. Achieving higher academic grades was associated with high psychological wellbeing despite consistently short, unrefreshing sleep. The long-term repercussions of such sleep behaviours on later professional functioning remain unclear, warranting further research.
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Affiliation(s)
- Erin Cvejic
- 1 Department of Human Behaviour, School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia.,2 University of Sydney, School of Public Health. Sydney, NSW, Australia
| | - Shiny Huang
- 1 Department of Human Behaviour, School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia
| | - Uté Vollmer-Conna
- 1 Department of Human Behaviour, School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia
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118
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Pereira-Morales AJ, Adan A, Forero DA. Network analysis of multiple risk factors for mental health in young Colombian adults. J Ment Health 2017; 28:153-160. [PMID: 29265896 DOI: 10.1080/09638237.2017.1417568] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND A considerable proportion of young adults are affected by psychological distress at any time and an important fraction of them may develop mental disorders. Use of novel approaches for the analysis of data from multiple psychological scales might facilitate the identification of key indicators of mental health. AIMS The aim of current study was to examine the relationship between multiple risk factors for mental illness, using a network analysis perspective. METHODS A sample of 334 young Colombian adults (mean age = 21.7) were evaluated with validated scales measuring several psychosocial factors previously associated with mental health (e.g. worry, sleep problems, suicidal ideation, childhood abuse, alcohol related-problems and personality traits). A total of 24 nodes were included in the network analysis and topology, centrality, and stability of the networks were studied. RESULTS Specific nodes that occupied critical positions in the network were identified, with worry, perceived distress and low energy being the most central nodes. CONCLUSIONS Our explorative findings suggest that a network analysis might identify risk factors that have a central role in the multiple dimensions of emotional health in young adults. These novel analyses could have important applications for the understanding of the psychological functioning affecting mental health.
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Affiliation(s)
- Angela J Pereira-Morales
- a Laboratory of Neuropsychiatric Genetics, Biomedical Sciences Research Group, School of Medicine, Universidad Antonio Nariño , Bogotá , Colombia
| | - Ana Adan
- b Department of Clinical Psychology and Psychobiology , School of Psychology, University of Barcelona , Barcelona , Spain , and.,c Institute of Neurosciences, University of Barcelona , Barcelona , Spain
| | - Diego A Forero
- a Laboratory of Neuropsychiatric Genetics, Biomedical Sciences Research Group, School of Medicine, Universidad Antonio Nariño , Bogotá , Colombia
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119
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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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120
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Ringer FB, Soberay KA, Rogers ML, Hagan CR, Chu C, Schneider M, Podlogar MC, Witte T, Holm-Denoma J, Plant EA, Gutierrez PM, Joiner TE. Initial validation of brief measures of suicide risk factors: Common data elements used by the Military Suicide Research Consortium. Psychol Assess 2017; 30:767-778. [PMID: 29130694 DOI: 10.1037/pas0000519] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The Military Suicide Research Consortium (MSRC) developed a 57-item questionnaire assessing suicide risk factors, referred to as the Common Data Elements (CDEs), in order to facilitate data sharing and improve collaboration across independent studies. All studies funded by MSRC are required to include the CDEs in their assessment protocol. The CDEs include shortened measures of the following: current and past suicide risk, lethality and intent of past suicide attempts, hopelessness, thwarted belongingness, anxiety sensitivity, posttraumatic stress disorder symptoms, traumatic brain injury, insomnia, and alcohol abuse. This study aimed to evaluate the psychometric properties of the CDE items drawn from empirically validated measures. Exploratory factor analysis was used to examine the overall structure of the CDE items, and confirmatory factor analyses were used to evaluate the distinct properties of each scale. Internal consistencies of the CDE scales and correlations with full measures were also examined. Merged data from 3,140 participants (81.0% military service members, 75.6% male) across 19 MSRC-funded studies were used in analyses. Results indicated that all measures exhibited adequate internal consistency, and all CDE shortened measures were significantly correlated with the corresponding full measures with moderate to strong effect sizes. Factor analyses indicated that the shortened CDE measures performed well in comparison with the full measures. Overall, our findings suggest that the CDEs are not only brief but also provide psychometrically valid scores when assessing suicide risk and related factors that may be used in future research. (PsycINFO Database Record
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Affiliation(s)
| | - Kelly A Soberay
- Rocky Mountain Mental Illness Research, Education and Clinical Center, Denver Veterans Affairs Medical Center
| | | | | | - Carol Chu
- Department of Psychology, Florida State University
| | | | | | - Tracy Witte
- Department of Psychology, Florida State University
| | | | | | - Peter M Gutierrez
- Rocky Mountain Mental Illness Research, Education and Clinical Center, Denver Veterans Affairs Medical Center
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121
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Fisher K, Houtsma C, Assavedo BL, Green BA, Anestis MD. Agitation as a Moderator of the Relationship Between Insomnia and Current Suicidal Ideation in the Military. Arch Suicide Res 2017; 21:531-543. [PMID: 27435680 DOI: 10.1080/13811118.2016.1193077] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Research has established a link between agitation and insomnia, both of which are considered to be risk factors for suicide. The present study aimed to investigate the moderating role of agitation within the relationship between insomnia and current suicidal ideation in a sample of U.S. military personnel. Consistent with hypotheses, the relationship between insomnia and current suicidal ideation was significant only at high levels of agitation. Results support previous findings indicating that both insomnia and agitation are suicide risk factors. These findings clarify the role of known risk factors in the pathway to suicide and may contribute to the advancement of suicide detection and prevention, as these factors may be more easily identified in individuals unwilling to admit thoughts of death and suicide, such as many military personnel.
