1
|
Logan JE, Ertl AM, Rostad WL, Herbst JH, Ashby Plant E. Shared correlates of prescription drug misuse and severe suicide ideation among clinical patients at risk for suicide. Suicide Life Threat Behav 2020; 50:1276-1287. [PMID: 32860264 PMCID: PMC7754473 DOI: 10.1111/sltb.12685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/29/2020] [Accepted: 06/29/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Unintentional drug overdose and suicide have emerged as public health problems. Prescription drug misuse can elevate risk of overdose. Severe suicidal ideation increases risk of suicide. We identified shared correlates of both risk factors to inform cross-cutting prevention efforts. METHODS We conducted a cross-sectional study using the Military Suicide Research Consortium's Common Data Elements survey; 2012-2017 baseline data collected from 10 research sites were analyzed. The sample included 3962 clinical patients at risk of suicide. Factors examined in relation to the outcomes, prescription drug misuse and severe suicidal ideation, included demographic characteristics and symptoms of: hopelessness; anxiety; post-traumatic stress disorder; alcohol use; other substance use; prior head/neck injury; insomnia; and belongingness. Poisson regression models with robust estimates provided adjusted prevalence ratios (aPRs) and 97.5% confidence intervals (CIs). RESULTS Medium and high (vs. low) levels of insomnia were positively associated with prescription drug misuse (aPRs p < 0.025). Medium (vs. low) level of insomnia was positively associated with severe suicidal ideation (aPR: 1.09; CI: 1.01-1.18). Medium and high (vs. low) levels of perceived belongingness were inversely associated with both outcomes (aPRs p < 0.025). CONCLUSIONS Research should evaluate whether addressing sleep problems and improving belongingness can reduce prescription drug misuse and suicidal ideation simultaneously.
Collapse
Affiliation(s)
- Joseph E. Logan
- Centers for Disease Control and Prevention (CDC)Division of Violence PreventionNational Center for Injury Prevention and Control4770 Buford Hwy NEAtlantaGeorgia30341USA
| | - Allison M. Ertl
- Centers for Disease Control and Prevention (CDC)Division of Violence PreventionNational Center for Injury Prevention and Control4770 Buford Hwy NEAtlantaGeorgia30341USA
| | - Whitney L. Rostad
- Centers for Disease Control and Prevention (CDC)Division of Violence PreventionNational Center for Injury Prevention and Control4770 Buford Hwy NEAtlantaGeorgia30341USA
| | - Jeffrey H. Herbst
- Centers for Disease Control and Prevention (CDC)Division of Violence PreventionNational Center for Injury Prevention and Control4770 Buford Hwy NEAtlantaGeorgia30341USA
| | - E. Ashby Plant
- Department of PsychologyFlorida State University1107 W. Call StreetTallahasseeFlorida32306USA
| |
Collapse
|
2
|
Chaudhary NS, Wong MM, Kolla BP, Kampman KM, Chakravorty S. The relationship between insomnia and the intensity of drinking in treatment-seeking individuals with alcohol dependence. Drug Alcohol Depend 2020; 215:108189. [PMID: 32768993 PMCID: PMC10082590 DOI: 10.1016/j.drugalcdep.2020.108189] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 06/16/2020] [Accepted: 07/13/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although insomnia is highly prevalent in alcohol use disorders(AUD), its associations with the severity of alcohol use, pre-existing psychiatric comorbidities and psychosocial problems are understudied. The present study evaluates the interplay between these factors using a structural equation model (SEM). METHODS We assessed baseline cross-sectional data on patients with AUD (N = 123) recruited to a placebo-controlled medication trial. Severity of alcohol use was measured by the Brief Michigan Alcoholism Screening Test (B-MAST). Insomnia Severity Index was used to assess insomnia symptoms. The Hamilton scales for Depression and Anxiety, Short Index of Problems and Timeline Follow Back evaluated psychiatric symptoms, psychosocial consequences of drinking and level of alcohol consumption respectively. We used logistic regression to evaluate the association between insomnia and severity of alcohol use while controlling for covariates. We constructed a SEM with observed variables to delineate the effect of psychiatric symptoms, psychosocial factors and current alcohol use on the pathway between alcohol use severity and insomnia. RESULTS The sample was predominately male(83.9 %), Black(54.6 %) and employed(60.0 %). About 45 % of the participants reported moderate-severe insomnia.The association between insomnia and B-MAST attenuated after adjustment for demographics, psychiatric symptoms and psychosocial problems(OR[95 % CI] = 1.17(0.99-1.47). SEM findings demonstrated that B-MAST and insomnia were linked to psychiatric symptoms (95 % Asymptotic-Confidence Interval (ACI): 0.015-0.159, p < 0.05) but not to psychosocial problems or current alcohol use. CONCLUSION Among treatment-seeking patients with AUD, psychiatric burden mediated the relationship between severity of alcohol use and insomnia. Clinicians should screen for underlying psychiatric disorders among treatment-seeking patients with AUD complaining of insomnia.
