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Tubbs AS, Perlis ML, Killgore WDS, Karp JF, Grandner MA, Fernandez FX. Empirical clustering to identify individuals for whom insomnia is more closely related to suicidal ideation. J Affect Disord 2024; 362:36-44. [PMID: 38942202 DOI: 10.1016/j.jad.2024.06.101] [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: 04/01/2024] [Revised: 05/29/2024] [Accepted: 06/25/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND Although the effect sizes are modest, insomnia is consistently associated with suicidal thoughts and behaviors. Subgroup analyses can efficiently identify for whom insomnia is most relevant to suicidal ideation. To improve clinical case identification, the present study sought to identify subclusters of lifetime suicidal ideators for whom insomnia was most closely related to current suicidal ideation. METHODS Data on N = 4750 lifetime suicidal ideators were extracted from the Military Suicide Research Consortium's Common Data Elements. Data on sociodemographic characteristics, severity and history of suicidal thoughts and behaviors, and related clinical characteristics were clustered by unsupervised machine learning algorithms. Robust Poisson regression estimated cluster by insomnia associations with current suicidal ideation. RESULTS Three clusters were identified: a modest symptom severity cluster (N = 1757, 37.0 %), an elevated severity cluster (N = 1444 30.4 %), and a high severity cluster (N = 1549 32.6 %). In Cluster 1, insomnia was associated with current suicidal ideation (PRR 1.29 [1.13-1.46]) and remained significant after adjusting for sociodemographic and clinical covariates. In Cluster 2, insomnia was associated with current suicidal ideation (PRR 1.14 [1.01-1.30]), but not after adjusting for sociodemographic and clinical covariates. In Cluster 3, insomnia was associated with current suicidal ideation (PRR 1.12 [1.03-1.21]) and remained significant after adjusting for sociodemographic covariates, but not clinical covariates. LIMITATIONS Cross-sectional design, lack of diagnostic data, non-representative sample. CONCLUSION Insomnia appears more closely related to current suicidal ideation among modest severity individuals than other subgroups. Future work should use prospective designs and more comprehensive risk factor measures to confirm these findings.
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Affiliation(s)
- Andrew S Tubbs
- Department of Psychiatry, University of Arizona College of Medicine - Tucson, Tucson, AZ 85724, USA.
| | - Michael L Perlis
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - William D S Killgore
- Department of Psychiatry, University of Arizona College of Medicine - Tucson, Tucson, AZ 85724, USA
| | - Jordan F Karp
- Department of Psychiatry, University of Arizona College of Medicine - Tucson, Tucson, AZ 85724, USA
| | - Michael A Grandner
- Department of Psychiatry, University of Arizona College of Medicine - Tucson, Tucson, AZ 85724, USA
| | - Fabian-Xosé Fernandez
- Evelyn F. McKnight Brain Institute, Department of Psychology, University of Arizona, Tucson, AZ 85719, USA
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Tuncay S, Sarman A. Determination of the relationship between depression and suicide in young adolescents. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2024; 37:e12473. [PMID: 38923673 DOI: 10.1111/jcap.12473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 06/12/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE This study was designed to explore the relationships between depression, and the likelihood of suicide among young adolescents by considering various factors. DESIGN AND SAMPLES It was conducted in a descriptive-cross-sectional format, with fieldwork spanning from November 16, 2022, to June 30, 2023. The study assessed the likelihood of depression, and suicide in young adolescents attending a university in Eastern Turkey. MEASUREMENTS Sociodemographic features survey form, Beck's Depression Inventory and Suicide Probability Scale were used to collect data. RESULTS The results from this investigation indicated that women, individuals with chronic illnesses, those with a history of psychiatric conditions, those expressing a constant desire to die, those with suicidal thoughts or plans, and those with a family member who had attempted suicide exhibited significantly higher mean scores for depression and suicide. There was a positive correlation between high depression scores and suicidal tendencies. However, no conclusive evidence of a link between depression, and suicide was established. CONCLUSIONS In this study, certain demographic and psychological factors were identified as correlating with elevated levels of depression and suicidal tendencies among young adolescents. It is imperative that individuals identified as being at risk be promptly referred to appropriate units for comprehensive interventions and support.
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Affiliation(s)
- Suat Tuncay
- Department of Pediatric Nursing, Faculty of Health Science, Bingöl University, Bingöl, Turkey
| | - Abdullah Sarman
- Department of Pediatric Nursing, Faculty of Health Science, Bingöl University, Bingöl, Turkey
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Malarkey ME, Fu AJ, Mannan N, Shaw OM, Haight TJ, Cota MR, Jahed NC, Werner JK, Brody DL. Internet-Guided Cognitive Behavioral Therapy for Insomnia Among Patients With Traumatic Brain Injury: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2420090. [PMID: 38980675 PMCID: PMC11234237 DOI: 10.1001/jamanetworkopen.2024.20090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/10/2024] Open
Abstract
Importance Many military service members and veterans report insomnia after sustaining traumatic brain injury (TBI). Limitations of first-line treatment, cognitive-behavioral therapy for insomnia (CBT-I), include availability of qualified clinicians, low completion rates, and cost. Objective To investigate the feasibility and efficacy of internet-guided CBT-I (eCBT-I) in military service members and veterans with insomnia and a history of TBI. Design, Setting, and Participants This randomized clinical trial of fully remote internet-based interventions and evaluations was conducted from September 1, 2020, to June 30, 2021, with 3 months of follow-up. Participants included a volunteer sample of military service members and veterans aged 18 to 64 years with a history of mild TBI/concussion and at least moderately severe insomnia defined as an insomnia severity index (ISI) score of greater than 14 and Pittsburgh Sleep Quality Index of greater than 4. Self-reported race, ethnicity, and educational level were generally representative of the US military. Data were analyzed from October 21, 2021, to April 29, 2024. Intervention Internet-based CBT-I delivered over 6 weekly lesson modules with assigned homework activities. Main Outcomes and Measures The prespecified primary outcome measure was change in ISI score over time. Prespecified secondary outcome measures included self-reported measures of depression symptoms, posttraumatic stress disorder (PTSD) symptoms, sleep quality, migraine impact, and fatigue. Results Of 204 people screened, 125 were randomized 3:1 to eCBT-I vs online sleep education, and 106 completed baseline evaluations (83 men [78.3%]; mean [SD] age, 42 [12] years). Of these, 22 participants (20.8%) were Hispanic or Latino and 78 (73.6%) were White. Fifty participants completed postintervention evaluations, and 41 completed the 3-month follow-up. Baseline mean (SD) ISI scores were 19.7 (4.0) in those randomized to eCBT-I and 18.9 (5.0) in those randomized to sleep education. After intervention, mean (SD) ISI scores were 13.7 (5.6) in those randomized to eCBT-I and 16.6 (5.7) in those randomized to sleep education. The difference in the extent of reduction in ISI scores between groups was 3.5 (95% CI,-6.5 to -0.4 [P = .03]; Cohen d, -0.32 [95% CI, -0.70 to -0.04]). In the eCBT-I group, the extent of insomnia improvement correlated with the extent of depressive symptom improvement (Spearman ρ = 0.68 [P < .001]), PTSD symptoms (ρ = 0.36 [P = .04]), sleep quality (ρ = 0.54 [P = .001]), and fatigue impact (ρ = -0.58 [P < .001]) but not migraine-related disability. Conclusions and Relevance The findings of this randomized clinical trial suggest that fully remote eCBT-I was moderately feasible and effective for self-reported insomnia and depression symptoms in military service members and veterans with a history of TBI. There is great potential benefit for eCBT-I due to low availability and cost of qualified CBT-I clinicians, although optimization of completion rates remains a challenge. Future studies may use home-based objective sleep assessments and should increase study retention. Trial Registration ClinicalTrials.gov Identifier: NCT04377009.
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Affiliation(s)
- Molly E Malarkey
- The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland
- Military Traumatic Brain Injury Initiative (formerly the Center for Neuroscience and Regenerative Medicine), Bethesda, Maryland
| | - Adele J Fu
- The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland
- Military Traumatic Brain Injury Initiative (formerly the Center for Neuroscience and Regenerative Medicine), Bethesda, Maryland
| | - Noushin Mannan
- The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland
- Military Traumatic Brain Injury Initiative (formerly the Center for Neuroscience and Regenerative Medicine), Bethesda, Maryland
| | - Olivia M Shaw
- The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland
- Military Traumatic Brain Injury Initiative (formerly the Center for Neuroscience and Regenerative Medicine), Bethesda, Maryland
| | - Thaddeus J Haight
- The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland
- Military Traumatic Brain Injury Initiative (formerly the Center for Neuroscience and Regenerative Medicine), Bethesda, Maryland
| | - Martin R Cota
- The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland
- Military Traumatic Brain Injury Initiative (formerly the Center for Neuroscience and Regenerative Medicine), Bethesda, Maryland
| | - Nasreen C Jahed
- The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland
- Military Traumatic Brain Injury Initiative (formerly the Center for Neuroscience and Regenerative Medicine), Bethesda, Maryland
| | - J Kent Werner
- Military Traumatic Brain Injury Initiative (formerly the Center for Neuroscience and Regenerative Medicine), Bethesda, Maryland
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - David L Brody
- Military Traumatic Brain Injury Initiative (formerly the Center for Neuroscience and Regenerative Medicine), Bethesda, Maryland
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Nazem S, Sun S, Barnes SM, Monteith LL, Hostetter TA, Forster JE, Brenner LA, Galfalvy H, Haghighi F. Impact of an internet-based insomnia intervention on suicidal ideation and associated correlates in veterans at elevated suicide risk. Transl Behav Med 2024:ibae032. [PMID: 38864695 DOI: 10.1093/tbm/ibae032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024] Open
Abstract
Improving public health approaches to suicide prevention requires scalable evidence-based interventions that can be easily disseminated. Given empirical data supporting the association between insomnia and suicide risk, internet-delivered insomnia interventions are promising candidates to meet this need. The purpose of this study was to examine whether an unguided internet-delivered cognitive-behavioral therapy for insomnia (iCBT-I) improved insomnia severity, suicidal ideation (SI), and suicide risk correlates (depression, post-traumatic stress disorder, anxiety, hostility, belongingness, hopelessness, agitation, irritability, concentration) in a sample of veterans. Secondary data analysis of Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn veterans (n = 50) with clinically significant insomnia and elevated SI drawn from a larger randomized controlled trial (RCT) of an iCBT-I, Sleep Healthy Using the Internet (SHUTi). Two-sample t-tests or Wilcoxon rank sum tests were used to evaluate between-group differences (SHUTi vs. Insomnia Education Website control) in symptom improvement from baseline to post-intervention. SHUTi participants experienced a significant improvement in insomnia severity (P < .001; d = -1.08) and a non-significant with small (subthreshold medium) effect size reduction of SI (P = .17, d = 0.40), compared to control participants. Significant improvement in hopelessness was observed (medium effect size), with non-significant small to medium effect size reductions in most remaining suicide risk correlates. Self-administered iCBT-I was associated with improvements in insomnia severity in veterans at elevated risk for suicide. These preliminary findings suggest that SI and suicide risk correlates may improve following an iCBT-I intervention, demonstrating the need for future well-powered iCBT-I RCTs targeted for populations at elevated suicide risk.
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Affiliation(s)
- Sarra Nazem
- Dissemination and Training Division, National Center for PTSD, Palo Alto, CA, USA
| | - Shengnan Sun
- Department of Neuroscience, Icahn School of Medicine, New York, NY, USA
- General Medical Research (GMR), James J. Peters VA Medical Center, Bronx, NY, USA
| | - Sean M Barnes
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, CO, USA
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
| | - Lindsey L Monteith
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, CO, USA
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Co, USA
| | - Trisha A Hostetter
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, CO, USA
| | - Jeri E Forster
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, CO, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Co, USA
| | - Lisa A Brenner
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, CO, USA
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Co, USA
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Hanga Galfalvy
- Department of Psychiatry, Columbia University, New York, NY, USA
- Department of Biostatistics, Columbia University, New York, NY, USA
| | - Fatemeh Haghighi
- Department of Neuroscience, Icahn School of Medicine, New York, NY, USA
- General Medical Research (GMR), James J. Peters VA Medical Center, Bronx, NY, USA
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Zemestani M, Abdolmaleki S, McGrew SJ, Vujanovic A. Associations between Sleep Disturbance and Suicidal Ideation Severity in Iranian University Students: Evaluating Emotion Regulation Difficulties and Distress Tolerance. Arch Suicide Res 2024; 28:454-470. [PMID: 36927369 DOI: 10.1080/13811118.2023.2190366] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
AIM Although sleep disturbance is associated with suicide ideation, underlying cognitive-affective mechanisms that may explain this association are not well understood. The aim of the present study was to concurrently evaluate whether emotion regulation difficulties and distress tolerance explain this association among Iranian university students. METHOD A total of 679 Iranian university students (66.42% females; Mage = 24.34 years, SD = 4.86) completed a battery of online self-report questionnaire. Structural equation modeling was used to empirically explore the relations among variables. RESULTS Sleep disturbance was positively associated with suicide ideation. Higher sleep disturbance symptoms were associated with higher levels of suicide ideation. Sleep disturbance was indirectly related to suicide ideation through both emotion regulation difficulties and distress tolerance. CONCLUSION Findings expand knowledge of cognitive-emotional processes that may explain the sleep disturbance-suicide ideation association among Iranian university students. Iranian students experiencing sleep disturbance may benefit from intervention strategies targeting emotion regulation skills and distress tolerance to reduce suicide ideation.