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122
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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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123
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Suh S, Ryu H, Chu C, Hom M, Rogers ML, Joiner T. Validation of the Korean Depressive Symptom Inventory-Suicidality Subscale. Psychiatry Investig 2017; 14:577-584. [PMID: 29042882 PMCID: PMC5639125 DOI: 10.4306/pi.2017.14.5.577] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/18/2016] [Accepted: 09/26/2016] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE The present study aimed to validate a Korean version of the self-report Depressive Symptom Inventory-Suicidality Subscale (DSI-SS). METHODS 553 South Korean undergraduate students (aged 18-34 years, 74.8% females) completed questionnaires. Participants completed Korean versions of the self-report Depressive Symptom Inventory-Suicidality Subscale (DSI-SS), Beck Depression Inventory-II (BDI-II), Insomnia Severity Index (ISI), Beck Scale for Suicide Ideation (BSS), and a measure of suicide-related symptom history. RESULTS Results indicated that the DSI-SS demonstrated excellent internal consistency (α=0.93) and strong convergent validity with the BDI (r=0.57, p<0.01), ISI (r=0.27, p<0.01), and BSS (r=0.70, p<0.01). DSI-SS scores also significantly differentiated between those reporting a history of suicide attempts compared to non-suicide attempters [t (38.80)=-3.28, p<0.05]. CONCLUSION Given the brevity of this measure, and evidence for its validity, the Korean version of the DSI-SS may be particularly promising for clinical and empirical use as a screening tool among South Korean undergraduates.
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Affiliation(s)
- Sooyeon Suh
- Department of Psychology, Sungshin Women's University, Seoul, Republic of Korea
- Department of Psychiatry, Stanford University, Palo Alto, CA, USA
| | - Hyera Ryu
- Department of Psychology, Sungshin Women's University, Seoul, Republic of Korea
| | - Carol Chu
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Melanie Hom
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Megan L. Rogers
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Thomas Joiner
- Department of Psychology, Florida State University, Tallahassee, FL, USA
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124
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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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125
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Bernert RA, Hom MA, Iwata NG, Joiner TE. Objectively Assessed Sleep Variability as an Acute Warning Sign of Suicidal Ideation in a Longitudinal Evaluation of Young Adults at High Suicide Risk. J Clin Psychiatry 2017; 78:e678-e687. [PMID: 28682534 PMCID: PMC6613567 DOI: 10.4088/jcp.16m11193] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 01/05/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Young adults attempt suicide at disproportionately high rates relative to other groups and demonstrate high rates of sleep disturbance. No study has yet prospectively evaluated disturbed sleep as an acute indicator of risk using an objective index of sleep. We investigated objective and subjective parameters of disturbed sleep as a warning sign of suicidal ideation among young adults over an acute period. METHODS A longitudinal study across a 21-day observation period and 3 time points. Fifty of 4,847 participants (aged 18-23 years) were prescreened from a university undergraduate research pool (February 2007-June 2008) on the basis of suicide attempt history and recent suicidal ideation. Actigraphic and subjective sleep parameters were evaluated as acute predictors of suicidal ideation (Beck Scale for Suicide Ideation), with adjustment for baseline symptoms. Hierarchical regression analyses were employed to predict residual change scores. RESULTS Ninety-six percent of participants (n = 48) endorsed a suicide attempt history. Mean actigraphy values revealed objectively disturbed sleep parameters; 78% (n = 39) and 36% (n = 18) endorsed clinically significant insomnia and nightmares, respectively. When results were controlled for baseline suicidal and depressive symptoms, actigraphic and subjective sleep parameters predicted suicidal ideation residual change scores at 7- and 21-day follow-ups (P < .001). Specifically, actigraphy-defined variability in sleep timing, insomnia, and nightmares predicted increases in suicidal ideation (P < .05). In a test of competing risk factors, sleep variability outperformed depressive symptoms in the longitudinal prediction of suicidal ideation across time points (P < .05). CONCLUSIONS Objectively and subjectively measured sleep disturbances predicted acute suicidal ideation increases in this population, independent of depressed mood. Self-reported insomnia and nightmares and actigraphically assessed sleep variability emerged as acute warning signs of suicidal ideation. These findings highlight the potential utility of sleep as a proposed biomarker of suicide risk and a therapeutic target.