Collapse
Affiliation(s)
- Ninad S Chaudhary
- University of Alabama at Birmingham School of Public Health, 1665 University Blvd, Birmingham, AL, 35211, USA.
| | - Maria M Wong
- Idaho State University, 921 S 8th Ave, Stop 8112, Pocatello, ID, 83209, USA
| | - Bhanu Prakash Kolla
- Department of Psychiatry and Psychology, Mayo Clinic, 2nd ST SW, Rochester, MN, 55905, USA
| | - Kyle M Kampman
- Department of Psychiatry, Perelman School of Medicine, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA; Cpl. Michael J. Crescenz VA Medical Center, 3900 Woodland Ave, Philadelphia, PA, 19104, USA
| | - Subhajit Chakravorty
- Department of Psychiatry, Perelman School of Medicine, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA; Cpl. Michael J. Crescenz VA Medical Center, 3900 Woodland Ave, Philadelphia, PA, 19104, USA.
| |
Collapse
|
3
|
Kolla BP, Mansukhani MP, Biernacka J, Chakravorty S, Karpyak VM. Sleep disturbances in early alcohol recovery: Prevalence and associations with clinical characteristics and severity of alcohol consumption. Drug Alcohol Depend 2020; 206:107655. [PMID: 31744670 DOI: 10.1016/j.drugalcdep.2019.107655] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 08/01/2019] [Accepted: 08/05/2019] [Indexed: 11/24/2022]
Abstract
AIMS We aimed to assess the prevalence of sleep disturbance in early alcohol recovery and its association with psychiatric comorbidity, cravings, propensity and severity of alcohol consumption. DESIGN The sample consisted of 18-80 year old patients (n = 303) receiving treatment for alcohol dependence. Sleep disturbance was measured using the Pittsburgh Sleep Quality Index (PSQI). Additional measures included PHQ-9, GAD-7 and Penn alcohol cravings scale (PACS), Inventory of Drug Taking Situations (IDTS) and alcohol consumption was measured utilizing the Time Line Follow Back (TLFB).Bivariate analyses evaluated the association between PSQI total score and other clinical characteristics. A multivariable model was computed for sleep disturbance with predictors entered into the model using automated stepwise selection. FINDINGS The sample was majority male (66%), White (93%) with a mean age of 42.2 ± 11.6 years. Baseline PSQI score was 10.2 ± 4.13 and most subjects (88%) reported sleep disturbance at baseline. Baseline sleep disturbance was associated with depressive symptoms (p < .0001), anxiety symptoms (p < .0001), craving (p < .0001), propensity to drink when experiencing unpleasant emotions (p < .0001), physical discomfort (p < .0001), loss of personal control (p = 0.03), conflict (p = 0.002), number of drinks consumed (p = 0.004), drinking days (p = 0.004) and hazardous drinking days (p = 0.03) in bivariate analyses. However, in the multivariable model, only PHQ-9 total score and IDTS physical discomfort subscale were associated with sleep disturbance. CONCLUSION Sleep disruption is common in early alcohol recovery. Future studies should examine the prognostic and clinical implications of its association with current depressive symptoms and a propensity to drink while experiencing physical discomfort.
Collapse
Affiliation(s)
- Bhanu Prakash Kolla
- Department of Psychiatry and Psychology, Mayo Clinic, 2nd ST SW, Rochester, MN 55905, USA; Center for Sleep Medicine, Mayo Clinic, 2nd ST SW, Rochester, MN 55905, USA.
| | - Meghna P Mansukhani
- Department of Psychiatry and Psychology, Mayo Clinic, 2nd ST SW, Rochester, MN 55905, USA
| | - Joanna Biernacka
- Department of Biostatistics, Mayo Clinic, 2nd ST SW, Rochester, MN 55905, USA
| | - Subhajit Chakravorty
- Department of Psychiatry, Perelman School of Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Victor M Karpyak
- Department of Biostatistics, Mayo Clinic, 2nd ST SW, Rochester, MN 55905, USA
| |
Collapse
|
4
|
McCarthy MS, Hoffmire C, Brenner LA, Nazem S. Sleep and timing of death by suicide among U.S. Veterans 2006–2015: analysis of the American Time Use Survey and the National Violent Death Reporting System. Sleep 2019; 42:5513337. [DOI: 10.1093/sleep/zsz094] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 01/28/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study Objectives
Suicide is a top public health priority, and U.S. Veterans are recognized to be at particularly elevated risk. Sleep disturbances are an independent risk factor for suicide; recent empirical data suggest that nocturnal wakefulness may be a key mechanism underlying this association. Given higher rates of sleep disturbances among U.S. Veterans compared with civilians, we examined associations between nocturnal wakefulness and timing of death by suicide in U.S. Veterans and civilians to determine whether temporal suicide patterns differed.
Methods
The American Time Use Survey and the National Violent Death Reporting System were analyzed (2006–2015) to determine whether sleep and temporal suicide patterns differed between age-stratified groups (18–39, 40–64, and ≥65) of U.S. Veterans and civilians. Observed temporal suicide patterns were reported and standardized incidence ratios (SIRs) calculated to compare the percentage of suicides observed with those expected, given the proportion of the population awake, across clock hours.
