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Law KC, O'Connell KL, Jacobson SV, Baer MM, Baker PM, Tull MT. Influences of sleep, cortisol reactivity, and risk/reward-based decision-making on suicide. J Behav Ther Exp Psychiatry 2024; 85:101975. [PMID: 38870548 PMCID: PMC11347093 DOI: 10.1016/j.jbtep.2024.101975] [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: 11/29/2023] [Revised: 04/03/2024] [Accepted: 05/25/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND AND OBJECTIVES Poor sleep quality is a known contributor to suicidal thoughts and behaviors. This study examines whether sleep quality modulates the effect of an individual's stress response and risk/reward-based decision making on suicide risk. METHODS Participants were 160 adults at a residential substance use treatment facility with lifetime exposure to trauma who completed a clinician-administered measure of suicide risk, the Iowa Gambling Task (IGT), and a self-report measure of sleep. Cortisol reactivity (i.e., changes in cortisol before and after a personalized trauma script) was used to measure stress response. We used quantile regression to examine the effects of sleep, cortisol, and risk/reward decision-making on suicide risk. RESULTS We found poor sleep quality to be increasingly salient in individuals at greater risk for suicide than those at lower risk for suicide. Furthermore, individuals with moderate to moderate-high levels of suicide risk seem to have greater cortisol reactivity. In the low-moderate quantile, we found suicide risk to be associated with both high stress reactivity and low-risk, high-reward decision-making, as well as low stress reactivity and high-risk/low-reward decision-making. LIMITATIONS These findings should be interpreted considering several methodological constraints, such as the use of a pre-determined sample and instruments not tailored for our hypotheses, the MINI 'Suicide' Module's limited differentiation between suicidal ideation and behavior, and variably timed cortisol sampling. CONCLUSIONS Despite these limitations, the findings from this study support the use of evidence-based interventions focused on improving sleep quality and managing emotional reactivity to decrease suicide risk.
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Affiliation(s)
- Keyne C Law
- Department of Clinical Psychology, Seattle Pacific University, Seattle, WA, USA.
| | | | - Samantha V Jacobson
- Department of Clinical Psychology, Seattle Pacific University, Seattle, WA, USA
| | - Margaret M Baer
- Department of Psychology, University of Toledo, Toledo, OH, USA
| | - Phillip M Baker
- Department of Psychology, Seattle Pacific University, Seattle, WA, USA
| | - Matthew T Tull
- Department of Psychology, University of Toledo, Toledo, OH, USA; Lyra Health Inc., Burlingame, CA, USA
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2
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Rasmussen S, Chandler JF, Russell K, Cramer RJ. A prospective examination of sleep chronotype and future suicide intent among adults in the United Kingdom: A test of the integrated motivational volitional model of suicide. Sleep Med 2024; 124:84-90. [PMID: 39277966 DOI: 10.1016/j.sleep.2024.09.004] [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: 12/15/2023] [Revised: 07/29/2024] [Accepted: 09/07/2024] [Indexed: 09/17/2024]
Abstract
OBJECTIVES/BACKGROUND Prior research identified a connection between evening chronotype and suicidality, but the mechanism underlying that connection is not well understood. The Integrated Motivational Volitional (IMV) Model of Suicide may provide a theoretical explanation for this link. The current project includes a three-time point longitudinal survey to examine whether 1) suicide intent likelihood varies across time, 2) chronotype affects suicide intent likelihood prospectively, and 3) defeat and entrapment explain the association between chronotype and suicide intent likelihood. PATIENTS/METHODS Participants (n = 187 UK adults) completed a baseline survey (demographics, chronotype (morning-eveningness; MEQ), defeat and entrapment, and perceived intent to make a future suicide attempt), and follow-up surveys (MEQ and suicide intent likelihood) 3 and 6 months later. RESULTS Results indicated that suicidal intent at 6-month follow-up was lower than baseline or 3-month follow-up. It was also found that strong evening chronotype at baseline is associated with increased suicidal intent 6 months later, and that defeat mediates this relationship. CONCLUSION Our theoretically informed findings shed light on the psychological mechanisms linking chronotype (i.e., eveningness) and future suicide intent by highlighting the role of defeat and entrapment. We propose that feelings of defeat might be derived from evening types' experiences of social jetlag (resulting from conflict between biologically driven sleep schedules and externally dictated social schedules), which consequently drives entrapment and greater future suicide intent. Within this context, defeat and entrapment may be good transdiagnostic and modifiable target variables for future intervention development.
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3
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Kwaśny A, Cubała WJ, Włodarczyk A, Pastuszak K. Sleep alterations in treatment-resistant depression patients undergoing ketamine treatment. Pharmacol Rep 2024:10.1007/s43440-024-00641-1. [PMID: 39207673 DOI: 10.1007/s43440-024-00641-1] [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] [Received: 05/18/2024] [Revised: 08/13/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND This study examines self-reported sleep alterations in treatment-resistant depression (TRD) inpatients following intravenous ketamine administration. METHODS This is a post-hoc analysis of a naturalistic observational study, which enrolled 28 inpatients with treatment-resistant major depressive disorder and analyzed self-reported sleep changes (items 1-4; 'insomnia', 'nighttime restlessness', 'early morning waking', 'hypersomnia') in Inventory of Depressive Symptomatology 30-item (IDS SR-30) in responders and non-responders stratified per Montgomery-Åsberg Depression Rating Scale (MADRS) during short-term ketamine treatment. RESULTS Responders, as well as non-responders, did not experience significant changes in IDS SR-30 sleep items ('insomnia', 'nighttime restlessness', 'early morning waking', 'hypersomnia') (p's > 0.05) at 7-day follow-up after eight intravenous ketamine infusions as compared to baseline. CONCLUSION Neither responders, nor non-responders reported any significant alterations in sleep patterns during ketamine infusions. These findings are not in line with current literature, as so far modest improvements in sleep during ketamine treatment have been reported. Results should be interpreted with caution, primarily due to the small sample size.
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Affiliation(s)
- Aleksander Kwaśny
- Department of Psychiatry, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, 80-214, Poland.
| | - Wiesław Jerzy Cubała
- Department of Psychiatry, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, 80-214, Poland
| | - Adam Włodarczyk
- Department of Psychiatry, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, 80-214, Poland
| | - Krzysztof Pastuszak
- Department of Algorithms and System Modeling, Gdansk University of Technology, Gdańsk, Poland
- Laboratory of Translational Oncology, Intercollegiate Faculty of Biotechnology, University of Gdańsk and Medical University of Gdańsk, Gdańsk, Poland
- Center of Biostatistics and Bioinformatics, Medical University of Gdańsk, Gdańsk, Poland
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Haddadi A, Matinnia N, Yazdi‐Ravandi S. The relationship between corona disease anxiety and sleep disturbances and suicidal ideation in medical staff: The mediating role of resiliency and cognitive flexibility: A cross-sectional study. Health Sci Rep 2024; 7:e2282. [PMID: 39144407 PMCID: PMC11322221 DOI: 10.1002/hsr2.2282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 07/02/2024] [Accepted: 07/22/2024] [Indexed: 08/16/2024] Open
Abstract
Background and Aims Medical staff have experienced anxiety, sleep disturbances, and suicide due to the COVID-19 epidemic. Thus, this study examined the relationship between corona disease anxiety, sleep problems, and suicidal ideation in medical staff and how resiliency and cognitive flexibility mediate it. Methods This descriptive-analytical cross-sectional study examined medical staff. In 2022, participants were affiliated with Hamadan University of Medical Sciences, Iran educational and treatment centers. Sampling was done at primary COVID-19 treatment centers. Data was collected using validated instruments. Ethics were observed during data collecting. Results Path analysis was employed to test hypotheses. Analysis showed significant positive relationships between Corona disease anxiety and sleep disturbances (p = 0.001, β = 0.438) and suicidal ideation (p = 0.001, β = 0.310). Conversely, negative and significant associations were identified between resiliency and cognitive flexibility with sleep disturbances and suicidal ideation. Conclusions The study illustrates how medical staff's psychological health is linked to COVID-19. High Corona disease anxiety causes sleep disturbances and suicidal thoughts. Resilience and cognitive flexibility modulated Corona disease anxiety, sleep problems, and suicidal thoughts. The comprehensive study focuses on medical staff mental health issues, suggesting targeted solutions.
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Affiliation(s)
- Arya Haddadi
- Department of Clinical Psychology, Faculty of Medical Sciences, Hamedan BranchIslamic Azad UniversityHamedanIran
- Behavioral Disorders and Substance Abuse Research CenterHamadan University of Medical SciencesHamadanIran
| | - Nasrin Matinnia
- Department of Nursing, Faculty of Medical Sciences, Hamedan BranchIslamic Azad UniversityHamedanIran
| | - Saeid Yazdi‐Ravandi
- Behavioral Disorders and Substance Abuse Research CenterHamadan University of Medical SciencesHamadanIran
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Ballard ED, Greenstein D, Reiss PT, Crainiceanu CM, Cui E, Duncan WC, Hejazi NS, Zarate CA. Functional changes in sleep-related arousal after ketamine administration in individuals with treatment-resistant depression. Transl Psychiatry 2024; 14:238. [PMID: 38834540 PMCID: PMC11150508 DOI: 10.1038/s41398-024-02956-2] [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: 01/05/2024] [Revised: 05/15/2024] [Accepted: 05/21/2024] [Indexed: 06/06/2024] Open
Abstract
The glutamatergic modulator ketamine is associated with changes in sleep, depression, and suicidal ideation (SI). This study sought to evaluate differences in arousal-related sleep metrics between 36 individuals with treatment-resistant major depression (TRD) and 25 healthy volunteers (HVs). It also sought to determine whether ketamine normalizes arousal in individuals with TRD and whether ketamine's effects on arousal mediate its antidepressant and anti-SI effects. This was a secondary analysis of a biomarker-focused, randomized, double-blind, crossover trial of ketamine (0.5 mg/kg) compared to saline placebo. Polysomnography (PSG) studies were conducted one day before and one day after ketamine/placebo infusions. Sleep arousal was measured using spectral power functions over time including alpha (quiet wakefulness), beta (alert wakefulness), and delta (deep sleep) power, as well as macroarchitecture variables, including wakefulness after sleep onset (WASO), total sleep time (TST), rapid eye movement (REM) latency, and Post-Sleep Onset Sleep Efficiency (PSOSE). At baseline, diagnostic differences in sleep macroarchitecture included lower TST (p = 0.006) and shorter REM latency (p = 0.04) in the TRD versus HV group. Ketamine's temporal dynamic effects (relative to placebo) in TRD included increased delta power earlier in the night and increased alpha and delta power later in the night. However, there were no significant diagnostic differences in temporal patterns of alpha, beta, or delta power, no ketamine effects on sleep macroarchitecture arousal metrics, and no mediation effects of sleep variables on ketamine's antidepressant or anti-SI effects. These results highlight the role of sleep-related variables as part of the systemic neurobiological changes initiated after ketamine administration. Clinical Trials Identifier: NCT00088699.
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Affiliation(s)
- Elizabeth D Ballard
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.
| | - Deanna Greenstein
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Philip T Reiss
- Department of Statistics, University of Haifa, Haifa, Israel
| | - Ciprian M Crainiceanu
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Erjia Cui
- Division of Biostatistics and Health Data Science, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Wallace C Duncan
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Nadia S Hejazi
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Carlos A Zarate
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
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Schwerthöffer D, Förstl H. [Insomniac symptoms and suicidality-link and management]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2024; 38:53-61. [PMID: 37171521 PMCID: PMC11143018 DOI: 10.1007/s40211-023-00466-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/01/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND A link between insomniac symptoms and suicidality has long been suspected and deserves specific attention. OBJECTIVE We examine the current evidence for this relationship from epidemiology and neurobiology in order to propose a targeted management. MATERIAL AND METHOD Clinical example and selective Medline-literature research for insomnia symptoms and suicidality. RESULTS Epidemiological data and statistical analysis show that symptoms of insomnia are independent risk factors for suicidality. Neurobiological factors associated with combined insomnia symptoms and suicidality are: serotonergic dysfunction and circadian rhythm disorder leading to hypofrontality with reduced problem solving capacity and impaired emotional and impulse-control. Social isolation, recurrent rumination, comorbid psychiatric disorders, access to potentially lethal drugs or weapons need urgent evaluation in patients with a combination of suicidality and symptoms of insomnia. CONCLUSION patients with insomnia and further risk factors for suicide need to be treated resolutely and at an early stage. Modern sleep-promoting antidepressants with low toxicity and antipsychotics must be preferred in the treatment of patients with insomniac sleep disorders and suicidality. Multimodal anti-insomnia and anti-depressive therapy adapted to the circadian rhythm can exert a favorable influence both on depressive-suicidal and insomnia symptoms and their inherent risks.
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Affiliation(s)
- Dirk Schwerthöffer
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, TU-München, Ismaningerstraße 22, 81675, München, Deutschland.
| | - Hans Förstl
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, TU-München, Ismaningerstraße 22, 81675, München, Deutschland
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Brailovskaia J, Teismann T, Margraf J. Positive mental health accounts for the relationship between insomnia symptoms and suicide-related outcomes. J Psychiatr Res 2024; 174:192-196. [PMID: 38642456 DOI: 10.1016/j.jpsychires.2024.04.030] [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: 07/05/2023] [Revised: 03/13/2024] [Accepted: 04/15/2024] [Indexed: 04/22/2024]
Abstract
Insomnia symptoms have been shown to be associated with suicide ideation/behavior. However, the underlying mechanism is unclear and studies on protective factors that might mitigate the association between sleep-related problems and suicide ideation/behavior are largely missing. On this background the aim of the current study was to investigate, whether positive mental health (PMH) accounts for the association between insomnia symptoms and suicidal ideation/behavior. A total of 913 participants (72.2% women; age: M(SD) = 25.91 (7.08)) completed measures on insomnia symptoms, PMH and suicide ideation/behavior via an online survey. The results reveal a significant association between insomnia symptoms and PMH. Both variables were significantly linked to lifetime suicide ideation/behavior and 12-month suicide ideation. Moreover, the association between insomnia symptoms and suicide-related outcomes was significantly mitigated by PMH. The current findings complement previous studies on the association between insomnia symptoms and suicide ideation/behavior. Furthermore, they demonstrate that PMH can mitigate the risk of suicide-related outcomes. Therapeutic intervention targeting insomnia symptoms and fostering PMH might be useful in the prevention of suicide ideation/behavior.
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Affiliation(s)
- Julia Brailovskaia
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Germany; DZPG (German Center for Mental Health), partner site Bochum/Marburg, Germany.
| | - Tobias Teismann
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Germany
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Germany; DZPG (German Center for Mental Health), partner site Bochum/Marburg, Germany
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Chen Y, Han X, Jiang Y, Jiang Y, Huang X, Wang W, Guo L, Xia R, Liao Y, Zhang H, Teopiz KM, McIntyre RS, Fan B, Lu C. Longitudinal Association between Stressful Life Events and Suicidal Ideation in Adults with Major Depression Disorder: The Mediating Effects of Insomnia Symptoms. Behav Sci (Basel) 2024; 14:467. [PMID: 38920799 PMCID: PMC11200868 DOI: 10.3390/bs14060467] [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] [Received: 03/15/2024] [Revised: 05/28/2024] [Accepted: 05/29/2024] [Indexed: 06/27/2024] Open
Abstract
Stressful life events (SLEs) and suicidal ideation (SI) are prevalent in persons with major depression disorder (MDD). Less is known about the underlying role of insomnia symptoms in the association between SLEs and SI. This three-wave prospective cohort study sought to investigate the longitudinal association among SLEs, insomnia symptoms, and SI in persons with MDD. The study population included 511 persons with MDD (mean [SD] age, 28.7 [6.7] years; 67.1% were females). Generalized estimated equations (GEEs) were utilized to explore prospective association among exposure of SLEs, insomnia symptoms, and SI. Additionally, a structural equation model (SEM) was employed to estimate the longitudinal mediating effect of insomnia symptoms in the relationship between SLEs and SI. Our study demonstrated that cumulative SLEs were determined to be longitudinally associated with SI in persons with MDD. We further observed that the association between SLEs and SI was significantly mediated by insomnia symptoms. Clinicians assessing persons with MDD, especially those with the history of SLE, could carefully evaluate and promptly treat insomnia symptoms as part of personalized assessment of their depressive illness, thereby achieving early prevention and intervention for suicidal behaviors in persons with MDD.
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Affiliation(s)
- Ya Chen
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; (Y.C.)