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Affiliation(s)
- Rebecca A. Bernert
- Stanford University School of Medicine, Stanford Mood Disorders Center, Department of Psychiatry and Behavioral Sciences, Stanford, CA, United States
| | - Melanie A. Hom
- Florida State University, Department of Psychology, Tallahassee, FL, United States
| | - Naomi G. Iwata
- Stanford University School of Medicine, Stanford Mood Disorders Center, Department of Psychiatry and Behavioral Sciences, Stanford, CA, United States
| | - Thomas E. Joiner
- Florida State University, Department of Psychology, Tallahassee, FL, United States
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126
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Michaels MS, Balthrop T, Nadorff MR, Joiner TE. Total sleep time as a predictor of suicidal behaviour. J Sleep Res 2017; 26:732-738. [DOI: 10.1111/jsr.12563] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 04/18/2017] [Indexed: 12/18/2022]
Affiliation(s)
| | | | - Michael R. Nadorff
- Mississippi State University; Starkville MS USA
- Department of Psychiatry and Behavioral Sciences; Baylor College of Medicine; Houston TX USA
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127
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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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128
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Allan NP, Conner KR, Pigeon WR, Gros DF, Salami TK, Stecker T. Insomnia and suicidal ideation and behaviors in former and current U.S. service members: Does depression mediate the relations? Psychiatry Res 2017; 252:296-302. [PMID: 28301827 DOI: 10.1016/j.psychres.2017.03.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 02/24/2017] [Accepted: 03/06/2017] [Indexed: 01/30/2023]
Abstract
Insomnia is a risk factor for Suicidal Ideation (SI) and Behavior (SB), yet the nature of the relations is unclear, including the potential mediating role of cognitive and affective/somatic symptoms of depression. It was hypothesized that the impact of insomnia on SI would be mediated through depressive symptoms and that insomnia would directly impact SB. Current and former military service members (N =405; M age =31.6 years, SD =7.3; 90.4% male, 76.5% White) who endorsed recent suicidal ideation and/or a history of suicide attempt completed measures of insomnia, depression, SI, and SB at baseline and at month 12 follow-up. Mediation models were conducted using structural equation modeling. Significant mediation from insomnia to baseline SI and month 12 SI was found through cognitive/affective depression. Insomnia was directly related to SB occurring between baseline and month 12 follow-up. These findings suggest that cognitive/affective depression mediates the association with SI but not SB. Results build on research showing the importance of depressive symptoms in SI in particular. The direct and indirect pathways from insomnia to SI/SB suggest that clinicians should be aware of these relations when treating patients reporting insomnia.
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Affiliation(s)
- Nicholas P Allan
- Mental Health Service, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA; Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA; Department of Psychology, Ohio University, Athens, OH, USA.
| | - Kenneth R Conner
- Departments of Emergency Medicine and Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Wilfred R Pigeon
- Center of Excellence for Suicide Prevention, Canandaigua Veterans Affairs Medical Center, Canandaigua, NY, USA; Departments of Emergency Psychiatry and Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Daniel F Gros
- Mental Health Service, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA; Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | | | - Tracy Stecker
- Mental Health Service, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA; Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
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129
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Musyimi CW, Mutiso VN, Nayak SS, Ndetei DM, Henderson DC, Bunders J. Quality of life of depressed and suicidal patients seeking services from traditional and faith healers in rural Kenya. Health Qual Life Outcomes 2017; 15:95. [PMID: 28482849 PMCID: PMC5422872 DOI: 10.1186/s12955-017-0657-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 04/13/2017] [Indexed: 11/27/2022] Open
Abstract
Background In rural Kenya, traditional and faith healers provide an alternative pathway to health care, including mental health care. However, not much is known about the characteristics of the populations they serve. The purpose of this study was to determine the relationship between depression, suicidal ideation, and socio-demographic variables with Quality of Life (QoL) indicators in a sample seeking mental health services from traditional and faith healers in rural Kenya. Understanding QoL in this sample can help develop mental health policy and training to improve the well-being of this population. Method This was a cross-sectional epidemiological survey (n = 443) conducted over a period of 3 months among adult patients seeking care from traditional and faith healers in rural Kenya. Data were collected using the Beck Depression Inventory II (BDI-II), Beck Scale for Suicide Ideation (BSS) and WHO Quality of Life Survey- BREF (WHOQOL-BREF), and analyzed using correlation analyses, parametric tests, and regression analyses. Results Increasing levels of depression were associated with lower QoL among patients seeking care from traditional and faith healers. BSS scores were significantly negatively correlated with overall, physical, psychological, and environmental QoL, p < .05. There was a statistically significant difference between mean scores for overall QoL between depressed (M = 2.35, SD = 0.76) and non-depressed participants (M = 3.03, SD = 0.67), t(441) = 8.899, p < .001. Overall life satisfaction for depressed participants (M = 2.23, SD = 0.69) was significantly lower than non-depressed participants. Regression analyses indicated that depression, suicidal ideation, and being married predicted lower overall QoL controlling for other variables. Post hoc tests and subgroup analysis by gender revealed significant differences for females only. Depression, and older age predicted lower life satisfaction whereas being self-employed predicted higher life satisfaction, when controlling for other variables. Conclusion This study sheds light on correlates of QoL in depressed and non-depressed patients in rural Kenya. Evidence suggests that traditional and faith healers treat patients with a variety of QoL issues. Further research should focus on understanding how these issues tie into QoL, and how these healers can target these to improve care.
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Affiliation(s)
- Christine W Musyimi
- Africa Mental Health Foundation, Nairobi, Kenya.,Vrije Universiteit, Amsterdam, Netherlands
| | | | | | - David M Ndetei
- Africa Mental Health Foundation, Nairobi, Kenya. .,University of Nairobi, Nairobi, Kenya.
