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Ma K, Chen C, Shen L, Tang P, Guan R. The relationship between nocturia and suicidal ideation: A study on The National Health and Nutrition Survey data. Neurourol Urodyn 2024. [PMID: 38973527 DOI: 10.1002/nau.25537] [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: 04/09/2024] [Revised: 06/12/2024] [Accepted: 06/21/2024] [Indexed: 07/09/2024]
Abstract
OBJECTIVES The focus of this research was to explore any potential link between nocturia and the risk of suicidal ideation. METHODS Drawing from the National Health and Nutrition Survey, data relating to 25 241 participants was scrutinized. This included 13 421 individuals identifying as male and 11 820 individuals identifying as female. Participants provided information on nocturia and suicidal ideation via self-completed questionnaires. To determine if nocturia was independently related to suicidal ideation, a multivariable logistic regression analysis was employed. Analyses were also undertaken separately for adult males and females. RESULTS It was found that around 3.5% of participants had experienced suicidal ideation. The results indicated that nocturia increased the risk for suicidal ideation in all adult groups (odds ratio [OR] = 1.67, 95% confidence interval[CI]: 1.37-2.03, p < 0.0001), including both males (OR = 1.91, 95% CI: 1.38-2.65, p < 0.001) and females (OR = 1.48, 95% CI: 1.158-1.90, p = 0.002). The risk for suicidal ideation increased with the severity of nocturia, with significant trends observed in adult males (p for trend = 0.04) and adult females (p for trend = 0.01). Additionally, subgroup examination showed a significant interaction between nocturia and educational level in adult males (p for interaction = 0.03). Among adult females, a noteworthy interaction was observed between nocturia and body mass index (p for interaction = 0.02). CONCLUSION The research uncovered a connection between nocturia and an elevated risk of suicidal ideation.
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Affiliation(s)
- Ke Ma
- Department of Urology, First People's Hospital of Linping District, Hangzhou, China
| | - Chen Chen
- Department of Urology, First People's Hospital of Linping District, Hangzhou, China
| | - Liyang Shen
- Department of Urology, First People's Hospital of Linping District, Hangzhou, China
| | - Peng Tang
- Department of Urology, First People's Hospital of Linping District, Hangzhou, China
| | - Rijian Guan
- Department of Urology, The Quzhou Affiliated Hospital of Wenzhou Medical University (Quzhou People's Hospital), Quzhou, China
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Kang MS, Kim DY, Kim SH, Kim JS, Yang JW, Han BG, Kang DR, Lee J, Lee JY. Comparison of depression and suicide between dialysis and kidney transplant recipients in Korea: a nationwide population study. CLINICAL TRANSPLANTATION AND RESEARCH 2024; 38:98-105. [PMID: 38895774 PMCID: PMC11228378 DOI: 10.4285/ctr.24.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 04/11/2024] [Accepted: 04/29/2024] [Indexed: 06/21/2024]
Abstract
Background Kidney transplantation (KT) improves physical and psychological prognoses for patients with end-stage kidney disease (ESKD). However, few comparative studies have examined depression and suicide rates among patients with ESKD treated with dialysis versus KT. Methods Data on 21,809 patients with ESKD were extracted from the Korean National Health Insurance Service database, extending from January 2002 to December 2018. These patients exhibited no history of depression or insomnia before starting renal replacement therapy. Outcomes were compared between dialysis and KT recipients using 1:2 propensity score matching (PSM). Results Of the patients, 17,649 received dialysis (hemodialysis, 15,537; peritoneal dialysis, 2,112), while 4,160 underwent KT. Of those on dialysis, 45.04% (7,949) experienced insomnia, compared to 25.72% (1,070) of KT recipients (P<0.001). Depression was more frequent among dialysis recipients (22.77%, 4,019) than KT recipients (8.61%, 358; P<0.001). Additionally, those on dialysis had a higher incidence of suicide (0.19%, 33) than recipients of KT (0.12%, 5; P=0.047). After PSM, the hazard ratio (HR) for depression in patients on dialysis compared to KT recipients was 1.76 (95% confidence interval [CI], 1.56-1.99). In subgroup analysis, the relative likelihood of depression among dialysis recipients was particularly high for residents of urban areas (HR, 2.10; 95% CI, 1.80-2.44) and patients under 65 years old (HR, 1.82; 95% CI, 1.62-2.09). Conclusions KT recipients exhibit a lower suicide rate than patients on dialysis. Furthermore, KT is associated with a lower prevalence of depression among Korean patients with ESKD, particularly urban residents and individuals under 65 years old.