Results
The raw proportion of Veteran suicides peaks between the hours of 1000–1200; however, the peak prevalence of suicide after accounting for the population awake is between 0000 and 0300 hr (p < .00001, ϕ = .88). The highest SIR was at midnight; U.S. Veterans were eight times more likely to die by suicide than expected given the population awake (SIR = 8.17; 95% CI = 7.45–8.94).
Conclusions
Nocturnal wakefulness is associated with increased risk for suicide in U.S. Veterans. Overall patterns of observed suicides by clock hour were similar between U.S. Veterans and civilians. However, Veteran-specific SIRs suggest differences in magnitude of risk by clock hour across age groups. Future research examining female and Post-9/11 U.S. Veterans is warranted.
Collapse
Affiliation(s)
| | - Claire Hoffmire
- Rocky Mountain Mental Illness Research Education and Clinical Center, Veterans Administration, Aurora, CO
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO
| | - Lisa A Brenner
- Rocky Mountain Mental Illness Research Education and Clinical Center, Veterans Administration, Aurora, CO
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO
| | - Sarra Nazem
- Rocky Mountain Mental Illness Research Education and Clinical Center, Veterans Administration, Aurora, CO
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO
| |
Collapse
|
5
|
Chakravorty S, Chaudhary NS, Morales K, Grandner MA, Oslin DW. Is family history of alcohol dependence a risk factor for disturbed sleep in alcohol dependent subjects? Drug Alcohol Depend 2018; 188:311-317. [PMID: 29843109 PMCID: PMC7486904 DOI: 10.1016/j.drugalcdep.2018.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 04/08/2018] [Accepted: 04/10/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Disturbed sleep and a family history of alcohol dependence (AD) are risk factors for developing AD, yet the underlying relationship between them is unclear among individuals with AD. Understanding these inherited associations will help us not only identify risk for development of these comorbid disorders, but also individualize treatment at this interface. We evaluated whether a first-degree family history of AD (FH+) was a risk factor for sleep continuity disturbance in patients with AD. We also evaluated whether alcohol use or mood disturbance moderated the relationship between FH and sleep. METHODS We analyzed cross-sectional baseline data from an alcohol clinical trial in a sample of individuals with AD (N = 280). Their family history of AD among nuclear family members, sleep complaints, alcohol use (over the last 90 days), and mood disturbance were assessed using the Family History Interview for Substance and Mood Disorders, Medical Outcomes Study Sleep Scale, Time Line Follow-Back Interview, and Profile of Mood States-Short Form, respectively. RESULTS A FH + status (65% of subjects) was significantly associated with lower model estimated mean sleep adequacy (β = - 7.05, p = 0.02) and sleep duration (β = - 0.38, p = 0.04) scale scores. FH was not associated with sleep disturbance scale. No significant moderating effect involving alcohol use or mood disturbance was seen. CONCLUSION Family history of AD is a unique risk factor for sleep complaints in AD. Non-restorative sleep and sleep duration may be noteworthy phenotypes to help probe for underlying genotypic polymorphisms in these comorbid disorders.
Collapse
Affiliation(s)
- Subhajit Chakravorty
- Cpl. Michael J. Crescenz VA Medical Center, 3900 Woodland Ave., Philadelphia, PA 19104, USA; Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd., Philadelphia, PA 19104, USA.
| | | | | | | | - David W. Oslin
- Cpl. Michael J. Crescenz VA Medical Center, Philadelphia, PA 19104;,Perelman School of Medicine, Philadelphia, PA 19104
| |
Collapse
|
6
|
Perney P, Lehert P. Insomnia in Alcohol-Dependent Patients: Prevalence, Risk Factors and Acamprosate Effect: An Individual Patient Data Meta-Analysis. Alcohol Alcohol 2018; 53:611-618. [DOI: 10.1093/alcalc/agy013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Pascal Perney
- Service d’Addictologie, Hôpital Caremeau, Place du Pr Debré, Nîmes, France
- université Montpellier 1, 2 rue de l'école de Médecine, Montpellier, France
- CESP, UMR 1018, INSERM, UPS, UVSQ. P. Descartes. Hôpital Paul Brousse – Bat 15/16 – 16 avenue PV Couturier 6 Villejuif Cedex, France
| | - Philippe Lehert
- Statistics Department, Faculty of Economics, University of Louvain, 181 chaussée de Binche, Mons, Belgium
| |
Collapse
|
7
|
Chakravorty S, Chaudhary NS, Brower KJ. Alcohol Dependence and Its Relationship With Insomnia and Other Sleep Disorders. Alcohol Clin Exp Res 2016; 40:2271-2282. [PMID: 27706838 DOI: 10.1111/acer.13217] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 08/09/2016] [Indexed: 12/12/2022]
Abstract
Sleep-related complaints are widely prevalent in those with alcohol dependence (AD). AD is associated not only with insomnia, but also with multiple sleep-related disorders as a growing body of literature has demonstrated. This article will review the various aspects of insomnia associated with AD. In addition, the association of AD with other sleep-related disorders will be briefly reviewed. The association of AD with insomnia is bidirectional in nature. The etiopathogenesis of insomnia has demonstrated multiple associations and is an active focus of research. Treatment with cognitive behavioral therapy for insomnia is showing promise as an optimal intervention. In addition, AD may be associated with circadian abnormalities, short sleep duration, obstructive sleep apnea, and sleep-related movement disorder. The burgeoning knowledge on insomnia associated with moderate-to-severe alcohol use disorder has expanded our understanding of its underlying neurobiology, clinical features, and treatment options.