| | - David C Henderson
- Boston University School of Medicine, Boston, USA.,Harvard Medical School, Boston, USA
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130
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Winslow BD, Nguyen N, Venta KE. Improved Mental Acuity Forecasting with an Individualized Quantitative Sleep Model. Front Neurol 2017; 8:160. [PMID: 28487671 PMCID: PMC5403829 DOI: 10.3389/fneur.2017.00160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 04/05/2017] [Indexed: 11/25/2022] Open
Abstract
Sleep impairment significantly alters human brain structure and cognitive function, but available evidence suggests that adults in developed nations are sleeping less. A growing body of research has sought to use sleep to forecast cognitive performance by modeling the relationship between the two, but has generally focused on vigilance rather than other cognitive constructs affected by sleep, such as reaction time, executive function, and working memory. Previous modeling efforts have also utilized subjective, self-reported sleep durations and were restricted to laboratory environments. In the current effort, we addressed these limitations by employing wearable systems and mobile applications to gather objective sleep information, assess multi-construct cognitive performance, and model/predict changes to mental acuity. Thirty participants were recruited for participation in the study, which lasted 1 week. Using the Fitbit Charge HR and a mobile version of the automated neuropsychological assessment metric called CogGauge, we gathered a series of features and utilized the unified model of performance to predict mental acuity based on sleep records. Our results suggest that individuals poorly rate their sleep duration, supporting the need for objective sleep metrics to model circadian changes to mental acuity. Participant compliance in using the wearable throughout the week and responding to the CogGauge assessments was 80%. Specific biases were identified in temporal metrics across mobile devices and operating systems and were excluded from the mental acuity metric development. Individualized prediction of mental acuity consistently outperformed group modeling. This effort indicates the feasibility of creating an individualized, mobile assessment and prediction of mental acuity, compatible with the majority of current mobile devices.
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Affiliation(s)
| | - Nam Nguyen
- Design Interactive Inc., Orlando, FL, USA
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131
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Pederson CL, Blettner Brook J. Sleep disturbance linked to suicidal ideation in postural orthostatic tachycardia syndrome. Nat Sci Sleep 2017; 9:109-115. [PMID: 28442939 PMCID: PMC5396946 DOI: 10.2147/nss.s128513] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE We investigated the prevalence of suicidal ideation in relationship with symptoms of sleep disruption in people with postural orthostatic tachycardia syndrome (POTS). METHODS Online surveys (including the Pittsburgh Sleep Quality Index and the Suicide Behaviors Questionnaire - Revised) were completed by 705 POTS patients and 170 non-POTS controls. RESULTS Poor sleep quality was reported in 98.4% of POTS patients with a calculated subjective sleep efficiency of 65.4%. The POTS group's sleep efficiency was significantly lower (t[873]= -11.32; p<0.001) and sleep disturbances because of pain were significantly higher (t[873]=15.36; p<0.001) than controls. Chi-square testing showed a larger proportion of individuals at high-risk for suicide among POTS patients than controls (c2 [1, n=875]=55.6; p<0.001). Multiple linear regression analysis showed that sleep scores (β=0.23, p<0.001), age (β=-0.03, p<0.001), and illness with POTS (β=0.68, p=0.05) were significantly associated with suicide ideation scores (F[4, 870]=38.34, p<0.001). This model explained 15% of variance (R2=0.15) in suicidal ideation scores. CONCLUSION Patients with POTS may suffer from increased sleep disturbance and suicidal ideation compared with the general population. Treatment to improve sleep efficiency and sleep quality is an important step toward better quality of life for POTS patients.
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132
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Cox RC, Tuck BM, Olatunji BO. Sleep Disturbance in Posttraumatic Stress Disorder: Epiphenomenon or Causal Factor? Curr Psychiatry Rep 2017; 19:22. [PMID: 28321643 DOI: 10.1007/s11920-017-0773-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE OF REVIEW The goal of this review is to integrate recent findings on sleep disturbance and PTSD, examine sleep disturbance as a causal factor in the development of PTSD, and identify future directions for research, treatment, and prevention. RECENT FINDINGS Recent research highlights a relationship between both objective and subjective sleep disturbance and PTSD across diverse samples. Sleep disturbance also predicts PTSD over time. Finally, treatments targeting sleep disturbance lead to decreased PTSD symptoms, while standard PTSD treatments conclude with residual sleep disturbance. Sleep disturbance may be more than a mere epiphenomenon of PTSD. Future research examining the causal role of sleep disturbance in the development of PTSD, as well as the utility of targeting sleep disturbance in prevention and treatment, is necessary to fully understand the likely bidirectional relationship between sleep disturbance and PTSD.
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Affiliation(s)
- Rebecca C Cox
- Department of Psychology, Vanderbilt University, 301 Wilson Hall, 111 21st Avenue South, Nashville, TN, 37240, USA
| | - Breanna M Tuck
- Department of Psychology, Vanderbilt University, 301 Wilson Hall, 111 21st Avenue South, Nashville, TN, 37240, USA
| | - Bunmi O Olatunji
- Department of Psychology, Vanderbilt University, 301 Wilson Hall, 111 21st Avenue South, Nashville, TN, 37240, USA.