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou 510080, China
- Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou 510080, China
| | - Xue Han
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen 518054, China; (X.H.)
| | - Yingchen Jiang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; (Y.C.)
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou 510080, China
- Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou 510080, China
| | - Yunbin Jiang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; (Y.C.)
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou 510080, China
- Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou 510080, China
| | - Xinyu Huang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; (Y.C.)
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou 510080, China
- Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou 510080, China
| | - Wanxin Wang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; (Y.C.)
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou 510080, China
- Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou 510080, China
| | - Lan Guo
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; (Y.C.)
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou 510080, China
- Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou 510080, China
| | - Ruirui Xia
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen 518054, China; (X.H.)
| | - Yuhua Liao
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen 518054, China; (X.H.)
| | - Huimin Zhang
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen 518054, China; (X.H.)
| | - Kayla M. Teopiz
- Brain and Cognition Discovery Foundation, Toronto, ON M2J 4A6, Canada
| | - Roger S. McIntyre
- Brain and Cognition Discovery Foundation, Toronto, ON M2J 4A6, Canada
- Department of Pharmacology, University of Toronto, Toronto, ON M2J 4A6, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M2J 4A6, Canada
| | - Beifang Fan
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen 518054, China; (X.H.)
| | - Ciyong Lu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; (Y.C.)
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou 510080, China
- Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou 510080, China
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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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Allen N, Crock L, Chun T, Reinhard MJ. Investigating a clinically informed sleep disturbance threshold for physical and mental health among Gulf War Illness veterans. SLEEP ADVANCES : A JOURNAL OF THE SLEEP RESEARCH SOCIETY 2024; 5:zpae018. [PMID: 38616799 PMCID: PMC11015895 DOI: 10.1093/sleepadvances/zpae018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/14/2024] [Indexed: 04/16/2024]
Abstract
Study Objectives This study (1) assessed sleep quality and health in Gulf War veterans (GWV) meeting the Gulf War Illness (GWI) criteria and (2) compared health associations for both those meeting a "clinically disturbed sleep" threshold, and those below, as determined by the Pittsburgh Sleep Quality Index (PSQI) cutoff for military populations (≥10) on measures of physical, mental, and cognitive health. Methods Participant data consisted of questionnaires and assessments completed prior to group assignment in a clinical trial. The sample consisted of 147 GWV, where 81.0% were males, and the median age was 53.4 years. Results The mean (SD) PSQI global score was 12.34 (4.00) with 61% of the sample qualifying as clinically disturbed sleepers according to the cutoff (global PSQI ≥ 10). GWI veterans with PSQI scores ≥10 did not differ from others in age (p = 0.20), sex (p = 0.19), or years of education (p = 0.87), but showed worse GW-related symptomology on the Gulf War Kansas questionnaire (p < 0.01), and poorer mental health on the Veterans Rand-36 (p < 0.01). Conclusions Disturbed sleep was associated with measures of pain, fatigue, and cognitive health. Our results suggest that a previously determined clinical threshold for clinically disturbed sleep is useful when examining the health status of the study population. Given that GWI is associated with elevated PSQI scores and a high frequency of disturbed sleep, cutoffs determining sleep health should be sensitive to population exposures and health history to improve interpretability.
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Affiliation(s)
- Nathaniel Allen
- Department of Veterans Affairs,War Related Illness and Injury Study Center (WRIISC), Washington, DC, USA
| | - Lucas Crock
- Department of Veterans Affairs,War Related Illness and Injury Study Center (WRIISC), Washington, DC, USA
| | - Timothy Chun
- Department of Veterans Affairs,War Related Illness and Injury Study Center (WRIISC), Washington, DC, USA
| | - Matthew J Reinhard
- Department of Veterans Affairs,War Related Illness and Injury Study Center (WRIISC), Washington, DC, USA
- Department of Psychiatry, Georgetown University Medical Center, Washington, DC, USA
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11
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Mao F, Wan J, Sun Y, Yang B, Wang Y, Cao F. Association between transition patterns of sleep problems and suicidal ideation in Chinese female nurses: A prospective study. J Clin Psychol 2024; 80:279-290. [PMID: 37847787 DOI: 10.1002/jclp.23612] [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: 03/10/2023] [Revised: 08/23/2023] [Accepted: 09/30/2023] [Indexed: 10/19/2023]
Abstract
OBJECTIVE Suicidal ideation and sleep problems are both common in nurses. However, few longitudinal studies are available to examine the temporal association between sleep and suicidal ideation in nurses. METHOD Data from the Health Longitudinal Survey of Nurses in Shandong Province was analyzed, involving 623 female nurses who had completed data of concern in 2018 (T1) and 2019 (T2). Sleep problem was assessed by the Pittsburgh Sleep Quality Index, in which the transition patterns for global and specific sleep component and the cumulative number of sleep component problems were defined. Suicidal ideation was measured by the ninth item of the Patient Health Questionnaire. Binary logistic regression was used to explore the association between sleep and suicidal ideation. RESULTS Chronic and deteriorated global sleep problems is associated with a greater risk of suicidal ideation. For the specific component of sleep, sleep disturbance and short sleep duration are associated with a higher risk of suicidal ideation. The higher number of cumulative sleep component problems is associated with a higher risk of suicidal ideation. CONCLUSION Findings indicate sleep disturbance and short sleep duration may be pathways to suicidal ideation. Initiatives that target at sleep problems may be important to reduce suicidal ideation in nurses.
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Affiliation(s)
- Fangxiang Mao
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, China
| | - Juan Wan
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, China
| | - Yaoyao Sun
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, China
| | - Bei Yang
- West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | | | - Fenglin Cao
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, China
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Hernandez E, Griggs S. Substance Use, Sleep Duration, and Health Among Adults in Ohio. Prev Chronic Dis 2023; 20:E117. [PMID: 38154118 PMCID: PMC10756651 DOI: 10.5888/pcd20.230198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023] Open
Abstract
Introduction Substance use affects approximately 46.3 million people aged 12 years or older (16.5% of the US population) and is associated with poor sleep health overall. Methods We conducted a cross-sectional secondary analysis of data from the 2020 Behavioral Risk Factor Surveillance System survey in Ohio. The sample comprised 14,676 adults. We examined associations between the use of 2 types of substances (marijuana and nonprescribed prescription pain medication) and short sleep duration (<6 hours per night) and overall health (mental, physical, and general). We used linear and logistic regression modeling while adjusting for individual-level (age, sex, race and ethnicity, education, income, and body mass index) and area-level (socioeconomic deprivation) covariates. Results Of survey respondents who answered questions, 9.2% (1,140 of 12,362) reported using marijuana, and 1.4% (111 of 8,203) used nonprescribed prescription pain medication. Respondents who used marijuana used it an average 17.3 days per month. In adjusted logistic regression models, the odds of reporting short sleep duration were 2.4 times greater among respondents who used nonprescribed prescription pain medication (vs those who did not). The odds of reporting short sleep duration, poor mental health, poor physical health, and poor general health were 1.5, 1.3, 2.1, and 1.9 times greater, respectively, among respondents who reported marijuana use (vs those who did not). In the linear regression models (adjusted), more days of marijuana use were associated with longer sleep duration, worse mental health, and worse general health. Conclusion Understanding the connection between substance use and health outcomes is needed to improve trajectories of substance use and recovery. Sleep duration is often underassessed among people who use substances. Expanding diagnostics and treatment options for those who use substances may result in lower levels of substance use and improved overall health.
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Affiliation(s)
- Estefania Hernandez
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio
- Case Western Reserve University, Frances Payne Bolton School of Nursing, 10900 Euclid Ave, Cleveland, OH 44106
| | - Stephanie Griggs
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio
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Hall A, Qureshi I, Meyer EG, Currier GW, Castaneda R, Cardin S. Incidence of Suicidal Ideation and Suicide Attempt Based on Time in a Deployed Environment. Mil Med 2023; 188:41-44. [PMID: 37948219 DOI: 10.1093/milmed/usac403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/22/2022] [Accepted: 12/06/2022] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION Knowing when suicidal ideation (SI) or suicide attempt (SA) is most likely to occur in a deployed environment would aid in focusing prevention efforts. This study aims to determine when evacuation for SA and SI is most likely to occur based on the absolute and relative number of months in a deployed setting. MATERIALS AND METHODS This is a case-control study of active-duty military personnel evacuated from the U.S. Central Command area of responsibility for SI or an SA between April 1, 2020, and March 30, 2021. The arrival month and expected departure month were identified for all the included evacuees. The month of evacuation and proportion of completed deployment were compared. Secondary outcomes of mental health diagnosis or need for a waiver was also examined. RESULTS A total of 138 personnel evacuated for SI or attempted suicide during the 12-month study period were included in the analysis. Evacuations occurring during month 3 of deployment were significantly higher (P < .0001) than those during other months. The 30% and 50% completion point of deployment had statistically higher frequencies of evacuations for SI/SA (<.0001). A secondary analysis revealed that 25.4% of the individuals had a documented preexisting behavioral health condition before deployment (P < .0001). CONCLUSION Specific points along a deployment timeline were significant predictors for being evacuated for SI and SA.
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Affiliation(s)
- Andrew Hall
- U.S. Central Command, Office of Surgeon General, MacDill AFB, FL 33621, USA
| | - Iram Qureshi
- Naval Medical Research Unit San Antonio, San Antonio, TX 78234, USA
| | - Eric G Meyer
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Glenn W Currier
- Department of Psychiatry, University of South Florida, Tampa, FL 33613, USA
| | | | - Sylvain Cardin
- Naval Medical Research Unit San Antonio, San Antonio, TX 78234, USA
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14
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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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15
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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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16
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Boyle JT, Rosenfield B, Di Tomasso RA, Moye J, Bamonti PM, Grandner M, Vargas I, Perlis M. Sleep Continuity, Sleep Related Daytime Dysfunction, and Problem Endorsement: Do These Vary Concordantly by Age? Behav Sleep Med 2023; 21:436-447. [PMID: 36170023 PMCID: PMC10043048 DOI: 10.1080/15402002.2022.2124994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVES Sleep continuity (i.e., ability to initiate and/or maintain sleep) worsens with age. It is unclear whether problem endorsement and/or daytime dysfunction show similar age-related trends. Accordingly, a large archival dataset was used to examine age differences in sleep continuity, problem endorsement, and sleep related daytime dysfunction. METHOD Participants were categorized as: Young Adults (18-29 years); Adults (30-44 years); Middle Aged Adults (45-64 years); and Older Adults (65-89 years). Young Adults, Adults, and Middle Aged Adults were 1:1 matched with Older Adults (n = 233) on the basis of gender, race, ethnicity, and BMI. MANOVA, ANOVAs, and chi-square analysis were performed to assess for age-related differences. RESULTS In a sample of 932 adults with self-reported sleep continuity disturbance (i.e., insomnia), sleep continuity was significantly worse in older age groups. This effect was limited to middle and late insomnia with middle aged and older adults waking up with greater frequency and for longer durations of time during the night and in the early morning than younger cohorts. Problem endorsement largely increased across age groups (except for sleep latency) but reports of overall sleep-related daytime dysfunction showed no difference by age. CONCLUSION When evaluating sleep continuity disturbance, assessing whether the patient identifies their sleep continuity disturbance as a problem and whether it affects their daytime function can be informative, particularly in older adults. It may serve to reveal (case-by-case) when there are discordances between incidence/severity of illness and problem endorsement/daytime dysfunction. Such information may better inform if treatment should be initiated.
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Affiliation(s)
- Julia T. Boyle
- Department of Clinical Psychology, School of Professional and Applied Psychology, Philadelphia College of Osteopathic Medicine (PCOM), Philadelphia, Pennsylvania, USA
- Department of Psychology, VA Boston Healthcare System, Boston, Massachusetts, USA
- New England Geriatric Research Education and Clinical Center (GRECC), Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Bradley Rosenfield
- Department of Clinical Psychology, School of Professional and Applied Psychology, Philadelphia College of Osteopathic Medicine (PCOM), Philadelphia, Pennsylvania, USA
| | - Robert A. Di Tomasso
- Department of Clinical Psychology, School of Professional and Applied Psychology, Philadelphia College of Osteopathic Medicine (PCOM), Philadelphia, Pennsylvania, USA
| | - Jennifer Moye
- Department of Psychology, VA Boston Healthcare System, Boston, Massachusetts, USA
- New England Geriatric Research Education and Clinical Center (GRECC), Boston, Massachusetts, USA
- School of Medicine, Boston University, Boston, Massachusetts, USA
- Department of Psychology, Harvard Medical School, Boston, Massachusetts, USA
| | - Patricia M. Bamonti
- Department of Psychology, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael Grandner
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona, Tucson, Arizona, USA
| | - Ivan Vargas
- Department of Psychological Science, University of Arkansas, Fayetteville, Arkansas, USA
| | - Michael Perlis
- Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Chronobiology and Sleep Institute, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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17
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Scarpelli S, Alfonsi V, Camaioni M, Gorgoni M, Albano A, Musetti A, Quattropani MC, Plazzi G, De Gennaro L, Franceschini C. Longitudinal Findings on the Oneiric Activity Changes Across the Pandemic. Nat Sci Sleep 2023; 15:435-447. [PMID: 37313311 PMCID: PMC10259600 DOI: 10.2147/nss.s410732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/28/2023] [Indexed: 06/15/2023] Open
Abstract
Purpose COVID-19 pandemic waves have strongly influenced individuals' behaviors and mental health. Here, we analyzed longitudinal data collected in the Spring 2020 and 2021 from a large Italian sample with the aim of assessing changes in dream features between the first and third wave. Specifically, we evaluated the modifications of pandemic dream activity as a function of the general distress variations over time. Also, we detected the best explanatory variables of nightmare frequency and distress. Materials and Methods Participants previously involved in the web survey during the first wave of the pandemic were asked to complete a new online survey on sleep and dream features available in Spring 2021 (N=728). Subjects decreasing their level of psychological general distress in the third (T3) vs the first (T1) pandemic wave were defined as "Improved" (N=330). In contrast, participants with an unchanged or increased level of general distress were defined as "Not Improved" (N=398). Results Statistical comparisons revealed that dream recall frequency, nightmare frequency, lucid dream frequency, and emotional intensity show a reduction in T3 than T1. Moreover, the Improved group is characterized by lower nightmare rate and nightmare distress than Not Improved people. Our findings confirmed that beyond the trait-like variables (ie, age, sex), specific sleep-related measures are related to nightmare features. In particular, poor sleep hygiene was one of the best determinants of nightmare distress among Not Improved subjects. Conclusion Our findings revealed that people experienced an adaptation to the pandemic during the third wave. We also strengthen the notion that nightmares and their variations over time are strongly related to human well-being, suggesting that specific trait-like and sleep-related factors could modulate the relationship between mental health and nightmare features.
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Affiliation(s)
- Serena Scarpelli
- Department of Psychology, University of Rome Sapienza, Rome, Italy
| | | | - Milena Camaioni
- Department of Psychology, University of Rome Sapienza, Rome, Italy
| | - Maurizio Gorgoni
- Department of Psychology, University of Rome Sapienza, Rome, Italy
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Antonio Albano
- Department of Medicine and Surgery, Faculty of Medicine and Surgery, University of Parma, Parma, Italy
| | - Alessandro Musetti
- Department of Humanities, Social Sciences and Cultural Industries, University of Parma, Parma, Italy
| | - Maria Catena Quattropani
- Department of Educational Sciences, University of Catania, Catania, Italy
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giuseppe Plazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Luigi De Gennaro
- Department of Psychology, University of Rome Sapienza, Rome, Italy
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Christian Franceschini
- Department of Medicine and Surgery, Faculty of Medicine and Surgery, University of Parma, Parma, Italy
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18
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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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19
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Fujieda M, Uchida K, Ikebe S, Kimura A, Kimura M, Watanabe T, Sakamoto H, Matsumoto T, Uchimura N. Fatigue on Waking, Insomnia, and Workplace Relationship Problems May Help to Detect Suicidal Ideation among New Middle-Aged Primary Care Patients: A 6-Month Prospective Study in Japan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085547. [PMID: 37107831 PMCID: PMC10138726 DOI: 10.3390/ijerph20085547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/27/2023] [Accepted: 04/13/2023] [Indexed: 05/11/2023]
Abstract
Signs of suicidal depression often go undetected in primary care settings. This study explored predictive factors for depression with suicidal ideation (DSI) among middle-aged primary care patients at 6 months after an initial clinic visit. New patients aged 35-64 years were recruited from internal medicine clinics in Japan. Baseline characteristics were elicited using self-administered and physician questionnaires. DSI was evaluated using the Zung Self-Rating Depression Scale and the Profile of Mood States at enrollment and 6 months later. Multiple logistic regression analysis was conducted to calculate adjusted odds ratios for DSI. Sensitivity, specificity, and likelihood ratios for associated factors were calculated. Among 387 patients, 13 (3.4%) were assessed as having DSI at 6 months. Adjusted for sex, age, and related factors, significant odds ratios for DSI were observed for "fatigue on waking ≥1/month" (7.90, 95% confidence intervals: 1.06-58.7), "fatigue on waking ≥1/week" (6.79, 1.02-45.1), "poor sleep status" (8.19, 1.05-63.8), and "relationship problems in the workplace" (4.24, 1.00-17.9). Fatigue on waking, sleep status, and workplace relationship problems may help predict DSI in primary care. Because the sample size in this investigation was small, further studies with larger samples are needed to confirm our findings.