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Slanitz C, Fuchshuber J, Fink A, Unterrainer HF. Anxious and depressive symptoms mediate the influence of sleep quality on suicidality in young adults. Front Public Health 2024; 12:1322069. [PMID: 38282761 PMCID: PMC10808692 DOI: 10.3389/fpubh.2024.1322069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 01/02/2024] [Indexed: 01/30/2024] Open
Abstract
This study investigated how sleep quality affects the global severity of psychiatric symptoms, including suicidality, in young adults. Poor sleep quality has a significant impact on mental health and should therefore be given special attention in suicidal treatment. 1,214 participants (914 females; age: M = 25.81, SD = 6.35) completed the Brief Symptom Inventory (BSI-18), the Scale for Suicidal Experience and Behavior (SSEV), and the Pittsburgh Sleep Quality Index (PSQI) via an online survey. Correlation statistics and path analysis were conducted for data evaluation. Thereby, anxiety and depression but not somatization mediated the relationship between sleep quality and suicidality. Our findings confirm the putative link between diminished sleep quality and increased suicidality and may lead to an early detection of suicidal behavior.
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Affiliation(s)
- Corinna Slanitz
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
- Institute of Psychology, University of Graz, Graz, Austria
| | - Jürgen Fuchshuber
- Department of Psychoanalysis and Psychotherapy, Medical University Vienna, Vienna, Austria
- Center for Integrative Addiction Research (CIAR), Grüner Kreis Society, Vienna, Austria
| | - Andreas Fink
- Institute of Psychology, University of Graz, Graz, Austria
| | - Human-Friedrich Unterrainer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
- Institute of Psychology, University of Graz, Graz, Austria
- Center for Integrative Addiction Research (CIAR), Grüner Kreis Society, Vienna, Austria
- Institute of Religious Studies, University of Vienna, Vienna, Austria
- Faculty of Psychotherapy Science, Sigmund Freud University, Vienna, Austria
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7
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Jamieson N, Carey LB, Jamieson A, Maple M. Examining the Association Between Moral Injury and Suicidal Behavior in Military Populations: A Systematic Review. JOURNAL OF RELIGION AND HEALTH 2023; 62:3904-3925. [PMID: 37592186 DOI: 10.1007/s10943-023-01885-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 08/19/2023]
Abstract
The increasing number of suicides among military populations cannot be fully accounted for by conventional risk factors like Post-Traumatic Stress Disorder (PTSD). As a result, researchers and theorists propose that delving into the concept of Moral Injury could offer a more comprehensive understanding of the phenomenon of suicide. Moral Injury is not currently a recognized mental health disorder but can be associated with PTSD. Moral Injury is a multi-dimensional issue that profoundly affects emotional, psychological, behavioral, social, and spiritual well-being. The objective of this systematic review is to examine the association between Moral Injury and suicidal behavior (suicide ideation, plans and or suicide attempt) within military populations. The review will specifically concentrate on identifying and analyzing studies that have investigated the connection between these variables, with a specific focus on the context of military personnel both serving and former serving members. Of the 2214 articles identified as part of this review, 12 studies satisfied the research criteria with a total participant sample having an average age of 40.7 years. The male population accounted for 78.6% of the overall sample. Two studies were identified as high-quality, while the remaining ten were rated as moderate. The analysis of these twelve studies consistently affirms a connection between Moral Injury and suicidal behavior; most obviously, that exposure to morally injurious events substantially amplify the risk of suicide, with higher levels of potential exposure being linked to increased Moral Injury and heightened levels of suicidal behavior. Our review uncovered noteworthy findings regarding the association between Moral Injury and suicidal behavior, marking a pioneering effort in exploring this association and offering valuable insights into this emerging issue. Several limitations are noted regarding this review and recommendations are made concerning the need to prioritize, expand and employ longitudinal research designs that include non-military populations such as first responders (e.g., police, paramedics, firefighters) and medical, nursing, or allied health professionals-all disciplines known to be impacted by Moral Injury.
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Affiliation(s)
- Nikki Jamieson
- Moral Injury Australia, Brisbane, Queensland, Australia.
| | - Lindsay B Carey
- Palliative Care Unit, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- Institue of Ethics and Society, The University of Notre Dame, Sydney Campus, New South Wales, Australia
| | | | - Myfanwy Maple
- School of Health, University of New England, Armidale, New South Wales, Australia
- Manna Institute, Faculty of Medicine and Health, University of New England, Armidale, New South Wales, Australia
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Werner‐Seidler A, Li SH, Spanos S, Johnston L, O'Dea B, Torok M, Ritterband L, Newby JM, Mackinnon AJ, Christensen H. The effects of a sleep-focused smartphone application on insomnia and depressive symptoms: a randomised controlled trial and mediation analysis. J Child Psychol Psychiatry 2023; 64:1324-1335. [PMID: 36991537 PMCID: PMC10952387 DOI: 10.1111/jcpp.13795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/24/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Rates of depression are increasing among adolescents. A novel way to reduce depression is by improving sleep. We evaluated whether an app-based intervention for insomnia improved sleep and depression, and whether changes in insomnia mediated changes in depression. METHODS We conducted a 2-arm single-blind randomised controlled trial at the Black Dog Institute in Australia. Adolescents 12-16 years experiencing insomnia symptoms were randomly allocated to receive Sleep Ninja, an app-delivered cognitive behavioural therapy program for insomnia, or to an active control group involving weekly text message sleep tips. Assessments took place at baseline, 6 weeks (post-intervention) and 14 weeks (post-baseline). Co-primary outcomes were symptoms of insomnia and depression at post-intervention (primary endpoint). Intent-to-treat analyses were conducted. The trial is registered with the Australian and New Zealand Clinical Trials Registry, number ACTRN12619001462178. RESULTS Between October 25, 2019, and September 6, 2020, 264 participants were randomised to receive Sleep Ninja (n = 131) or to the control group (n = 133). Relative to the control group, those allocated to the intervention reported a greater reduction in insomnia symptoms at 6 weeks (95% CI: -2.96 to -0.41, d = .41) and 14 weeks (95% CI: -3.34 to -0.19, d = .39), and a greater reduction in depression symptoms at 6 weeks (95% CI: -3.46 to -0.56, d = .28) but not 14 weeks (p < 1). Change in insomnia mediated change in depression. No adverse events were reported. CONCLUSIONS An app-delivered program for insomnia could be a practical, non-stigmatising and scalable way to reduce symptoms of insomnia and depression among adolescents experiencing difficulties getting enough good quality sleep.
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Affiliation(s)
- Aliza Werner‐Seidler
- Black Dog InstituteUniversity of New South WalesSydneyNSWAustralia
- School of PsychologyUniversity of New South WalesSydneyNSWAustralia
| | - Sophie H. Li
- Black Dog InstituteUniversity of New South WalesSydneyNSWAustralia
- School of PsychologyUniversity of New South WalesSydneyNSWAustralia
| | - Samantha Spanos
- Australian Institute of Health InnovationMacquarie UniversitySydneyNSWAustralia
| | - Lara Johnston
- Black Dog InstituteUniversity of New South WalesSydneyNSWAustralia
| | - Bridianne O'Dea
- Black Dog InstituteUniversity of New South WalesSydneyNSWAustralia
| | - Michelle Torok
- Black Dog InstituteUniversity of New South WalesSydneyNSWAustralia
| | - Lee Ritterband
- School of MedicineUniversity of VirginiaCharlottesvilleVAUSA
| | - Jill M. Newby
- Black Dog InstituteUniversity of New South WalesSydneyNSWAustralia
- School of PsychologyUniversity of New South WalesSydneyNSWAustralia
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Tadros M, Li S, Upton E, Newby J, Werner-Seidler A. Preferences of University Students for a Psychological Intervention Designed to Improve Sleep: Focus Group Study. JMIR Hum Factors 2023; 10:e44145. [PMID: 37616036 PMCID: PMC10485721 DOI: 10.2196/44145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 06/27/2023] [Accepted: 07/11/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Many university students have difficulties with sleep; therefore, effective psychological treatments are needed. Most research on psychological treatments to improve sleep has been conducted with middle-aged and older adults, which means it is unclear whether existing psychological treatments are helpful for young adult university students. OBJECTIVE This study aimed to discover university student preferences for a psychological intervention to improve sleep quality. METHODS Focus groups were conducted over 3 stages to examine students' views regarding content, format, and session duration for a psychological intervention to improve sleep. A thematic analysis was conducted to analyze participant responses. RESULTS In total, 30 participants attended small focus group discussions. Three key themes were identified: (1) program development, (2) help-seeking, and (3) student sleep characteristics. Program development subthemes were program format, program content, and engagement facilitators. Help-seeking subthemes were when to seek help, where to access help, stigma, and barriers. Student sleep characteristics subthemes were factors disturbing sleep and consequences of poor sleep. CONCLUSIONS Students emphasized the need for a sleep intervention with an in-person and social component, individualized content, and ways to monitor their progress. Participants did not think there was a stigma associated with seeking help for sleep problems. Students identified the lack of routine in their lifestyle, academic workload, and the pressure of multiple demands as key contributors to sleep difficulties.
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Affiliation(s)
- Michelle Tadros
- The Black Dog Institute, The University of New South Wales, Randwick, Australia
| | - Sophie Li
- The Black Dog Institute, The University of New South Wales, Randwick, Australia
- School of Psychology, The University of New South Wales, Sydney, Australia
| | - Emily Upton
- The Black Dog Institute, The University of New South Wales, Randwick, Australia
| | - Jill Newby
- The Black Dog Institute, The University of New South Wales, Randwick, Australia
- School of Psychology, The University of New South Wales, Sydney, Australia
| | - Aliza Werner-Seidler
- The Black Dog Institute, The University of New South Wales, Randwick, Australia
- School of Psychology, The University of New South Wales, Sydney, Australia
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10
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Carbone JT, Casement MD. Sleep disorders and relative risk of suicidal ideation and suicide attempts in youth presenting to emergency departments. Sleep Health 2023; 9:537-543. [PMID: 37331902 DOI: 10.1016/j.sleh.2023.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/28/2023] [Accepted: 05/25/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVE Sleep problems predict suicide, which is a leading cause of death in adolescents and young adults, but the relative risk of suicidality in youth with sleep disorders has not been established in nationally representative samples. This study evaluated the relative risk of suicidal ideation and attempt in youth ages 6-24 who presented to United States emergency departments between 2015 and 2017. METHODS Youths' diagnoses of sleep and psychiatric disorders, and emergency department encounters with suicide attempt and suicidal ideation, were extracted from the Health Care Cost Utilization Project's Nationwide Emergency Department Sample (N = 65,230,478). Relative risk of suicidal ideation and suicide attempt were evaluated through logistic regression and predicted rate ratios after adjustment for history of self-harm and demographic characteristics. RESULTS Youth with at least 1 sleep disorder had 3 times greater odds of an emergency department encounter involving suicidal ideation compared to those without a sleep disorder (aOR = 3.22, 95% CI: 2.61, 3.98). The predicted probability of suicidal ideation was 46.03% higher in youth with a mood disorder and a sleep disorder, and 47.04% higher in youth with a psychotic disorder and sleep disorder, compared to youth without a sleep disorder. Only 0.32% of youth presenting to emergency departments were diagnosed with a sleep disorder. CONCLUSIONS Sleep disorders are associated with increased risk for suicidal ideation in youth presenting to emergency departments. Sleep disorders are also underdiagnosed in youth presenting to emergency departments relative to their estimated prevalence in epidemiologic surveys. Research and public health campaigns to prevent suicide in youth should incorporate assessment and intervention for sleep disorders.
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Affiliation(s)
- Jason T Carbone
- School of Social Work, Wayne State University, Detroit, MI, USA.
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11
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Cox RC, Brown SL, Chalmers BN, Scott LN. Examining sleep disturbance components as near-term predictors of suicide ideation in daily life. Psychiatry Res 2023; 326:115323. [PMID: 37392522 PMCID: PMC10527974 DOI: 10.1016/j.psychres.2023.115323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/20/2023] [Accepted: 06/23/2023] [Indexed: 07/03/2023]
Abstract
Suicide ideation emerges and fluctuates over short timeframes (minutes, hours, days); however, near-term predictors of such fluctuations have not been well-elucidated. Sleep disturbance is a distal suicide risk factor, but less work has examined whether daily sleep disturbance predicts near-term changes in suicide ideation. We examined subjective sleep disturbance components as predictors of passive and active suicide ideation at the within-person (i.e., day-to-day changes within individuals relative to their own mean) and between-persons (individual differences relative to the sample mean) levels. A transdiagnostic sample of 102 at-risk young adults ages 18-35 completed a 21-day ecological momentary assessment protocol, during which they reported on sleep and passive and active suicide ideation. At the within-persons level, nightmares, sleep quality, and wake after sleep onset predicted passive suicide ideation, and sleep quality and wake after sleep onset predicted active suicide ideation. At the between-persons level, nightmares, sleep onset latency, and sleep quality were associated with passive suicide ideation, and sleep onset latency was associated with active suicide ideation. In contrast, suicide ideation did not predict subsequent sleep at the within-person level. Specific sleep disturbance components are near-term predictors of intraindividual increases in suicide ideation and may hold promise for suicide prevention and intervention.