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Affiliation(s)
- Min Seok Kang
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Dong Young Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sung Hwa Kim
- Department of Biostatistics, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jae Seok Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jae Won Yang
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Byoung Geun Han
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Dae Ryong Kang
- Department of Precision Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jinhee Lee
- Department of Psychiatry, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jun Young Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
- Transplantation Center, Wonju Severance Christian Hospital, Wonju, Korea
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Wang J, Chen K, Huang X, Jin Z, He J, Han B, Feng L, Meng N, Yang C, Yao P, Li Z. Parent-child attachment mediates the association between parental conflict perceptions and suicide intention: a cross-sectional survey among middle school students in China. Front Public Health 2024; 12:1332095. [PMID: 38633232 PMCID: PMC11021730 DOI: 10.3389/fpubh.2024.1332095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/18/2024] [Indexed: 04/19/2024] Open
Abstract
Introduction Adolescent suicide is a prevalent issue globally, with various factors contributing to this phenomenon. This study aimed to investigate these factors and their interrelationships to better understand the causes of adolescent suicide and provide evidence for its prevention. Methods This study conducted among middle school students in Liaoning Province, China, from April to May 2016, A cross-sectional survey was administered to 1,028 students aged 10-19, using instruments such as the Behavior Questionnaire-Revised (SBQ-R), Children's Perception of Interparental Conflict Scale (CPIC), and revised version of Inventory of Parent Attachment (IPPA-R). Result Binary logistic regression analysis revealed that adolescents aged 15-19, adolescents with strong perceptions of parental conflict were at high risk of suicide intention. Adolescents living in rural areas, adolescents with high mother-child attachment, adolescents with high father-child attachment were at low risk of suicide intention. Furthermore, parent-child attachment played a mediating role between two dimensions of parental conflict perception (resolved situations and response effect) and suicide intention. Discussion The study concludes that adolescents living in urban areas, older adolescents, adolescents with a high level of parental conflict intensity, and those with low levels of parent-child attachment are at high risk of suicide intention. parent-child attachment played a mediating role between two dimensions of parental conflict perception (resolved situations and response effect) and suicide intention. Interventions aimed at reducing family conflicts and improving parent-child relationships are recommended to decrease the incidence of adolescent suicide.
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Affiliation(s)
- Jiana Wang
- School of Public Health, Health Science Center, Ningbo University, Ningbo, Zhejiang, China
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, Liaoning, China
| | - Kun Chen
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, Liaoning, China
| | - Xinyuan Huang
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, Liaoning, China
| | - Zhiyu Jin
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, Liaoning, China
| | - Jing He
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, Liaoning, China
| | - Bingsong Han
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, Liaoning, China
| | - Lin Feng
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, Liaoning, China
| | - Nana Meng
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, Liaoning, China
| | - Cong Yang
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, Liaoning, China
| | - Pin Yao
- Department of Health Management, Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Zhe Li
- Department of Anesthesiology, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
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Palagini L, Manni R, Liguori C, De Gennaro L, Gemignani A, Fanfulla F, Ferri R, Nobili L, Ferini-Strambi L. Evaluation and management of insomnia in the clinical practice in Italy: a 2023 update from the Insomnia Expert Consensus Group. J Neurol 2024; 271:1668-1679. [PMID: 38063870 DOI: 10.1007/s00415-023-12112-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 11/06/2023] [Accepted: 11/08/2023] [Indexed: 03/28/2024]
Abstract
BACKGROUND Insomnia is the most reported sleep disorder in industrialized countries, affecting, in the chronic form, around 10% of the European population. In Italy, such a percentage seems to be even higher. Although insomnia can be an independent disorder, it is frequently described as comorbid condition and may precipitate, exacerbate, or prolong a broad range of physical and mental disorders. Evaluating and targeting insomnia in the Italian clinical practice should be a priority. METHODS The present expert opinions and recommendations represent an update from 2020 and insights from Insomnia Expert Consensus Group, based on systematic reviews according to PRISMA on available options in Italy from January 2020 to March 2023. RESULTS We evaluated 28 papers among international guidelines, expert opinions, systematic reviews, and meta-analysis produced during the last 26 months. CONCLUSIONS Our findings suggest that symptoms of insomnia must be assessed in the Italian clinical practice by evaluating nocturnal and daytime symptoms, comorbid conditions, and lifestyle. Cognitive behavioral therapy for insomnia should be the first option according to availability. The choice of the drug should be based on different factors including type of insomnia, age, comorbidities, and potential side effects. If the choice would be a Z-drug or a short-acting benzodiazepine (in subjects < 65 years old), the use should be in the short term (≤ 4 weeks). Indeed, eszopiclone, as a new option in Italy, may present a different profile and may be used for up to 6 months, also in the elderly. If the choice is melatonin, it should be used melatonin 2 mg prolonged release in adults ≥ 55 years for up to 13 weeks. A new dual orexin antagonist, daridorexant, is available in Italy; it has been shown to be effective in adults and elderly and it can be used for at least 3 months and up to 1 year.
