Day workers suffering from a wider range of sleep problems are more likely to experience suicidality

Verification of sleep scales as predictors of suicidal ideation in Japanese dayworkers: a longitudinal study

The objective of this study was to verify whether the assessment of poor sleep based on two sleep scales could predict suicidal ideation in Japanese dayworkers. A longitudinal survey was conducted among 446 Japanese dayworkers working at a company in Japan. Questionnaires were administered in 2013 (baseline) and 2014 (follow-up). To evaluate suicidal ideation, we used Question 19 of the Self-rating Depression Scale, categorizing participants who chose response options "some/a good part/most of the time" as suicidal ideation (+), and those who chose option "never or only a little of the time" as suicidal ideation (-). Two sleep scales, the Pittsburgh Sleep Quality Index (PSQI) and the 3-Dimensional Sleep Scale (3DSS), were selected as potential predictors of suicidal ideation. Only participants who were suicidal ideation (-) at baseline were included in the analysis, and suicidal ideation (+) individuals at follow-up were considered to have developed suicidal ideation during the interval between baseline and follow-up surveys. Data from 293 participants (236 men, 57 women) were analyzed. Twenty-two participants (7.5%) became suicidal ideation (+) at follow-up. Multiple logistic regression analysis showed that only sleep quality of the 3DSS subscale significantly predicted suicidal ideation, even after adjusting for depressive symptoms. That is, assessment of poor sleep did not predict suicidal ideation when based on the PSQI, but did when based on the 3DSS. Assessment of sleep quality based on the 3DSS may prove more useful in predicting worker suicidal ideation in industrial settings with limited facilities than PSQI.

Supplementary Information

The online version contains supplementary material available at 10.1007/s41105-022-00404-6.

The relationship between marital status and multifactorial sleep in Japanese day workers

Unmarried people often have disorderly lifestyles, and sleep problems (e.g., insomnia, short sleep duration, social jetlag) are becoming more complex due to the modern 24-h society. To improve health promotion measures for unmarried people, this study examined the relationship between marital status and sleep assessed as a multifactorial structure (phase, quality, quantity) in Japanese day workers. A cross-sectional survey was conducted with employees at five workplaces in Japan. Participants indicated their marital status, and the 3-Dimensional Sleep Scale measured sleep condition. We used scale cutoff values to define poor sleep phase, quality, and quantity (scores below the cutoff). "All poor sleep" and "all good sleep" were defined as when all scores were below or above the cutoff, respectively. Data from 786 participants (578 men, 208 women) were analyzed. Multivariate analysis showed that being unmarried was significantly related to poor sleep phase, quality, and quantity, with increased odds ratios. In unmarried participants, odds ratios (OR) were highest for poor sleep quantity in men (OR: 2.15) and poor sleep phase in women (OR: 2.73). All poor sleep showed the highest odds ratio for both unmarried men (OR: 2.74) and women (OR: 6.13), while unmarried men showed significantly decreased odds ratios for all good sleep (OR: 0.51). The finding that being unmarried was more closely associated with poor sleep quality and quantity in men, and more closely associated with poor sleep phase in women, could greatly contribute to creating measures to promote improved sleep in unmarried people.

Supplementary Information

The online version contains supplementary material available at 10.1007/s41105-021-00357-2.

Insomnia symptoms mediate the association between eveningness and suicidal ideation, defeat, entrapment, and psychological distress in students