Collapse
Affiliation(s)
- Subhajit Chakravorty
- Corporal Michael J. Crescenz VA Medical Center , Philadelphia, Pennsylvania. .,Perelman School of Medicine , Philadelphia, Pennsylvania.
| | | | - Kirk J Brower
- University of Michigan Medical School , Ann Arbor, Michigan
| |
Collapse
|
8
|
Grandner MA, Williams NJ, Knutson KL, Roberts D, Jean-Louis G. Sleep disparity, race/ethnicity, and socioeconomic position. Sleep Med 2016; 18:7-18. [PMID: 26431755 PMCID: PMC4631795 DOI: 10.1016/j.sleep.2015.01.020] [Citation(s) in RCA: 247] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 01/14/2015] [Accepted: 01/20/2015] [Indexed: 12/26/2022]
Abstract
Sleep represents a set of biological functions necessary for the maintenance of life. Performing these functions, though, requires that an individual engage in behaviors, which are affected by social and environmental factors. Race/ethnicity and socioeconomic position represent categories of factors that likely play a role in the experience of sleep in the community. Previous studies have suggested that racial/ethnic minorities and the socioeconomically disadvantaged may be more likely to experience sleep patterns that are associated with adverse health outcomes. It is possible that disparities in sleep represent a pathway by which larger disparities in health emerge. This review (1) contextualizes the concept of race/ethnicity in biomedical research, (2) summarizes previous studies that describe patterns of sleep attainment across race/ethnicity groups, (3) discusses several pathways by which race/ethnicity may be associated with sleep, (4) introduces the potential role of socioeconomic position in the patterning of sleep, and (5) proposes future research directions to address this issue.
Collapse
Affiliation(s)
- Michael A Grandner
- Behavioral Sleep Medicine Program, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA, USA.
| | - Natasha J Williams
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, New York University Langone Medical Center, New York University School of Medicine, New York, NY, USA
| | | | - Dorothy Roberts
- University of Pennsylvania Law School, Philadelphia, PA, USA; Department of Sociology, University of Pennsylvania, Philadelphia, PA, USA; Department of Africana Studies, University of Pennsylvania, Philadelphia, PA, USA
| | - Girardin Jean-Louis
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, New York University Langone Medical Center, New York University School of Medicine, New York, NY, USA
| |
Collapse
|
9
|
Chakravorty S, Siu HYK, Lalley-Chareczko L, Brown GK, Findley JC, Perlis ML, Grandner MA. Sleep Duration and Insomnia Symptoms as Risk Factors for Suicidal Ideation in a Nationally Representative Sample. Prim Care Companion CNS Disord 2015; 17:13m01551. [PMID: 27057399 DOI: 10.4088/pcc.13m01551] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 07/16/2015] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE Suicidal behavior (suicidal ideation, suicide attempts, and suicide completion) has been increasingly linked with difficulty initiating sleep, maintaining sleep, and early morning awakenings. However, the relationship between suicidal behavior and sleep duration abnormalities is unclear, especially at the population level. The present study used a nationally representative sample to examine the association of suicidal ideation with extreme sleep durations and insomnia symptoms. METHOD Cross-sectional data from adult respondents (≥ 18 years of age, N = 6,228) were extracted from the 2007-2008 wave of the National Health and Nutritional Examination Survey. Ordinal logistic regression analyses were used to evaluate the relationship of suicidal ideation with sleep duration, global insomnia, and individual insomnia symptoms in models adjusted for sociodemographic, socioeconomic, and health-related covariates. RESULTS Suicidal ideation was associated with abnormalities of sleep duration. This relationship ceased to exist once the model was adjusted for depressive symptoms. As expected, an increased level of suicidal ideation was consistently associated with insomnia. Of the insomnia symptoms, difficulty maintaining sleep was found to be the most predictive of suicidal ideation, followed by difficulty initiating sleep (P< .05). CONCLUSIONS Abnormalities of sleep duration and continuity should prompt a clinical assessment for suicide risk.