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Affiliation(s)
- Laura Palagini
- Unit of Psychiatry, Department of Neuroscience, Azienda Ospedaliero Universitaria Pisana AUOP, Pisa, Italy.
| | - Raffaele Manni
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Claudio Liguori
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Neurology Unit, Sleep Medicine Centre, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Luigi De Gennaro
- Department of Psychology, Sapienza University of Rome, 00185, Rome, Italy
- Body and Action Lab, IRCSS Fondazione Santa Lucia, 00179, Rome, Italy
| | - Angelo Gemignani
- Psychology Unit, Department of Neuroscience, University of Pisa, Pisa, Italy
| | - Francesco Fanfulla
- Respiratory Function and Sleep Medicine Unit, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Raffaele Ferri
- Clinical Neurophysiology Research Unit, Oasi Research Institute-IRCCS, Troina, Italy
| | - Lino Nobili
- Department of Neuroscience (DINOGMI), University of Genoa, Genoa, Italy
- Child Neuropsychiatry Unit, IRCCS Istituto G. Gaslini, Genoa, Italy
| | - Luigi Ferini-Strambi
- Department of Clinical Neurosciences, Neurology Sleep Disorders Centre, RCCS San Raffaele Scientific Institute, Milan, Italy
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Varallo G, Scarpina F, Arnison T, Giusti EM, Tenti M, Rapelli G, Cattivelli R, Landi G, Tossani E, Grandi S, Franceschini C, Baldini V, Plazzi G, Capodaglio P, Castelnuovo G. Suicidal ideation in female individuals with fibromyalgia and comorbid obesity: prevalence and association with clinical, pain-related, and psychological factors. PAIN MEDICINE (MALDEN, MASS.) 2024; 25:239-247. [PMID: 37843440 PMCID: PMC10906707 DOI: 10.1093/pm/pnad139] [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: 07/27/2023] [Revised: 09/24/2023] [Accepted: 10/08/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE Individuals with fibromyalgia report alarming levels of suicidal ideation, and comorbidity with other chronic health conditions such as obesity-a risk factor for suicidal ideation per se-could further complicate the clinical picture. The aim of this study is to determine, in a sample of women with fibromyalgia and comorbid obesity, the prevalence of suicidal ideation and to evaluate clinical, pain-related and psychological factors associated with suicidal ideation. METHODS In total, 156 female individuals with fibromyalgia and obesity were recruited and completed a series of self-report measures that assessed (i) the level of pain intensity, (ii) depressive symptomatology, (iii) sleep quality, and (iv) pain catastrophizing. Suicidal ideation was evaluated by item #9 of the Beck Depression Inventory. In addition, information regarding previous suicide attempts and current opioid use was collected. RESULTS 3n sum, 7.8% of participants reported presence of suicidal ideation. According to the results of the multiple logistic regression, depressive symptomatology, sleep quality, and pain catastrophizing were associated with the presence of suicidal ideation. DISCUSSION The presence of suicidal ideation in our sample was significantly associated with depressive symptomatology, sleep quality, and pain catastrophizing. Our findings are the first to suggest a unique (ie, independent of depressive symptomatology, and sleep quality) association between pain catastrophizing and suicidal ideation in the context of fibromyalgia and comorbid obesity. In order to prevent and reduce suicidal ideation, these factors should be assessed and targeted in interventions for pain management. Future research should investigate the extent to which addressing depressive symptoms, sleep quality, and pain catastrophizing reduces suicidal ideation.