Chronotype describes a person's general preference for mornings, evenings, or neither. It is typically conceptualized as a continuous unidimensional spectrum from morningness to eveningness. Eveningness is associated with poorer outcomes across a myriad of physical and mental health outcomes. This preference for later sleep and wake times is associated with increased risk of depression, anxiety, and suicidal ideation in both clinical and community samples. However, the mechanisms underlying the negative consequences of this preference for evenings are not fully understood. Previous research has found that sleep disturbances may act as a mediator of this relationship. The present study aimed to explore the associations between chronotype and affective outcomes in a sample of students. Additionally, it aimed to investigate the potential role of insomnia as a mediator within these relationships. Participants (n = 190) completed an anonymous self-report survey of validated measures online which assessed chronotype, insomnia symptoms, and a range of affective outcomes (defeat, entrapment, suicide risk, stress, and depressive and anxious symptomology). Eveningness was associated with more severe or frequent experiences of these outcomes, with participants that demonstrated a preference for eveningness more likely to report poorer affective functioning and increased psychological distress. Mediation analysis found the relationship between chronotype and these outcome measures was completely or partially mediated by insomnia symptom severity measured by the validated Sleep Condition Indicator insomnia scale. Taken together, these findings add further evidence for the negative consequences of increased eveningness. Additionally, our results show that chronotype and sleep disturbances should be considered when assessing mental well-being. Implementing appropriate sleep-related behavior change or schedule alterations can offer a tool for mitigation or prevention of psychological distress in students that report a preference for later sleep and wake times.

Predictive factors of anxiety and depression among nurses fighting coronavirus disease 2019 in China

Anxiety and depression are common mental illnesses among nurses fighting coronavirus disease 2019 (COVID-19). However, the precise factors that affect anxiety and depression in this population require further evaluation. This study aimed to explore factors associated with anxiety and depression among nurses fighting COVID-19 in China. We used convenience sampling to recruit 282 nurses fighting COVID-19 in three hospitals. Participants were questioned about demographic characteristics, daily working time, daily sleep duration, sleep quality, anxiety, depression, resilience, and coping styles. Linear regression analysis indicated that resilience (β = -0.217, P < 0.001), positive coping style (β = -0.281, P < 0.001), negative coping style (β = 0.395, P < 0.001), and sleep quality (β = 0.153, P = 0.010) were predictive factors for anxiety, and the model explained 44.20% (P < 0.001) of variability. Resilience (β = -0.239, P < 0.001), positive coping style (β = -0.222, P < 0.001), negative coping style (β = 0.152, P < 0.001), and sleep quality (β = 0.104, P = 0.003) were identified as explanatory factors for depression, and the model explained 34.50% (P < 0.001) of variability. The present study suggested that resilience, coping styles, and sleep quality could account for an individual's levels of anxiety and depression.

Sleep Disturbances and Suicidal Behavior

Sleep disturbances, particularly insomnia, nightmares, and excessive daytime sleepiness (EDS), are significant, proximal, and modifiable risk factors for suicidal ideation and behaviors (SIB) and could be targeted for preventative interventions. In this chapter, we review the evidence supporting the association of insomnia, nightmares, and EDS with SIB. We also describe these sleep disturbances in the general population, as well as their association with psychiatric disorders. A PubMed search was conducted to identify the relevant literature. Insomnia is very frequent across mental disorders, but SIB patients are particularly exposed. Specific interventions focused on insomnia are useful in contending suicidal ideation. Nightmares seem to constitute an independent risk factor for SIB, beyond insomnia, particularly in young people and when experienced frequently. The evidence regarding the association of EDS and SIB is less clear and probably explained by the reduction of health-related quality of life and comorbid depression. The mechanisms underlying the relationship between sleep disturbances and SIB as well as the role of potential confounders and future perspectives in this field are also discussed.

Suicidal Ideation and Insomnia in Bipolar Disorders: Idéation suicidaire et insomnie dans les troubles bipolaires

OBJECTIVE

Bipolar disorder (BD) confers elevated suicide risk and associates with misaligned circadian rhythm. Real-time monitoring of objectively measured sleep is a novel approach to detect and prevent suicidal behavior. We aimed at understanding associations between subjective insomnia and actigraphy data with severity of suicidal ideation in BDs.

METHODS

This prospective cohort study comprised 76 outpatients with a BD aged 18 to 65 inclusively. Main measures included 10 consecutive days of wrist actigraphy; the Athens Insomnia Scale (AIS); the Montgomery-Åsberg Depression Rating Scale (MADRS); the Quick Inventory of Depressive Symptoms-16, self-rating (QIDS-SR-16); and the Columbia Suicide Severity Rating Scale. Diagnoses, medications, and suicide attempts were obtained from chart review.