Collapse
Affiliation(s)
- Subhajit Chakravorty
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - H Y Katy Siu
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | - Gregory K Brown
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - James C Findley
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Michael L Perlis
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Michael A Grandner
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia; University of Arizona College of Medicine, Tuscon
| |
Collapse
|
10
|
Rehm J, Anderson P, Manthey J, Shield KD, Struzzo P, Wojnar M, Gual A. Alcohol Use Disorders in Primary Health Care: What Do We Know and Where Do We Go? Alcohol Alcohol 2015; 51:422-7. [DOI: 10.1093/alcalc/agv127] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Accepted: 10/20/2015] [Indexed: 11/14/2022] Open
|
11
|
Chaudhary NS, Kampman KM, Kranzler HR, Grandner MA, Debbarma S, Chakravorty S. Insomnia in alcohol dependent subjects is associated with greater psychosocial problem severity. Addict Behav 2015; 50:165-72. [PMID: 26151580 DOI: 10.1016/j.addbeh.2015.06.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 03/19/2015] [Accepted: 06/04/2015] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Although psychosocial problems are commonly associated with both alcohol misuse and insomnia, very little is known about the combined effects of insomnia and current alcohol dependence on the severity of psychosocial problems. The present study evaluates whether the co-occurrence of insomnia and alcohol dependence is associated with greater psychosocial problem severity. METHODS Alcohol dependent individuals (N = 123) were evaluated prior to participation in a placebo-controlled medication trial. The Short Index of Problems (SIP), Addiction Severity Index (ASI), Insomnia Severity Index (ISI), and Time Line Follow Back (TLFB), were used to assess psychosocial, employment, and legal problems; insomnia symptoms; and alcohol consumption, respectively. Bivariate and multivariate analyses were used to evaluate the relations between insomnia and psychosocial problems. RESULTS Subjects' mean age was 44 years (SD = 10.3), 83% were male, and their SIP sub-scale scores approximated the median for normative data. A quarter of subjects reported no insomnia; 29% reported mild insomnia; and 45% reported moderate-severe insomnia. The insomnia groups did not differ on alcohol consumption measures. The ISI total score was associated with the SIP total scale score (β = 0.23, p = 0.008). Subjects with moderate-severe insomnia had significantly higher scores on the SIP total score, and on the social and impulse control sub-scales, and more ASI employment problems and conflicts with their spouses than others on the ASI. CONCLUSION In treatment-seeking alcohol dependent subjects, insomnia may increase alcohol-related adverse psychosocial consequences. Longitudinal studies are needed to clarify the relations between insomnia and psychosocial problems in these subjects.
Collapse
Affiliation(s)
- Ninad S Chaudhary
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA 19104, United States; Washington University in St. Louis, St. Louis, MO 63110, United States
| | - Kyle M Kampman
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA 19104, United States; Philadelphia Veterans Affairs Medical Center, Philadelphia, PA 19104, United States
| | - Henry R Kranzler
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA 19104, United States; Philadelphia Veterans Affairs Medical Center, Philadelphia, PA 19104, United States
| | - Michael A Grandner
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA 19104, United States; Philadelphia Veterans Affairs Medical Center, Philadelphia, PA 19104, United States
| | - Swarnalata Debbarma
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA 19104, United States; Thomas Jefferson University, Philadelphia, PA 19107, United States
| | - Subhajit Chakravorty
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA 19104, United States; Philadelphia Veterans Affairs Medical Center, Philadelphia, PA 19104, United States.
| |
Collapse
|
12
|
Magnée EHB, de Weert-van Oene GH, Wijdeveld TAGM, Coenen AML, de Jong CAJ. Sleep disturbances are associated with reduced health-related quality of life in patients with substance use disorders. Am J Addict 2015; 24:515-22. [PMID: 26073849 DOI: 10.1111/ajad.12243] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 04/16/2015] [Accepted: 04/26/2015] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Sleep problems and substance use are strongly linked. Sleep problems play a role in the etiology of substance use, but also may be a result of it. After detoxification, sleep problems may worsen leading to relapse. Nowadays, most substance dependence treatment programs aim at recovery rather than total abstinence, and in that view health-related quality of life (HRQL) is a relevant construct. This article describes the association between self-perceived sleep problems and HRQL in a naturalistic population of polydrug-using inpatients. METHODS At the start of treatment, 388 polydrug-using inpatients completed questionnaires concerning their sleep quality and HRQL. Three categories were established based on reported sleep problems: patients without sleep problems (21.6%), those with clinically relevant sleep problems (34.5%), and patients with sleep disorders (43.8%). RESULTS Mean grades for quality of sleep were M = 7.3 (sd 1.7), M = 6.6 (sd 1.7) and M = 5.3 (sd 1.9) for the three categories, respectively. In addition, patients in the disorder category perceived a lower HRQL than those in the other categories. In the explanation of HRQL, both sleep problems and sleep disorders added significantly to the model when controlling for baseline characteristics. DISCUSSION AND CONCLUSIONS Our findings stress the need for clinicians to pay attention to the quality of sleep of recovering polydrug users, since this may play an important role in the recovery process. Monitoring sleep during treatment is advocated. This study adds to the knowledge about the way HRQL and sleep are related in a naturalistic sample of substance-dependent patients.
