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Rogers E, Gresswell M, Durrant S. The relationship between sleep and suicidality in schizophrenia spectrum and other psychotic disorders: A systematic review. Schizophr Res 2023; 261:291-303. [PMID: 37879227 DOI: 10.1016/j.schres.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 09/06/2023] [Accepted: 10/14/2023] [Indexed: 10/27/2023]
Abstract
Individuals with Schizophrenia Spectrum Disorders (SSDs) have significantly higher rates of suicidal thoughts, attempts, and death by suicide in comparison to the general population. Sleep disturbances (reduced duration, timing and quality of sleep) are risk factors for suicidality in the general population, with research indicating the relationship is both immediate and accumulative. Sleep disturbances are also considered to be implicated in the onset and exacerbation of psychotic symptoms in SSDs. Reducing the risk of suicidality in SSDs remains an important public health priority, thus exploration of contributing risk factors is warranted. Sleep monitoring may also offer an adjunct risk monitoring method to suicidality assessments in SSDs, and a potential treatment target for psychotic symptoms. This review aimed to explore proximal and longitudinal relationships between self-reported and objectively measured sleep and suicidality in SSDs and other psychotic disorders. A comprehensive search of four databases was conducted. Eleven studies met the inclusion criteria (10 cross sectional and 1 longitudinal). Narrative synthesis indicated that self-reported sleep disturbances and sleep disorders (e.g. insomnia) were associated with increased risk of suicidal ideation and attempt. However, one study employing polysomnography did not find sleep to be associated with suicidality. Methodological limitations of the evidence base include: i) little experimental or longitudinal evidence, (ii) self-report and/or single item assessment of sleep disturbance, (iii) limited use of validated measures of suicidality, (iv) considerable research in long-term schizophrenia but sparse evidence in early psychosis. Future research should explore (i) cross-sectional and longitudinal relationships between specific aspects of suicidality and objective sleep parameters, (ii) use qualitative or mixed-methods designs to disentangle the nuances and bidirectionality in the sleep-suicide relationship, (iii) explore the psychological processes underpinning or mediating the sleep-suicide relationship in SSDs.
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Affiliation(s)
- Eva Rogers
- Xu Yafen Building, Jubilee Campus, University of Nottingham, NG8 1BB, United Kingdom; Nottinghamshire Healthcare NHS Foundation Trust, Duncan Macmillan House, Porchester Road, Nottingham, NG3 6AA, United Kingdom.
| | - Mark Gresswell
- Department of Clinical Psychology, Sarah Swift Building Brayford Wharf East, University of Lincoln, United Kingdom
| | - Simon Durrant
- School of Psychology, Sarah Swift Building Brayford Wharf East, University of Lincoln, United Kingdom
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2
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Kramer EB, Gaeddert LA, Jackson CL, Hostetter TA, Forster JE, Nazem S. The association among insomnia symptom severity, comorbid symptoms, and suicidal ideation in two veteran cohorts meeting diagnostic criteria for insomnia disorder. J Clin Psychol 2023; 79:1420-1433. [PMID: 36696685 DOI: 10.1002/jclp.23488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 12/15/2022] [Accepted: 01/10/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Examine the association between insomnia symptom severity and suicidal ideation (SI), after adjusting for clinical comorbidity in veterans meeting diagnostic criteria for insomnia disorder. METHODS Secondary data analyses of psychometrically validated baseline assessments of depression, posttraumatic stress disorder (PTSD), and anxiety symptoms from two online insomnia intervention randomized clinical trials (n = 232; n = 80) were conducted. Multiple linear regression was used to determine the association between insomnia symptom severity and SI, after controlling for clinical comorbidity and demographics. RESULTS Insomnia symptom severity was significantly correlated with comorbid depression, PTSD, and anxiety symptoms in both cohorts and significantly correlated with SI in one. After controlling for demographics and clinical comorbidity, insomnia symptom severity was not significantly associated with SI in linear regression models. CONCLUSION Findings extend insomnia-suicide research by providing evidence that insomnia symptom severity may not confer a unique risk for SI above comorbid mental health symptoms in veterans meeting diagnostic criteria for insomnia disorder.