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Affiliation(s)
- Megumi Fujieda
- Department of Neuropsychiatry, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Fukuoka, Japan
- Department of Environmental Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Fukuoka, Japan
- Department of Healthcare Management, College of Healthcare Management, 960-4 Takayanagi, Setaka-machi, Miyama 835-0018, Fukuoka, Japan
- Correspondence: ; Tel.: +81-942-31-7564
| | - Katsuhisa Uchida
- Mental Health and Welfare Center of Shizuoka Prefectural Government, 2-20 Ariake-cho, Suruga-ku, Shizuoka-shi 422-8031, Shizuoka, Japan
| | - Shinichiro Ikebe
- Fuji Medical Association, 2850 Denbo, Fuji 417-0061, Shizuoka, Japan
| | - Akihiro Kimura
- Fuji Medical Association, 2850 Denbo, Fuji 417-0061, Shizuoka, Japan
| | - Masashi Kimura
- Fuji Medical Association, 2850 Denbo, Fuji 417-0061, Shizuoka, Japan
| | - Toshiaki Watanabe
- Fuji Medical Association, 2850 Denbo, Fuji 417-0061, Shizuoka, Japan
| | - Hisako Sakamoto
- Mental Health and Welfare Center of Shizuoka Prefectural Government, 2-20 Ariake-cho, Suruga-ku, Shizuoka-shi 422-8031, Shizuoka, Japan
| | - Teruaki Matsumoto
- Shizuoka General Hospital, 4-27-1 Kitaando, Aoi-ku, Shizuoka-shi 420-8527, Shizuoka, Japan
| | - Naohisa Uchimura
- Department of Neuropsychiatry, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Fukuoka, Japan
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20
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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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Effects of sleep quality on suicide risk in COVID-19 patients: The chain mediating of anxiety and depressive symptoms. Heliyon 2023; 9:e15051. [PMID: 37012905 PMCID: PMC10060188 DOI: 10.1016/j.heliyon.2023.e15051] [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: 07/09/2022] [Revised: 03/21/2023] [Accepted: 03/24/2023] [Indexed: 04/03/2023] Open
Abstract
Background Although current studies have identified sleep disorders as an independent risk factor for suicide, the relationship between sleep disorders and suicide risk has not been well established. This study explored whether anxiety and depressive symptoms are used as mediators to participate in the impact of sleep quality on suicide risk. Methods This is a cross-sectional study. We administered a psychological questionnaire to the participants, using a combination of self-assessment and psychiatrist assessment.Sleep quality, suicide risk, level of anxiety and depressive symptoms were assessed by PSQI, NGASR, SAS and SDS.The study subjects were 391 hospitalized COVID-19 patients from Wuhan hospitals. We used model 6 in the PROCESS (version 3.5) plug-in of SPSS software to conduct mediation test with sleep quality as the independent variable, suicide risk as the dependent variable, level of anxiety and depressive symptoms as intermediate variables. Results The severity of anxiety and depressive symptoms and the risk of suicide in the sleep disorder group (63.15 ± 13.71, 59.85 ± 13.38, 6.52 ± 3.67) were higher than those in the non-sleep disorder group (49.83 ± 13.14, 44.87 ± 10.19, 2.87 ± 3.26) (P < 0.001). The mediation model works well, The total indirect effect was 0.22 (95%CI = [0.17, 0.28]), and the direct effect was 0.16 (95%CI = [0.08, 0.24]). Limitations This study used a self-assessment scale. Conclusions Anxiety and depressive symptoms played a chain mediating role between sleep quality and suicide risk.
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Wang J, Zhao H, Shi K, Wang M. Treatment of insomnia based on the mechanism of pathophysiology by acupuncture combined with herbal medicine: A review. Medicine (Baltimore) 2023; 102:e33213. [PMID: 36930068 PMCID: PMC10019201 DOI: 10.1097/md.0000000000033213] [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: 01/24/2023] [Accepted: 02/15/2023] [Indexed: 03/18/2023] Open
Abstract
Insomnia is a sleep disorder which severely affects patients mood, quality of life and social functioning, serves as a trigger or risk factor to a variety of diseases such as depression, cardiovascular and cerebrovascular diseases, obesity and diabetes, and even increases the risk of suicide, and has become an increasingly widespread concern worldwide. Considerable research on insomnia has been conducted in modern medicine in recent years and encouraging results have been achieved in the fields of genetics and neurobiology. Unfortunately, however, the pathogenesis of insomnia remains elusive to modern medicine, and pharmacological treatment of insomnia has been regarded as conventional. However, in the course of treatment, pharmacological treatment itself is increasingly being questioned due to potential dependence and drug resistance and is now being replaced by cognitive behavior therapy as the first-line treatment. As an important component of complementary and alternative medicine, traditional Chinese medicine, especially non-pharmacological treatment methods such as acupuncture, is gaining increasing attention worldwide. In this article, we discuss the combination of traditional Chinese medicine, acupuncture, and medicine to treat insomnia based on neurobiology in the context of modern medicine.
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Affiliation(s)
- Jie Wang
- Department of Pain, Datong Hospital of Traditional Chinese Medicine, Shanxi Province, Datong, China
| | - Haishen Zhao
- Department of Rehabilitation, Luchaogang Community Health Service Center, Pudong New District, Shanghai, China
| | - Kejun Shi
- Department of Rehabilitation, Luchaogang Community Health Service Center, Pudong New District, Shanghai, China
| | - Manya Wang
- Department of Rehabilitation, Luchaogang Community Health Service Center, Pudong New District, Shanghai, China
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23
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Nowakowska-Domagała K, Podlecka M, Sadowski K, Pietras T, Mokros Ł. The relationship between chronotype, dispositional mindfulness and suicidal ideation among medical students: mediating role of anxiety, insomnia and social dysfunction. J Sleep Res 2023:e13823. [PMID: 36682738 DOI: 10.1111/jsr.13823] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 01/24/2023]
Abstract
The aim of the study was to assess whether chronotype and subjective amplitude may predict suicidal ideation independently of mindfulness, and whether anxiety/insomnia and social dysfunction may be mediators of the relationship between chronotype and suicidal thoughts among medical students. The study group comprised 600 students of the medical faculties (191 men and 409 women), with a mean (SD, range) age of 21.94 (1.81, 18-31) years. The participants completed the Chronotype Questionnaire, the Five Facet Mindfulness Questionnaire (FFMQ) and the General Health Questionnaire (GHQ-28). Two items from GHQ-28 depression scale were extracted to measure suicidal ideation. The FFMQ score correlated negatively with the suicidal ideation score. The total effect of chronotype was insignificant when controlled for FFMQ. In the case of indirect effects, subjective amplitude score predicted suicidal ideation via both anxiety/insomnia and social dysfunction scores. The FFMQ score predicted suicidal ideation only via the social dysfunction scale. The direct effect of subjective amplitude was insignificant. Our findings indicate that the flexibility (or rigidity) of circadian rhythm may be linked to the intensity of experienced suicidal ideation, but only via anxiety/insomnia and social dysfunction, independently of mindfulness and morningness-eveningness.
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Affiliation(s)
| | - Marlena Podlecka
- Department of Neurosis, Personality and Eating Disorders, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Karol Sadowski
- Central Clinical Hospital, Medical University of Lodz, Lodz, Poland
| | - Tadeusz Pietras
- Second Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Łukasz Mokros
- Department of Clinical Pharmacology, Medical University of Lodz, Lodz, Poland
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24
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Romier A, Maruani J, Lopez-Castroman J, Palagini L, Serafini G, Lejoyeux M, d'Ortho MP, Geoffroy PA. Objective sleep markers of suicidal behaviors in patients with psychiatric disorders: A systematic review and meta-analysis. Sleep Med Rev 2023; 68:101760. [PMID: 36706699 DOI: 10.1016/j.smrv.2023.101760] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/29/2022] [Accepted: 01/10/2023] [Indexed: 01/19/2023]
Abstract
Close relationships have been reported between sleep alterations and suicidal behaviors, nevertheless few studies used objective measures of sleep. Such objective markers would be interesting in clinical practice to better screen and prevent suicide. We conducted a systematic review and meta-analysis of published studies examining the relationship between sleep markers and suicidal behaviors using PubMed, Cochrane Library, and Web of Science databases. Actigraphy, polysomnography, and nocturnal EEG were considered. The qualitative analysis retained 15 original studies, including 1179 participants (939 with a psychiatric disorder), and 11 studies were included for the meta-analysis. Current suicidal behaviors were associated with a decreased total sleep time (TST) (SMD = -0.35, [95% CI: -0.66 to -0.04], p = 0.026, I2 = 39.8%). The evaluation of possible moderators shows that age, gender, and depression scores had no effects on the random effect model. No significant differences were observed regarding sleep efficiency, REM latency, or percentage of REM sleep. In conclusion, among candidate objective markers, decreased total sleep time seems associated with suicidal behaviors and could be easily used to assess suicide risk. Alterations of regular sleep duration should invite healthcare professionals to screen the cause and propose sleep interventions to prevent suicide.
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Affiliation(s)
- Alix Romier
- Département de psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hopital Bichat - Claude Bernard, F-75018, Paris, France; Université Paris Cité, NeuroDiderot, Inserm, FHU I2-D2, F-75019, Paris, France.
| | - Julia Maruani
- Département de psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hopital Bichat - Claude Bernard, F-75018, Paris, France; Université Paris Cité, NeuroDiderot, Inserm, FHU I2-D2, F-75019, Paris, France; GHU Paris - Psychiatry & Neurosciences, 1 rue Cabanis, 75014, Paris, France
| | - Jorge Lopez-Castroman
- Department of Psychiatry, CHU Nîmes & IGF, CNRS-INSERM, University of Montpellier, France
| | - Laura Palagini
- Department of Clinical Experimental Medicine, Psychiatric Unit, University of Pisa, School of Medicine, Pisa, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health, Psychiatry Section, University of Genoa, IRCCS San Martino, Genoa, Italy
| | - Michel Lejoyeux
- Département de psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hopital Bichat - Claude Bernard, F-75018, Paris, France; Université Paris Cité, NeuroDiderot, Inserm, FHU I2-D2, F-75019, Paris, France; GHU Paris - Psychiatry & Neurosciences, 1 rue Cabanis, 75014, Paris, France
| | - Marie-Pia d'Ortho
- Université Paris Cité, NeuroDiderot, Inserm, FHU I2-D2, F-75019, Paris, France; Centre du Sommeil, Service de Physiologie - Explorations Fonctionnelles, AP-HP, Hôpital Bichat, F-75018, Paris, France
| | - Pierre A Geoffroy
- Département de psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hopital Bichat - Claude Bernard, F-75018, Paris, France; Université Paris Cité, NeuroDiderot, Inserm, FHU I2-D2, F-75019, Paris, France; GHU Paris - Psychiatry & Neurosciences, 1 rue Cabanis, 75014, Paris, France; CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, F-67000, Strasbourg, France.
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25
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Dolsen EA, Byers AL, Flentje A, Goulet JL, Jasuja GK, Lynch KE, Maguen S, Neylan TC. Sleep disturbance and suicide risk among sexual and gender minority people. Neurobiol Stress 2022; 21:100488. [PMID: 36164391 PMCID: PMC9508603 DOI: 10.1016/j.ynstr.2022.100488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 11/01/2022] Open
Abstract
Sleep disturbance has emerged as an independent, mechanistic, and modifiable risk factor for suicide. Sexual and gender minority (SGM) people disproportionately experience sleep disturbance and are at higher risk of death by suicide relative to cisgender and/or heterosexual individuals. The present narrative review evaluates nascent research related to sleep disturbance and suicide-related thoughts and behaviors (STBs) among SGM populations, and discusses how experiences of minority stress may explain heightened risk among SGM people. Although there is a growing understanding of the link between sleep disturbance and STBs, most research has not been conducted in SGM populations or has not examined suicide as an outcome. Research is needed to examine whether and how aspects of sleep disturbances relate to STBs among SGM people in order to better tailor sleep treatments for SGM populations.
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Affiliation(s)
- Emily A Dolsen
- Mental Health Service, San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA.,Mental Illness Research Education and Clinical Centers, San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA
| | - Amy L Byers
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA.,Research Service, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA.,Department of Medicine, Division of Geriatrics, University of California, San Francisco, CA, USA
| | - Annesa Flentje
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA, USA.,Alliance Health Project, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, San Francisco, USA
| | - Joseph L Goulet
- Yale School of Medicine, Department of Emergency Medicine, New Haven, CT, USA.,VA Connecticut Healthcare System, West Haven, CT, USA
| | - Guneet K Jasuja
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA.,Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Kristine E Lynch
- VA Informatics and Computing Infrastructure (VINCI), VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,University of Utah School of Medicine, Department of Internal Medicine, Division of Epidemiology, Salt Lake City, UT, USA
| | - Shira Maguen
- Mental Health Service, San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA.,Mental Illness Research Education and Clinical Centers, San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA
| | - Thomas C Neylan
- Mental Health Service, San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA.,Mental Illness Research Education and Clinical Centers, San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA
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26
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Killgore WDS, Grandner MA, Tubbs AS, Fernandez FX, Doty TJ, Capaldi II VF, Dailey NS. Sleep loss suicidal ideation: the role of trait extraversion. Front Behav Neurosci 2022; 16:886836. [PMID: 36338878 PMCID: PMC9630630 DOI: 10.3389/fnbeh.2022.886836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 09/26/2022] [Indexed: 11/29/2022] Open
Abstract
Background: It is known that sleep disturbance is associated with increased suicidal thinking. Moreover, completed suicides, when adjusted for the proportion of the populace that is awake at a given time, are more probable during the late night/early morning hours. Despite these concerns, no studies have examined the role of trait-like individual differences in vulnerability to suicidal ideation during sleep deprivation or insomnia. In two separate studies, we examined whether the trait of extraversion is predictive of changes in suicidal thinking following two nights of sleep deprivation and among individuals meeting the criteria for insomnia. Methods:Study 1: Twenty-five healthy military personnel (20 males), ages 20–35 completed the NEO-PI-R Extraversion scale and the Suicidal Ideation (SUI) scale of the Personality Assessment Inventory (PAI). Participants completed 77 h of continuous sleep deprivation. After 56 h of sleep deprivation, participants completed the SUI scale a second time. We predicted a change in SUI scores from baseline extraversion. Study 2: 2,061 adults aged 18–79 (900 males) were divided into two groups based on the clinical threshold (≥ 10) on the Insomnia Severity Index (ISI) and completed measures of extraversion and depression, including the suicide item of the Patient Health Questionnaire-9 (PHQ9). Results:Study 1: After controlling for the caffeine group and changes in PAI Depression, Extraversion scores were used to predict changes in SUI scores using stepwise multiple linear regression. Higher Extraversion was significantly associated with increased non-clinical suicidal ideation following sleep loss, β = 0.463, partial r = 0.512, p = 0.013. Study 2: After controlling for depression, the effect of insomnia on suicidal ideation was moderated by trait extraversion (p < 0.0001). Overall, the presence or absence of insomnia had little effect on individuals low in trait extraversion (i.e., introverts), but insomnia was associated with significantly higher suicidal ideation among high trait extraverted individuals. Conclusions: Higher trait extraversion was associated with increased vulnerability to suicidal ideation between rested baseline and total sleep deprivation and was associated with greater suicidal ideation among those meeting criteria for clinically severe insomnia. These findings point to a potential trait-like vulnerability factor that may further our understanding of sleep disruption in the phenomenology of suicide.