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133
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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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134
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Edinger JD, Manber R, Buysse DJ, Krystal AD, Thase ME, Gehrman P, Fairholme CP, Luther J, Wisniewski S. Are Patients with Childhood Onset of Insomnia and Depression More Difficult to Treat Than Are Those with Adult Onsets of These Disorders? A Report from the TRIAD Study. J Clin Sleep Med 2017; 13:205-213. [PMID: 27784414 DOI: 10.5664/jcsm.6448] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 09/12/2016] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To determine if patients with childhood onsets (CO) of both major depression and insomnia disorder show blunted depression and insomnia treatment responses to concurrent interventions for both disorders compared to those with adult onsets (AO) of both conditions. METHODS This study was a secondary analysis of data obtained from a multisite randomized clinical trial designed to test the efficacy of combining a psychological/behavior insomnia therapy with antidepressant medication to enhance depression treatment outcomes in patients with comorbid major depression and insomnia. This study included 27 adults with CO of depression and insomnia and 77 adults with AO of both conditions. They underwent a 16-week treatment including: (1) a standardized two-step pharmacotherapy for depression algorithm, consisting of escitalopram, sertraline, and desvenlafaxine in a prescribed sequence; and (2) either cognitive behavioral insomnia therapy (CBT-I) or a quasi-desensitization control (CTRL) therapy. Main outcome measures were the 17-item Hamilton Rating Scale for Depression (HRSD-17) and the Insomnia Severity Index (ISI) completed pre-treatment and every 2 weeks thereafter. RESULTS The AO and CO groups did not differ significantly in regard to their pre-treatment HRSD-17 and ISI scores. Mixed model analyses that adjusted for the number of insomnia treatment sessions attended showed that the AO group achieved significantly lower, subclinical scores on the HRSD-17 and ISI than did the CO group by the time of study exit. Moreover, a significant group by treatment arm interaction suggested that HRSD-17 scores at study exit remained significantly higher in the CO group receiving the CTRL therapy than was the case for the participants in the CO group receiving CBT-I. Greater proportions of the AO group achieved a priori criteria for remission of insomnia (49.3% vs. 29.2%, p = 0.04) and depression (45.5% vs. 29.6%, p = 0.07) than did those in the CO group. CONCLUSIONS Patients with comorbid depression and insomnia who experienced the first onset of both disorders in childhood are less responsive to the treatments offered herein than are those with adult onsets of these comorbid disorders. Further research is needed to identify therapies that enhance the depression and insomnia treatment responses of those with childhood onsets of these two conditions.
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Affiliation(s)
- Jack D Edinger
- Department of Medicine, National Jewish Health, Denver, CO.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Rachel Manber
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA
| | - Daniel J Buysse
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - Andrew D Krystal
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Michael E Thase
- Department of Psychiatry, Perelman School of Medicine of the University of Pennsylvania and the Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA
| | - Phillip Gehrman
- Department of Psychiatry, Perelman School of Medicine of the University of Pennsylvania and the Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA
| | | | - James Luther
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
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135
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Pederson CL, Brook JB. Health-related quality of life and suicide risk in postural tachycardia syndrome. Clin Auton Res 2017; 27:75-81. [PMID: 28168561 DOI: 10.1007/s10286-017-0399-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 01/18/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE Postural tachycardia syndrome (POTS) is a disorder featured by orthostatic intolerance. The purpose of this study was to investigate the severity of quality of life issues in POTS patients. METHODS Online surveys for health related quality of life, sleep quality, fatigue, pain, and suicidal ideation were completed by 624 POTS patients and 139 controls. RESULTS People with POTS have significantly more days of poor physical health (p < 0.001), fewer days with good energy (p < 0.001), and significantly more days with activity limitations (p < 0.001) than controls. Pain severity was significantly higher for those with POTS (p < 0.001) while feelings of control over life was lower than controls (p < 0.001). Sleep quality and daytime fatigue were also significantly worse for those with POTS than controls (p < 0.001). Finally, those with POTS have a significantly higher risk of suicide compared with controls (p < 0.001). INTERPRETATION The myriad of symptoms from which many POTS patients suffer is associated with a decreased quality of life. Nearly half of our sample with POTS was at high risk for suicide. More work needs to be done to determine the underlying issues surrounding suicide in POTS so that an appropriate treatment regimen can be developed.
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Affiliation(s)
- Cathy L Pederson
- Department of Biology, Wittenberg University, P.O. Box 720, Springfield, OH, 45501, USA.
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136
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Hom MA, Chu C, Schneider ME, Lim IC, Hirsch JK, Gutierrez PM, Joiner TE. Thwarted belongingness as an explanatory link between insomnia symptoms and suicidal ideation: Findings from three samples of military service members and veterans. J Affect Disord 2017; 209:114-123. [PMID: 27898373 PMCID: PMC5333761 DOI: 10.1016/j.jad.2016.11.032] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 10/27/2016] [Accepted: 11/15/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although insomnia has been identified as a robust predictor of suicidal ideation and behaviors, little is known about the mechanisms by which sleep disturbances confer risk for suicide. We investigated thwarted belongingness as an explanatory link between insomnia symptoms and suicidal ideation across three military service member and veteran samples. METHODS Data were collected among United States military service members and veterans (N1=937, N2=3,386, N3=417) who completed self-report measures of insomnia symptoms, thwarted belongingness, suicidal ideation, and related psychiatric symptoms (e.g., anxiety, hopelessness). Bias-corrected bootstrap mediation analyses were utilized to examine the indirect effects of insomnia symptoms on suicidal ideation through thwarted belongingness, controlling for related psychiatric symptoms. RESULTS Consistent with study hypotheses, thwarted belongingness significantly accounted for the relationship between insomnia and suicidal ideation across all three samples; however, insomnia symptoms did not significantly account for the relationship between thwarted belongingness and suicidal ideation, highlighting the specificity of our findings. LIMITATIONS This study utilized cross-sectional self-report data. CONCLUSIONS Insomnia may confer suicide risk for military service members and veterans, in part, through the pathway of thwarted belongingness. Additional prospective studies are warranted to further delineate this model of risk. Our results offer a potential therapeutic target for the prevention of suicide, via the promotion of belongingness, among service members and veterans experiencing insomnia symptoms.