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Affiliation(s)
- Giorgia Varallo
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena 41125, Italy
| | - Federica Scarpina
- Istituto Auxologico Italiano, IRCCS, U.O. di Neurologia e Neuroriabilitazione, Ospedale San Giuseppe, Piancavallo 28884, Italy
- “Rita Levi Montalcini” Department of Neurosciences, University of Turin, Turin 10126, Italy
| | - Tor Arnison
- Clinical Epidemiology and Biostatistics, Faculty of Medicine and Health, School of medical Sciences, Örebro University, Örebro 70182, Sweden
| | - Emanuele Maria Giusti
- EPIMED Research Center, Department of Medicine and Surgery, University of Insubria, Varese 21100, Italy
| | - Micheal Tenti
- Institute for Research on Pain, ISAL Foundation, Rimini 47921, Italy
| | - Giada Rapelli
- Department of Medicine and surgery, University of Parma, Parma 43125, Italy
| | - Roberto Cattivelli
- Department of Psychology “Renzo Canestrari”, Alma Mater Studiorum, University of Bologna, Bologna 40126, Italy
| | - Giulia Landi
- Department of Psychology “Renzo Canestrari”, Alma Mater Studiorum, University of Bologna, Bologna 40126, Italy
| | - Eliana Tossani
- Department of Psychology “Renzo Canestrari”, Alma Mater Studiorum, University of Bologna, Bologna 40126, Italy
| | - Silvana Grandi
- Department of Psychology “Renzo Canestrari”, Alma Mater Studiorum, University of Bologna, Bologna 40126, Italy
| | | | - Valentina Baldini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena 41125, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna 40126, Italy
| | - Giuseppe Plazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena 41125, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna 40139, Italy
| | - Paolo Capodaglio
- Laboratory of Biomechanics, Rehabilitation and Ergonomics, IRCCS, Istituto Auxologico Italiano, Verbania 28884, Italy
- Department of Surgical Sciences, Physical Medicine and Rehabilitation, University of Torino, Turin 10124, Italy
| | - Gianluca Castelnuovo
- Department of Psychology, Catholic University of the Sacred Heart of Milan, Milan 20123, Italy
- IRCCS Istituto Auxologico Italiano, Psychology Research Laboratory, Ospedale San Giuseppe, Verbania 28884, Italy
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Tsai YT, Chuang TJ, Mudiyanselage SPK, Ku HC, Wu YL, Li CY, Ko NY. The impact of sleep disturbances on suicide risk among people living HIV: An eleven-year national cohort. J Affect Disord 2024; 346:122-132. [PMID: 37890538 DOI: 10.1016/j.jad.2023.10.045] [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: 05/05/2023] [Revised: 09/22/2023] [Accepted: 10/08/2023] [Indexed: 10/29/2023]
Abstract
OBJECTIVES The suicide rate among individuals who experience sleep disturbances is five times higher than in the general population. Up to 70 % of people living with HIV (PLHIV) experience sleep disturbances. This study's purpose was to determine whether this population has higher rates of suicide compared to those without sleep disorders. Possible risk factors were also explored. METHODS A secondary analysis of nationwide data on all males and females over 15 years old with HIV living in Taiwan was conducted from January 1, 2005, to December 31, 2016. Sleep disturbances were identified through recorded diagnoses and medical treatments. Cox proportional hazard models and hazard ratios (HRs) and mediation analysis were employed to estimate the association between sleep disturbances and suicide risk during the follow-up period. RESULTS Of the 5680 PLHIV, 72 suicide events were reported. The suicide incidence rate among PLHIV suffering from sleep disturbances was 769 per 100,000 person-years. Sleep disturbances were associated with a significantly increased risk of suicide (AHR = 1.75, 95 % CI 1.02-3.02, p = 0.0429). A premium-based monthly salary of <24,000 (NT $) was also associated with an increased hazard of suicide (AHR = 4.14, 95 % CI 1.60-10.75, p = 0.0035). The pathway effect analysis using potential outcomes showed that depression did not mediate the effect of sleep disturbance on suicide. CONCLUSIONS Sleep disturbances were associated with higher suicide rates, even after adjusting for pre-existing depression. These findings suggest that paying attention to suicidal ideation among PLHIV suffering from sleep disturbances is necessary.