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Affiliation(s)
- William D. S. Killgore
- Department of Psychiatry, University of Arizona College of Medicine, Tucson, AZ, United States
- Walter Reed Army Institute of Research, Silver Spring, MD, United States
- *Correspondence: William D. S. Killgore
| | - Michael A. Grandner
- Department of Psychiatry, University of Arizona College of Medicine, Tucson, AZ, United States
| | - Andrew S. Tubbs
- Department of Psychiatry, University of Arizona College of Medicine, Tucson, AZ, United States
| | | | - Tracy Jill Doty
- Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | | | - Natalie S. Dailey
- Department of Psychiatry, University of Arizona College of Medicine, Tucson, AZ, United States
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27
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Holmgren JG, Morrow A, Coffee AK, Nahod PM, Santora SH, Schwartz B, Stiegmann RA, Zanetti CA. Utilizing digital predictive biomarkers to identify Veteran suicide risk. Front Digit Health 2022; 4:913590. [PMID: 36329831 PMCID: PMC9624222 DOI: 10.3389/fdgth.2022.913590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 09/12/2022] [Indexed: 12/02/2022] Open
Abstract
Veteran suicide is one of the most complex and pressing health issues in the United States. According to the 2020 National Veteran Suicide Prevention Annual Report, since 2018 an average of 17.2 Veterans died by suicide each day. Veteran suicide risk screening is currently limited to suicide hotlines, patient reporting, patient visits, and family or friend reporting. As a result of these limitations, innovative approaches in suicide screening are increasingly garnering attention. An essential feature of these innovative methods includes better incorporation of risk factors that might indicate higher risk for tracking suicidal ideation based on personal behavior. Digital technologies create a means through which measuring these risk factors more reliably, with higher fidelity, and more frequently throughout daily life is possible, with the capacity to identify potentially telling behavior patterns. In this review, digital predictive biomarkers are discussed as they pertain to suicide risk, such as sleep vital signs, sleep disturbance, sleep quality, and speech pattern recognition. Various digital predictive biomarkers are reviewed and evaluated as well as their potential utility in predicting and diagnosing Veteran suicidal ideation in real time. In the future, these digital biomarkers could be combined to generate further suicide screening for diagnosis and severity assessments, allowing healthcare providers and healthcare teams to intervene more optimally.
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Affiliation(s)
- Jackson G. Holmgren
- Rocky Vista University College of Osteopathic Medicine, Ivins, UT, United States,Correspondence: Jackson G. Holmgren
| | - Adelene Morrow
- Rocky Vista University College of Osteopathic Medicine, Ivins, UT, United States
| | - Ali K. Coffee
- Rocky Vista University College of Osteopathic Medicine, Ivins, UT, United States
| | - Paige M. Nahod
- Rocky Vista University College of Osteopathic Medicine, Parker, CO, United States
| | - Samantha H. Santora
- Rocky Vista University College of Osteopathic Medicine, Parker, CO, United States
| | - Brian Schwartz
- Department of Medical Humanities, Rocky Vista University College of Osteopathic Medicine, Parker, CO, United States
| | - Regan A. Stiegmann
- Department of Tracks and Special Programs, Rocky Vista University College of Osteopathic Medicine, Parker, CO, United States,Flight Medicine, US Air Force Academy, Colorado Springs, CO, United States
| | - Cole A. Zanetti
- Department of Tracks and Special Programs, Rocky Vista University College of Osteopathic Medicine, Parker, CO, United States,Chief Health Informatics Officer, Ralph H Johnson VA Health System, Charleston, SC, United States
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28
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Høier NK, Madsen T, Spira AP, Hawton K, Jennum P, Nordentoft M, Erlangsen A. Associations between treatment with melatonin and suicidal behavior: a nationwide cohort study. J Clin Sleep Med 2022; 18:2451-2458. [PMID: 35801338 PMCID: PMC9516579 DOI: 10.5664/jcsm.10118] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/12/2022] [Accepted: 05/12/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Melatonin is often prescribed to patients with sleep disorders who are known to have elevated suicide risks, yet melatonin's association with suicidal behavior remains to be examined. We investigated whether individuals prescribed melatonin had higher rates of suicide and suicide attempts when compared to individuals who were not prescribed this drug, including both those with and without known mental disorders. METHODS A cohort design was applied to longitudinal, register data on all persons aged ≥ 10 years in Denmark during 2007-2016. Based on data from the National Prescription Registry, periods of being in treatment with melatonin were defined using information on the number of tablets and the daily defined dose. We calculated incidence rate ratios for suicide and suicide attempts, as identified in register records, comparing those in treatment with melatonin to those not in treatment. RESULTS Among 5,798,923 individuals, 10,577 (0.2%) were treated with melatonin (mean treatment length, 50 days) during the study period. Of those, 22 died by suicide and 134 had at least 1 suicide attempt. People in treatment with melatonin had a 4-fold higher rate of suicide (incidence rate ratio, 4.8; 95% CI, 3.0-7.5) and a 5-fold higher rate of suicide attempt (incidence rate ratio, 5.9; 95% CI, 4.4-8.0) than those not in treatment and when adjusting for sex and age group. CONCLUSIONS Treatment with melatonin was associated with suicide and suicide attempt. Although there are several possible explanations, attention to suicide risk is particularly warranted for people with mental comorbidity who are in treatment with melatonin. CITATION Høier NK, Madsen T, Spira AP, et al. Associations between treatment with melatonin and suicidal behavior: a nationwide cohort study. J Clin Sleep Med. 2022;18(10):2451-2458.
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Affiliation(s)
- Nikolaj Kjær Høier
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Trine Madsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Adam P. Spira
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Johns Hopkins Center on Aging and Health, Baltimore, Maryland
| | - Keith Hawton
- Center for Suicide Research, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
| | - Poul Jennum
- Danish Center for Sleep Medicine, Rigshospitalet and Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Merete Nordentoft
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Annette Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
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29
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Mijnster T, Boersma GJ, Meijer E, Lancel M. Effectivity of (Personalized) Cognitive Behavioral Therapy for Insomnia in Mental Health Populations and the Elderly: An Overview. J Pers Med 2022; 12:1070. [PMID: 35887566 PMCID: PMC9319701 DOI: 10.3390/jpm12071070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 11/16/2022] Open
Abstract
Insomnia is very prevalent in psychiatry and is considered a transdiagnostic symptom of mental disorders. Yet, it is not only a consequence of a mental condition but may also exert detrimental effects on psychiatric symptom severity and therapeutic response; thus, adequate insomnia treatment is particularly important in psychiatric populations. The first choice of intervention is cognitive behavioral therapy for insomnia (CBT-I) as it is rather effective, also in the long run without side effects. It is offered in various forms, ranging from in-person therapy to internet-delivered applications. CBT-I protocols are typically developed for individuals with insomnia disorder without co-occurring conditions. For an optimal therapeutic outcome of CBT-I in individuals with comorbid mental disorders, adaptations of the protocol to tailor the treatment might be beneficial. Based on a literature search using major search engines (Embase; Medline; APA Psych Info; and Cochrane Reviews), this paper provides an overview of the effectiveness of the different CBT-I applications in individuals with diverse comorbid mental conditions and older adults and describes the functionality of CBT-I protocols that have been personalized to specific psychiatric populations, such as depression, substance abuse, and schizophrenia spectrum disorder. Finally, we discuss urgent needs for insomnia therapy targeted to improve both sleep and psychopathologies.
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Affiliation(s)
- Teus Mijnster
- Centre of Expertise on Sleep and Psychiatry, GGZ Drenthe, Mental Health Institute, 9404 LA Assen, The Netherlands; (T.M.); (G.J.B.); (E.M.)
| | - Gretha J. Boersma
- Centre of Expertise on Sleep and Psychiatry, GGZ Drenthe, Mental Health Institute, 9404 LA Assen, The Netherlands; (T.M.); (G.J.B.); (E.M.)
- Forensic Psychiatric Hospital, GGZ Drenthe, Mental Health Institute, 9404 LA Assen, The Netherlands
| | - Esther Meijer
- Centre of Expertise on Sleep and Psychiatry, GGZ Drenthe, Mental Health Institute, 9404 LA Assen, The Netherlands; (T.M.); (G.J.B.); (E.M.)
| | - Marike Lancel
- Centre of Expertise on Sleep and Psychiatry, GGZ Drenthe, Mental Health Institute, 9404 LA Assen, The Netherlands; (T.M.); (G.J.B.); (E.M.)
- Forensic Psychiatric Hospital, GGZ Drenthe, Mental Health Institute, 9404 LA Assen, The Netherlands
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, 9712 TS Groningen, The Netherlands
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30
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Sweetman A, Adams RJ. Comorbid insomnia and sleep apnea as a potential predictor of suicide and self-harm. Commentary on Udholm et al. Obstructive sleep apnea and risk of suicide and self-harm: a Danish Nationwide Cohort Study. Sleep 2022; 45:6532487. [DOI: 10.1093/sleep/zsac043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alexander Sweetman
- The Adelaide Institute for Sleep Health, Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University , Adelaide, SA , Australia
- National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University , Adelaide, SA , Australia
| | - Robert J Adams
- The Adelaide Institute for Sleep Health, Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University , Adelaide, SA , Australia
- National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University , Adelaide, SA , Australia
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31
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Ahmad SR, Tarabochia AD, Budahn L, Lemahieu AM, Anderson B, Vashistha K, Karnatovskaia L, Gajic O. Feasibility of Extracting Meaningful Patient Centered Outcomes From the Electronic Health Record Following Critical Illness in the Elderly. Front Med (Lausanne) 2022; 9:826169. [PMID: 35733861 PMCID: PMC9207323 DOI: 10.3389/fmed.2022.826169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/11/2022] [Indexed: 12/04/2022] Open
Abstract
Background Meaningful patient centered outcomes of critical illness such as functional status, cognition and mental health are studied using validated measurement tools that may often be impractical outside the research setting. The Electronic health record (EHR) contains a plethora of information pertaining to these domains. We sought to determine how feasible and reliable it is to assess meaningful patient centered outcomes from the EHR. Methods Two independent investigators reviewed EHR of a random sample of ICU patients looking at documented assessments of trajectory of functional status, cognition, and mental health. Cohen's kappa was used to measure agreement between 2 reviewers. Post ICU health in these domains 12 month after admission was compared to pre- ICU health in the 12 months prior to assess qualitatively whether a patient's condition was “better,” “unchanged” or “worse.” Days alive and out of hospital/health care facility was a secondary outcome. Results Thirty six of the 41 randomly selected patients (88%) survived critical illness. EHR contained sufficient information to determine the difference in health status before and after critical illness in most survivors (86%). Decline in functional status (36%), cognition (11%), and mental health (11%) following ICU admission was observed compared to premorbid baseline. Agreement between reviewers was excellent (kappa ranging from 0.966 to 1). Eighteen patients (44%) remained home after discharge from hospital and rehabilitation during the 12- month follow up. Conclusion We demonstrated the feasibility and reliability of assessing the trajectory of changes in functional status, cognition, and selected mental health outcomes from EHR of critically ill patients. If validated in a larger, representative sample, these outcomes could be used alongside survival in quality improvement studies and pragmatic clinical trials.
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Affiliation(s)
- Sumera R. Ahmad
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
- *Correspondence: Sumera R. Ahmad
| | - Alex D. Tarabochia
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States
| | - Luann Budahn
- Anesthesia and Critical Care Research Unit, Mayo Clinic, Rochester, MN, United States
| | - Allison M. Lemahieu
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Brenda Anderson
- Anesthesia and Critical Care Research Unit, Mayo Clinic, Rochester, MN, United States
| | - Kirtivardhan Vashistha
- Department of Infectious Disease, Multi-disciplinary Epidemiology and Translational Research in Intensive Care Research Group, Mayo Clinic, Rochester, MN, United States
| | | | - Ognjen Gajic
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
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32
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Høier NK, Madsen T, Spira AP, Hawton K, Benros ME, Nordentoft M, Erlangsen A. Association between hospital-diagnosed sleep disorders and suicide: a nationwide cohort study. Sleep 2022; 45:zsac069. [PMID: 35554572 DOI: 10.1093/sleep/zsac069] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 02/22/2022] [Indexed: 01/10/2023] Open
Abstract
STUDY OBJECTIVES Sleep disorders are related to mental disorders. Yet few studies have examined their association with suicide. We examined whether males and females diagnosed with sleep disorders had higher rates of suicide than individuals not diagnosed with sleep disorders. METHODS In a cohort study, nationwide data on all males and females aged over 15 years living in Denmark during 1980-2016 were analyzed. Sleep disorders were identified through diagnoses recorded during contacts to somatic hospitals. Incidence rate ratios (IRR) were estimated using Poisson regression models and adjusted for covariates. RESULTS In all, 3 674 563 males and 3 688 164 females were included, of whom 82 223 (2.2%, mean age: 50.2 years, SD: 17.5) males and 40 003 (1.1%, mean age: 50.6 years, SD: 19.9) females had sleep disorder diagnoses. Compared with those with no sleep disorders, the adjusted IRR for suicide were 1.6 (95% CI, 1.4 to 1.7) and 2.2 (95% CI, 1.8 to 2.6) for males and females with sleep disorders, respectively. Excess rates for narcolepsy were found for males (IRR: 1.2, 95% CI, 1.0 to 1.5) and females (IRR: 3.3, 95% CI, 3.0 to 4.1), and for sleep apnea in males (IRR: 1.8, 95% CI, 1.5 to 2.2). A difference with respect to age and sex was observed (p < 0.001) between males and females. Males and females had IRR of 4.1 (95% CI, 3.1 to 5.5) and 7.0 (95% CI, 4.8 to 10.1), during the first 6 months after being diagnosed with a sleep disorder. CONCLUSIONS Sleep disorders were associated with higher suicide rates even after adjusting for preexisting mental disorders. Our findings suggest attention toward suicidality in patients with sleep disorders is warranted.
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Affiliation(s)
- Nikolaj Kjær Høier
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Denmark
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, UK
| | - Trine Madsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Denmark
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Public Health, Faculty of Health, University of Copenhagen, Denmark
| | - Adam P Spira
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Center on Aging and Health, Baltimore, MD, USA
| | - Keith Hawton
- Centre for Suicide Research, University of Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Michael Eriksen Benros
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Merete Nordentoft
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Denmark
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Annette Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Denmark
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
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Unnarsdóttir AB, Hauksdóttir A, Aspelund T, Gunnarsdóttir V, Tómasson G, Jakobsdóttir J, Valdimarsdóttir UA, Thordardottir EB. Sleep disturbances among women in a Subarctic region: a nationwide study. Sleep 2022; 45:6582689. [PMID: 35532192 PMCID: PMC9366651 DOI: 10.1093/sleep/zsac100] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/31/2022] [Indexed: 01/10/2023] Open
Abstract
STUDY OBJECTIVES To date, few studies have assessed sleep problems among women residing in Subarctic regions. Therefore, the aim of this large-scale population-based study was to assess the prevalence of severe sleep problems and associated factors among Icelandic women, living at 63-66°N. METHODS Participants were 29 681 women (18-69 years old) who took part in the Icelandic Stress-And-Gene-Analysis study in 2018-2019. Background information, health-related behavior, and mental health symptoms were assessed with an online questionnaire. The Pittsburgh Sleep Quality Index (PSQI) was used to assess severe sleep problems during the past month. Adjusting for age, marital status, number of children, education, personal income, work schedule, region, and response period, we used modified Poisson log-linear models to obtain prevalence ratios (PRs) with 95% confidence intervals (CIs). RESULTS Overall, 24.2% of women reported severe sleep problems (PSQI >10). Women responding in the winter presented with an overall higher prevalence of severe sleep problems, compared to those responding in the summer (PR 1.21; 95% CI, 1.15 to 1.28). Severe sleep problems were more prevalent among young and late-midlife women, those who were single, had children, socio-economic challenges, worked shifts, and flexible hours. Furthermore, obesity, suboptimal health behaviors, excessive screen time, and mental health problems were associated with severe sleep problems. CONCLUSION Severe sleep problems are more common among women in Subarctic regions than elsewhere, particularly during winter. These findings motivate the development of preventive strategies and interventions for women in the Subarctic who suffer from sleep problems.