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Affiliation(s)
- Rebecca C Cox
- Department of Integrative Physiology, University of Colorado Boulder, USA; Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA
| | - Sarah L Brown
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA
| | - Brittany N Chalmers
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA
| | - Lori N Scott
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA.
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12
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Ehlers CL, Karriker-Jaffe KJ, Bernert R. Poor self-reported sleep quality associated with suicide risk in a community sample of American Indian adults. SLEEP ADVANCES : A JOURNAL OF THE SLEEP RESEARCH SOCIETY 2023; 4:zpad024. [PMID: 37293513 PMCID: PMC10246582 DOI: 10.1093/sleepadvances/zpad024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/18/2023] [Indexed: 06/10/2023]
Abstract
Study Objectives Although American Indian/Alaska Native (AI/AN) have high suicide rates few studies have systematically investigated sleep quality and its association with suicidal behaviors in AI/AN. This study is a cross-sectional investigation of self-reported sleep quality and suicidal behaviors in an adult AI population. Methods A semi-structured interview was used to collect data on suicidal ideation, suicidal plans, and suicidal attempts and the Pittsburgh Sleep Quality Index (PSQI) was collected to assess sleep quality in American Indian adults. Results In this sample (n = 477), 91 (19%) of the participants endorsed suicidal ideation (thoughts and plans), and 66 (14%) reported suicidal attempts, including four who subsequently died by suicide. More women reported suicidal thoughts or acts than men. Those endorsing suicidal thoughts slept fewer hours during the night, reported more nocturnal awakenings, and showed poorer subjective sleep quality according to PSQI total scores compared to those with no suicidal thoughts or acts. Participants with suicidal acts (n = 66) reported more bad dreams and higher PSQI total scores compared to those with no suicidal thoughts or acts. When those with any suicidal thoughts or acts (n = 157, 33%) were compared to those without, they were more likely to endorse nocturnal awakenings and bad dreams and demonstrated significantly higher PSQI total scores. Conclusions Although additional research is needed to evaluate sleep disturbances as a proximal, causal risk factor for suicidal behaviors in AI, findings highlight need for further study of sleep as a warning sign and intervention tool for suicide prevention among American Indian adults.
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Affiliation(s)
- Cindy L Ehlers
- Neurosciences Department, The Scripps Research Institute, La Jolla, CA, USA
| | | | - Rebecca Bernert
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, CAUSA
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13
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Primack JM, Quinn MJ, Carskadon MA, Holman CS, Nazem S, Kelsey MR, Fedorenko EJ, McGeary S, Brick LA, McGeary JE. Longitudinal assessment of the sleep suicide link in Veterans: methods and study protocol. SLEEP ADVANCES : A JOURNAL OF THE SLEEP RESEARCH SOCIETY 2023; 4:zpad025. [PMID: 37303865 PMCID: PMC10254730 DOI: 10.1093/sleepadvances/zpad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/18/2023] [Indexed: 06/13/2023]
Abstract
Although sleep disruption has emerged as a theoretically consistent and empirically supported suicide risk factor, the mechanistic pathways underlying the sleep-suicide link are less understood. This paper describes the methodology of a study intended to examine longitudinal mechanisms driving the link between sleep and suicide in Veterans at elevated suicide risk. Participants will be 140 Veterans hospitalized for suicide attempt or ideation with plan and intent or those identified through the Suicide Prevention Coordinator (SPC) office as being at acute risk. After study enrollment, actigraphy and ecological momentary assessment (EMA) data will be collected for 8 weeks, with follow-up assessments occurring at 2, 4, 6, 8, and 26 weeks. Participants respond to EMA questionnaires, derived from psychometrically validated assessments targeting emotional reactivity, emotion regulation, impulsivity, suicide risk, and sleep timing constructs, five times a day. First and last daily EMA target sleep parameters including sleep quantity, quality, timing, nightmares, and nocturnal awakenings. During follow-up assessments, participants will complete self-report assessments and interviews consistent with EMA constructs and the Iowa Gambling Task. The primary outcome for aim 1 is suicide ideation severity and for the primary outcome for aim 2 is suicide behavior. Findings from this study will improve our understanding of the dynamic interactions among sleep disturbance, emotion reactivity/regulation, and impulsivity to inform conceptual Veteran sleep-suicide mechanistic models. Improved models will be critical to optimizing the precision of suicide prevention efforts that aim to intervene and mitigate risk in Veteran populations, especially during a period of acute risk.
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Affiliation(s)
- Jennifer M Primack
- Providence Veterans Affairs Medical Center, Providence, RI, USA
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Mary A Carskadon
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- E.P. Bradley Hospital, Sleep Research Laboratory, Providence, RI, USA
| | - Caroline S Holman
- Providence Veterans Affairs Medical Center, Providence, RI, USA
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Sarra Nazem
- National Center for PTSD Dissemination & Training Division, Menlo Park, CA, USA
| | | | - Erick J Fedorenko
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Department of Psychology, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Sarah McGeary
- Providence Veterans Affairs Medical Center, Providence, RI, USA
| | - Leslie A Brick
- Providence Veterans Affairs Medical Center, Providence, RI, USA
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - John E McGeary
- Providence Veterans Affairs Medical Center, Providence, RI, USA
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
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14
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Dong QY, Yang XF, Liu BP, Zhang YY, Wan LP, Jia CX. Menstrual pain mediated the association between daytime sleepiness and suicidal risk: A prospective study. J Affect Disord 2023; 328:238-244. [PMID: 36806594 DOI: 10.1016/j.jad.2023.02.041] [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: 12/22/2022] [Revised: 02/05/2023] [Accepted: 02/11/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Adolescents with daytime sleepiness have been demonstrated to have a higher level of suicidal risk than those without. Currently, few studies had examined the pathway from daytime sleepiness to suicidal risk among female adolescents. This study aimed to explore the association among menstrual pain, daytime sleepiness, and suicidal risk among female adolescents in China. METHODS Of 7072 adolescents who participated in the follow-up survey of Shandong Adolescents Behavior & Health Cohort (SABHC), 3001 were female adolescents who had begun to menstruate and included for the analysis. A structured self-administrated questionnaire was used to measure menstrual pain, daytime sleepiness, suicidal risk and demographic characteristics. Participants were first surveyed in November-December 2015 and resurveyed 1 year later. RESULTS Of 3001 participants, 11.43 % had suicidal risk, 79.8 % experienced menstrual pain. Cross-lagged analysis showed that there was cause-and-effect relationship between menstrual pain and daytime sleepiness. Moderate (OR = 1.79, 95%CI: 1.22-2.63) and severe (OR = 2.73, 95%CI: 1.80-4.12) menstrual pain (follow-up) were associated with suicidal risk (follow-up). Daytime sleepiness (baseline: OR = 1.04, 95%CI: 1.02-1.06, follow-up: OR = 1.07, 95%CI: 1.05-1.09) had effects on suicidal risk (follow-up). Mediation analysis showed that menstrual pain played a partially mediating role between daytime sleepiness and suicidal risk, with the indirect effect being 0.002 (95%CI: 0.001-0.004). LIMITATIONS All data were self-reported. CONCLUSIONS Menstrual pain and daytime sleepiness had effects on each other, and they both were the risk factors of suicidal risk. Among female adolescents, the association between daytime sleepiness and suicidal risk could be partially mediated by menstrual pain. Releasing the menstrual pain of female adolescents with daytime sleepiness could reduce their suicidal risk.
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Affiliation(s)
- Qiu-Yue Dong
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong Province, China; Shandong University Center for Suicide Prevention Research, Jinan, Shandong, China
| | - Xiao-Fan Yang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong Province, China; Shandong University Center for Suicide Prevention Research, Jinan, Shandong, China
| | - Bao-Peng Liu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong Province, China; Shandong University Center for Suicide Prevention Research, Jinan, Shandong, China
| | - Ying-Ying Zhang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong Province, China; Shandong University Center for Suicide Prevention Research, Jinan, Shandong, China
| | - Li-Peng Wan
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong Province, China; Shandong University Center for Suicide Prevention Research, Jinan, Shandong, China
| | - Cun-Xian Jia
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong Province, China; Shandong University Center for Suicide Prevention Research, Jinan, Shandong, China.
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Farah N, Obeid S, Malaeb D, Haddad C, Fekih-Romdhane F, Hallit S. Mediation effect of insomnia symptoms between positive psychotic like experiences and suicidal ideation among Lebanese young adults. BMC Psychiatry 2023; 23:272. [PMID: 37081441 PMCID: PMC10116113 DOI: 10.1186/s12888-023-04778-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 04/12/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Psychotic symptoms reported by healthy individuals in the general population are referred to as psychotic-like experiences (PLEs) and have been proven to increase the risk of suicidal ideation (SI) in these individuals. As it is well established that PLEs and insomnia share a bidirectional association and also that insomnia is linked to SI, we hypothesized that insomnia may represent a mediator underlying the relationship between PLEs and SI. Our aim was to validate this hypothesis among Lebanese young adults. METHODS A total of 3103 young adults (mean age 21.73 ± 3.80 years; 63.6% females) recruited from all Lebanese governorates completed a self-administered online questionnaire. PLEs were assessed using the CAPE-42 scale, SI using the Columbia Suicide Rating Scale, and insomnia using the Insomnia Severity Index). We conducted a mediation analysis using SPSS PROCESS v3.4 model 4 with three pathways. Variables that showed a p < 0.25 in the bivariate analysis were entered in the path analysis. RESULTS A total of 1378 participants (44.4%) had insomnia; 18.8% had SI; 42.5% reported at least one positive PE 'nearly always', and 30.5% reported at least one negative PE with this frequency. The results of the mediation analysis showed that insomnia severity partially mediated the association between positive dimension and SI; higher positive dimension was significantly associated with more insomnia severity, which was, in turn, significantly associated with more SI. Finally, more positive dimension was significantly and directly associated with more SI. CONCLUSION These preliminary findings might encourage the implementation of new preventive measures to reduce SI among PLEs patients. Treating symptoms of insomnia might help reduce the risk of suicide.
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Affiliation(s)
- Nour Farah
- Faculty of Science, Lebanese University, Fanar, Lebanon
| | - Sahar Obeid
- School of Arts and Sciences, Social and Education Sciences Department, Lebanese American University, Jbeil, Lebanon
| | - Diana Malaeb
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
| | - Chadia Haddad
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
- School of Health Sciences, Modern University for Business and Science, Beirut, Lebanon
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique Et de Toxicologie-Liban), Beirut, Lebanon
| | - Feten Fekih-Romdhane
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry "Ibn Omrane", Razi Hospital, 2010, Manouba, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Souheil Hallit
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
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16
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Zhong W, Zhao A, Lan H, Ren Z, Mao S, Zhang J, Li P, Szeto IMY, Wang P, Zhang Y. Sleep quality, antepartum depression and self-harm thoughts in pregnant Chinese women. J Affect Disord 2023; 327:292-298. [PMID: 36754093 DOI: 10.1016/j.jad.2023.01.127] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Previous literature has shown a significant association between sleep and depression, whereas limited studies have examined the association of sleep quality with self-harm ideation in pregnant Chinese women. METHODS A total of 898 pregnant women (first to third trimester) from the Young Investigation Study were enrolled in this study. The Pittsburgh Sleep Quality Index (PSQI) questionnaire was used to assess sleep quality. Antepartum depression and self-harm ideation were evaluated using the Edinburgh Postnatal Depression Scale (EPDS). Multivariable logistic regression models were used to calculate odds ratios (ORs) and 95 % confidence intervals (CIs). RESULTS In this sample, the prevalence of poor sleep quality and antepartum depression was 44.3 % and 24.4 %, respectively. Furthermore, 12.8 % of women were considered as having self-harm ideation. Individuals in different trimesters reported similar prevalence of self-harm thoughts. Women were more likely to report self-harm thoughts if they were categorized as poor sleep quality or antepartum depression. And women with moderate or severe depression had higher risk of self-harm ideation and poor sleep, compared with those with mild depression. Although sleep quality indirectly influenced self-harm thoughts through the mediation effect of depressive symptoms, poor sleep quality was still associated with a 2.62-fold increased odds of self-harm ideation among women in the second trimester (OR = 2.62; 95 % CI: 1.11-6.21), after adjustment for depression. LIMITATIONS Causality cannot be inferred. Results should be generalized carefully. Depression was evaluated by a screening tool rather than clinical interviews. CONCLUSIONS The prevalence of poor sleep quality, depressive symptoms and self-harm ideation in pregnant Chinese women were noteworthy and high. Besides, a direct effect was also found between sleep quality and self-harm thoughts among women in the second trimester. Our findings suggest the need to identify and intervene when sleep disturbances are observed in women during pregnancy.