Collapse
Affiliation(s)
- Ellis H B Magnée
- Department of Addiction and Korsakov Care, Vincent van Gogh Institute, Oostrum, the Netherlands.,Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud University, Nijmegen, the Netherlands
| | - Gerdien H de Weert-van Oene
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud University, Nijmegen, the Netherlands.,Victas, Addiction Treatment Center, Utrecht, the Netherlands
| | - Toon A G M Wijdeveld
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud University, Nijmegen, the Netherlands
| | - Anton M L Coenen
- Donders Institute, Radboud University Nijmegen, Nijmegen, the Netherlands
| | - Cor A J de Jong
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud University, Nijmegen, the Netherlands
| |
Collapse
|
13
|
Williams NJ, Grandne MA, Snipes A, Rogers A, Williams O, Airhihenbuwa C, Jean-Louis G. Racial/ethnic disparities in sleep health and health care: importance of the sociocultural context. Sleep Health 2015; 1:28-35. [PMID: 26229976 PMCID: PMC4517599 DOI: 10.1016/j.sleh.2014.12.004] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Natasha J. Williams
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, NYU Medical Center, 227 East 30th St, New York, NY 10016
| | - Michael A. Grandne
- Department of Psychiatry, Behavioral Sleep Medicine Program, University of Pennsylvania, 3535 Market St, Philadelphia, PA 19104
| | - Amy Snipes
- Department of Biobehavioral Health, The Penn State University, 219 Biobehavioral Health Building, University Park, PA, 16802
| | - April Rogers
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, NYU Medical Center, 227 East 30th St, New York, NY 10016
| | - Olajide Williams
- Columbia University, Department of Neurology, 710 West 168th St, New York, NY 10032
| | - Collins Airhihenbuwa
- Department of Biobehavioral Health, The Penn State University, 219 Biobehavioral Health Building, University Park, PA, 16802
| | - Girardin Jean-Louis
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, NYU Medical Center, 227 East 30th St, New York, NY 10016
| |
Collapse
|
14
|
Tang J, Liao Y, He H, Deng Q, Zhang G, Qi C, Cui H, Jiao B, Yang M, Feng Z, Chen X, Hao W, Liu T. Sleeping problems in Chinese illicit drug dependent subjects. BMC Psychiatry 2015; 15:28. [PMID: 25884573 PMCID: PMC4337091 DOI: 10.1186/s12888-015-0409-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 02/10/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Illicit drug use/dependence has been recognized as a major problem. Clinical studies demonstrate that poor sleep quality is associated with increased frequency of drug use and relapse. However, few studies have addressed the issue of sleep quality among illicit drug dependent subjects. METHODS This cross-sectional study explored sleep quality in drug dependent subjects in China. We studied 2178 illicit drug dependent subjects from drug rehabilitation centres in Changsha and 2236 non-drug-using subjects, all of whom completed the self-report Pittsburgh Sleep Quality Index (PSQI). RESULTS We found that the prevalence of sleep disturbance was much higher in drug users (68.5%, PSQI >5; specifically, 80.24% in heroin users, 54.16% in methamphetamine users and 81.98% in ketamine users with PSQI >5) than non-users (26.4%, PSQI >5). Drug users had approximately twice the sleep latency than nondrug users (37.7 minutes V.S 18.4 minutes). Although drug users and non-users reported similar sleep duration (about 7.4 hours), drug users showed poorer subjective sleep quality and habitual sleep efficiency. They reported more sleep disturbance and need for sleep medications, more daytime dysfunction and poorer subjective sleep quality compared with nondrug users. The total PSQI score positively correlated with the duration of drug use (rp = 0.164, p < 0.001). We also found a link between sleep problems and cigarette smoking, alcohol drinking, and duration of drug use. CONCLUSIONS Poor sleep quality is common among illicit drug dependent subjects. Long-term substance users had more sleep problems. Future research aiming at quantifying the benefits of treatment interventions should not neglect the influence of sleep problems. Gaining more insight into the impact of sleep quality on the addiction treatment could also help to target future intervention measures more effectively.
Collapse
Affiliation(s)
- Jinsong Tang
- Department of Psychiatry, Institute of Mental Health, the Second Xiangya Hospital of Central South University, 139 Renmin (M) Rd, Changsha, Hunan, 410011, P. R. China.
| | - Yanhui Liao
- Department of Psychiatry, Institute of Mental Health, the Second Xiangya Hospital of Central South University, 139 Renmin (M) Rd, Changsha, Hunan, 410011, P. R. China.
| | - Haoyu He
- Department of Psychiatry, Institute of Mental Health, the Second Xiangya Hospital of Central South University, 139 Renmin (M) Rd, Changsha, Hunan, 410011, P. R. China.
| | - Qijian Deng
- Department of Psychiatry, Institute of Mental Health, the Second Xiangya Hospital of Central South University, 139 Renmin (M) Rd, Changsha, Hunan, 410011, P. R. China.
| | - Guanbai Zhang
- Department of Psychiatry, Institute of Mental Health, the Second Xiangya Hospital of Central South University, 139 Renmin (M) Rd, Changsha, Hunan, 410011, P. R. China. .,Yunnan Institute for Drug Abuse, Kunming, Yunnan, China.
| | - Chang Qi
- Department of Psychiatry, Institute of Mental Health, the Second Xiangya Hospital of Central South University, 139 Renmin (M) Rd, Changsha, Hunan, 410011, P. R. China.
| | - Hangtao Cui
- Department of Psychiatry, Institute of Mental Health, the Second Xiangya Hospital of Central South University, 139 Renmin (M) Rd, Changsha, Hunan, 410011, P. R. China. .,Department of Psychiatry, Hunan Brain Hospital, Changsha, Hunan, China.
| | - Bin Jiao
- Department of Psychiatry, Institute of Mental Health, the Second Xiangya Hospital of Central South University, 139 Renmin (M) Rd, Changsha, Hunan, 410011, P. R. China. .,Department of Neurology, Xiangya Hospital of Central South University, Changsha, Hunan, China.