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Affiliation(s)
- Anna Bára Unnarsdóttir
- Corresponding author. Anna Bára Unnarsdóttir, Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Sturlugata 8, 101 Reykjavik, Iceland.
| | - Arna Hauksdóttir
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Thor Aspelund
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Vigdís Gunnarsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Gunnar Tómasson
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland,Department of Rheumatology, University Hospital, Reykjavik, Iceland
| | - Jóhanna Jakobsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Unnur Anna Valdimarsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Edda Bjork Thordardottir
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
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Translational Approaches to Influence Sleep and Arousal. Brain Res Bull 2022; 185:140-161. [PMID: 35550156 PMCID: PMC9554922 DOI: 10.1016/j.brainresbull.2022.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/27/2022] [Accepted: 05/03/2022] [Indexed: 12/16/2022]
Abstract
Sleep disorders are widespread in society and are prevalent in military personnel and in Veterans. Disturbances of sleep and arousal mechanisms are common in neuropsychiatric disorders such as schizophrenia, post-traumatic stress disorder, anxiety and affective disorders, traumatic brain injury, dementia, and substance use disorders. Sleep disturbances exacerbate suicidal ideation, a major concern for Veterans and in the general population. These disturbances impair quality of life, affect interpersonal relationships, reduce work productivity, exacerbate clinical features of other disorders, and impair recovery. Thus, approaches to improve sleep and modulate arousal are needed. Basic science research on the brain circuitry controlling sleep and arousal led to the recent approval of new drugs targeting the orexin/hypocretin and histamine systems, complementing existing drugs which affect GABAA receptors and monoaminergic systems. Non-invasive brain stimulation techniques to modulate sleep and arousal are safe and show potential but require further development to be widely applicable. Invasive viral vector and deep brain stimulation approaches are also in their infancy but may be used to modulate sleep and arousal in severe neurological and psychiatric conditions. Behavioral, pharmacological, non-invasive brain stimulation and cell-specific invasive approaches covered here suggest the potential to selectively influence arousal, sleep initiation, sleep maintenance or sleep-stage specific phenomena such as sleep spindles or slow wave activity. These manipulations can positively impact the treatment of a wide range of neurological and psychiatric disorders by promoting the restorative effects of sleep on memory consolidation, clearance of toxic metabolites, metabolism, and immune function and by decreasing hyperarousal.
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Valsecchi P, Nibbio G, Rosa J, Vita A. Adult ADHD and sleep disorders: Prevalence, severity and predictors of sleep disorders in a sample of Italian psychiatric outpatients. Psychiatry Res 2022; 310:114447. [PMID: 35192987 DOI: 10.1016/j.psychres.2022.114447] [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: 08/25/2021] [Revised: 02/03/2022] [Accepted: 02/12/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Sleep disorders are frequent in adult subjects diagnosed with ADHD. The aims of the present study were to assess the prevalence and the severity of sleep disorders in a sample of Italian psychiatric outpatients, to compare the prevalence and severity of sleep disorders in patients with and without diagnosis of adult ADHD, and to evaluate the role of ADHD as an individual predictor of sleep disturbances severity. METHOD 634 outpatients accessing psychiatric services were assessed with the Mini-International Neuropsychiatric Interview (MINI) Plus V. 5.0.0 interview and the Adult ADHD self-report Scale Symptoms Checklist (ASRS)-V 1.1 Short Form. Patients positive to the ASRS-V 1.1 were assessed with the Diagnostic Interview for ADHD in Adults (DIVA) 2.0. Sleep disorders and sleep disturbances' severity were assessed with the PROMIS Adult Sleep Disturbance Scale. RESULTS Sleep disorders were more frequent (p < 0.001) and sleep disturbances were more severe (d = 1.26, p < 0.001) in subjects diagnosed with adult ADHD compared to other outpatients. Among the 44 subjects diagnosed with ADHD, 15 (34.1%) reported no or slight sleep disturbances, 9 (20.5%) a mild sleep disorder, 17 (38.6%) a moderate sleep disorder and 3 (6.8%) a severe sleep disorder. ADHD diagnosis, multiple psychiatric comorbidity and history of suicide attempts emerged as individual predictors of worse sleep disturbances. CONCLUSION Sleep disorders are more frequent and severe in subjects diagnosed with ADHD compared to other adult outpatients. Sleep disturbances might represent an intrinsic feature in adult ADHD subjects, presenting important clinical repercussions, and should be routinely evaluated and monitored in this population.
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Affiliation(s)
- Paolo Valsecchi
- Department of Clinical and Experimental Sciences, University of Brescia, Piazzale Spedali Civili 1, Brescia 25123, Italy; Department of Mental Health and Addiction Services, Spedali Civili Hospital, Brescia, Italy.
| | - Gabriele Nibbio
- Department of Clinical and Experimental Sciences, University of Brescia, Piazzale Spedali Civili 1, Brescia 25123, Italy; Department of Mental Health and Addiction Services, Spedali Civili Hospital, Brescia, Italy
| | - Jennifer Rosa
- Department of Clinical and Experimental Sciences, University of Brescia, Piazzale Spedali Civili 1, Brescia 25123, Italy; Department of Mental Health and Addiction Services, Spedali Civili Hospital, Brescia, Italy
| | - Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Piazzale Spedali Civili 1, Brescia 25123, Italy; Department of Mental Health and Addiction Services, Spedali Civili Hospital, Brescia, Italy
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36
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Mullins N, Kang J, Campos AI, Coleman JRI, Edwards AC, Galfalvy H, Levey DF, Lori A, Shabalin A, Starnawska A, Su MH, Watson HJ, Adams M, Awasthi S, Gandal M, Hafferty JD, Hishimoto A, Kim M, Okazaki S, Otsuka I, Ripke S, Ware EB, Bergen AW, Berrettini WH, Bohus M, Brandt H, Chang X, Chen WJ, Chen HC, Crawford S, Crow S, DiBlasi E, Duriez P, Fernández-Aranda F, Fichter MM, Gallinger S, Glatt SJ, Gorwood P, Guo Y, Hakonarson H, Halmi KA, Hwu HG, Jain S, Jamain S, Jiménez-Murcia S, Johnson C, Kaplan AS, Kaye WH, Keel PK, Kennedy JL, Klump KL, Li D, Liao SC, Lieb K, Lilenfeld L, Liu CM, Magistretti PJ, Marshall CR, Mitchell JE, Monson ET, Myers RM, Pinto D, Powers A, Ramoz N, Roepke S, Rozanov V, Scherer SW, Schmahl C, Sokolowski M, Strober M, Thornton LM, Treasure J, Tsuang MT, Witt SH, Woodside DB, Yilmaz Z, Zillich L, Adolfsson R, Agartz I, Air TM, Alda M, Alfredsson L, Andreassen OA, Anjorin A, Appadurai V, Soler Artigas M, Van der Auwera S, Azevedo MH, Bass N, Bau CHD, Baune BT, Bellivier F, Berger K, Biernacka JM, Bigdeli TB, Binder EB, Boehnke M, Boks MP, Bosch R, Braff DL, Bryant R, Budde M, Byrne EM, Cahn W, Casas M, Castelao E, Cervilla JA, Chaumette B, Cichon S, Corvin A, Craddock N, Craig D, Degenhardt F, Djurovic S, Edenberg HJ, Fanous AH, Foo JC, Forstner AJ, Frye M, Fullerton JM, Gatt JM, Gejman PV, Giegling I, Grabe HJ, Green MJ, Grevet EH, Grigoroiu-Serbanescu M, Gutierrez B, Guzman-Parra J, Hamilton SP, Hamshere ML, Hartmann A, Hauser J, Heilmann-Heimbach S, Hoffmann P, Ising M, Jones I, Jones LA, Jonsson L, Kahn RS, Kelsoe JR, Kendler KS, Kloiber S, Koenen KC, Kogevinas M, Konte B, Krebs MO, Landén M, Lawrence J, Leboyer M, Lee PH, Levinson DF, Liao C, Lissowska J, Lucae S, Mayoral F, McElroy SL, McGrath P, McGuffin P, McQuillin A, Medland SE, Mehta D, Melle I, Milaneschi Y, Mitchell PB, Molina E, Morken G, Mortensen PB, Müller-Myhsok B, Nievergelt C, Nimgaonkar V, Nöthen MM, O'Donovan MC, Ophoff RA, Owen MJ, Pato C, Pato MT, Penninx BWJH, Pimm J, Pistis G, Potash JB, Power RA, Preisig M, Quested D, Ramos-Quiroga JA, Reif A, Ribasés M, Richarte V, Rietschel M, Rivera M, Roberts A, Roberts G, Rouleau GA, Rovaris DL, Rujescu D, Sánchez-Mora C, Sanders AR, Schofield PR, Schulze TG, Scott LJ, Serretti A, Shi J, Shyn SI, Sirignano L, Sklar P, Smeland OB, Smoller JW, Sonuga-Barke EJS, Spalletta G, Strauss JS, Świątkowska B, Trzaskowski M, Turecki G, Vilar-Ribó L, Vincent JB, Völzke H, Walters JTR, Shannon Weickert C, Weickert TW, Weissman MM, Williams LM, Wray NR, Zai CC, Ashley-Koch AE, Beckham JC, Hauser ER, Hauser MA, Kimbrel NA, Lindquist JH, McMahon B, Oslin DW, Qin X, Agerbo E, Børglum AD, Breen G, Erlangsen A, Esko T, Gelernter J, Hougaard DM, Kessler RC, Kranzler HR, Li QS, Martin NG, McIntosh AM, Mors O, Nordentoft M, Olsen CM, Porteous D, Ursano RJ, Wasserman D, Werge T, Whiteman DC, Bulik CM, Coon H, Demontis D, Docherty AR, Kuo PH, Lewis CM, Mann JJ, Rentería ME, Smith DJ, Stahl EA, Stein MB, Streit F, Willour V, Ruderfer DM. Dissecting the Shared Genetic Architecture of Suicide Attempt, Psychiatric Disorders, and Known Risk Factors. Biol Psychiatry 2022; 91:313-327. [PMID: 34861974 PMCID: PMC8851871 DOI: 10.1016/j.biopsych.2021.05.029] [Citation(s) in RCA: 101] [Impact Index Per Article: 50.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 05/07/2021] [Accepted: 05/26/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Suicide is a leading cause of death worldwide, and nonfatal suicide attempts, which occur far more frequently, are a major source of disability and social and economic burden. Both have substantial genetic etiology, which is partially shared and partially distinct from that of related psychiatric disorders. METHODS We conducted a genome-wide association study (GWAS) of 29,782 suicide attempt (SA) cases and 519,961 controls in the International Suicide Genetics Consortium (ISGC). The GWAS of SA was conditioned on psychiatric disorders using GWAS summary statistics via multitrait-based conditional and joint analysis, to remove genetic effects on SA mediated by psychiatric disorders. We investigated the shared and divergent genetic architectures of SA, psychiatric disorders, and other known risk factors. RESULTS Two loci reached genome-wide significance for SA: the major histocompatibility complex and an intergenic locus on chromosome 7, the latter of which remained associated with SA after conditioning on psychiatric disorders and replicated in an independent cohort from the Million Veteran Program. This locus has been implicated in risk-taking behavior, smoking, and insomnia. SA showed strong genetic correlation with psychiatric disorders, particularly major depression, and also with smoking, pain, risk-taking behavior, sleep disturbances, lower educational attainment, reproductive traits, lower socioeconomic status, and poorer general health. After conditioning on psychiatric disorders, the genetic correlations between SA and psychiatric disorders decreased, whereas those with nonpsychiatric traits remained largely unchanged. CONCLUSIONS Our results identify a risk locus that contributes more strongly to SA than other phenotypes and suggest a shared underlying biology between SA and known risk factors that is not mediated by psychiatric disorders.
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Affiliation(s)
- Niamh Mullins
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - JooEun Kang
- Division of Genetic Medicine, Department of Medicine, Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Adrian I Campos
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia; School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Jonathan R I Coleman
- National Institute for Health Research Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, United Kingdom; Social Genetic and Developmental Psychiatry Centre, King's College London, London, United Kingdom
| | - Alexis C Edwards
- Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia
| | - Hanga Galfalvy
- Department of Biostatistics, Columbia University, New York, New York; Department of Psychiatry, Columbia University, New York, New York
| | - Daniel F Levey
- Department of Psychiatry, Veterans Affairs Connecticut Healthcare Center, West Haven, Connecticut; Division of Human Genetics, Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Adriana Lori
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Andrey Shabalin
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, Utah
| | - Anna Starnawska
- Centre for Genomics and Personalized Medicine, Aarhus University, Aarhus, Denmark; Centre for Integrative Sequencing, Aarhus University, Aarhus, Denmark; Department of Biomedicine, Aarhus University, Aarhus, Denmark; Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus University, Aarhus, Denmark
| | - Mei-Hsin Su
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Hunna J Watson
- School of Psychology, Curtin University, Perth, Western Australia, Australia; Division of Paediatrics, The University of Western Australia, Perth, Western Australia, Australia; Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Mark Adams
- Division of Psychiatry, University of Edinburgh, Edinburgh, United Kingdom
| | - Swapnil Awasthi
- Department of Psychiatry and Psychotherapy, Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Gandal
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | | | - Akitoyo Hishimoto
- Department of Psychiatry, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Minsoo Kim
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Satoshi Okazaki
- Department of Psychiatry, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ikuo Otsuka
- Department of Psychiatry, Columbia University, New York, New York; Department of Psychiatry, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Stephan Ripke
- Department of Psychiatry and Psychotherapy, Universitätsmedizin Berlin, Berlin, Germany; Stanley Center for Psychiatric Research, Broad Institute, Cambridge, Massachusetts; Analytical and Translational Genetics Unit, Massachusetts General Hospital, Boston, Massachusetts
| | - Erin B Ware
- Population Studies Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan; Survery Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Andrew W Bergen
- BioRealm, LLC, Walnut, California; Oregon Research Institute, Eugene, Oregon
| | - Wade H Berrettini
- Department of Psychiatry, Center for Neurobiology and Behavior, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Martin Bohus
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Harry Brandt
- Center for Eating Disorders at Sheppard Pratt, Baltimore, Maryland
| | - Xiao Chang
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Wei J Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan; Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli County, Taiwan
| | - Hsi-Chung Chen
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Steven Crawford
- Center for Eating Disorders at Sheppard Pratt, Baltimore, Maryland
| | - Scott Crow
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota
| | - Emily DiBlasi
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, Utah
| | - Philibert Duriez
- Hôpital Sainte-Anne, GHU Paris Psychiatrie et Neurosciences, Paris, France; Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université de Paris, Paris, France
| | | | - Manfred M Fichter
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany; Schön Klinik Roseneck affiliated with the Medical Faculty of the University of Munich, Munich, Germany
| | - Steven Gallinger
- Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stephen J Glatt
- Department of Psychiatry and Behavioral Sciences, SUNY Upstate Medical University, Syracuse, New York
| | - Philip Gorwood
- Hôpital Sainte-Anne, GHU Paris Psychiatrie et Neurosciences, Paris, France; Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université de Paris, Paris, France
| | - Yiran Guo
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Hakon Hakonarson
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Katherine A Halmi
- Department of Psychiatry, Weill Cornell Medical College, New York, New York
| | - Hai-Gwo Hwu
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Sonia Jain
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, La Jolla, California
| | - Stéphane Jamain
- Inserm U955, Institut Mondor de recherches Biomédicales, Laboratoire, Neuro-Psychiatrie Translationnelle, and Fédération Hospitalo-Universitaire de Précision Médecine en Addictologie et Psychiatrie, University Paris-Est-Créteil, Créteil, France
| | - Susana Jiménez-Murcia
- Department of Psychiatry, University Hospital Bellvitge-IDIBELL and CIBEROBN, Barcelona, Spain
| | | | - Allan S Kaplan
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Walter H Kaye
- Department of Psychiatry, Department of Psychiatry, University of California San Diego, San Diego, California
| | - Pamela K Keel
- Department of Psychology, Florida State University, Tallahassee, Florida
| | - James L Kennedy
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Kelly L Klump
- Department of Psychology, Michigan State University, Lansing, Michigan
| | - Dong Li
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Shih-Cheng Liao
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Klaus Lieb
- Department of Psychiatry and Psychotherapy, University Medical Center, Mainz, Germany
| | - Lisa Lilenfeld
- Department of Clinical Psychology, The Chicago School of Professional Psychology, Washington, DC
| | - Chih-Min Liu
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Pierre J Magistretti
- BESE Division, King Abdullah University of Science and Technology, Thuwal, Saudi Arabia; Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Christian R Marshall
- Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - James E Mitchell
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - Eric T Monson
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, Utah
| | - Richard M Myers
- HudsonAlpha Institute for Biotechnology, Huntsville, Alabama
| | - Dalila Pinto
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Nicolas Ramoz
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université de Paris, Paris, France
| | - Stefan Roepke
- Department of Psychiatry, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Vsevolod Rozanov
- Department of Psychology, St. Petersburg State University, Saint Petersburg, Russian Federation; Department of Borderline Disorders and Psychotherapy, V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology, Saint Petersburg, Russian Federation
| | - Stephen W Scherer
- Department of Genetics and Genomic Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Marcus Sokolowski
- National Centre for Suicide Research and Prevention of Mental Ill-Health, LIME, Karolinska Institutet, Stockholm, Sweden
| | - Michael Strober
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, California
| | - Laura M Thornton
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Janet Treasure
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, London, United Kingdom; National Institute for Health Research Biomedical Research Centre, King's College London and South London and Maudsley National Health Service Foundation Trust, London, United Kingdom
| | - Ming T Tsuang
- Center for Behavioral Genomics, Department of Psychiatry, University of California San Diego, San Diego, California
| | - Stephanie H Witt
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - D Blake Woodside
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada; Centre for Mental Health, University Health Network, Toronto, Ontario, Canada; Program for Eating Disorders, University Health Network, Toronto, Ontario, Canada
| | - Zeynep Yilmaz
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark; Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Lea Zillich
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Rolf Adolfsson
- Department of Clinical Sciences, Psychiatry, Umeå University Medical Faculty, Umeå, Sweden
| | - Ingrid Agartz
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden; Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway; NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Tracy M Air
- Discipline of Psychiatry, University of Adelaide, Adelaide, South Australia, Australia
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada; National Institute of Mental Health, Klecany, Czech Republic
| | - Lars Alfredsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Institut of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ole A Andreassen
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; NORMENT, University of Oslo, Oslo, Norway
| | - Adebayo Anjorin
- Psychiatry, Berkshire Healthcare NHS Foundation Trust, Bracknell, United Kingdom
| | - Vivek Appadurai
- Institute of Biological Psychiatry, Copenhagen Mental Health Services, Copenhagen University Hospital, Copenhagen, Denmark; Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Copenhagen, Denmark
| | - María Soler Artigas
- Department of Psychiatry, Hospital Universitari Vall d'Hebrón, Barcelona, Spain; Department of Genetics, Microbiology & Statistics, University of Barcelona, Barcelona, Spain; Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain; Biomedical Network Research Centre on Mental Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Sandra Van der Auwera
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - M Helena Azevedo
- Department of Psychiatry, University of Coimbra, Coimbra, Portugal
| | - Nicholas Bass
- Division of Psychiatry, University College London, London, United Kingdom
| | - Claiton H D Bau
- Laboratory of Developmental Psychiatry, Adult Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; Department of Genetics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Bernhard T Baune
- Department of Psychiatry, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia; Department of Psychiatry, University of Münster, Münster, Nordrhein-Westfalen, Germany
| | - Frank Bellivier
- Department of Psychiatry and Addiction Medicine, Assistance Publique Hôpitaux de Paris, Paris, France; Paris Bipolar and TRD Expert Centres, FondaMental Foundation, Paris, France; UMR-S1144 Team 1: Biomarkers of relapse and therapeutic response in addiction and mood disorders, INSERM, Paris, France; Psychiatry, Université Paris Diderot, Paris, France
| | - Klaus Berger
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Nordrhein-Westfalen, Germany
| | | | - Tim B Bigdeli
- Department of Psychiatry and Behavioral Sciences, State University of New York Downstate Medical Center, New York, New York; Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia
| | - Elisabeth B Binder