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Affiliation(s)
- Emily B Kramer
- U.S. Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, Colorado, USA
| | - Laurel A Gaeddert
- U.S. Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, Colorado, USA
| | - Christine L Jackson
- U.S. Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, Colorado, USA
| | - Trisha A Hostetter
- U.S. Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, Colorado, USA
| | - Jeri E Forster
- U.S. Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, Colorado, USA.,Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Sarra Nazem
- U.S. Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, Colorado, USA.,U.S. Department of Veterans Affairs, National Center for PTSD, Dissemination & Training Division, Menlo Park, California, USA
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Goldstein TR, Franzen PL. A Comprehensive Review of the Literature on Sleep Difficulties and Suicidality in Youth to Inform an Integrative Developmental Model and Future Directions. CURRENT SLEEP MEDICINE REPORTS 2022; 8:1-19. [PMID: 36274826 PMCID: PMC9586157 DOI: 10.1007/s40675-022-00222-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 12/16/2022]
Abstract
Purpose of Review Suicide is currently the second leading cause of death among youth. Identification of modifiable near-term risk factors can inform suicide prevention strategies. One promising, readily assessed factor is sleep. We critically review the literature on sleep and suicidal thoughts and behaviors among youth. Recent Findings Most studies examining the youth sleep-suicidality relationship are from epidemiological samples in which both sleep problems and suicidality were assessed over variable timeframes using limited items from scales not designed to measure these constructs. Nonetheless, these data overwhelmingly support an association between suicidality and a range of sleep difficulties (e.g., insomnia, short/long sleep, weekend oversleep), above and beyond depressive symptoms. Limited studies include clinical samples or prospective designs. We review potential mechanisms and present a developmentally-informed integrative model. Summary Literature supports a clear association between sleep difficulties and youth suicidality. Future directions include prospective longitudinal studies and targeted prevention efforts.
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Affiliation(s)
- Tina R Goldstein
- Western Psychiatric Hospital and the Center for Sleep and Circadian Science, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Peter L Franzen
- Western Psychiatric Hospital and the Center for Sleep and Circadian Science, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Byrne SP, McCarthy E, DeViva JC, Southwick SM, Pietrzak RH. Prevalence, risk correlates, and health comorbidities of insomnia in US military veterans: results from the 2019-2020 National Health and Resilience in Veterans Study. J Clin Sleep Med 2021; 17:1267-1277. [PMID: 33656983 PMCID: PMC8314657 DOI: 10.5664/jcsm.9182] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 12/11/2022]
Abstract
STUDY OBJECTIVES Veterans experience high levels of trauma, psychiatric, and medical conditions that may increase their risk for insomnia. To date, however, no known study has examined the prevalence, risk correlates, and comorbidities of insomnia in a nationally representative sample of veterans. METHODS A nationally representative sample of 4,069 US military veterans completed a survey assessing insomnia severity; military, trauma, medical, and psychiatric histories; and health and psychosocial functioning. Multivariable analyses examined the association between insomnia severity, psychiatric and medical comorbidities, suicidality, and functioning. RESULTS A total of 11.4% of veterans screened positive for clinical insomnia and 26.0% for subthreshold insomnia. Greater age and retirement were associated with a lower likelihood of insomnia. Adverse childhood experiences, traumatic life events, lower education and income were associated with greater risk for insomnia. A "dose-response" association was observed for health comorbidities, with increasing levels of insomnia associated with elevated odds of psychiatric and medical conditions (clinical vs no insomnia odds ratio = 1.8-13.4) and greater reductions in health and psychosocial functioning (clinical vs no insomnia Cohen's d = 0.2-0.4). The prevalence of current suicidal ideation was 3-5 times higher in veterans with clinical and subthreshold insomnia relative to those without insomnia (23.9% and 13.6% vs 4.5%, respectively). CONCLUSIONS Nearly 2 in 5 US veterans experience clinical or subthreshold insomnia, which is associated with substantial health burden and independent risk for suicidal ideation. Results underscore the importance of assessment, monitoring, and treatment of insomnia in veterans as they transition from the military.