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Affiliation(s)
- Wuxian Zhong
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China
| | - Ai Zhao
- Vanke School of Public Health, Tsinghua University, Beijing 100084, China
| | - Hanglian Lan
- Inner Mongolia Dairy Technology Research Institute Co., Ltd., Hohhot 010110, China; Yili Maternal and Infant Nutrition Institute, Beijing 100071, China
| | - Zhongxia Ren
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China
| | - Shuai Mao
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China
| | - Jian Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China
| | - Pin Li
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China
| | - Ignatius Man-Yau Szeto
- Inner Mongolia Dairy Technology Research Institute Co., Ltd., Hohhot 010110, China; Yili Maternal and Infant Nutrition Institute, Beijing 100071, China
| | - Peiyu Wang
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing 100191, China
| | - Yumei Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China.
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17
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Mason EC, Grierson AB, Sie A, Sharrock MJ, Li I, Chen AZ, Newby JM. Co-occurring insomnia and anxiety: a randomized controlled trial of internet cognitive behavioral therapy for insomnia versus internet cognitive behavioral therapy for anxiety. Sleep 2023; 46:6679359. [PMID: 36041459 DOI: 10.1093/sleep/zsac205] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/27/2022] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Insomnia and anxiety are highly prevalent and frequently co-occur. Given limited therapeutic resources and time constraints, the aim of this study was to compare which treatment-internet cognitive behavioral therapy (CBT) for insomnia or internet CBT for anxiety-leads to the best outcomes in individuals with comorbid insomnia and anxiety. METHODS 120 participants with comorbid insomnia and clinical anxiety (as defined by scores above the clinical cutoff on the insomnia severity index (ISI) and the generalized anxiety disorder 7-item scale (GAD-7)) were randomized to receive internet-based cognitive behavioral therapy (iCBT) for insomnia or iCBT for anxiety. The primary outcome measures were the ISI and the generalized anxiety disorder 7-item scale. Primary outcome measures were assessed before treatment, at mid-treatment, at post-treatment, and 3 months after treatment. Secondary outcome measures assessed depression symptoms, distress, and sleep diary parameters. RESULTS Participants in both groups experienced large reductions in symptoms of insomnia, anxiety, depression, and distress, as well as improvements in sleep efficiency and total sleep time. Improvements were maintained at follow-up. Crucially, at the end of treatment, the insomnia treatment was more effective in reducing symptoms of insomnia than the anxiety treatment, and equally effective in reducing symptoms of anxiety. Treatment gains were maintained at 3-month follow-up, however, there were no differences between groups at that time point. CONCLUSIONS These results suggest that in the common case of a patient presenting with comorbid insomnia and anxiety, treatment for insomnia may be the most efficient treatment strategy. TRIAL REGISTRATION The trial was registered with the Australian and New Zealand Clinical Trials Registry, https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618001141235. Trial ID: ACTRN12618001141235. Trial name: a comparison of internet-based CBT for insomnia versus internet-based CBT for anxiety in a comorbid sample.
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Affiliation(s)
- Elizabeth C Mason
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, NSW, Australia.,School of Psychology, Faculty of Science, University of New South Wales, Sydney, NSW, Australia
| | - Ashlee B Grierson
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, NSW, Australia
| | - Amanda Sie
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, NSW, Australia
| | - Maria J Sharrock
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, NSW, Australia
| | - Ian Li
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, NSW, Australia
| | - Aileen Z Chen
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, NSW, Australia
| | - Jill M Newby
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, NSW, Australia.,Black Dog Institute, Randwick, NSW, Australia
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18
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Post-Discharge Suicide among High-Risk Psychiatric Inpatients: Risk factors and warnings signs. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2023. [DOI: 10.1016/j.jadr.2023.100506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
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19
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Chen Y, Zhu J. Longitudinal Associations Between Cybervictimization and Adolescent Sleep Problems: The Role of Anxiety and Depressive Symptoms. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:2806-2827. [PMID: 35585655 DOI: 10.1177/08862605221102485] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Adolescents who have experienced cybervictimization are at risk for sleep problems. However, there is a gap in knowledge about the mechanism that would explain this link. The study used a longitudinal design to test if cybervictimization predicted adolescents' sleep problems 6 and 12 months later, and whether these patterns could be explained in part by emotional distress in response to the victimization. Participants were 1987 Chinese adolescents (56.1% males) ages 10 to 14 (M = 12.32, SD = 0.53) at baseline. Data were collected over the course of 1 year, in three waves 6 months apart. The adolescents completed questionnaires regarding cybervictimization, sleep problems, depressive symptoms, and anxiety symptoms at all three time points. Autoregressive cross-lagged models showed that cybervictimization predicted later sleep problems after controlling for traditional peer victimization, and anxiety and depressive symptoms mediated this link. Multivariate latent growth models showed that the developmental trajectories of cybervictimization, sleep problems, anxiety symptoms, and depressive symptoms were related in complex ways over time. Measures of study variables were self-reported, and generalizability may be limited by a sample of adolescents from school in China. These results are important because of their implications for prevention and treatment of adolescents' sleep problems evoked by cybervictimization.
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Affiliation(s)
- Yuanyuan Chen
- School of Education, 47875Guangzhou University, Guangzhou, China
| | - Jianjun Zhu
- Department of Psychology, 47875Guangzhou University, Guangzhou, China
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20
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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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21
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Actigraphic sleep monitoring in patients with post-traumatic stress disorder (PTSD): A meta-analysis. J Affect Disord 2023; 320:450-460. [PMID: 36174789 DOI: 10.1016/j.jad.2022.09.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 08/05/2022] [Accepted: 09/20/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Sleep disruption is a common complaint among patients with post-traumatic stress disorder (PTSD). Modern technology of activity monitoring (actigraphy) enables extended, objective, unobtrusive recording and measuring of daytime and nighttime activity. We conducted a meta-analysis to investigate the actigraphic sleep patterns in PTSD compared with healthy controls. METHODS We searched through seven electronic databases from inception to July 2022. Only case-control studies comparing rest-activity variables measured by actigraphy devices between clinically diagnosed PTSD patients and healthy individuals were included. RESULTS We identified 12 eligible studies comparing 323 PTSD patients and 416 healthy controls. Using a random-effects model, we showed that PTSD patients have significantly lower sleep efficiency (SMD: -0.26, 95 % CI = -0.51 to -0.004, p < .05, I2 = 29.31 %), more fragmented sleep (SMD: 0.52, 95 % CI = 0.17 to 0.87, p < .01, I2 = 0 %), and longer time in bed (SMD: 0.41, 95 % CI = 0.07 to 0.74, p < .05, I2 = 0 %) compared to healthy controls. LIMITATIONS This study included a limited number of studies. Publication bias was not examined on all variables, which could lead to an overestimation of effect size. Four studies involved veterans, which likely differ from civilians regarding traumatic exposure. CONCLUSION This meta-analytic review highlighted a pattern of sleep disturbances in PTSD patients compared with non-PTSD individuals. High-quality, large-scale studies are necessary to draw a definitive conclusion regarding the distinctive sleep profile in PTSD. Future research can pay attention to sleep-specific mechanisms underlying PTSD and explore the momentary interactions between sleep-wake variables.
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22
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Kearns JC, Kittel JA, Schlagbaum P, Pigeon WR, Glenn CR. Worry-related sleep problems and suicidal thoughts and behaviors among adolescents in 88 low-, middle-, and high-income countries: an examination of individual- and country-level factors. Eur Child Adolesc Psychiatry 2022; 31:1995-2011. [PMID: 34213638 DOI: 10.1007/s00787-021-01838-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 06/25/2021] [Indexed: 01/26/2023]
Abstract
A strong association between sleep problems and suicidal thoughts and behaviors (STBs) has been demonstrated in high-income countries. The sleep-STB relationship, however, is minimally understood among youth in low and middle-incomes countries. There also is a limited understanding of how individual- (i.e., age, sex) and country-level (i.e., economic inequality, economic quality) factors may moderate the magnitude of the sleep-STB association among youth. Data were analyzed from the cross-national Global School-based Health Survey 2003-2017, which assessed a range of health behaviors among school-enrolled adolescents aged 11-18 years from 88 low-, lower-middle, upper-middle, and high-income countries. Multilevel models were used to examine the influence of individual- and country-level factors on the association between past-year worry-related sleep problems and past-year suicide ideation, suicide plans, and suicide attempts. Worry-related sleep problems were significantly associated with suicide ideation, plans, and attempts. Adolescent sex, country economic quality (income group designation), and country economic inequality moderated the sleep-STB association, but age did not. The sleep-STB relationship was stronger for males and across macroeconomic indices, the relationship was generally strongest among upper-middle income countries (economic quality) and countries with a big income gap (economic inequality). When examining how individual-level factors differentially affected the sleep-STB relationship within economic quality (income group designation), the effects were driven by older adolescents in high-income countries for suicide ideation and suicide plans. Study findings suggest an important role for global macroeconomic factors, for males, and older adolescents in high-income countries in the sleep-STB relationship. Future directions include expanding worldwide coverage of countries, assessing a wider range of sleep problems, and longitudinal work to understand potential mechanisms in the sleep-STB relationship.
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Affiliation(s)
- Jaclyn C Kearns
- Department of Psychology, University of Rochester, 180 Meliora Hall, Box 270266, Rochester, NY, 14627, USA.
| | - Julie A Kittel
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Paige Schlagbaum
- Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Wilfred R Pigeon
- VA Center for Excellence for Suicide Prevention, Finger Lakes Healthcare System, Canandaigua, NY, USA.,Sleep and Neurophysiology Research Lab, University of Rochester Medical Center Rochester, Rochester, NY, USA
| | - Catherine R Glenn
- Department of Psychology, Old Dominion University, Norfolk, VA, USA.,Virginia Consortium Program in Clinical Psychology, Norfolk, VA, USA
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23
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Chiang YH, Ma YC, Lin YC, Jiang JL, Wu MH, Chiang KC. The Relationship between Depressive Symptoms, Rumination, and Suicide Ideation in Patients with Depression. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192114492. [PMID: 36361367 PMCID: PMC9658339 DOI: 10.3390/ijerph192114492] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/29/2022] [Accepted: 11/02/2022] [Indexed: 05/30/2023]
Abstract
UNLABELLED The relationship between suicide and rumination in depression is a recent topic of attention in mental health. The purpose of this study was to investigate the relationship between demographic variables, depressive symptoms, rumination, and suicide ideation in patients with depression, as well as the predictors of suicide ideation. RESEARCH DESIGN A cross-sectional study of 95 subjects with depression recruited intentionally from the psychiatric ward of Tzu Chi Hospital. The questionnaire included demographic data, the Beck Depression Inventory-II, the Ruminative Response Scale, and the Beck Scale for Suicide Ideation. Independent sample t-test, Pearson product difference correlation, and the stepwise regression test were adopted for data analysis. RESULTS Age (r = -0.41, p < 0.01), age at diagnosis (r = -0.34, p < 0.01), and sleep duration (r = -0.25, p < 0.05) were negatively correlated with rumination-reflection. The depressive symptoms (r = 0.72, p < 0.01) were positively correlated with rumination, whereas rumination (r = 0.57, p < 0.01) and suicide ideation were positively correlated. Depressive symptoms and rumination could predict suicide ideation, and the effective explanatory power reached 60%. CONCLUSIONS If the patient with depression was younger or the patient was diagnosed at a younger age, the depressive symptoms of the reflection subscale of rumination thinking and suicide ideation were more serious. Our results indicate that clinicians who care for patients with depression should be aware of rumination and its impact on suicide ideation, specifically in younger patients.
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Affiliation(s)
- Yi-Hsuan Chiang
- Department of Nursing, Fu Jen Catholic University, New Taipei City 24205, Taiwan
| | - Yu-Chin Ma
- Department of Nursing, Tzu Chi University, Hualien 97004, Taiwan
| | - Yu-Chuan Lin
- Department of Nursing, Tzu Chi University, Hualien 97004, Taiwan
| | - Jin-Ling Jiang
- Department of Nursing, Tzu Chi University, Hualien 97004, Taiwan
| | - Mei-Hui Wu
- Department of Nursing, Tzu Chi University of Science and Technology, Hualien 970302, Taiwan
| | - Kuo-Cheng Chiang
- Psychiatric Ward for Hualien Tzu Chi Hospital, Hualien 97004, Taiwan
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24
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Ernst M, Brähler E, Kampling H, Kruse J, Fegert JM, Plener PL, Beutel ME. Is the end in the beginning? Child maltreatment increases the risk of non-suicidal self-injury and suicide attempts through impaired personality functioning. CHILD ABUSE & NEGLECT 2022; 133:105870. [PMID: 36084408 DOI: 10.1016/j.chiabu.2022.105870] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/18/2022] [Accepted: 08/31/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Child maltreatment is a risk factor for a range of mental disorders later in life, including dangerous self-harm and suicide attempts. A better understanding of the mechanisms underlying this association can inform prevention and intervention. OBJECTIVE To investigate personality functioning as a potential mediator of the association of childhood abuse and neglect and self-harm and suicide attempts in the general population. PARTICIPANTS AND SETTING Data were drawn from a representative German population sample (N = 2510). METHODS Participants filled out the Childhood Trauma Questionnaire (CTQ), OPD Structure Questionnaire (OPD-SQS), and items of the Self-Injurious Thoughts and Behaviors Interview (SITBI). In structural equation models, we operationalized impaired personality functioning as the mediator between childhood abuse and neglect and self-harm. RESULTS Individuals with a history of self-harm (combining suicide attempts, N = 47, and non-suicidal self-injury, N = 83) reported more childhood abuse and neglect (d = 1.39, p < .001) and greater impairments in personality functioning (d = 1.64, p < .001) than the rest of the population. The indirect effect via personality functioning accounted for 48.8 % of the total effect of childhood abuse and neglect on self-harm. In more differentiated analyses, emotional abuse showed the strongest association with self-harm. Only physical and sexual abuse had direct effects. CONCLUSIONS The results specify the relationship between child maltreatment and self-harm by demonstrating that it is partly mediated by basic functions of personality assessed using a dimensional measure. These abilities constitute modifiable risk factors that can be addressed by psychotherapy.