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia; Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| | - Michael Boehnke
- Center for Statistical Genetics and Department of Biostatistics, Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Marco P Boks
- Department of Psychiatry, UMC Utrecht Hersencentrum, Utrecht, the Netherlands
| | - Rosa Bosch
- Department of Psychiatry, Hospital Universitari Vall d'Hebrón, Barcelona, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Biomedical Network Research Centre on Mental Health, Instituto de Salud Carlos III, Madrid, Spain
| | - David L Braff
- Department of Psychiatry, University of California San Diego, La Jolla, California
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Monika Budde
- Institute of Psychiatric Phenomics and Genomics, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Enda M Byrne
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia; Centre for Children's Health Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Wiepke Cahn
- Department of Psychiatry, UMC Utrecht Hersencentrum, Utrecht, the Netherlands
| | - Miguel Casas
- Department of Psychiatry, Hospital Universitari Vall d'Hebrón, Barcelona, Spain; Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Biomedical Network Research Centre on Mental Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Enrique Castelao
- Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jorge A Cervilla
- Mental Health Unit, Department of Psychiatry, Faculty of Medicine, Granada University Hospital Complex, Biomedical Research Centre, University of Granada, Granada, Spain
| | - Boris Chaumette
- Institut de Psychiatrie, CNRS GDR 3557, Paris, France; Department of Evaluation, Prevention and Therapeutic innovation, GHU Paris Psychiatrie et Neurosciences, Paris, France; Team Pathophysiology of psychiatric diseases, Université de Paris, Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Paris, France
| | - Sven Cichon
- Institute of Neuroscience and Medicine, Research Centre Jülich, Jülich, Germany; Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland; Department of Biomedicine, University Hospital Basel, Basel, Switzerland; Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Aiden Corvin
- Neuropsychiatric Genetics Research Group, Department of Psychiatry and Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Nicholas Craddock
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
| | - David Craig
- Department of Translational Genomics, University of Southern California, Pasadena, California
| | - Franziska Degenhardt
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Srdjan Djurovic
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway; NORMENT, KG Jebsen Centre for Psychosis Research, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Howard J Edenberg
- Department of Medical & Molecular Genetics, Indiana University, Indianapolis, Indiana; Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Ayman H Fanous
- Department of Psychiatry and Behavioral Sciences, State University of New York Downstate Medical Center, New York, New York; Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia
| | - Jerome C Foo
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Andreas J Forstner
- Institute of Neuroscience and Medicine, Research Centre Jülich, Jülich, Germany; Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany; Centre for Human Genetics, University of Marburg, Marburg, Germany
| | - Mark Frye
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota
| | - Janice M Fullerton
- School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia; Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Justine M Gatt
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia; Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Pablo V Gejman
- Department of Psychiatry and Behavioral Sciences, NorthShore University HealthSystem, Evanston, Illinois; Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, Illinois
| | - Ina Giegling
- Department of Psychiatry, University of Munich, Munich, Germany; Department of Psychiatry, Psychotherapy and Psychosomatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Hans J Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Melissa J Green
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia; Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Eugenio H Grevet
- ADHD Outpatient Program, Adult Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Maria Grigoroiu-Serbanescu
- Biometric Psychiatric Genetics Research Unit, Alexandru Obregia Clinical Psychiatric Hospital, Bucharest, Romania
| | - Blanca Gutierrez
- Department of Psychiatry, Biomedical Research Centre, University of Granada, Granada, Spain
| | - Jose Guzman-Parra
- Mental Health Department, University Regional Hospital, Biomedicine Institute, Málaga, Spain
| | - Steven P Hamilton
- Psychiatry, Kaiser Permanente Northern California, San Francisco, California
| | - Marian L Hamshere
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
| | - Annette Hartmann
- Department of Psychiatry, Psychotherapy and Psychosomatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Joanna Hauser
- Department of Psychiatry, Laboratory of Psychiatric Genetics, Poznan University of Medical Sciences, Poznań, Poland
| | - Stefanie Heilmann-Heimbach
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Per Hoffmann
- Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland; Department of Biomedicine, University Hospital Basel, Basel, Switzerland; Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Marcus Ising
- Max Planck Institute of Psychiatry, Munich, Germany
| | - Ian Jones
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
| | - Lisa A Jones
- Department of Psychological Medicine, University of Worcester, Worcester, United Kingdom
| | - Lina Jonsson
- Department of Psychiatry and Neuroscience, University of Gothenburg, Gothenburg, Sweden
| | - René S Kahn
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Psychiatry, UMC Utrecht Hersencentrum, Utrecht, the Netherlands
| | - John R Kelsoe
- Department of Psychiatry, University of California San Diego, La Jolla, California; Institute for Genomic Medicine, University of California San Diego, La Jolla, California
| | - Kenneth S Kendler
- Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia
| | - Stefan Kloiber
- Max Planck Institute of Psychiatry, Munich, Germany; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Karestan C Koenen
- Stanley Center for Psychiatric Research, Broad Institute, Cambridge, Massachusetts; Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts
| | | | - Bettina Konte
- Department of Psychiatry, Psychotherapy and Psychosomatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Marie-Odile Krebs
- Institut de Psychiatrie, CNRS GDR 3557, Paris, France; Department of Evaluation, Prevention and Therapeutic innovation, GHU Paris Psychiatrie et Neurosciences, Paris, France; Team Pathophysiology of psychiatric diseases, Université de Paris, Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Paris, France
| | - Mikael Landén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Psychiatry and Neuroscience, University of Gothenburg, Gothenburg, Sweden
| | - Jacob Lawrence
- Psychiatry, North East London NHS Foundation Trust, Ilford, Cheshire, United Kingdom
| | - Marion Leboyer
- Faculté de Médecine, University Paris-Est-Créteil, Créteil, France; Department of Psychiatry and Addiction Medicine, Assistance Publique Hôpitaux de Paris, Paris, France; INSERM, Paris, France
| | - Phil H Lee
- Stanley Center for Psychiatric Research, Broad Institute, Cambridge, Massachusetts; Analytical and Translational Genetics Unit, Massachusetts General Hospital, Boston, Massachusetts; Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, Massachusetts
| | - Douglas F Levinson
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Calwing Liao
- Department of Human Genetics, Faculty of Medicine, McGill University, Montreal, Québec, Canada; Montreal Neurological Institute and Hospital, Montreal, Québec, Canada
| | - Jolanta Lissowska
- Cancer Epidemiology and Prevention, Sklodowska-Curie Cancer Center and Institute of Oncology, Warsaw, Poland
| | | | - Fermin Mayoral
- Mental Health Department, University Regional Hospital, Biomedicine Institute, Málaga, Spain
| | | | - Patrick McGrath
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York
| | - Peter McGuffin
- Social Genetic and Developmental Psychiatry Centre, King's College London, London, United Kingdom
| | - Andrew McQuillin
- Division of Psychiatry, University College London, London, United Kingdom
| | - Sarah E Medland
- Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Divya Mehta
- Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia; School of Psychology and Counseling, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Ingrid Melle
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Division of Mental Health and Addiction, University of Oslo, Institute of Clinical Medicine, Oslo, Norway
| | - Yuri Milaneschi
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit and GGZ inGeest, Amsterdam, Netherlands
| | - Philip B Mitchell
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Esther Molina
- Department of Nursing, Faculty of Medicine, Biomedical Research Centre, University of Granada, Granada, Spain
| | - Gunnar Morken
- Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway; Psychiatry, St. Olavs University Hospital, Trondheim, Norway
| | - Preben Bo Mortensen
- Centre for Integrative Sequencing, Aarhus University, Aarhus, Denmark; National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark; Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark; Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Copenhagen, Denmark
| | - Bertram Müller-Myhsok
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany; Munich Cluster for Systems Neurology, Munich, Germany; University of Liverpool, Liverpool, United Kingdom
| | - Caroline Nievergelt
- Department of Psychiatry, University of California San Diego, La Jolla, California
| | - Vishwajit Nimgaonkar
- Psychiatry and Human Genetics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Markus M Nöthen
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Michael C O'Donovan
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
| | - Roel A Ophoff
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, California; Psychiatry, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Michael J Owen
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
| | - Carlos Pato
- College of Medicine Institute for Genomic Health, SUNY Downstate Medical Center College of Medicine, Brooklyn, New York; Institute for Genomic Health, SUNY Downstate Medical Center College of Medicine, Brooklyn, New York
| | - Michele T Pato
- Institute for Genomic Health, SUNY Downstate Medical Center College of Medicine, Brooklyn, New York
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit and GGZ inGeest, Amsterdam, Netherlands
| | - Jonathan Pimm
- Division of Psychiatry, University College London, London, United Kingdom
| | - Giorgio Pistis
- Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - James B Potash
- Department of Psychiatry, University of Iowa, Iowa City, Iowa
| | - Robert A Power
- Social Genetic and Developmental Psychiatry Centre, King's College London, London, United Kingdom; Genetics, BioMarin Pharmaceuticals, London, United Kingdom; University of Oxford, St. Edmund Hall, Oxford, United Kingdom
| | - Martin Preisig
- Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Digby Quested
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Josep Antoni Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebrón, Barcelona, Spain; Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Biomedical Network Research Centre on Mental Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Marta Ribasés
- Department of Psychiatry, Hospital Universitari Vall d'Hebrón, Barcelona, Spain; Department of Genetics, Microbiology & Statistics, University of Barcelona, Barcelona, Spain; Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain; Biomedical Network Research Centre on Mental Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Vanesa Richarte
- Department of Psychiatry, Hospital Universitari Vall d'Hebrón, Barcelona, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Biomedical Network Research Centre on Mental Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Margarita Rivera
- Social Genetic and Developmental Psychiatry Centre, King's College London, London, United Kingdom; Department of Biochemistry and Molecular Biology II and Institute of Neurosciences, Biomedical Research Centre, University of Granada, Granada, Spain
| | - Andrea Roberts
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, Massachusetts
| | - Gloria Roberts
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Guy A Rouleau
- Department of Neurology and Neurosurgery, Faculty of Medicine, McGill University, Montreal, Québec, Canada; Montreal Neurological Institute and Hospital, Montreal, Québec, Canada
| | - Diego L Rovaris
- Department of Physiology and Biophysics, Instituto de Ciencias Biomedicas Universidade de Sao Paulo, São Paulo, Brazil
| | - Dan Rujescu
- Department of Psychiatry, Psychotherapy and Psychosomatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Cristina Sánchez-Mora
- Department of Psychiatry, Hospital Universitari Vall d'Hebrón, Barcelona, Spain; Department of Genetics, Microbiology & Statistics, University of Barcelona, Barcelona, Spain; Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain; Biomedical Network Research Centre on Mental Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Alan R Sanders
- Department of Psychiatry and Behavioral Sciences, NorthShore University HealthSystem, Evanston, Illinois; Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, Illinois
| | - Peter R Schofield
- School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia; Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Thomas G Schulze
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland; Institute of Psychiatric Phenomics and Genomics, University Hospital, Ludwig-Maximilians-University, Munich, Germany; Human Genetics Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland; Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - Laura J Scott
- Center for Statistical Genetics and Department of Biostatistics, Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Jianxin Shi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Stanley I Shyn
- Behavioral Health Services, Kaiser Permanente Washington, Seattle, Washington, DC
| | - Lea Sirignano
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Pamela Sklar
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Olav B Smeland
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; NORMENT, University of Oslo, Oslo, Norway
| | - Jordan W Smoller
- Stanley Center for Psychiatric Research, Broad Institute, Cambridge, Massachusetts; Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, Massachusetts
| | - Edmund J S Sonuga-Barke
- Institute of Psychology, Psychiatry & Neuroscience, King's College London, London, United Kingdom
| | - Gianfranco Spalletta
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas; Laboratory of Neuropsychiatry, IRCCS Santa Lucia Foundation, Rome, Italy
| | - John S Strauss
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Beata Świątkowska
- Department of Environmental Epidemiology, Nofer Institute of Occupational Medicine, Lódz, Poland
| | - Maciej Trzaskowski
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia
| | - Gustavo Turecki
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Québec, Canada
| | - Laura Vilar-Ribó
- Department of Psychiatry, Hospital Universitari Vall d'Hebrón, Barcelona, Spain; Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - John B Vincent
- Molecular Brain Science, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - James T R Walters
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
| | - Cynthia Shannon Weickert
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia; Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Thomas W Weickert
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia; Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Myrna M Weissman
- Columbia University College of Physicians and Surgeons, New York, New York; Division of Translational Epidemiology, New York State Psychiatric Institute, New York, New York
| | - Leanne M Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Naomi R Wray
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia; Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Clement C Zai
- Stanley Center for Psychiatric Research, Broad Institute, Cambridge, Massachusetts; Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada; Molecular Brain Science, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Allison E Ashley-Koch
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, North Carolina
| | - Jean C Beckham
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina; VISN 6 Mid-Atlantic Mental Illness Research, Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Elizabeth R Hauser
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, North Carolina; Cooperative Studies Program Epidemiology Center, Education, and Clinical Center, Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Michael A Hauser
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, North Carolina
| | - Nathan A Kimbrel
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina; VISN 6 Mid-Atlantic Mental Illness Research, Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Jennifer H Lindquist
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Benjamin McMahon
- Theoretical Division, Los Alamos National Laboratory, Los Alamos National Laboratory, Los Alamos, New Mexico
| | - David W Oslin
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; VISN 4 Mental Illness Research, Education, and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - Xuejun Qin
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, North Carolina
| | - Esben Agerbo
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark; Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark; Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
| | - Anders D Børglum
- Centre for Genomics and Personalized Medicine, Aarhus University, Aarhus, Denmark; Centre for Integrative Sequencing, Aarhus University, Aarhus, Denmark; Department of Biomedicine, Aarhus University, Aarhus, Denmark; Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus University, Aarhus, Denmark
| | - Gerome Breen
- National Institute for Health Research Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, United Kingdom; Social Genetic and Developmental Psychiatry Centre, King's College London, London, United Kingdom
| | - Annette Erlangsen
- Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus University, Aarhus, Denmark; Department of Mental Health, Johns Hopkins University School of Medicine, Baltimore, Maryland; Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark; Center of Mental Health Research, Australian National University, Canberra, Australia
| | - Tõnu Esko
- Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts; Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Joel Gelernter
- Department of Psychiatry, Veterans Affairs Connecticut Healthcare Center, West Haven, Connecticut; Division of Human Genetics, Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - David M Hougaard
- Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark; Center for Neonatal Screening, Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Henry R Kranzler
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; VISN 4 Mental Illness Research, Education, and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - Qingqin S Li
- Neuroscience, Janssen Research & Development, LLC, Titusville, New Jersey
| | - Nicholas G Martin
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Herston, Brisbane, Queensland, Australia
| | - Andrew M McIntosh
- Division of Psychiatry, University of Edinburgh, Edinburgh, United Kingdom
| | - Ole Mors
- Psychosis Research Unit, Aarhus University, Aarhus, Denmark; Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
| | - Merete Nordentoft
- Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark; Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Catherine M Olsen
- Department of Population Health, QIMR Berghofer Medical Research Institute, Herston, Brisbane, Queensland, Australia
| | - David Porteous
- Institute for Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Robert J Ursano
- Department of Psychiatry, Uniformed University of the Health Sciences, Bethesda, Maryland
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health, LIME, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Werge
- Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark; Institute of Biological Psychiatry, Copenhagen Mental Health Services, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Lundbeck Foundation GeoGenetics Centre, GLOBE Institute, University of Copenhagen, Copenhagen, Denmark
| | - David C Whiteman
- Department of Population Health, QIMR Berghofer Medical Research Institute, Herston, Brisbane, Queensland, Australia
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Hilary Coon
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, Utah; Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Ditte Demontis
- Centre for Genomics and Personalized Medicine, Aarhus University, Aarhus, Denmark; Centre for Integrative Sequencing, Aarhus University, Aarhus, Denmark; Department of Biomedicine, Aarhus University, Aarhus, Denmark; Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus University, Aarhus, Denmark
| | - Anna R Docherty
- Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia; Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, Utah
| | - Po-Hsiu Kuo
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Cathryn M Lewis
- Department of Medical & Molecular Genetics, King's College London, London, United Kingdom; Social Genetic and Developmental Psychiatry Centre, King's College London, London, United Kingdom
| | - J John Mann
- Departments of Psychiatry and Radiology, Columbia University, New York, New York
| | - Miguel E Rentería
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia; School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Daniel J Smith
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Eli A Stahl
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York; Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts
| | - Murray B Stein
- Department of Psychiatry and School of Public Health, University of California San Diego, La Jolla, California
| | - Fabian Streit
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | | | - Douglas M Ruderfer
- Division of Genetic Medicine, Department of Medicine, Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee.