| | - Mei Yang
- Department of Psychiatry, Institute of Mental Health, the Second Xiangya Hospital of Central South University, 139 Renmin (M) Rd, Changsha, Hunan, 410011, P. R. China. .,School of Public Health, Central South University, Changsha, Hunan, China.
| | - Zhijuan Feng
- Department of Psychiatry, Institute of Mental Health, the Second Xiangya Hospital of Central South University, 139 Renmin (M) Rd, Changsha, Hunan, 410011, P. R. China.
| | - Xiaogang Chen
- Department of Psychiatry, Institute of Mental Health, the Second Xiangya Hospital of Central South University, 139 Renmin (M) Rd, Changsha, Hunan, 410011, P. R. China.
| | - Wei Hao
- Department of Psychiatry, Institute of Mental Health, the Second Xiangya Hospital of Central South University, 139 Renmin (M) Rd, Changsha, Hunan, 410011, P. R. China.
| | - Tieqiao Liu
- Department of Psychiatry, Institute of Mental Health, the Second Xiangya Hospital of Central South University, 139 Renmin (M) Rd, Changsha, Hunan, 410011, P. R. China. .,National Technology of Institute of Psychiatry, Central South University, Changsha, Hunan, China. .,The State Key Laboratory of Medical Genetics, Central South University, Changsha, Hunan, China.
| |
Collapse
|
15
|
Chakravorty S, Siu HYK, Lalley-Chareczko L, Brown GK, Findley JC, Perlis ML, Grandner MA. Sleep Duration and Insomnia Symptoms as Risk Factors for Suicidal Ideation in a Nationally Representative Sample. Prim Care Companion CNS Disord 2015. [PMID: 27057399 DOI: 10.4088/pcc.13m01551.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022] Open
Abstract
OBJECTIVE Suicidal behavior (suicidal ideation, suicide attempts, and suicide completion) has been increasingly linked with difficulty initiating sleep, maintaining sleep, and early morning awakenings. However, the relationship between suicidal behavior and sleep duration abnormalities is unclear, especially at the population level. The present study used a nationally representative sample to examine the association of suicidal ideation with extreme sleep durations and insomnia symptoms. METHOD Cross-sectional data from adult respondents (≥ 18 years of age, N = 6,228) were extracted from the 2007-2008 wave of the National Health and Nutritional Examination Survey. Ordinal logistic regression analyses were used to evaluate the relationship of suicidal ideation with sleep duration, global insomnia, and individual insomnia symptoms in models adjusted for sociodemographic, socioeconomic, and health-related covariates. RESULTS Suicidal ideation was associated with abnormalities of sleep duration. This relationship ceased to exist once the model was adjusted for depressive symptoms. As expected, an increased level of suicidal ideation was consistently associated with insomnia. Of the insomnia symptoms, difficulty maintaining sleep was found to be the most predictive of suicidal ideation, followed by difficulty initiating sleep (P< .05). CONCLUSIONS Abnormalities of sleep duration and continuity should prompt a clinical assessment for suicide risk.
Collapse
Affiliation(s)
- Subhajit Chakravorty
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - H Y Katy Siu
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | - Gregory K Brown
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - James C Findley
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Michael L Perlis
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Michael A Grandner
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia; University of Arizona College of Medicine, Tuscon
| |
Collapse
|
16
|
Hui SKA, Grandner MA. Associations between Poor Sleep Quality and Stages of Change of Multiple Health Behaviors among Participants of Employee Wellness Program. Prev Med Rep 2015; 2:292-299. [PMID: 26046013 PMCID: PMC4450439 DOI: 10.1016/j.pmedr.2015.04.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Using the Transtheoretical Model of behavioral change, this study evaluates the relationship between sleep quality and the motivation and maintenance processes of healthy behavior change. METHODS The current study is an analysis of data collected in 2008 from an online health risk assessment (HRA) survey completed by participants of the Kansas State employee wellness program (N=13,322). Using multinomial logistic regression, associations between self-reported sleep quality and stages of change (i.e. precontemplation, contemplation, preparation, action, maintenance) in five health behaviors (stress management, weight management, physical activities, alcohol use, and smoking) were analyzed. RESULTS Adjusted for covariates, poor sleep quality was associated with an increased likelihood of contemplation, preparation, and in some cases action stage when engaging in the health behavior change process, but generally a lower likelihood of maintenance of the healthy behavior. CONCLUSIONS The present study demonstrated that poor sleep quality was associated with an elevated likelihood of contemplating or initiating behavior change, but a decreased likelihood of maintaining healthy behavior change. It is important to include sleep improvement as one of the lifestyle management interventions offered in EWP to comprehensively reduce health risks and promote the health of a large employee population.