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Affiliation(s)
- Melanie A Hom
- Department of Psychology, Florida State University, United States.
| | - Carol Chu
- Department of Psychology, Florida State University, United States
| | | | - Ingrid C Lim
- Office of the Army Surgeon General, United States
| | - Jameson K Hirsch
- Department of Psychology, East Tennessee State University, United States
| | - Peter M Gutierrez
- Rocky Mountain Mental Illness Research, Education and Clinical Center, Denver Veterans Affairs Medical Center, United States; Department of Psychiatry, University of Colorado School of Medicine, United States
| | - Thomas E Joiner
- Department of Psychology, Florida State University, United States
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137
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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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138
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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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139
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An examination of sleep quality in veterans with a dual diagnosis of PTSD and severe mental illness. Psychiatry Res 2017; 247:15-20. [PMID: 27863313 DOI: 10.1016/j.psychres.2016.07.062] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/25/2016] [Accepted: 07/12/2016] [Indexed: 11/21/2022]
Abstract
Poor sleep quality is one of the most frequently reported symptoms by veterans with Posttraumatic Stress Disorder (PTSD) and by veterans with severe mental illness (SMI; i.e., schizophrenia spectrum disorders, bipolar disorder, major depression with or without psychotic features). However, little is known about the compounding effects of co-occurring PTSD/SMI on sleep quality in this population. Given the high rates of comorbidity and poor functional outcomes associated with sleep dysfunction, there is a need to better understand patterns of poor sleep quality in this population. The present study provides a description of sleep quality in veterans with a dual diagnosis of PTSD/SMI relative to veterans with PTSD only. Results indicated that, despite similar reports of PTSD symptom severity between the groups, veterans with PTSD/SMI reported higher levels of poor sleep quality than veterans only diagnosed with PTSD. Specifically, veterans with PTSD/SMI reported significantly greater difficulties with sleep onset and overall more sleep disturbance than their non-SMI counterparts. Implications of the findings are discussed within the context of an existing model of insomnia and suggest that more comprehensive sleep assessment and the provision of targeted sleep interventions may be helpful for those with a dual diagnosis of PTSD/SMI.
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140
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O'Connor SS, Carney E, Jennings KW, Johnson LL, Gutierrez PM, Jobes DA. Relative Impact of Risk Factors, Thwarted Belongingness, and Perceived Burdensomeness on Suicidal Ideation in Veteran Service Members. J Clin Psychol 2016; 73:1360-1369. [DOI: 10.1002/jclp.22426] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 10/14/2016] [Accepted: 10/31/2016] [Indexed: 11/08/2022]
Affiliation(s)
| | | | | | | | - Peter M. Gutierrez
- Rocky Mountain Mental Illness Research, Education and Clinical Center, Denver Veterans Affairs Medical Center
- University of Colorado School of Medicine
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141
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Logan J, Bohnert A, Spies E, Jannausch M. Suicidal ideation among young Afghanistan/Iraq War Veterans and civilians: Individual, social, and environmental risk factors and perception of unmet mental healthcare needs, United States, 2013. Psychiatry Res 2016; 245:398-405. [PMID: 27611069 PMCID: PMC5808402 DOI: 10.1016/j.psychres.2016.08.054] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 08/17/2016] [Accepted: 08/19/2016] [Indexed: 11/20/2022]
Abstract
Suicidal Ideation among Afghanistan/Iraq War Veterans remains a health concern. As young Veterans adjust to civilian life, new risk factors might emerge and manifest differently in this group versus those in the general population. We explored these differences. With 2013 National Survey on Drug Use and Health data, we examined differences in risk of past-year suicidal ideation between Veterans of the Afghanistan/Iraq War periods aged 18-34 years (N=328) and age-comparable civilians (N=23,222). We compared groups based on individual and socio-environmental risk factors as well as perceptions of unmet mental healthcare needs. We report adjusted rate ratios (aRRs); interaction terms tested for between-group differences. PY suicidal ideation rates for Veterans and civilians did not differ (52 versus 59 per 1,000, p=0.60) and both groups shared many risk factors. However, drug problems and perceived unmet mental health care needs were vastly stronger risk factors among Veterans versus civilians (interaction terms indicated that the aRRs were 3.8-8.0 times higher for Veterans versus civilians). Other differences were discovered as well. Past-year suicidal ideation rates did not differ by Veteran status among young adults. However, different risk factors per group were detected, which can inform Veteran suicide prevention efforts.
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Affiliation(s)
- Joseph Logan
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention, 4770 Buford Highway, MS-F63, Atlanta, GA 30341-3724, USA.
| | - Amy Bohnert
- University of Michigan and US Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Erica Spies
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention, 4770 Buford Highway, MS-F63, Atlanta, GA 30341-3724, USA
| | - Mary Jannausch
- University of Michigan and US Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA
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142
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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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143
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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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144
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Insomnia brings soldiers into mental health treatment, predicts treatment engagement, and outperforms other suicide-related symptoms as a predictor of major depressive episodes. J Psychiatr Res 2016; 79:108-115. [PMID: 27218816 PMCID: PMC7871899 DOI: 10.1016/j.jpsychires.2016.05.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 04/04/2016] [Accepted: 05/09/2016] [Indexed: 11/21/2022]
Abstract
Given the high rates of suicide among military personnel and the need to characterize suicide risk factors associated with mental health service use, this study aimed to identify suicide-relevant factors that predict: (1) treatment engagement and treatment adherence, and (2) suicide attempts, suicidal ideation, and major depressive episodes in a military sample. Army recruiters (N = 2596) completed a battery of self-report measures upon study enrollment. Eighteen months later, information regarding suicide attempts, suicidal ideation, major depressive episodes, and mental health visits were obtained from participants' military medical records. Suicide attempts and suicidal ideation were very rare in this sample; negative binomial regression analyses with robust estimation were used to assess correlates and predictors of mental health treatment visits and major depressive episodes. More severe insomnia and agitation were significantly associated with mental health visits at baseline and over the 18-month study period. In contrast, suicide-specific hopelessness was significantly associated with fewer mental health visits. Insomnia severity was the only significant predictor of major depressive episodes. Findings suggest that assessment of sleep problems might be useful in identifying at-risk military service members who may engage in mental health treatment. Additional research is warranted to examine the predictive validity of these suicide-related symptom measures in a more representative, higher suicide risk military sample.