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Management of Insomnia Disorder. Respir Med 2022. [DOI: 10.1007/978-3-030-93739-3_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Udholm N, Fuglsang M, Lundbye-Christensen S, Bille J, Udholm S. Obstructive Sleep Apnea and Risk of Suicide and Self-Harm: A Danish Nationwide Cohort Study. Sleep 2021; 45:6458465. [PMID: 34888700 DOI: 10.1093/sleep/zsab286] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 12/01/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES In this nationwide study, we used the unique Danish registries to estimate the risk of suicide and deliberate self-harm in patients with obstructive sleep apnea (OSA). METHODS We identified all Danish citizens receiving a diagnosis of OSA between 1995 and 2015. As a reference cohort, we randomly selected 10 citizens for each patient, matched by sex and birth year. Using the Fine and Gray competing risk regression, we estimated the cumulative incidences of suicide, and Cox proportional regression analysis was used to compare the risk of suicide and deliberate self-harm in patients with OSA with the reference cohort. RESULTS We identified 48,168 patients with OSA. A total of 135 patients had died by suicide, compared with 999 suicides in the reference cohort. Patients with OSA had an increased risk of dying by suicide when compared with the reference cohort (hazard ratio, 1.29; 95%CI, 1.07-1.55; and subhazard ratio, 1.23; 95%CI, 1.10-1.45). We identified 1,004 events of self-harm among patients with OSA, and 5,270 events in the reference group. The overall risk of self-harm was increased in patients with OSA when compared with the reference group (hazard ratio, 1.28; 95%CI, 1.19-1.37). CONCLUSION This is the first study to estimate the risk of suicide and deliberate self-harm in patients with OSA. We found that patients with OSA have an increased risk of both suicide and deliberate self-harm when compared with a large reference cohort, thereby highlighting the importance of a mental health screening in these patients.
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Affiliation(s)
- Nichlas Udholm
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Milos Fuglsang
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | - Jesper Bille
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Sebastian Udholm
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
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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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Furihata R, Otsuki R, Hasegawa N, Tsuboi T, Numata S, Yasui-Furukori N, Kashiwagi H, Hori H, Ochi S, Muraoka H, Onitsuka T, Komatsu H, Takeshima M, Hishimoto A, Nagasawa T, Takaesu Y, Nakamura T, Asami T, Miura K, Matsumoto J, Ohi K, Yasuda Y, Iida H, Ogasawara K, Hashimoto N, Ichihashi K, Yamada H, Watanabe K, Inada K, Hashimoto R. Hypotic medication use among inpatients with schizophrenia and major depressive disorder: results of a nationwide study. Sleep Med 2021; 89:23-30. [PMID: 34875519 DOI: 10.1016/j.sleep.2021.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 12/13/2022]
Abstract
STUDY OBJECTIVES To investigate the proportion of inpatients with schizophrenia and major depressive disorder prescribed hypnotic medication, and the association between such medication and the use of other antipsychotic agents. METHODS This was a nationwide cross-sectional study performed as part of the 'Effectiveness of Guidelines for Dissemination and Education in Psychiatric Treatment' (EGUIDE) project. Data from 2146 inpatients with schizophrenia and 1031 inpatients with major depressive disorder were analyzed. All types and dosages of psychotropic drugs were recorded and the data at the time of discharge were analyzed. Associations between the use of hypnotic medication and other antipsychotic agents were evaluated using multivariate logistic regression analyses. RESULTS The proportions of schizophrenia patients who were prescribed any and two or more hypnotic agents were 55.7% and 17.6%, respectively, and the corresponding proportions for patients with major depressive disorder were 63.6% and 22.6%, respectively. In schizophrenia patients, multivariate logistic regression analyses showed that two or more antipsychotics, anticholinergic drugs, anxiolytics, and mood stabilizers/antiepileptic drugs were positively associated with the use of any hypnotic agent. In patients with major depressive disorder, multivariate logistic regression analyses revealed that two or more antidepressants, two or more antipsychotics, anxiolytics, and mood stabilizers/antiepileptic drugs were positively associated with the use of any hypnotic agent. CONCLUSIONS Prescription of hypnotic agents was found to be highly frequent among inpatients with psychiatric disorders. Prescription of two or more main antipsychotic agents was commonly associated with the use of hypnotic medication for both schizophrenia and major depressive disorder.
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Affiliation(s)
| | - Rei Otsuki
- Department of Psychiatry, Nihon University School of Medicine, Japan
| | - Naomi Hasegawa
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Japan
| | - Takashi Tsuboi
- Department of Neuropsychiatry, Kyorin University School of Medicine, Japan
| | - Shusuke Numata
- Department of Psychiatry, Graduate School of Biomedical Science, Tokushima University, Japan
| | | | - Hiroko Kashiwagi
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Japan; Department of Forensic Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Japan
| | - Hikaru Hori
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Japan
| | - Shinichiro Ochi
- Department of Neuropsychiatry, Molecules and Function, Ehime University Graduate School of Medicine, Japan
| | - Hiroyuki Muraoka
- Department of Psychiatry, Tokyo Women's Medical University, Japan
| | - Toshiaki Onitsuka
- Department of Neuroimaging Psychiatry, Graduate School of Medical Sciences, Kyushu University, Japan
| | | | - Masahiro Takeshima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Japan
| | - Akitoyo Hishimoto
- Department of Psychiatry, Yokohama City University Graduate School of Medicine, Japan
| | - Tatsuya Nagasawa
- Department of Neuropsychiatry Kanazawa Medical University, Japan
| | - Yoshikazu Takaesu
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Japan
| | | | - Takeshi Asami
- Department of Psychiatry, Yokohama City University Graduate School of Medicine, Japan
| | - Kenichiro Miura
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Japan
| | - Junya Matsumoto
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Japan
| | - Kazutaka Ohi
- Department of Psychiatry, Gifu University Graduate School of Medicine, Japan
| | - Yuka Yasuda
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Japan; Medical Corporation Foster, Japan
| | - Hitoshi Iida
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Japan
| | - Kazuyoshi Ogasawara
- Center for Postgraduate Clinical Training and Career Development, Nagoya University Hospital, Japan
| | - Naoki Hashimoto
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Japan
| | - Kayo Ichihashi
- Department of Neuropsychiatry, University of Tokyo Hospital, Japan
| | - Hisashi Yamada
- Department of Neuropsychiatry, Hyogo College of Medicine, Japan; Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Japan
| | - Koichiro Watanabe
- Department of Neuropsychiatry, Kyorin University School of Medicine, Japan
| | - Ken Inada
- Department of Psychiatry, Tokyo Women's Medical University, Japan
| | - Ryota Hashimoto
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Japan.
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Britton PC, Crasta D, Bohnert KM, Kane C, Klein J, Pigeon WR. Shorter and longer-term risk for non-fatal suicide attempts among male U.S. military veterans after discharge from psychiatric hospitalization. J Psychiatr Res 2021; 143:9-15. [PMID: 34438203 DOI: 10.1016/j.jpsychires.2021.08.027] [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: 06/11/2021] [Revised: 07/30/2021] [Accepted: 08/18/2021] [Indexed: 11/24/2022]
Abstract
Although there are key differences in shorter-term (days 1-90) and longer-term (days 91-365) risk factors for suicide after discharge from inpatient psychiatry, there are no comparable data on non-fatal suicide attempts. Risk factors for non-fatal attempts in the first 90 days after discharge were compared with those over the remainder of the year to identify temporal changes in risk. Records were extracted from 208,554 male veterans discharged from Veterans Health Administration acute psychiatric inpatient units from 2008 through 2013. Proportional hazard regression models identified correlates of non-fatal attempts for 1-90 days and 91-365 days; adjusted piecewise proportional hazards regression compared risk between these time frames. 5010 (2.4%) veterans made a non-fatal attempt, 1261 (0.60%) on days 1-90 and 3749 (1.78%) on days 91-365. Risk across both time frames was highest among younger veterans ages 18-59, and those hospitalized with a suicide attempt or suicidal ideation. It was lowest among those with a dementia diagnosis. Risk estimates were generally stable over time but increased among those with substance use disorders and decreased among those with sleep disturbance and discharged against medical advice. Estimates of some risk factors for non-fatal attempts change over time in the year after discharge and differ from those that change for suicide. Different preventive approaches may be needed to reduce shorter and longer-term risk for non-fatal attempts and suicide in the year after discharge.
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Affiliation(s)
- Peter C Britton
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veteran Affairs, Finger Lakes Healthcare System, Canandaigua, NY, USA; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Dev Crasta
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veteran Affairs, Finger Lakes Healthcare System, Canandaigua, NY, USA; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Kipling M Bohnert
- Department of Public Health, Michigan State University, Lansing, MI, USA; Department of Veteran Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Cathleen Kane
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veteran Affairs, Finger Lakes Healthcare System, Canandaigua, NY, USA
| | - John Klein
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veteran Affairs, Finger Lakes Healthcare System, Canandaigua, NY, USA
| | - Wilfred R Pigeon
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veteran Affairs, Finger Lakes Healthcare System, Canandaigua, NY, USA; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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Weber FC, Wetter TC. The Many Faces of Sleep Disorders in Post-Traumatic Stress Disorder: An Update on Clinical Features and Treatment. Neuropsychobiology 2021; 81:85-97. [PMID: 34474413 PMCID: PMC9153357 DOI: 10.1159/000517329] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/17/2021] [Indexed: 11/19/2022]
Abstract
Sleep disorders and nightmares are core symptoms of post-traumatic stress disorder (PTSD). The relationship seems to be bidirectional, and persistent disturbed sleep may influence the course of the disorder. With regard to sleep quality, insomnia and nocturnal anxiety symptoms, as well as nightmares and stressful dreams, are the most prominent sleep symptoms. Polysomnographic measurements reveal alterations of the sleep architecture and fragmentation of rapid eye movement sleep. In addition, sleep disorders, such as sleep-related breathing disorders and parasomnias are frequent comorbid conditions. The complex etiology and symptomatology of trauma-related sleep disorders with frequent psychiatric comorbidity require the application of multimodal treatment concepts, including psychological and pharmacological interventions. However, there is little empirical evidence on the effectiveness of long-term drug treatment for insomnia and nightmares. For nondrug interventions, challenges arise from the current lack of PTSD-treatment concepts integrating sleep- and trauma-focused therapies. Effective therapy for sleep disturbances may consequently also improve well-being during the day and probably even the course of PTSD. Whether early sleep interventions exert a preventive effect on the development of PTSD remains to be clarified in future studies.
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Affiliation(s)
- Franziska C. Weber
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Thomas C. Wetter
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
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Wasserman D, Carli V, Iosue M, Javed A, Herrman H. Suicide prevention in psychiatric patients. Asia Pac Psychiatry 2021; 13:e12450. [PMID: 33605074 DOI: 10.1111/appy.12450] [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: 09/22/2020] [Revised: 01/12/2021] [Accepted: 02/02/2021] [Indexed: 01/21/2023]
Abstract
An increased risk of suicide has been reported for psychiatric patients. In several world regions, an underlying psychiatric disorder is reported in up to 90% of people who die from suicide, though this rate seems to be considerably lower in low- and middle-income countries. Major psychiatric conditions associated with suicidality are mood disorders, alcohol and substance use disorders, borderline personality disorder, and schizophrenia. Comorbidity between different disorders is frequently associated with a higher suicide risk. A history of suicide attempts, feelings of hopelessness, impulsivity and aggression, adverse childhood experiences, severe psychopathology, and somatic disorders are common risk factors for suicide among psychiatric patients. Stressful life events and interpersonal problems, including interpersonal violence, are often triggers. A comprehensive and repeated suicide risk assessment represents the first step for effective suicide prevention. Particular attention should be paid during and after hospitalization, with the first days and weeks after discharge representing the most critical period. Pharmacological treatment of mood disorders and schizophrenia has been shown to have an anti-suicidal effect. A significant reduction of suicidal thoughts and behavior has been reported for cognitive behavioral therapy and dialectical behavior therapy. Brief interventions, including psychoeducation and follow-ups, are associated with a decrease in suicide deaths. Further development of suicide prevention in psychiatric patients will require a better understanding of additional risk and protective factors, such as the role of a person's decision-making capacity and social support, the role of spiritual and religious interventions, and the reduction of the treatment gap in mental health care.