RESULTS

Suicidal ideation correlated moderately with subjective insomnia (AIS with QIDS-SR-16 item 12 ρ =0.26, P = 0.03; MADRS item 10 ρ = 0.33, P = 0.003). Graphical sleep patterns showed that suicidal patients were enriched among the most fragmented sleep patterns, and this was confirmed by correlations of suicidal ideation with actigraphy data at 2 visits. Patients with lifetime suicide attempts (n = 8) had more varied objective sleep (a higher standard deviation of center of daily inactivity [0.64 vs. 0.26, P = 0.01], consolidation of daily inactivity [0.18 vs. 0.10, P = <0.001], sleep offset [3.02 hours vs. 1.90 hours, P = <0.001], and total sleep [105 vs. 69 minutes, P = 0.02], and a lower consolidation of daily inactivity [0.65 vs. 0.79, P = 0.03]).

CONCLUSIONS

Subjective insomnia, a nonstigmatized symptom, can complement suicidality screens. Longer follow-ups and larger samples are warranted to understand whether real-time sleep monitoring predicts suicidal ideation in patient subgroups or individually.

Poor sleep quality is associated with obesity and depression in farmers

BACKGROUND

Farmers' work schedules can result in inconsistent sleep patterns which negatively impact health.

PURPOSE

To explore the relationships between sleep, obesity, and depression in working, older farmers and their spouses. Covariates included body mass index (BMI), age, and gender.

METHODS

Sleep quality, BMI, and depression were assessed in farmers (n = 1,394) 50 years and older. Bivariate associations among all covariates (i.e., age, gender, BMI, sleep) and dependent variable (i.e., depression) were analyzed using Pearson's correlation. Multivariable associations of the Center for Epidemiologic Studies Depression Scale (CESD). BMI with other study variables were assessed using linear regression.

RESULTS

BMI was positively associated with sleep apnea symptoms (p ≤ 0.0001) and CESD scores (p = 0.0006). Participants with difficulty falling asleep were more likely to have poor sleep quality (p ≤ 0.0001) and higher CESD scores (p ≤ 0.0001). Poor sleep quality was associated with higher CESD scores (p ≤ 0.0001). Increased age, female gender, higher BMI, sleep apnea symptoms, and poorer sleep quality were all predictive of higher depressive symptoms.

DISCUSSION

Farmers have unique lifestyles that increase the risk of poor sleep. Screening for sleep pattern disruption and understanding its impact could result in lower rates of depression and obesity in this group of high-risk individuals.

Suicidality in sleep disorders: prevalence, impact, and management strategies

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.

The relationship of sleep complaints risk factors with sleep phase, quality, and quantity in Japanese workers

Numerous studies have determined that lifestyle factors (smoking, drinking, snacking, etc.) and the bedroom environment can influence sleep. We developed a new sleep scale-the 3-Dimensional Sleep Scale (3DSS)-which measures three elements of sleep: phase, quality, and quantity. The purpose of this study is to determine which risk factors of sleep complaints are associated with these sleep elements. Data were obtained from 366 Japanese day workers (302 men and 64 women). Sleep condition was assessed with the 3DSS, and we also assessed various habits within 2 h of going to bed, including smoking, drinking, snacking, caffeine intake, mobile phone use, and working. We also asked about bedroom environmental conditions (noise, lighting, and temperature and humidity). Multivariate logistic regression analysis using the backward selection method (likelihood ratio) was used, with 3DSS scores as the outcome (i.e., over or under the cutoff). The results showed that smoking was associated with significantly greater odds ratio [2.71 (1.65-4.44)] of disordered sleep phase, while lighting as well as temperature and humidity led to greater odds [3.67 (1.55-8.68), 1.93 (1.20-3.11)] of poor sleep quality. Finally, only noise was significantly related to greater odds [1.98 (1.13-3.46)] of low sleep quantity. These findings indicated the various risk factors of sleep complaints could be associated with different sleep elements. This might help in the effective treatment of sleep complaints.