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145
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Silva C, Hagan CR, Rogers ML, Chiurliza B, Podlogar MC, Hom MA, Tzoneva M, Lim IC, Joiner TE. Evidence for the Propositions of the Interpersonal Theory of Suicide Among a Military Sample. J Clin Psychol 2016; 73:669-680. [PMID: 27478932 DOI: 10.1002/jclp.22347] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 03/01/2016] [Accepted: 05/31/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Although the interpersonal theory of suicide may explain the elevated suicide risk among military service members, past explorations have been equivocal. This study aimed to investigate the propositions of the interpersonal theory in a sample of U.S. Army recruiters. METHOD Participants (N = 3,428) completed self-report measures assessing the interpersonal theory's constructs (i.e., thwarted belongingness (TB), perceived burdensomeness (PB), acquired capability for suicide), current suicidal ideation, agitation, and insomnia. History of depression was obtained from medical records. RESULTS Hierarchical multiple regression analyses revealed that the interaction between TB and PB was associated with current suicidal ideation, controlling for depression, agitation, and insomnia. This effect was especially notable among those with high capability for suicide. CONCLUSION Findings provide support for the interpersonal theory in a large, diverse military sample. It may be advantageous to assess and therapeutically address TB and PB among at-risk service members.
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146
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Bozzay ML, Karver MS, Verona E. Linking insomnia and suicide ideation in college females: The role of socio-cognitive variables and depressive symptoms in suicide risk. J Affect Disord 2016; 199:106-13. [PMID: 27100055 DOI: 10.1016/j.jad.2016.04.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 03/17/2016] [Accepted: 04/11/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Although insomnia symptoms are associated with risk of suicide ideation, the means by which insomnia influences ideation, as well as the role depression plays in these relationships, require further study. In this study, we examined whether certain socio-cognitive variables (fatigue, social problem-solving, and hopelessness) in conjunction with depression explained this relationship among female college students. METHODS 483 female students completed measures assessing insomnia and depressive symptoms, fatigue, social problem-solving ability, hopelessness, and suicide ideation. RESULTS Path analyses indicated that socio-cognitive variables partially explained the insomnia-ideation relationship above the influence of depressive symptoms. Higher depressive symptoms exacerbated relationships between social problem-solving and hopelessness, heightening ideation risk. CONCLUSIONS Our findings expand knowledge of intermediate socio-cognitive variables that may contribute to the insomnia-ideation relationship, and indicate that clinically-severe depressive symptoms compound the contribution of negative self and future appraisals to thoughts of suicide. Suicidal females with insomnia and depressive symptoms may benefit from interventions targeting problem-solving skills and improving sleep.
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Affiliation(s)
- Melanie L Bozzay
- Department of Psychology, University of South Florida, 4202 East Fowler Ave, PCD 4118G, Tampa, FL 33620, USA.
| | - Marc S Karver
- Department of Psychology, University of South Florida, 4202 East Fowler Ave, PCD 4118G, Tampa, FL 33620, USA
| | - Edelyn Verona
- Department of Psychology, University of South Florida, 4202 East Fowler Ave, PCD 4118G, Tampa, FL 33620, USA
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147
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Matsumoto Y, Uchimura N, Ishida T, Toyomasu K, Morimatsu Y, Mori M, Kushino N, Hoshiko M, Ishitake T. Day workers suffering from a wider range of sleep problems are more likely to experience suicidality. Sleep Biol Rhythms 2016; 14:369-376. [PMID: 27738408 PMCID: PMC5037152 DOI: 10.1007/s41105-016-0067-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 06/06/2016] [Indexed: 12/17/2022]
Abstract
Both a higher suicide rate and widespread sleep problems are serious health concerns in Japan when compared with those of other countries. We investigated the relationship between suicidal ideation and sleep problems in Japanese day workers using the 3-dimensional sleep scale (3DSS), which measures three sleep elements (phase, quality, and quantity). Data from 635 Japanese day workers (461 mens and 174 womens) were included. The 3DSS was used to assess participants' sleep condition. Participants were classified into eight sleep types based on scores of phase, quality, and quantity: All Good Sleep, Owl (poor phase), Inefficient (poor quality), Short (poor quantity), Owl + Inefficient (poor phase and quality), Owl + Short (poor phase and quantity), Inefficient + Short (poor quality and quantity), and All Poor Sleep. We assessed participants' suicidal ideation using question 19 of the self-rating depression scale (SDS); 119 cases (18.7 %) had ratings of 2-4 for this question and were considered to have suicidal ideation. The higher the number of sleep problems, the higher the risk of suicidal ideation compared to sleep types not indicative of problems. All Poor Sleep had the highest risk of the eight sleep types. Individuals with Owl + Short, Inefficient + Short, or All Poor Sleep had a significant risk of suicidal ideation even after adjusting for hopelessness and nightmares. Our findings suggested that sleep problems assessed by the 3DSS were related to suicidal ideation. Analysis of various aspects of sleep could be helpful for suicide prevention.