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Affiliation(s)
- Mareike Ernst
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; Research and Treatment Center Adiposity Diseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Leipzig, Leipzig, Germany
| | - Hanna Kampling
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
| | - Johannes Kruse
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
| | - Jörg M Fegert
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital Ulm, Ulm, Germany
| | - Paul L Plener
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital Ulm, Ulm, Germany; Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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25
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Matsumoto Y, Uchimura N, Ishitake T, Itani O, Otsuka Y. Verification of sleep scales as predictors of suicidal ideation in Japanese dayworkers: a longitudinal study. Sleep Biol Rhythms 2022; 20:577-583. [PMID: 38468627 PMCID: PMC10899985 DOI: 10.1007/s41105-022-00404-6] [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: 02/25/2022] [Accepted: 07/09/2022] [Indexed: 10/17/2022]
Abstract
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.
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Affiliation(s)
- Yuuki Matsumoto
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, 30-1 Oyaguchi, Kami-cho, Itabashi-ku, Tokyo, Japan
- Department of Neuropsychiatry, Kurume University School of Medicine, Kurume, Japan
| | - Naohisa Uchimura
- Department of Neuropsychiatry, Kurume University School of Medicine, Kurume, Japan
| | - Tatsuya Ishitake
- Department of Environmental Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Osamu Itani
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, 30-1 Oyaguchi, Kami-cho, Itabashi-ku, Tokyo, Japan
| | - Yuichiro Otsuka
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, 30-1 Oyaguchi, Kami-cho, Itabashi-ku, Tokyo, Japan
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26
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Liu XK, Li QF, Han DC, Cheng W, Song N, Hu M, Xiao SY. The association between sleep and suicidality in the presence and absence of depressive symptoms: A cross-sectional study in rural China. Medicine (Baltimore) 2022; 101:e29725. [PMID: 35984179 PMCID: PMC9388002 DOI: 10.1097/md.0000000000029725] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
This study aimed to explore the association between sleep and suicidality in the presence and absence of depressive symptoms in the rural Chinese population. The research involved a cross-sectional survey conducted in Liuyang, China, between November 2010 and August 2011. A total of 2052 participants were surveyed (987 males and 1065 females). To investigate the mediating effect of depressive symptoms in the correlation between sleep quality and suicidality. The association between sleep quality and suicidality in the absence of depressive symptoms was also explored. Suicide risk was measured using the Mini-International Neuropsychiatric Interview subscale. The visual analog scale was used to assess sleep quality. Patient Health Questionnaire-9 and Patient Health Questionnaire-2, avoiding the overlap in sleep and suicidality assessments, were used for detecting depressive symptoms in participants. Depressive symptoms partially mediated the association between sleep quality and suicidality among rural adults. Furthermore, some participants did not exhibit depressive symptoms in this study yet still exhibited a risk for suicidality, with poor sleep quality contributing significantly to their suicidality even after adjusting for cofounders. Poor sleep quality significantly increases the likelihood of suicidality in the presence and absence of depressive symptoms in the rural Chinese population. Poor sleep quality could correlate with increased suicide risk independently of depressive symptoms.
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Affiliation(s)
- Xiao-Kun Liu
- Psychology Department, The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Qi-Fu Li
- Neurology Department, The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Dong-Chou Han
- Rehabilitation Department, The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Wei Cheng
- Psychology Department, The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Na Song
- Psychology Department, The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Mi Hu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, China
| | - Shui-Yuan Xiao
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, China
- Mental Health Center, Xiangya Hospital, Central South University, Changsha, Hunan, China
- *Correspondence: Shui-Yuan Xiao, Mental Health Center, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China (e-mail: )
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27
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Saulnier KG, Singh R, Lenker KP, Calhoun SL, He F, Liao D, Vgontzas AN, Bixler EO, Fernandez-Mendoza J. Association of insomnia phenotypes based on polysomnography-measured sleep duration with suicidal ideation and attempts. Sleep Health 2022; 8:391-397. [PMID: 35732555 PMCID: PMC9378467 DOI: 10.1016/j.sleh.2022.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/04/2022] [Accepted: 05/14/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the association of insomnia phenotypes, being insomnia with short sleep duration (ISSD) and insomnia with normal sleep duration (INSD), with suicidality in a randomly selected population-based sample. METHODS Data were analyzed from the Penn State Adult Cohort. Participants (N = 1741, 52.5 years, 57.4% female) were randomly recruited from the general population between January 1990 through March 1999 and mortality data were available through December 2018. Insomnia symptoms were defined as self-reports of moderate-to-severe difficulties initiating or maintaining sleep, early morning awakening and non-restorative sleep, or having chronic insomnia (n = 719). Short sleep duration was defined as <6 hours of in-lab polysomnography-measured sleep duration (n = 879). Suicidality (SAI; n = 102) was ascertained by a lifetime history of suicidal ideation (SI; n = 84), suicide attempts (SA; n = 48) or death by suicide (DBS; n = 10). RESULTS Compared to normal sleepers who slept ≥6 hours, participants with ISSD and INSD were associated with 1.72-fold and 2.22-fold increased odds of SAI, respectively; these associations were significant for SI, with 2.09-fold and 2.24-fold increased odds, respectively, but not for SA, after adjusting for physical and mental health comorbidities. ISSD and INSD differed in SAI age of onset and hospitalizations after SA. CONCLUSIONS The results of this cohort study suggest that both INSD and ISSD phenotypes are associated with increased suicidal ideation, while the INSD phenotype has an earlier age of onset and is more likely to experience hospitalizations after attempting suicide. These results highlight the importance of targeting insomnia symptoms to help prevent suicide.
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Affiliation(s)
- Kevin G Saulnier
- Sleep Research & Treatment center, Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA, USA
| | - Rupsha Singh
- Sleep Research & Treatment center, Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA, USA
| | - Kristina P Lenker
- Sleep Research & Treatment center, Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA, USA
| | - Susan L Calhoun
- Sleep Research & Treatment center, Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA, USA
| | - Fan He
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Duanping Liao
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Alexandros N Vgontzas
- Sleep Research & Treatment center, Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA, USA
| | - Edward O Bixler
- Sleep Research & Treatment center, Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA, USA
| | - Julio Fernandez-Mendoza
- Sleep Research & Treatment center, Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA, USA.
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28
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de Diego-Cordero R, Acevedo-Aguilera R, Vega-Escaño J, Lucchetti G. The Use of Spiritual and Religious Interventions for the Treatment for Insomnia: A Scoping Review. JOURNAL OF RELIGION AND HEALTH 2022; 61:507-523. [PMID: 32803656 DOI: 10.1007/s10943-020-01067-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Insomnia is a common problem, affecting individuals' health and quality of life. Among several therapies used to treat this condition, spiritual interventions are suggested to have beneficial outcomes on sleep disturbances. Nevertheless, a systematic compilation of the evidence available is still needed in the literature in order to scientifically investigate the topic. To examine the most common spiritual interventions proposed to treat sleep disorders and to assess the scientific evidence of these interventions. This is a scoping literature review conducted by independent researchers on the following databases: PubMed, SCOPUS, Web of Science, Cochrane Library and OpenGrey. A boolean expression was used, and all studies published in the last 5 years investigating the role of spiritual or religious interventions on insomnia were included. From a total of 3257 articles retrieved in our search, ten studies were included in the final analysis. There is a wide array of techniques used to treat insomnia or the mental disorders associated with insomnia, such as mantra, yoga, mindfulness, praying/meditation, daily spiritual experiences, psycho-religious training and intervention. The included studies showed a positive influence of spiritual/religious interventions on insomnia directly and indirectly. However, there is a scarcity of clinical trials and most studies have small sample sizes and used only subjective measures, resulting in a low evidence. The results of the present review point to a promising role of spirituality and religion on better sleep outcomes, particularly in the improvement in insomnia. However, the heterogeneity and the quality of these studies suggest caution while interpreting these findings. More clinical trials are needed in this area to provide a recommendation of these methods in clinical practice.
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Affiliation(s)
- Rocío de Diego-Cordero
- Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, c/Avenzoar 6, Seville, 41009, Spain
- Research Group PAIDI CTS-969 "Innovation in Health Care and Social Determinants of Health", Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain
| | - Rosa Acevedo-Aguilera
- Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, c/Avenzoar 6, Seville, 41009, Spain
| | - Juan Vega-Escaño
- Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, c/Avenzoar 6, Seville, 41009, Spain.
- Research Group PAIDI CTS-1054 "Interventions and Health Care. Red Cross", Spanish Red Cross Nursing School, University of Seville, Seville, Spain.
| | - Giancarlo Lucchetti
- Department of Medicine, School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Brazil
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29
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Te T. You lack the season of all natures, sleep. J Clin Sleep Med 2022; 18:343-344. [PMID: 34857085 PMCID: PMC8805017 DOI: 10.5664/jcsm.9826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Tue Te
- Division of Sleep Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;,Division of Sleep Medicine, Penn Medicine—Hospital of the University of Pennsylvania, Penn Sleep Center Market Street, Philadelphia, Pennsylvania,Address correspondence to: Tue Te, MD, Division of Sleep Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Translational Research Laboratories, Suite 2100, 125 South 31st Street, Philadelphia, PA 19104;
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30
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Colic S, He JC, Richardson JD, Cyr KS, Reilly JP, Hasey GM. A machine learning approach to identification of self-harm and suicidal ideation among military and police Veterans. JOURNAL OF MILITARY, VETERAN AND FAMILY HEALTH 2022. [DOI: 10.3138/jmvfh-2021-0035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
LAY SUMMARY Combat Veterans are vulnerable to suicidal thoughts and behaviour. Many who die by suicide deny having suicidal ideation (SI). Typically, researchers try to find variables indicating the presence of SI using traditional statistical approaches. These approaches do not possess the capacity to detect highly complex multivariable interactions. In contrast, machine learning (ML) is designed to detect such patterns and can consequently yield much higher predictive accuracy. In this study, the authors trained ML algorithms using 192 variables extracted from questionnaires administered to 738 Veterans and serving personnel to detect the presence of self-harm and SI (SHSI). Using the 10 most predictive non-suicide-related items, the ML algorithms could detect SHSI with 75.3% accuracy. Most of these items reflect psychological phenomena that can change quickly over time, allowing repeated risk reassessment from day to day. The study’s findings suggest that ML methods may play an important role in the discovery, within a large data set, of predictive patterns that might be useful in suicide risk assessment.