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Affiliation(s)
- Simon P. Byrne
- Department of Psychiatry, Westmead Hospital, Sydney, Australia
| | - Elissa McCarthy
- US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, White River Junction, Vermont
| | - Jason C. DeViva
- US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | | | - Robert H. Pietrzak
- US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut
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Hochard KD, Pendrous R, Mari T, Flynn S. Examining the Relationship Between Autism Traits and Sleep Duration as Predictors of Suicidality. J Autism Dev Disord 2020; 50:3575-3584. [PMID: 32086693 PMCID: PMC7502050 DOI: 10.1007/s10803-020-04405-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Short sleep duration is a known risk factor for suicidality in the general population, yet it is unclear how short sleep interacts with autism traits in predicting suicidality. In this cross-sectional online study, a general population sample (N = 650) completed measures assessing autism traits, suicidal ideation, and sleep duration. Moderated hierarchical regressions demonstrated that higher autism traits and shorter sleep were independent predictors of increased suicide ideation. However, sleep duration did not significantly moderate the autism trait to suicide ideation relationship. Future work should explore this relationship longitudinally using objective measures before considering intervention work to increase sleep duration in those with elevated autism traits.
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Affiliation(s)
- K D Hochard
- Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Parkgate Road, Chester, CH1 4BJ, UK.
| | - R Pendrous
- Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Parkgate Road, Chester, CH1 4BJ, UK
| | - T Mari
- Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Parkgate Road, Chester, CH1 4BJ, UK
| | - S Flynn
- Centre for Educational Development, Appraisal and Research, University of Warwick, Coventry, CV4 7AL, UK
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Kearns JC, Coppersmith DDL, Santee AC, Insel C, Pigeon WR, Glenn CR. Sleep problems and suicide risk in youth: A systematic review, developmental framework, and implications for hospital treatment. Gen Hosp Psychiatry 2020; 63:141-151. [PMID: 30301558 DOI: 10.1016/j.genhosppsych.2018.09.011] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 08/15/2018] [Accepted: 09/24/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Sleep problems are transdiagnostic symptoms that confer significant risk for suicidal thoughts and behaviors (STBs) in adults. However, less is known about the sleep-STB association in adolescence-a developmental period when rates of STBs increase drastically, and sleep problems may be particularly pernicious. This article provides a systematic review of research on the sleep-STB association in youth, an overview of changes in sleep regulation during adolescence that may make sleep problems particularly detrimental for youth, and a discussion of the clinical implications of the sleep-STB association for hospitalized youth. METHOD The systematic review included all longitudinal studies in which sleep problems were examined as prospective predictors of STBs in adolescents (aged 10-24 years). The search was conducted on December 1, 2017 using PsychINFO, PubMed, and Web of Science databases. RESULTS Ten studies qualified for inclusion in this review. Of these, seven studies found at least one type of sleep problem significantly predicted a STB outcome. CONCLUSIONS Although findings are mixed, growing research suggests that sleep problems may be a unique risk factor for STBs in youth. Sleep problems may be particularly important intervention target because they are easily assessed across healthcare settings and are amenable to treatment.
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Affiliation(s)
- Jaclyn C Kearns
- Department of Psychology, University of Rochester, Rochester, NY, USA
| | | | - Angela C Santee
- Department of Psychology, University of Rochester, Rochester, NY, USA
| | - Catherine Insel
- Department of Psychology, Harvard University, Cambridge, MA, USA; Center for Brain Science, Harvard University, Cambridge, MA, USA
| | - Wilfred R Pigeon
- VISN 2 Center for Excellence at Canandaigua VA Medical Center, Canandaigua, NY, USA; Sleep and Neurophysiology Research Lab, Department of Psychiatry, University of Rochester Medical Center Rochester, NY, USA; Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA
| | - Catherine R Glenn
- Department of Psychology, University of Rochester, Rochester, NY, USA.