Collapse
Affiliation(s)
- Siu-kuen Azor Hui
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Michael A. Grandner
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
17
|
Vandrey R, Babson KA, Herrmann ES, Bonn-Miller MO. Interactions between disordered sleep, post-traumatic stress disorder, and substance use disorders. Int Rev Psychiatry 2014; 26:237-47. [PMID: 24892898 PMCID: PMC4052373 DOI: 10.3109/09540261.2014.901300] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Disordered sleep is associated with a number of adverse health consequences and is an integral component of many psychiatric disorders. Rates of substance use disorders (SUDs) are markedly higher among individuals with post-traumatic stress disorder (PTSD), and this relationship may be partly mediated by disturbed sleep. Sleep disturbances (e.g. insomnia, daytime sleepiness, vivid nightmares) are hallmark features of PTSD and there is evidence that individuals with PTSD engage in substance use as a means of coping with these symptoms. However, prolonged substance use can lead to more severe sleep disturbances due to the development of tolerance and withdrawal. Behavioural or pharmacological treatment of disordered sleep is associated with improved daytime symptoms and psychosocial functioning among individuals who have developed PTSD. Initial research also suggests that improving sleep could be similarly beneficial in reducing coping oriented substance use and preventing relapse among those seeking treatment for SUDs. Together, these findings suggest that ameliorating sleep disturbance among at-risk individuals would be a viable target for the prevention and treatment of PTSD and associated SUDs, but prospective research is needed to examine this hypothesis. Enhanced understanding of the interrelation between sleep, PTSD, and SUDs may yield novel prevention and intervention approaches for these costly, prevalent and frequently co-occurring disorders.
Collapse
Affiliation(s)
- Ryan Vandrey
- Johns Hopkins University School of Medicine, University of Pennsylvania
| | - Kimberly A. Babson
- Center for Innovation to Implementation, VA Palo Alto Health Care System, University of Pennsylvania
- Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, University of Pennsylvania
| | - Evan S. Herrmann
- Johns Hopkins University School of Medicine, University of Pennsylvania
| | - Marcel O. Bonn-Miller
- Center for Innovation to Implementation, VA Palo Alto Health Care System, University of Pennsylvania
- Center of Excellence in Substance Abuse Treatment and Education, Philadelphia VAMC; Department of Psychiatry, University of Pennsylvania
| |
Collapse
|
18
|
Abstract
There is increasing awareness of the role of sleep disturbance as an important factor in health and disease. Although sub-clinical sleep disturbances (insufficient sleep duration or inadequate sleep quality) may be difficult to assess with conceptual and/or methodological clarity, this review attempts to summarize and synthesize these findings. First, the concept of sleep disturbance in a public health context is introduced, to provide context and rationale. Second, operational definitions of 'cardiometabolic disease' and 'sleep disturbance' are offered, to address many unclear operationalizations. Third, the extant literature is summarized regarding short or long sleep duration and/or insufficient sleep, insomnia and insomnia symptoms, general (non-specific sleep disturbances), circadian rhythm abnormalities that result in sleep disturbances, and, briefly, sleep-disordered breathing. Fourth, the review highlights the social/behavioural context of sleep, including discussions of sleep and race/ethnicity, socio-economic position, and other social/environmental factors, in order to place these findings in a social-environmental context relevant to public health. Fifth, the review highlights the issue of sleep as a domain of health behaviour and addresses issues regarding development of healthy sleep interventions. Finally, a research agenda of future directions is proposed.
Collapse
Affiliation(s)
- Michael A Grandner
- Behavioral Sleep Medicine Program, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania , USA
| |
Collapse
|
19
|
Chakravorty S, Grandner MA, Mavandadi S, Perlis ML, Sturgis EB, Oslin DW. Suicidal ideation in veterans misusing alcohol: relationships with insomnia symptoms and sleep duration. Addict Behav 2014; 39:399-405. [PMID: 24169371 PMCID: PMC4406056 DOI: 10.1016/j.addbeh.2013.09.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Revised: 09/20/2013] [Accepted: 09/24/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The aim of this investigation was to assess the relationships between suicidal ideation and insomnia symptoms in Veterans misusing alcohol. METHOD Data were extracted in this retrospective chart review of Veterans referred from primary care for a behavioral health evaluation (N=161) based on evidence of heavy drinking, drug use or another behavioral problem. Suicidal ideation (SI) was assessed using the Paykel questionnaire. Insomnia symptoms were assessed with standard diary questions in an interview format and pertained to sleep latency (SL), wake after sleep onset time (WASO), sleep quality (SQ), and habitual sleep duration (HSD). The relations between suicidal ideation and insomnia symptoms were assessed using ordinal regression analyses adjusted for socio-demographic, psychiatric and addiction-related variables. RESULTS Suicidal ideation was reported in 62 (39%) of the Veterans interviewed. In a multivariable model, only inadequate SQ was associated with suicidal ideation. Short sleepers were more likely to endorse suicidal ideation and have attempted suicide in the past year. In addition, older age, inadequate financial status, and the presence of a psychiatric disorder were also significantly associated with suicidal ideation in most of the adjusted models. CONCLUSION Given their association with suicidal ideation, insomnia symptoms in Veterans misusing alcohol should prompt an assessment of underlying psychiatric and social factors.
Collapse
Affiliation(s)
- Subhajit Chakravorty
- MIRECC VISN-4, Philadelphia Veterans Affairs Medical Center, United States; Perelman School of Medicine, University Of Pennsylvania, United States.
| | | | | | | | | | | |
Collapse
|