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Affiliation(s)
- Sinisa Colic
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Jiang Chen He
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
| | - J. Don Richardson
- St. Joseph’s Operational Stress Injury Clinic, St. Joseph’s Health Care London, London, Ontario, Canada
| | - Kate St. Cyr
- MacDonald Franklin Operational Stress Injury Research Centre, St. Joseph’s Health Care London, London, Ontario, Canada
| | - James P. Reilly
- Department of Electrical and Computer Engineering, McMaster University, Hamilton, Ontario, Canada
| | - Gary M. Hasey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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31
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Rimmer SE, Cohn TJ, Hastings SL, Steele JC, Woods C. Does social support moderate the relationship between gender minority stress and suicide within a sample of transgender and gender diverse people? JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2022. [DOI: 10.1080/19359705.2021.1997855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Sarah E. Rimmer
- Department of Psychology, Radford University, Radford, Virginia, USA
| | - Tracy J. Cohn
- Department of Psychology, Radford University, Radford, Virginia, USA
| | - Sarah L. Hastings
- Department of Psychology, Radford University, Radford, Virginia, USA
| | - Jenessa C. Steele
- Department of Psychology, Radford University, Radford, Virginia, USA
| | - Charles Woods
- Department of Psychology, Radford University, Radford, Virginia, USA
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32
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Chen S, Xu Z, Li Y, Wang T, Yue Y, Hou Z, You L, Lu N, Yin Y, Liu X, Tan L, Ji H, Shi Y, Xin X, Jiang W, Yuan Y. Clinical Efficacy of the Chinese Herbal Medicine Shumian Capsule for Insomnia: A Randomized, Double-Blind, Placebo-Controlled Trial. Neuropsychiatr Dis Treat 2022; 18:669-679. [PMID: 35378821 PMCID: PMC8976492 DOI: 10.2147/ndt.s349427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 03/09/2022] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Shumian capsule (SMC) is a patent Chinese herbal medicine that can soothe the liver and relieves depression, quiet the spirit. Here, we aimed to investigate the efficacy of SMC for treating insomnia using both scales and polysomnography (PSG). PATIENTS AND METHODS A randomized, double-blind, placebo-controlled trial was performed. Twenty-six insomnia patients randomly received SMC (n = 11) or placebo (n = 15) for four weeks. Pittsburgh Sleep Quality Inventory (PSQI), Insomnia Severity Index (ISI), 9-items Patient Health Questionnaire (PHQ-9), 7-items Generalized Anxiety Disorder (GAD-7), 17-item Hamilton Depression Rating Scale (HAMD-17), and Hamilton Anxiety Rating Scale (HAMA) were applied at the baseline and the 2nd, 4th week after treatment. Treatment Emergent Symptom Scale was used to assess adverse reactions. We used PSG to record and analyze sleep features at baseline and after four weeks. RESULTS PSQI, ISI, PHQ-9, HAMD-17, and HAMA scores decreased significantly after SMC treatment. Also, the total sleep time, rapid-eye-movement (REM) sleep latency, stage 2 sleep, deep sleep, REM sleep, and sleep efficiency improved significantly after SMC treatment. In the placebo group, the only significant change was the decrease of PHQ-9 at week-2. Furthermore, both SMC and placebo reported no adverse events. CONCLUSION SMC could safely improve sleep quality with depression and anxiety remission in insomnia patients.
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Affiliation(s)
- Suzhen Chen
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, People's Republic of China.,Institute of Psychosomatics, School of Medicine, Southeast University, Nanjing, People's Republic of China
| | - Zhi Xu
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, People's Republic of China.,Institute of Psychosomatics, School of Medicine, Southeast University, Nanjing, People's Republic of China
| | - Yinghui Li
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, People's Republic of China.,Institute of Psychosomatics, School of Medicine, Southeast University, Nanjing, People's Republic of China
| | - Tianyu Wang
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, People's Republic of China.,Institute of Psychosomatics, School of Medicine, Southeast University, Nanjing, People's Republic of China
| | - Yingying Yue
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, People's Republic of China.,Institute of Psychosomatics, School of Medicine, Southeast University, Nanjing, People's Republic of China
| | - Zhenghua Hou
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, People's Republic of China.,Institute of Psychosomatics, School of Medicine, Southeast University, Nanjing, People's Republic of China
| | - Linlin You
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, People's Republic of China.,Institute of Psychosomatics, School of Medicine, Southeast University, Nanjing, People's Republic of China
| | - Na Lu
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, People's Republic of China.,Institute of Psychosomatics, School of Medicine, Southeast University, Nanjing, People's Republic of China
| | - Yingying Yin
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, People's Republic of China.,Institute of Psychosomatics, School of Medicine, Southeast University, Nanjing, People's Republic of China
| | - Xiaoyun Liu
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, People's Republic of China.,Institute of Psychosomatics, School of Medicine, Southeast University, Nanjing, People's Republic of China
| | - Liangliang Tan
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, People's Republic of China.,Institute of Psychosomatics, School of Medicine, Southeast University, Nanjing, People's Republic of China
| | - Houcheng Ji
- Department of Psychiatry, The Second People's Hospital of Jiangning District, Nanjing, People's Republic of China
| | - Yaoran Shi
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, People's Republic of China.,Institute of Psychosomatics, School of Medicine, Southeast University, Nanjing, People's Republic of China
| | - Xiaoyun Xin
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, People's Republic of China.,Institute of Psychosomatics, School of Medicine, Southeast University, Nanjing, People's Republic of China
| | - Wenhao Jiang
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, People's Republic of China.,Institute of Psychosomatics, School of Medicine, Southeast University, Nanjing, People's Republic of China
| | - Yonggui Yuan
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, People's Republic of China.,Institute of Psychosomatics, School of Medicine, Southeast University, Nanjing, People's Republic of China
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Miller BJ, McCall WV, Xia L, Zhang Y, Li W, Yao X, Liu H. Insomnia, suicidal ideation, and psychopathology in Chinese patients with chronic schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2021; 111:110202. [PMID: 33285266 DOI: 10.1016/j.pnpbp.2020.110202] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Insomnia occurs frequently in the clinical course of schizophrenia. A growing literature has found associations between insomnia, suicidal ideation, and psychopathology in patients with schizophrenia. We explored these associations in a cross-sectional study of a large sample of patients with chronic schizophrenia in China. We hypothesized that insomnia would be associated with an increased odds of current suicidal ideation and higher current psychopathology scores. METHODS We recruited 328 inpatients with chronic schizophrenia, all of whom were prescribed psychotropics. We investigated relationships between current insomnia, suicidal ideation over the past two weeks, and current psychopathology for subjects using regression models. RESULTS After controlling for multiple potential confounding factors, current insomnia was an indicator of a significant, 2.5-fold increased odds of suicidal ideation (OR = 2.56, 95% CI 1.10-5.95, p = 0.029). Insomnia was also a significant indicator of lifetime suicide attempt (OR = 1.07) as well as higher Positive and Negative Syndrome Scale total (β = 0.134, p = 0.017), positive (β = 0.154, p = 0.006) and general (β = 0.145, p = 0.010) subscale scores. CONCLUSION Insomnia is associated with suicidal ideation, lifetime suicide attempt, and higher psychopathology scores in inpatients with chronic schizophrenia. Formal assessment of insomnia appears relevant to the clinical care of patients with schizophrenia as an indicator of suicidal thinking and behavior, depression, and symptom severity.
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Affiliation(s)
- Brian J Miller
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, Georgia.
| | - William V McCall
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Lei Xia
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Yulong Zhang
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Wenzheng Li
- Department of Psychiatry, Hefei Fourth People's Hospital, Hefei, Anhui Province, China
| | - Xianhu Yao
- Department of Psychiatry, Maanshan Fourth People's Hospital, Maanshan, Anhui Province, China
| | - Huanzhong Liu
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, Anhui Province, China.
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Sleep problems predict next-day suicidal thinking among adolescents: A multimodal real-time monitoring study following discharge from acute psychiatric care. Dev Psychopathol 2021. [DOI: 10.1017/s0954579421000699] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AbstractSuicidal thoughts and behaviors (STBs) are major public health concerns among adolescents, and research is needed to identify how risk is conferred over the short term (hours and days). Sleep problems may be associated with elevated risk for STBs, but less is known about this link in youth over short time periods. The current study utilized a multimodal real-time monitoring approach to examine the association between sleep problems (via daily sleep diary and actigraphy) and next-day suicidal thinking in 48 adolescents with a history of STBs during the month following discharge from acute psychiatric care. Results indicated that specific indices of sleep problems assessed via sleep diary (i.e., greater sleep onset latency, nightmares, ruminative thoughts before sleep) predicted next-day suicidal thinking. These effects were significant even when daily sadness and baseline depression were included in the models. Moreover, several associations between daily-level sleep problems and next-day suicidal thinking were moderated by person-level measures of the construct. In contrast, sleep indices assessed objectively (via actigraphy) were either not related to suicidal thinking or were related in the opposite direction from hypothesized. Together, these findings provide some support for sleep problems as a short-term risk factor for suicidal thinking in high-risk adolescents.
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35
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Pottschmidt NR, Castonguay LG, Janis RA, Carney DM, Kilcullen JR, Davis KA, Scofield BE. Client-Therapist Convergence on Sleep Difficulty and its Impact on Treatment Outcomes. Psychother Res 2021; 32:663-677. [PMID: 34763613 DOI: 10.1080/10503307.2021.1995068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
While agreement between clients and their clinicians on therapy goals has frequently been investigated as a process-level variable (i.e., working alliance), dyadic convergence on presenting concerns is also important for initial case formulation. Transdiagnostic presenting problems, like sleep difficulty, pose a particular challenge for client-therapist convergence. The current study describes sleep difficulty in a treatment-seeking college population and investigates the impact of client and therapist baseline sleep problem reports on therapy outcomes. Data were collected through a large practice research network, with the sample comprising 47,023 clients from 99 university counseling centers across the United States. A larger proportion of clients (49.3%) had self-reported high baseline sleep difficulty than those with a clinician-identified sleep concern (16.0%). Clients with baseline sleep difficulty were more likely to end treatment with greater self-reported sleep difficulty and psychological symptom distress, although they may experience larger gross symptom change than clients without baseline sleep difficulty. Clinician-identified sleep concerns were significantly associated with client outcomes, particularly when clients did not report baseline sleep difficulty themselves. Findings from this study suggest that it may be efficacious and efficient with limited time for treatment to address sleep concerns in a college setting. Clinicians' attendance to their clients' transdiagnostic presenting concerns, like sleep difficulty, may increase clients' own awareness of problematic patterns of behavior. When time for therapy is short, as is often the case in college counseling, it may be efficient to prioritize these concerns with the potential to impact a broad range of symptoms.
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Affiliation(s)
- Natalie R Pottschmidt
- Department of Psychology, Pennsylvania State University, University Park, United States
| | - Louis G Castonguay
- Department of Psychology, Pennsylvania State University, University Park, United States
| | - Rebecca A Janis
- Center for Counseling and Psychological Services, Pennsylvania State University, University Park, United States
| | - Dever M Carney
- Department of Psychology, Pennsylvania State University, University Park, United States
| | - J Ryan Kilcullen
- Department of Psychology, Pennsylvania State University, University Park, United States
| | - Katherine A Davis
- Department of Psychology, Pennsylvania State University, University Park, United States
| | - Brett E Scofield
- Center for Counseling and Psychological Services, Pennsylvania State University, University Park, United States
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36
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Lieberman A, Rogers ML, Graham A, Joiner TE. Examining Correlates of Suicidal Ideation between those with and without Psychosis in a Psychiatric Inpatient Sample. J Affect Disord 2021; 294:254-260. [PMID: 34303305 DOI: 10.1016/j.jad.2021.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 07/11/2021] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The present study explored group differences in suicide-related variables between those with and without psychosis within the context of a psychiatric inpatient sample that included a range of affective disorder diagnoses. METHODS 54 individuals with psychosis and 103 individuals without psychosis (but experiencing other severe and acute mental health issues) were compared, and analyses of indirect effects were conducted to test specificity of thwarted belongingness, perceived burdensomeness, capability for suicide, agitation, and insomnia as accounting for group differences in suicidal ideation. RESULTS Patients without psychosis experienced higher levels of suicidal ideation, perceived burdensomeness, thwarted belongingness, agitation, and insomnia than patients with psychosis. Additionally, perceived burdensomeness and agitation emerged as robust explanatory factors for the relationship between psychosis status and suicidal ideation. LIMITATIONS Future work should include longitudinal analyses to understand temporal relationships between study variables. Additionally, stability of patients' psychotic symptoms was required and therefore may not reflect those at greatest acuity. CONCLUSIONS Although several studies have investigated suicide-related variables among those with psychosis as compared to the general population, the present study is novel in that the severity of these symptoms in those with psychosis is compared to that of those in other acutely ill populations (e.g., major depression, substance use).
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Affiliation(s)
- Amy Lieberman
- Department of Psychology, Florida State University, United States.
| | | | - Adam Graham
- Mental Health Cooperative, Nashville, TN, United States
| | - Thomas E Joiner
- Department of Psychology, Florida State University, United States
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37
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McCarthy E, DeViva JC, Southwick SM, Pietrzak RH. Self-rated sleep quality predicts incident suicide ideation in US military veterans: Results from a 7-year, nationally representative, prospective cohort study. J Sleep Res 2021; 31:e13447. [PMID: 34328228 DOI: 10.1111/jsr.13447] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/29/2021] [Accepted: 07/04/2021] [Indexed: 11/30/2022]
Abstract
Sleep disturbance is a risk factor for future suicidal behaviours (e.g. suicidal ideation, suicide attempt, death by suicide), and military veterans are at increased risk for both poor sleep and death by suicide relative to civilians. The purpose of this study was to evaluate whether self-reported sleep quality was associated with risk of new-onset suicidal ideation in a 7-year prospective nationally representative cohort study of US military veterans. Multivariable logistic regression analyses were conducted to identify the relation between self-rated sleep quality and incident suicidal ideation in 2,059 veterans without current suicidal ideation or lifetime suicide attempt history at baseline. Relative importance analyses were then conducted to identify the relative variance explained by sleep quality and other significant determinants of incident suicidal ideation. A total of 169 (weighted 8.9%, 95% confidence interval =7.7%-10.3%) veterans developed suicidal ideation over the 7-year study period. Poor self-rated sleep quality was associated with a more than 60% greater likelihood of developing suicidal ideation (relative risk ratio = 1.62, 95% confidence interval = 1.11-2.36), even after adjustment for well-known suicide risk factors such as major depressive disorder. Relative importance analysis revealed that poor self-rated sleep quality accounted for 44.0% of the explained variance in predicting incident suicidal ideation. These results underscore the importance of assessing, monitoring and treating sleep difficulties as part of suicide prevention efforts in military veterans.