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Sleep, suicide behaviors, and the protective role of sleep medicine. Sleep Med 2019; 66:264-270. [PMID: 31727433 DOI: 10.1016/j.sleep.2019.07.016] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 06/26/2019] [Accepted: 07/12/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE/BACKGROUND Sleep disturbance is associated with suicidal thoughts and behaviors. The relationship of specific sleep disorders to suicide attempts is less well established. Whether treating sleep disorders reduces suicide attempts remains controversial. METHODS Suicide attempts, treatment utilization, and psychiatric diagnoses were extracted from electronic medical records and a suicide attempt database from the U.S. Department of Veterans Affairs. The sample (N = 60,102) consisted of patients with any record of suicide attempt in FY13-14 and a 1:1 case-control of patients with no record of attempt, who were propensity score-matched based on age, gender, and prior year mental health treatment utilization. Associations among sleep disorders and suicide attempt were examined via logistic regression. Covariates included depression, anxiety, posttraumatic stress disorder (PTSD), bipolar, schizophrenia, substance use disorder (SUD), medical comorbidity, and obesity. RESULTS Insomnia (OR = 5.62; 95% CI, 5.39-5.86), nightmares (odds ratio, OR = 2.49; 95% confidence interval, CI, 2.23-2.77), and sleep-related breathing disorders (OR = 1.37; 95% CI, 1.27-1.48) were positively associated with suicide attempt after accounting for age, gender, treatment utilization, and comorbid sleep disorders. Furthermore, when controlling for depression, anxiety, PTSD, bipolar, schizophrenia, substance use disorder (SUD), medical comorbidity, and obesity, insomnia (OR = 1.51, 95% CI, 1.43-1.59) remained positively associated with suicide attempt nightmares (OR = 0.96; 95% CI, 0.85-1.09) nor sleep-related breathing disorders (OR = 0.87, 95% CI = 0.79-0.94). Additionally, sleep medicine visits 180 days prior to index date were associated with decreased likelihood of suicide attempt for individuals with sleep disorders (OR = 0.86; 95% CI, 0.79-0.94). CONCLUSION Insomnia is associated with suicide attempt among veterans. Sleep medicine visits were associated with a reduced risk of suicide attempt in sleep disordered patients. The assessment and treatment of sleep disorders should be considered in context of strategies to augment suicide prevention efforts.
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Fekih‐Romdhane F, Jendoubi J, Saguem BN, Ridha R, Cheour M. The link between sleep disturbances and suicidal thoughts and behaviors in remitted bipolar I patients. J Clin Psychol 2019; 75:1643-1657. [DOI: 10.1002/jclp.22793] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 03/20/2019] [Accepted: 04/01/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Feten Fekih‐Romdhane
- Faculty of Medicine of TunisTunis El Manar University Tunisia
- Psychiatry Department "E"Razi HospitalMannouba Tunisia
| | - Jihen Jendoubi
- Faculty of Medicine of TunisTunis El Manar University Tunisia
- Psychiatry Department "E"Razi HospitalMannouba Tunisia
| | - Bochra Nourhène Saguem
- Faculty of Medicine of TunisTunis El Manar University Tunisia
- Psychiatry Department "E"Razi HospitalMannouba Tunisia
| | - Rym Ridha
- Faculty of Medicine of TunisTunis El Manar University Tunisia
- Psychiatry Department "E"Razi HospitalMannouba Tunisia
| | - Majda Cheour
- Faculty of Medicine of TunisTunis El Manar University Tunisia
- Psychiatry Department "E"Razi HospitalMannouba Tunisia
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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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