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Affiliation(s)
- Yuuki Matsumoto
- Department of Environmental Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011 Japan
| | - Naohisa Uchimura
- Department of Neuropsychiatry, Kurume University School of Medicine, Kurume, Japan
| | - Tetsuya Ishida
- Department of Neuropsychiatry, Kurume University School of Medicine, Kurume, Japan
| | - Kouji Toyomasu
- Institute of Health and Sports Science, Kurume University, Kurume, Japan
| | - Yoshitaka Morimatsu
- Department of Environmental Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011 Japan
| | - Mihoko Mori
- Department of Environmental Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011 Japan
| | - Nanae Kushino
- Department of Environmental Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011 Japan
| | - Michiko Hoshiko
- Department of Environmental Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011 Japan
| | - Tatsuya Ishitake
- Department of Environmental Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011 Japan
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148
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Gutierrez PM, Davidson CL, Friese AH, Forster JE. Physical Activity, Suicide Risk Factors, and Suicidal Ideation in a Veteran Sample. Suicide Life Threat Behav 2016; 46:284-92. [PMID: 26404757 DOI: 10.1111/sltb.12190] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 07/10/2015] [Indexed: 11/28/2022]
Abstract
The association between current level of suicidal ideation and physical activity was tested in a broad sample of veterans seeking care from the Veterans Health Administration. It was hypothesized that the two variables would be significantly inversely related. It was further hypothesized that the relationship would be mediated by depressive symptoms, disturbed sleep, and a measure of heart rate variability based on existing research regarding physical activity and sleep. Due to the first hypothesis not being supported, the second could not be tested. Post hoc correlation analyses did find associations between physical activity and depressive symptoms, in expected directions, and are discussed. Possible explanations for the negative findings along with recommendations for future research to continue exploring links between suicide risk and physical activity are presented. We conclude by suggesting that physical activity may have promise as a risk reduction intervention and that prospective data are more likely to yield significant results than the cross-sectional methodology employed in the current study.
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Affiliation(s)
- Peter M Gutierrez
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Denver VA Medical Center, Denver, CO, USA.,Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
| | - Collin L Davidson
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Denver VA Medical Center, Denver, CO, USA
| | - Ariel H Friese
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Denver VA Medical Center, Denver, CO, USA
| | - Jeri E Forster
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Denver VA Medical Center, Denver, CO, USA.,Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO, USA.,Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA
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149
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Perlis ML, Grandner MA, Brown GK, Basner M, Chakravorty S, Morales KH, Gehrman PR, Chaudhary NS, Thase ME, Dinges DF. Nocturnal Wakefulness as a Previously Unrecognized Risk Factor for Suicide. J Clin Psychiatry 2016; 77:e726-33. [PMID: 27337421 PMCID: PMC6314836 DOI: 10.4088/jcp.15m10131] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 10/26/2015] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Suicide is a major public health problem and the 10th leading cause of death in the United States. The identification of modifiable risk factors is essential for reducing the prevalence of suicide. Recently, it has been shown that insomnia and nightmares significantly increase the risk for suicidal ideation, attempted suicide, and death by suicide. While both forms of sleep disturbance may independently confer risk, and potentially be modifiable risk factors, it is also possible that simply being awake at night represents a specific vulnerability for suicide. The present analysis evaluates the frequency of completed suicide per hour while taking into account the percentage of individuals awake at each hour. METHODS Archival analyses were conducted estimating the time of fatal injury using the National Violent Death Reporting System for 2003-2010 and the proportion of the American population awake per hour across the 24-hour day using the American Time Use Survey. RESULTS The mean ± SD incident rate from 06:00-23:59 was 2.2% ± 0.7%, while the mean ± SD incident rate from 00:00-05:59 was 10.3% ± 4.9%. The maximum incident rate was from 02:00-02:59 (16.3%). Hour-by-hour observed values differed from those that would be expected by chance (P < .001), and when 6-hour blocks were examined, the observed frequency at night was 3.6 times higher than would be expected by chance (P < .001). CONCLUSIONS Being awake at night confers greater risk for suicide than being awake at other times of the day, suggesting that disturbances of sleep or circadian neurobiology may potentiate suicide risk.
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Affiliation(s)
- Michael L. Perlis
- Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, Philadelphia PA,Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia PA,School or Nursing, University of Pennsylvania, Philadelphia PA
| | - Michael A. Grandner
- Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, Philadelphia PA,Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia PA
| | - Gregory K. Brown
- Center for the Prevention of Suicide, Department of Psychiatry, University of Pennsylvania, Philadelphia PA
| | - Mathias Basner
- Division of Sleep and Chronobiology, Unit for Experimental Psychiatry, Department of Psychiatry University of Pennsylvania, Philadelphia PA
| | - Subhajit Chakravorty
- Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, Philadelphia PA,Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia PA,Mental Illness Research, Education, and Clinical Center of the Philadelphia Veterans Affairs Medical Center, Philadelphia PA
| | - Knashawn H. Morales
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology University of Pennsylvania, Philadelphia PA
| | - Philip R. Gehrman
- Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, Philadelphia PA,Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia PA
| | - Ninad S. Chaudhary
- Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, Philadelphia PA,Master of Population Health Sciences Program, Washington University, St. Louis MO
| | - Michael E. Thase
- Mood and Anxiety Disorders Treatment & Research Program, Department of Psychiatry University of Pennsylvania, Philadelphia PA
| | - David F. Dinges
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia PA,Center for the Prevention of Suicide, Department of Psychiatry, University of Pennsylvania, Philadelphia PA,Division of Sleep and Chronobiology, Unit for Experimental Psychiatry, Department of Psychiatry University of Pennsylvania, Philadelphia PA
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150
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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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