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Affiliation(s)
- Elissa McCarthy
- US Department of Veterans Affairs National Center for PTSD, White River Junction, VT, USA
| | - Jason C DeViva
- Veterans Affairs Connecticut Health Care System, West Haven, CT, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | | | - Robert H Pietrzak
- Veterans Affairs Connecticut Health Care System, West Haven, CT, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.,US Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA.,Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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38
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Tucker RP, Cramer RJ, Langhinrichsen-Rohling J, Rodriguez-Cue R, Rasmussen S, Oakey-Frost N, Franks CM, Cunningham CCA. Insomnia and suicide risk: a multi-study replication and extension among military and high-risk college student samples. Sleep Med 2021; 85:94-104. [PMID: 34298228 DOI: 10.1016/j.sleep.2021.06.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/31/2021] [Accepted: 06/21/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE/BACKGROUND A clear link between insomnia concerns and suicidal ideation has been shown in a variety of populations. These investigations failed to use a theoretical lens in understanding this relationship. Research within the veteran population has demonstrated that feelings of thwarted belongingness (TB), but not perceived burdensomeness (PB), mediate the insomnia and suicidal ideation relationship. Using two high risk samples, the present investigation replicated and extended this line of inquiry to include interpersonal hopelessness about TB, a key component of the Interpersonal Psychological Theory of Suicide. METHODS/RESULTS/CONCLUSIONS Using medical record review and survey data, study 1 replicated the finding that TB is a stronger explanatory factor of the insomnia to suicidal ideation/suicide risk relationship in a sample of N = 200 treatment-seeking active-duty personnel. Study 2 found that insomnia symptoms had an indirect effect on suicidal ideation through TB and PB but not interpersonal hopelessness in a sample of N = 151 college students with a history of suicidal thoughts and/or behaviors. TB was the only mediator of the insomnia-suicide attempt likelihood link and insomnia to clinically significant suicide risk screening status. Limitations include cross-sectional design of both studies and the lack of formal diagnoses of insomnia. Implications and future research directions are discussed.
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Affiliation(s)
| | | | | | | | | | | | - Capt Michael Franks
- US Public Health Service, Naval Medical Center Psychology Training Programs, Navy Medicine Readiness and Training Command Portsmouth, Portsmouth, VA, 23708, USA
| | - Capt Craig A Cunningham
- Nursing Research and Consultation Services, Navy Medicine Readiness and Training Command Portsmouth, Portsmouth, VA, 23708, USA
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39
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Bradford DRR, Biello SM, Russell K. Insomnia symptoms mediate the association between eveningness and suicidal ideation, defeat, entrapment, and psychological distress in students. Chronobiol Int 2021; 38:1397-1408. [PMID: 34100311 DOI: 10.1080/07420528.2021.1931274] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
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.
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40
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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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41
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Paterson A, Khundakar M, Young A, Ling J, Chakraborty S, Rathbone AP, Watson S, Donaldson T, Anderson KN. The Smarter Sleep educational interventions: an initiative to reduce hypnotic prescribing in in-patient psychiatric care. BJPsych Bull 2021; 46:1-9. [PMID: 33949304 PMCID: PMC9768515 DOI: 10.1192/bjb.2021.41] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 03/31/2021] [Accepted: 04/09/2021] [Indexed: 12/31/2022] Open
Abstract
AIMS AND METHOD In-patients on mental health wards are commonly prescribed hypnotics for the long-term management of disturbed sleep. Specific sleep disorders remain underdiagnosed and effective behavioural interventions are underused. We developed a suite of three educational interventions (a video, poster and handbook) about sleep, sleep disorders, the safe prescribing of hypnotics and use of psychological strategies (sleep hygiene and cognitive-behavioural therapy for insomnia, CBTi) using co-design and multiprofessional stakeholder involvement. This controlled before-and-after study evaluated the effectiveness of these interventions across seven in-patient psychiatric wards, examining their impact on hypnotic prescribing rates and staff confidence scores (data collected by retrospective drug chart analysis and survey respectively). RESULTS A marked reduction was seen in the percentage of patients prescribed hypnotics on in-patient prescription charts (-24%), with a 41% reduction in the number of hypnotics administered per patient (mean reduction -1.142 administrations/patient). CLINICAL IMPLICATIONS These simple educational strategies about the causes and treatment of insomnia can reduce hypnotic prescribing rates and increase staff confidence in both the medical and psychological management of insomnia.
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Affiliation(s)
- Alastair Paterson
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Martina Khundakar
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Anthony Young
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
- Faculty of Health Sciences and Wellbeing, University of Sunderland, UK
| | - Jonathan Ling
- Faculty of Health Sciences and Wellbeing, University of Sunderland, UK
| | | | - Adam Pattison Rathbone
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Stuart Watson
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Inpatient Services, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Tim Donaldson
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Kirstie N. Anderson
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Regional Sleep Disorders Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
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Anna Karin H, Hössjer O, Bellocco R, Ye W, Trolle LY, Åkerstedt T. Insomnia in the context of short sleep increases suicide risk. Sleep 2021; 44:5995546. [PMID: 33216134 PMCID: PMC8033451 DOI: 10.1093/sleep/zsaa245] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 02/28/2020] [Indexed: 01/25/2023] Open
Abstract
Study Objectives The relationship between insomnia and suicide risk is not completely understood. We aimed to investigate the influence of insomnia on suicide risk, taking both sleep duration and depression into consideration. Methods The present study is based on a Swedish prospective cohort study of 38,786 participants with a mean follow-up time of 19.2 years. Cox proportional hazards models with attained age as time-scale were used to estimate hazard ratios (HRs) of death by suicide with 95% confidence intervals (CI) for participants categorized by frequency of insomnia symptoms. Causal mediation analysis was performed to assess to what extent the relationship between insomnia and suicide risk is mediated by depression. Results Insomnia was only associated with suicide risk among short sleepers, whereas no significant association was observed among those who slept 7 h/night or more. The total effect of insomnia in the context of short sleep on suicide risk, expressed on the HR scale, was 2.85 (95% CI 1.42–5.74). The direct effect was 2.25 (95% CI 1.12–4.54) and the indirect effect, mediated by depression, was 1.27 (95% CI 1.05–1.53). Of the total effect, 32% was mediated by depression. The association between insomnia and suicide risk became more pronounced with decreasing depressive symptoms (p value for trend <0.05). Conclusions Insomnia in the context of short sleep increases suicide risk, both directly and indirectly by affecting the risk of depression. Abnormalities of sleep duration and insomnia symptoms should be evaluated when assessing suicide risk.
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Affiliation(s)
- Hedström Anna Karin
- Department of Clinical Neuroscience and Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ola Hössjer
- Mathematical Statistics, Stockholm University, Stockholm, Sweden
| | - Rino Bellocco
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Weimin Ye
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Lagerros Ylva Trolle
- Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.,Obesity Center, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
| | - Torbjörn Åkerstedt
- Stress Research, Stockholm University, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Alter S, Wilson C, Sun S, Harris RE, Wang Z, Vitale A, Hazlett EA, Goodman M, Ge Y, Yehuda R, Galfalvy H, Haghighi F. The association of childhood trauma with sleep disturbances and risk of suicide in US veterans. J Psychiatr Res 2021; 136:54-62. [PMID: 33561736 DOI: 10.1016/j.jpsychires.2021.01.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 12/14/2020] [Accepted: 01/16/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Sleep dysregulation is prevalent among veterans and is associated with increased risk of suicidal ideation and behaviors. A confluence of risk factors have been identified to date that contribute to increase risk for suicidal behavior. How these risk factors including childhood trauma, comorbid psychopathology, impulsivity, and hostility together with sleep disturbance contribute to suicide risk remains an open question. These factors have never been examined simultaneously in a unified mediation model, as investigated in the present study, to determine their relative contribution to suicide risk. METHODS Veterans (N = 105) were recruited across 3-groups, including Major Depressive Disorder (MDD) with/without a history of a suicide attempt (n = 35 and n = 37, respectively), and non-psychiatric controls, who had no history of mental illness or suicidal behavior (n = 33). The participants were assessed using validated self-report assessments with in-depth phenotyping for relevant risk factors associated with suicidal behavior including childhood adversity, depression severity, impulsivity, hostility, and sleep quality. These factors were included in mediation models using path analysis. RESULTS Across all subjects including those with MDD and non-psychiatric controls, mediation analysis showed that higher levels of childhood trauma had an indirect effect on poor sleep quality (p = 0.001). This effect was orthogonal, being independently mediated by both MDD psychopathology (p = 0.003), and higher traits of impulsivity (p = 0.001) and hostility (p = 0.015). Amongst MDD veterans, childhood trauma was directly associated with increased suicide risk (p = 0.034), irrespective of their severity of depression, or their degree of hostility and impulsivity. LIMITATIONS include use of self-report data, and the inability to establish causal inferences with cross-sectional design. CONCLUSION Childhood adversity as a significant pre-deployment risk factor for disturbed sleep and elevated suicide risk, potentially important for incorporation in clinical practice for suicide.
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Affiliation(s)
| | | | - Shengnan Sun
- Icahn School of Medicine at Mount Sinai, New York, USA
| | | | - Zhaoyu Wang
- Icahn School of Medicine at Mount Sinai, New York, USA
| | - Amanda Vitale
- Icahn School of Medicine at Mount Sinai, New York, USA
| | - Erin A Hazlett
- James J. Peters VA Medical Center, Bronx, USA; Icahn School of Medicine at Mount Sinai, New York, USA
| | - Marianne Goodman
- James J. Peters VA Medical Center, Bronx, USA; Icahn School of Medicine at Mount Sinai, New York, USA
| | - Yongchao Ge
- Icahn School of Medicine at Mount Sinai, New York, USA
| | - Rachel Yehuda
- James J. Peters VA Medical Center, Bronx, USA; Icahn School of Medicine at Mount Sinai, New York, USA
| | | | - Fatemeh Haghighi
- James J. Peters VA Medical Center, Bronx, USA; Icahn School of Medicine at Mount Sinai, New York, USA.
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44
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Vitale A, Byma L, Sun S, Podolak E, Wang Z, Alter S, Galfalvy H, Geraci J, Langhoff E, Klingbeil H, Yehuda R, Haghighi F, Feder A. Effectiveness of Complementary and Integrative Approaches in Promoting Engagement and Overall Wellness Toward Suicide Prevention in Veterans. J Altern Complement Med 2021; 27:S14-S27. [PMID: 33788604 PMCID: PMC8035924 DOI: 10.1089/acm.2020.0245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objective: Suicide is a major public health problem, specifically among U.S. veterans, who do not consistently engage in mental health services, often citing stigma as a barrier. Complementary and Integrative Health (CIH) interventions are promising alternatives in promoting patient engagement and further, they may play a critical role in transitioning people into mental health care. Toward this goal, the Resilience and Wellness Center (RWC) was developed to break through the stigma barrier by addressing risk factors of suicide through multimodal CIH interventions via cohort design, promoting social connectedness and accountability among participants. Design: This is a program evaluation study at a large urban VA medical center, where assessments were evaluated from pre- to post-program completion to determine the effectiveness of an intensive multimodal CIH 4-week group outpatient intervention for suicide prevention. Outcome measures: Primary outcomes measured included group connectedness, severity of depression and hopelessness symptoms, suicidal ideation, sleep quality, and diet. Secondary outcomes included measures of post-traumatic stress disorder (PTSD), generalized anxiety severity stress/coping skills, pain, and fatigue. Results: The RWC showed high participant engagement, with an 84%-95% attendance engagement rate depending on suicide risk history. Data from 15 cohorts (N = 126) demonstrate favorable outcomes associated with participation in this comprehensive program, as evidenced by a reduction in suicidal ideation, depression, and hopelessness, but not sleep quality and diet. In addition, in a subset of veterans with a history of suicidal ideation or attempt, significant improvements were noted in pain, PTSD/anxiety symptoms, and stress coping measures. Conclusions: The RWC shows that an intensive complement of CIH interventions is associated with a significant improvement with high veteran engagement. Findings from this program evaluation study can be used to aid health care systems and their providers in determining whether or not to utilize such multimodal CIH integrated interventions as an effective treatment for at-risk populations as a part of suicide prevention efforts.