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Affiliation(s)
- Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden.,World Psychiatric Association (WPA)-Section on Suicidology, Geneva, Switzerland
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden.,World Psychiatric Association (WPA)-Section on Suicidology, Geneva, Switzerland
| | - Miriam Iosue
- National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden.,World Psychiatric Association (WPA)-Section on Suicidology, Geneva, Switzerland
| | - Afzal Javed
- Coventry and Warwickshire Partnership NHS Trust, Nuneaton Coventry, Coventry, UK
| | - Helen Herrman
- Orygen, and Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
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Ashrafioun L, Bishop TM, Pigeon WR. The Relationship Between Pain Severity, Insomnia, and Suicide Attempts Among a National Veteran Sample Initiating Pain Care. Psychosom Med 2021; 83:733-738. [PMID: 34297006 DOI: 10.1097/psy.0000000000000975] [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: 11/25/2022]
Abstract
OBJECTIVE We assessed the longitudinal association of suicide attempts by moderate to severe pain and insomnia before and after the initiation of pain services among veterans. METHODS A cohort of 221,817 veterans initiating pain care was divided into four subgroups: a) no/mild pain + no insomnia (LowPain-NoINS), b) no/mild pain + insomnia (LowPain-INS), c) moderate/severe pain + no insomnia (HighPain-NoINS), and d) moderate/severe pain + insomnia (HighPain-INS). Data on diagnoses, pain severity, demographics, medications, and suicide attempts were extracted from Veterans Health Administration data sets. RESULTS Overall, there were 2227 (1.0%) suicide attempts before initiating pain services and 1655 (0.8%) after initiating pain services. Cox proportional hazard models accounting for key covariates revealed that patients in the HighPain-INS group were significantly more likely to attempt suicide in the year after the initiation of pain services relative to all subgroups (versus LowPain-NoINS: hazard ratio [HR] = 1.44, 95% confidence interval [CI] = 1.21-1.72; versus LowPain-INS: HR = 1.71, 95% CI = 1.23-2.38; versus HighPain-NoINS: HR = 1.17, 95% CI = 1.01-1.34) even after accounting for prior attempts. Adjusted logistic regression analyses found that patients with moderate/severe pain and insomnia had higher odds of attempting suicide in the year before initiating pain services compared to all subgroups (versus LowPain-NoINS: HR = 1.75, 95% CI = 1.50-2.05; versus LowPain-INS: HR = 1.41, 95% CI = 1.09-1.82; versus HighPain-NoINS: HR = 1.21, 95% CI = 1.07-1.37). CONCLUSIONS These results suggest that those with both moderate/severe pain and insomnia are more likely to have a history of suicide attempts and are at greater risk of a suicide attempt relative to those with insomnia with low/mild pain and those with moderate/severe pain with no insomnia. Suicide prevention efforts for chronic pain and insomnia could address pain and insomnia within the same intervention or in parallel.
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Affiliation(s)
- Lisham Ashrafioun
- From the VA Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System (Ashrafioun, Bishop, Pigeon), Canandaigua; and Department of Psychiatry (Ashrafioun, Bishop, Pigeon), University of Rochester School of Medicine and Dentistry, Rochester, New York
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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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Ferrer-Lluis I, Castillo-Escario Y, Montserrat JM, Jané R. SleepPos App: An Automated Smartphone Application for Angle Based High Resolution Sleep Position Monitoring and Treatment. SENSORS (BASEL, SWITZERLAND) 2021; 21:4531. [PMID: 34282793 PMCID: PMC8271412 DOI: 10.3390/s21134531] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 11/17/2022]
Abstract
Poor sleep quality or disturbed sleep is associated with multiple health conditions. Sleep position affects the severity and occurrence of these complications, and positional therapy is one of the less invasive treatments to deal with them. Sleep positions can be self-reported, which is unreliable, or determined by using specific devices, such as polysomnography, polygraphy or cameras, that can be expensive and difficult to employ at home. The aim of this study is to determine how smartphones could be used to monitor and treat sleep position at home. We divided our research into three tasks: (1) develop an Android smartphone application ('SleepPos' app) which monitors angle-based high-resolution sleep position and allows to simultaneously apply positional treatment; (2) test the smartphone application at home coupled with a pulse oximeter; and (3) explore the potential of this tool to detect the positional occurrence of desaturation events. The results show how the 'SleepPos' app successfully determined the sleep position and revealed positional patterns of occurrence of desaturation events. The 'SleepPos' app also succeeded in applying positional therapy and preventing the subjects from sleeping in the supine sleep position. This study demonstrates how smartphones are capable of reliably monitoring high-resolution sleep position and provide useful clinical information about the positional occurrence of desaturation events.
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Affiliation(s)
- Ignasi Ferrer-Lluis
- Institute for Bioengineering of Catalonia (IBEC), Barcelona Institute of Science and Technology (BIST), 08028 Barcelona, Spain;
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 28029 Madrid, Spain
- Department of Automatic Control (ESAII), Universitat Politècnica de Catalunya-Barcelona Tech (UPC), 08028 Barcelona, Spain
| | - Yolanda Castillo-Escario
- Institute for Bioengineering of Catalonia (IBEC), Barcelona Institute of Science and Technology (BIST), 08028 Barcelona, Spain;
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 28029 Madrid, Spain
- Department of Automatic Control (ESAII), Universitat Politècnica de Catalunya-Barcelona Tech (UPC), 08028 Barcelona, Spain
| | - Josep Maria Montserrat
- Sleep Lab, Pneumology Service, Hospital Clínic de Barcelona, 08036 Barcelona, Spain;
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
| | - Raimon Jané
- Institute for Bioengineering of Catalonia (IBEC), Barcelona Institute of Science and Technology (BIST), 08028 Barcelona, Spain;
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 28029 Madrid, Spain
- Department of Automatic Control (ESAII), Universitat Politècnica de Catalunya-Barcelona Tech (UPC), 08028 Barcelona, Spain
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Osiogo F, Shalaby R, Adegboyega S, Hrabok M, Gusnowski A, Vuong W, Surood S, Greenshaw AJ, Agyapong VIO. COVID-19 pandemic: demographic and clinical correlates of disturbed sleep among 6,041 Canadians. Int J Psychiatry Clin Pract 2021; 25:164-171. [PMID: 33606597 DOI: 10.1080/13651501.2021.1881127] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Psychological burdens of the COVID-19 pandemic are likely to impact sleep negatively. We investigate prevalence and correlates of disturbed sleep among subscribers to Text4Hope a daily supportive text message program launched in Alberta to support residents to deal with stress, anxiety, and depression. METHODS A survey link was sent to Text4Hope subscribers to assess demographic and clinical variables, including disturbed sleep, stress, anxiety, and depression using the third question on the Patient Health Questionnaire-9 (PHQ-9), Perceived Stress Scale, Generalised Anxiety Disorder 7-item scale, and PHQ-9, respectively. Data were analysed using univariate and logistic regression analyses. RESULTS Overall, 6041 out of 32,805 Text4Hope subscribers completed the survey (18.4% response rate). Prevalence of disturbed sleep was 77.8%. Subscribers aged 41-60 years were twice as likely to present with sleep disturbance compared to individuals ≤25 years (OR 1.89, 95% CI: 1.27-2.81). Individuals with moderate/high anxiety and stress symptoms and those with passive death wish/suicidal ideation had higher probability for sleep disturbance [(OR 4.05, 95% CI: 3.33-4.93), (OR 2.42, 95% CI: 1.99-2.94), and (OR 2.39, 95% CI: 1.69-3.38)], respectively. CONCLUSION As the pandemic continues, more Canadians are likely to develop sleep problems, an important consideration for planning mental health services.KEY POINTSThis is the first study to examine the prevalence rates and demographic and clinical correlates of disturbed sleep in a large sample (n = 6041) of Canadians during the COVID-19 pandemic.Prevalence of disturbed sleep was high at 77.8%.Individuals aged 41-60 years were twice as likely to present with sleep disturbance compared to individuals ≤25 years (OR 1.89, 95% CI: 1.27-2.81).Individuals with moderate/high anxiety symptoms, moderate/high stress symptoms, and suicidal ideation/thoughts of self-harm had higher likelihood of developing sleep disturbance, compared to individuals lacking these symptoms [(OR 4.05, 95% CI: 3.33-4.93) and (OR 2.42, 95% CI: 1.98-2.94)], respectively.As the pandemic continues, with fear of multiple waves, more Canadians are likely to develop sleep problems, an important consideration for planning the provision of mental health services.
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Affiliation(s)
- Felix Osiogo
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.,Addiction and Mental Health, Alberta Health Services, Edmonton, Canada
| | - Reham Shalaby
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Sapara Adegboyega
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.,Addiction and Mental Health, Alberta Health Services, Edmonton, Canada
| | - Marianne Hrabok
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.,Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - April Gusnowski
- Addiction and Mental Health, Alberta Health Services, Edmonton, Canada
| | - Wesley Vuong
- Addiction and Mental Health, Alberta Health Services, Edmonton, Canada
| | - Shireen Surood
- Addiction and Mental Health, Alberta Health Services, Edmonton, Canada
| | - Andrew J Greenshaw
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Vincent I O Agyapong
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.,Addiction and Mental Health, Alberta Health Services, Edmonton, Canada
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Ferrer-Lluis I, Castillo-Escario Y, Montserrat JM, Jané R. Enhanced Monitoring of Sleep Position in Sleep Apnea Patients: Smartphone Triaxial Accelerometry Compared with Video-Validated Position from Polysomnography. SENSORS 2021; 21:s21113689. [PMID: 34073215 PMCID: PMC8198328 DOI: 10.3390/s21113689] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/13/2021] [Accepted: 05/20/2021] [Indexed: 12/11/2022]
Abstract
Poor sleep quality is a risk factor for multiple mental, cardiovascular, and cerebrovascular diseases. Certain sleep positions or excessive position changes can be related to some diseases and poor sleep quality. Nevertheless, sleep position is usually classified into four discrete values: supine, prone, left and right. An increase in sleep position resolution is necessary to better assess sleep position dynamics and to interpret more accurately intermediate sleep positions. This research aims to study the feasibility of smartphones as sleep position monitors by (1) developing algorithms to retrieve the sleep position angle from smartphone accelerometry; (2) monitoring the sleep position angle in patients with obstructive sleep apnea (OSA); (3) comparing the discretized sleep angle versus the four classic sleep positions obtained by the video-validated polysomnography (PSG); and (4) analyzing the presence of positional OSA (pOSA) related to its sleep angle of occurrence. Results from 19 OSA patients reveal that a higher resolution sleep position would help to better diagnose and treat patients with position-dependent diseases such as pOSA. They also show that smartphones are promising mHealth tools for enhanced position monitoring at hospitals and home, as they can provide sleep position with higher resolution than the gold-standard video-validated PSG.
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Affiliation(s)
- Ignasi Ferrer-Lluis
- Institute for Bioengineering of Catalonia (IBEC), Barcelona Institute of Science and Technology (BIST), 08028 Barcelona, Spain; (Y.C.-E.)
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBERBBN), 28029 Madrid, Spain
- Department of Automatic Control (ESAII), Universitat Politècnica de Catalunya-Barcelona Tech (UPC), 08028 Barcelona, Spain
- Correspondence: (I.F.-L.); (R.J.)
| | - Yolanda Castillo-Escario
- Institute for Bioengineering of Catalonia (IBEC), Barcelona Institute of Science and Technology (BIST), 08028 Barcelona, Spain; (Y.C.-E.)
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBERBBN), 28029 Madrid, Spain
- Department of Automatic Control (ESAII), Universitat Politècnica de Catalunya-Barcelona Tech (UPC), 08028 Barcelona, Spain
| | - Josep Maria Montserrat
- Sleep Lab, Pneumology Service, Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (J.M.M.)
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
| | - Raimon Jané
- Institute for Bioengineering of Catalonia (IBEC), Barcelona Institute of Science and Technology (BIST), 08028 Barcelona, Spain; (Y.C.-E.)
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBERBBN), 28029 Madrid, Spain
- Department of Automatic Control (ESAII), Universitat Politècnica de Catalunya-Barcelona Tech (UPC), 08028 Barcelona, Spain
- Correspondence: (I.F.-L.); (R.J.)
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49
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Tubbs AS, Fernandez FX, Ghani SB, Karp JF, Patel SI, Parthasarathy S, Grandner MA. Prescription medications for insomnia are associated with suicidal thoughts and behaviors in two nationally representative samples. J Clin Sleep Med 2021; 17:1025-1030. [PMID: 33560206 DOI: 10.5664/jcsm.9096] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
STUDY OBJECTIVES Z-drugs (eszopiclone, zolpidem, and zaleplon) are commonly used for insomnia but are also associated with suicide risk. However, it is unclear if this association is unique to Z-drugs. Therefore, the present study estimated the associations between multiple prescription insomnia medications and suicidal thoughts and behaviors. METHODS Data were acquired from the National Survey on Drug Use and Health for 2015-2018 and the National Health and Nutrition Examination Survey for 2005-2018. Samples were balanced on sociodemographic and mental health covariates using inverse probability of treatment weighting. Associations of Z-drugs, trazodone, and sedative benzodiazepines (temazepam, triazolam, flurazepam) with suicidal ideation, planning, and attempts were estimated using binomial logistic regression. RESULTS In the National Survey on Drug Use and Health, Z-drugs were associated with suicidal ideation (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.14-1.54]), suicide planning (OR, 1.44; 95% CI, 1.19-1.75), and suicide attempts (OR, 1.45; 95% CI, 1.13-1.86) after adjusting for age, sex, race/ethnicity, income, depression, illicit substance use, and the 6-item Kessler Psychological Distress Scale and World Health Organization Disability Assessment Schedule II scores. When analyses accounted for the same factors, sedative benzodiazepines were associated with suicide attempts (OR, 1.76; 95% CI, 1.06-2.87) but not suicidal ideation (OR, 1.37; 95% CI, 0.99-1.88) or suicide planning (OR, 1.39; 95% CI, 0.97-2.00). In the National Health and Nutrition Examination Survey, Z-drugs were associated with suicidal ideation (OR, 2.44; 95% CI, 1.41-4.22), as was trazodone (OR, 2.33; 95% CI, 1.45-3.75), after analyses adjusted for age, sex, race/ethnicity, and exposure to various psychotropic medications. CONCLUSIONS Multiple classes of prescription insomnia medications are associated with suicidal thinking and behaviors, even after analyses adjusted for measures of mental health.
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Affiliation(s)
- Andrew S Tubbs
- Department of Psychiatry, University of Arizona, Tucson, Arizona.,Co-first authors
| | - Fabian-Xosé Fernandez
- Departments of Psychology and Neurology, BIO5 and McKnight Brain Research Institutes, University of Arizona, Tucson, Arizona.,Co-first authors
| | - Sadia B Ghani
- Department of Psychiatry, University of Arizona, Tucson, Arizona
| | - Jordan F Karp
- Department of Psychiatry, University of Arizona, Tucson, Arizona
| | - Salma I Patel
- Department of Medicine, University of Arizona, Tucson, Arizona
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Yoon CG, Jung J, Yoon JH, Lee D, Jeon H, Lee SY. How Is the Suicide Ideation in the Korean Armed Forces Affected by Mental Illness, Traumatic Events, and Social Support? J Korean Med Sci 2021; 36:e96. [PMID: 33876585 PMCID: PMC8055514 DOI: 10.3346/jkms.2021.36.e96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 01/29/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Suicide is one of the leading causes of death in the military as in the general population. To mitigate such a serious public health problem, identifying the risk or protective factors of suicide behaviors is crucial. METHODS We analyzed the representative data of the 2014 Korean Armed Forces to explore the relationship between past year adverse events (PAE), accumulated lifetime trauma (ALT), mental illness vulnerability, perceived social support, and suicidal ideation in the previous year. RESULTS Among the 6,377 subjects, 3.7% of males and 6.2% of females reported suicidal ideation in the previous year. Multivariate analytic models identified significant associations of PAE and ALT with suicidal ideation with a dose-response pattern. The mental illness vulnerability showed the most significant association with suicidal ideation even after controlling PAE or ALT. We found that perceived social support may be potentially linked with a reduced risk of suicidal ideation. CONCLUSION This Korean military representative data demonstrates mental illness vulnerability; PAE; and lifetime trauma as significant risk factors of suicidal ideation, while perceived social support was found as a potential protective factor. Given the importance of the prevention of suicide in the military, those risk and protective factors may be used to screen soldiers at risk of suicide and provide further support on mental health services as needed.
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Affiliation(s)
- Chang Gyo Yoon
- Department of Preventive Medicine, Armed Forces Medical Command, Seongnam, Korea
- Preventive Medicine Program, Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Jaehun Jung
- Department of Preventive Medicine, Armed Forces Medical Command, Seongnam, Korea
- Department of Preventive Medicine, Gachon University College of Medicine, Incheon, Korea
| | - Jin Ha Yoon
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Dawon Lee
- Department of Psychiatry, Armed Forces Capital Hospital, Seongnam, Korea
- Geumcheon Kidari Mental Clinic, Seoul, Korea
| | - Hankaram Jeon
- Department of Psychiatry, Armed Forces Guri Hospital, Armed Forces Medical Command, Guri, Korea
| | - Seung Yup Lee
- Department of Psychiatry, Armed Forces Capital Hospital, Seongnam, Korea
- Department of Psychiatry, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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