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Affiliation(s)
| | - Lauren Byma
- James J. Peters VA Medical Center, Bronx, NY, USA
| | - Shengnan Sun
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Evan Podolak
- James J. Peters VA Medical Center, Bronx, NY, USA
| | - Zhaoyu Wang
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sharon Alter
- James J. Peters VA Medical Center, Bronx, NY, USA
| | - Hanga Galfalvy
- Department of Psychiatry, Columbia University, New York, NY, USA
| | | | - Erik Langhoff
- James J. Peters VA Medical Center, Bronx, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Rachel Yehuda
- James J. Peters VA Medical Center, Bronx, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Fatemeh Haghighi
- James J. Peters VA Medical Center, Bronx, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ann Feder
- James J. Peters VA Medical Center, Bronx, NY, USA
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King CD, Joyce VW, Nash CC, Buonopane RJ, Black JM, Zuromski KL, Millner AJ. Fear of sleep and sleep quality mediate the relationship between trauma exposure and suicide attempt in adolescents. J Psychiatr Res 2021; 135:243-247. [PMID: 33508543 DOI: 10.1016/j.jpsychires.2021.01.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 12/17/2020] [Accepted: 01/18/2021] [Indexed: 12/26/2022]
Abstract
Prior work has established bivariate associations between suicidal thoughts and behaviors, trauma exposure and sleep disturbance broadly. Specifically, this study tested whether fear of sleep and sleep quality mediated the association between trauma exposure and suicide attempt. Participants (N = 100) were adolescents admitted to an inpatient psychiatric program for suicidality. Trauma exposure history was retrieved from admission notes and participants completed self-report surveys assessing sleep quality, fear of sleep and number of suicide attempts within the previous month. Structural equation modelling was used to investigate the relationships between childhood trauma, fear of sleep, sleep quality, and suicide attempt. Path analysis was used to investigate the indirect effects from trauma exposure to suicide attempt through fear of sleep, and sleep quality. Path analysis revealed a significant indirect effect from trauma exposure to suicide attempt through fear of sleep and sleep quality. Our findings suggest that a significant portion of the association between trauma exposure and suicide attempts in adolescence may be explained by the negative impact of trauma exposure on sleep. Fear of sleep may increase the risk of a suicide attempt by negatively impacting sleep quality. Future studies should investigate whether interventions targeting sleep and fear of sleep reduce the association between trauma and suicide attempt.
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Affiliation(s)
- Christopher D King
- Franciscan Children's, Brighton, MA, United States; McLean Hospital, Belmont, MA, United States
| | | | - Carol C Nash
- Franciscan Children's, Brighton, MA, United States
| | - Ralph J Buonopane
- Franciscan Children's, Brighton, MA, United States; McLean Hospital, Belmont, MA, United States
| | - Jessica M Black
- Boston College School of Social Work, Newton, MA, United States
| | - Kelly L Zuromski
- Franciscan Children's, Brighton, MA, United States; Harvard University, Department of Psychology, Cambridge, MA, United States
| | - Alexander J Millner
- Franciscan Children's, Brighton, MA, United States; Harvard University, Department of Psychology, Cambridge, MA, United States.
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Johnson C, Mathew SJ, Oh H, Rufino KA, Najafi B, Colombo AE, Patriquin MA. Wearable technology: A promising opportunity to improve inpatient psychiatry safety and outcomes. J Psychiatr Res 2021; 135:104-106. [PMID: 33465608 DOI: 10.1016/j.jpsychires.2021.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Affiliation(s)
| | - Sanjay J Mathew
- The Menninger Clinic, Houston, TX, 77035, USA; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, 77030, USA; Michael E. Debakey VA Medical Center, Houston, TX, 77030, USA
| | - Hyuntaek Oh
- The Menninger Clinic, Houston, TX, 77035, USA; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Katrina A Rufino
- The Menninger Clinic, Houston, TX, 77035, USA; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, 77030, USA; University of Houston Downtown, Houston, TX, 77002, USA
| | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP) Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | | | - Michelle A Patriquin
- The Menninger Clinic, Houston, TX, 77035, USA; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, 77030, USA; Michael E. Debakey VA Medical Center, Houston, TX, 77030, USA.
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McCabe CT, Watrous JR, Galarneau MR. Health Behaviors Among Service Members Injured on Deployment: A Study From the Wounded Warrior Recovery Project. Mil Med 2021; 186:67-74. [PMID: 33005930 DOI: 10.1093/milmed/usaa242] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/06/2020] [Accepted: 08/03/2020] [Indexed: 01/12/2023] Open
Abstract
ABSTRACT
Introduction
Service members (SMs) who are injured on deployment are at risk for myriad long-term health problems that may be ancillary to their physical injury, including high rates of depression and posttraumatic stress disorder, and poor health behaviors (e.g., problem drinking, cigarette and tobacco use, poor sleep quality, and sedentary lifestyle). As the specific health behaviors injured SMs engage in have been largely ignored, the primary aim of this study was to compare health behavior patterns among those with and without mental health problems in a large, representative sample of SMs injured on combat deployment.
Materials and Methods
Participants (N = 3,303) completed behavioral health assessments between September 2018 and April 2019 as part of the Wounded Warrior Recovery Project. Multivariate linear regressions and binary logistic regressions were used to evaluate differences between mental health screening status and health behavior outcomes, adjusting for injury severity, age, and years since injury.
Results
Overall, about half of participants screened positive for posttraumatic stress disorder and/or depression (49%). Participants reported high rates of alcohol use and problems, cigarette and tobacco use, inadequate sleep and poor sleep quality, and low levels of physical activity. With the exception of number of drinking days and likelihood of current tobacco use, participants who screened positive for a mental health disorder evidenced significantly worse health behavior outcomes.
Conclusions
The results provide a preliminary glance into the mental health and health behaviors of SMs roughly a decade after injury, and underscore the importance of examining the interplay between mental, physical, and behavioral health outcomes among wounded warriors to promote health and wellness.
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Affiliation(s)
- Cameron T McCabe
- Operational Readiness Directorate, Naval Health Research Center, San Diego, CA 92106, USA
- Leidos, San Diego, CA 92106, USA
| | - Jessica R Watrous
- Operational Readiness Directorate, Naval Health Research Center, San Diego, CA 92106, USA
- Leidos, San Diego, CA 92106, USA
| | - Michael R Galarneau
- Operational Readiness Directorate, Naval Health Research Center, San Diego, CA 92106, USA
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Germain A, Markwald RR, King E, Bramoweth AD, Wolfson M, Seda G, Han T, Miggantz E, O’Reilly B, Hungerford L, Sitzer T, Mysliwiec V, Hout JJ, Wallace ML. Enhancing behavioral sleep care with digital technology: study protocol for a hybrid type 3 implementation-effectiveness randomized trial. Trials 2021; 22:46. [PMID: 33430955 PMCID: PMC7798254 DOI: 10.1186/s13063-020-04974-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 12/14/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Insomnia affects almost one in four military service members and veterans. The first-line recommended treatment for insomnia is cognitive-behavioral therapy for insomnia (CBTI). CBTI is typically delivered in-person or online over one-to-four sessions (brief versions) or five-to-eight sessions (standard versions) by a licensed doctoral or masters-level clinician with extensive training in behavioral sleep medicine. Despite its effectiveness, CBTI has limited scalability. Three main factors inhibit access to and delivery of CBTI including restricted availability of clinical expertise; rigid, resource-intensive treatment formats; and limited capacities for just-in-time monitoring and treatment personalization. Digital technologies offer a unique opportunity to overcome these challenges by providing scalable, personalized, resource-sensitive, adaptive, and cost-effective approaches for evidence-based insomnia treatment. METHODS This is a hybrid type 3 implementation-effectiveness randomized trial using a scalable evidence-based digital health software platform, NOCTEM™'s Clinician-Operated Assistive Sleep Technology (COAST™). COAST includes a clinician portal and a patient app, and it utilizes algorithms that facilitate detection of sleep disordered patterns, support clinical decision-making, and personalize sleep interventions. The first aim is to compare three clinician- and system-centered implementation strategies on the reach, adoption, and sustainability of the COAST digital platform by offering (1) COAST only, (2) COAST plus external facilitation (EF: assistance and consultation to providers by NOCTEM's sleep experts), or (3) COAST plus EF and internal facilitation (EF/IF: assistance/consultation to providers by NOCTEM's sleep experts and local champions). The second aim is to quantify improvements in insomnia among patients who receive behavioral sleep care via the COAST platform. We hypothesize that reach, adoption, and sustainability and the magnitude of improvements in insomnia will be superior in the EF and EF/IF groups relative to the COAST-only group. DISCUSSION Digital health technologies and machine learning-assisted clinical decision support tools have substantial potential for scaling access to insomnia treatment. This can augment the scalability and cost-effectiveness of CBTI without compromising patient outcomes. Engaging providers, stakeholders, patients, and decision-makers is key in identifying strategies to support the deployment of digital health technologies that can promote quality care and result in clinically meaningful sleep improvements, positive systemic change, and enhanced readiness and health among service members. TRIAL REGISTRATION ClinicalTrials.gov NCT04366284 . Registered on 28 April 2020.
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Affiliation(s)
- Anne Germain
- NOCTEM, LLC, 218 Oakland Avenue, Pittsburgh, PA 15213 USA
| | - Rachel R. Markwald
- Warfighter Performance Department, Naval Health Research Center, 140 Sylvester Rd, San Diego, CA 92106 USA
| | - Erika King
- Mental Health Division, Air Force Medical Readiness Agency, 2261 Hughes Ave, Suite 153, JBSA Lackland AFB, TX 78236-9853 USA
| | - Adam D. Bramoweth
- VA Pittsburgh Healthcare System, Research Office Building (151RU), University Drive C, Pittsburgh, PA 15240 USA
| | - Megan Wolfson
- NOCTEM, LLC, 218 Oakland Avenue, Pittsburgh, PA 15213 USA
| | - Gilbert Seda
- Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134 USA
| | - Tony Han
- Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134 USA
| | - Erin Miggantz
- Warfighter Performance Department, Naval Health Research Center, 140 Sylvester Rd, San Diego, CA 92106 USA
- Leidos, Inc., 4161 Campus Point Ct., San Diego, 92121 USA
| | - Brian O’Reilly
- Madigan Army Medical Center, 9040A Jackson Ave, Joint Base Lewis-McChord, WA 98431 USA
| | - Lars Hungerford
- Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134 USA
- Defense and Veterans Brain Injury Center, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134 USA
| | - Traci Sitzer
- Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134 USA
| | - Vincent Mysliwiec
- Division of Behavioral Medicine, Department of Psychiatry, UT Health San Antonio, 7703 Floyd Curl Drive, MC 7747, San Antonio, TX 78229-3900 USA
| | - Joseph J. Hout
- Knowesis, Inc., 816 Camaron St. Suite 231, San Antonio, TX 78212 USA
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Rosenbusch H, Soldner F, Evans AM, Zeelenberg M. Supervised machine learning methods in psychology: A practical introduction with annotated R code. SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2021. [DOI: 10.1111/spc3.12579] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Hannes Rosenbusch
- Department of Social Psychology Tilburg University Tilburg The Netherlands
| | - Felix Soldner
- Department of Security and Crime Science University College London London UK
| | - Anthony M. Evans
- Department of Social Psychology Tilburg University Tilburg The Netherlands
| | - Marcel Zeelenberg
- Department of Social Psychology Tilburg University Tilburg The Netherlands
- Department of Marketing Tilburg University Tilburg The Netherlands
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50
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Rohr JC, Rufino KA, Alfano CA, Patriquin MA. Sleep disturbance in patients in an inpatient hospital mediates relationship between PTSD and suicidal ideation. J Psychiatr Res 2021; 133:174-180. [PMID: 33348251 DOI: 10.1016/j.jpsychires.2020.12.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/12/2020] [Accepted: 12/09/2020] [Indexed: 10/22/2022]
Abstract
A common reason for admission to inpatient psychiatric units is suicidal ideation. Growing evidence of the link between sleep disturbance and suicidal ideation brings an interest in greater clarity of the pathways; this paper focused on post-traumatic stress disorder (PTSD), which carries increased risk for both sleep disturbance and suicidal ideation, as well as sex differences in those pathways. Patients were 2822 inpatients studied at admission to an inpatient psychiatric hospital and mediation analyses were used to examine pathways of interest. There was an indirect effect of PTSD on suicidal ideation through sleep disturbances for the entire sample and for men and women separately. The effect for men was larger than that for women, suggesting a stronger effect for sleep disturbance in the relationship for men. For women only, the direct effect between PTSD and suicidal ideation remained significant after mediation. Sleep disturbance plays an important role in the relationship between PTSD and suicidal ideation. Early identification of sleep disturbance in inpatients and targeted focus of sleep in conjunction with resolving trauma-related symptoms may help reduce suicidal ideation. This may be especially true of men; the indirect effect was smaller for women, suggesting that sleep disturbance should be addressed in conjunction with other PTSD symptoms likely leading to suicidal ideation.
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Affiliation(s)
- Jessica C Rohr
- The Menninger Clinic, 12301 S. Main St., Houston TX 77035, USA; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd., Houston TX 77030, USA.
| | - Katrina A Rufino
- The Menninger Clinic, 12301 S. Main St., Houston TX 77035, USA; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd., Houston TX 77030, USA; The University of Houston Downtown, 1 Main St., Houston TX 77002, USA
| | - Candice A Alfano
- Sleep and Anxiety Center of Houston, University of Houston, 4505 Cullen Blvd., Houston TX 77204, USA
| | - Michelle A Patriquin
- The Menninger Clinic, 12301 S. Main St., Houston TX 77035, USA; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd., Houston TX 77030, USA; Michaeld E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd, Houston, TX, 77030, USA
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