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Affiliation(s)
- Yi-Tseng Tsai
- Department of Nursing, An Nan Hospital, China Medical University, Tainan, Taiwan
| | - Tzu-Jung Chuang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | | | - Han-Chang Ku
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Yi-Lin Wu
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Nai-Ying Ko
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Xu YE, Barron DA, Sudol K, Zisook S, Oquendo MA. Suicidal behavior across a broad range of psychiatric disorders. Mol Psychiatry 2023; 28:2764-2810. [PMID: 36653675 PMCID: PMC10354222 DOI: 10.1038/s41380-022-01935-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 12/12/2022] [Accepted: 12/16/2022] [Indexed: 01/20/2023]
Abstract
Suicide is a leading cause of death worldwide. In 2020, some 12.2 million Americans seriously contemplated suicide, 3.2 million planned suicide attempts, and 1.2 million attempted suicide. Traditionally, the approach to treating suicidal behavior (SB) has been to treat the "underlying" psychiatric disorder. However, the number of diagnoses associated with SB is considerable. We could find no studies describing the range of disorders reported to be comorbid with SB. This narrative review summarizes literature documenting the occurrence of SB across the lifespan and the full range of psychiatric diagnoses, not only BPD and those that comprise MDE, It also describes the relevance of these observations to clinical practice, research, and nosology. The literature searches contained the terms "suicid*" and each individual psychiatric diagnosis and identified 587 studies. We did not include case reports, case series, studies only addressing suicidal ideation or non-suicidal self-injury (NSSI), studies on self-harm, not distinguishing between SB and NSSI and studies that did not include any individuals that met criteria for a specific DSM-5 diagnosis (n = 366). We found that SB (suicide and/or suicide attempt) was reported to be associated with 72 out of 145 diagnoses, although data quality varied. Thus, SB is not exclusively germane to Major Depressive Episode (MDE) and Borderline Personality Disorder (BPD), the only conditions for which it is a diagnostic criterion. That SB co-occurs with so many diagnoses reinforces the need to assess current and past SB regardless of diagnosis, and supports the addition of charting codes to the DSM-5 to indicate current or past SB. It also comports with new data that specific genes are associated with SB independent of psychiatric diagnoses, and suggests that SB should be managed with specific suicide prevention interventions in addition to treatments indicated for co-occurring diagnoses. SB diagnostic codes would help researchers and clinicians document and measure SB's trajectory and response to treatment over time, and, ultimately, help develop secondary and tertiary prevention strategies. As a separate diagnosis, SB would preclude situations in which a potentially life-threatening behavior is not accounted for by a diagnosis, a problem that is particularly salient when no mental disorder is present, as is sometimes the case.
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Affiliation(s)
- Yingcheng E Xu
- Department of Psychiatry and Behavioral Health, Cooper Medical School of Rowan University and Cooper University Health Care, Camden, NJ, 08103, US
| | - Daniel A Barron
- Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, Philadelphia, PA, 19104, USA
| | - Katherin Sudol
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, 37212, USA
| | - Sidney Zisook
- Department of Psychiatry, University of California San Diego School of Medicine, San Diego, CA, 92103, USA
| | - Maria A Oquendo
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
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Zhao FY, Xu P, Kennedy GA, Conduit R, Zhang WJ, Wang YM, Fu QQ, Zheng Z. Identifying complementary and alternative medicine recommendations for insomnia treatment and care: a systematic review and critical assessment of comprehensive clinical practice guidelines. Front Public Health 2023; 11:1157419. [PMID: 37397764 PMCID: PMC10308125 DOI: 10.3389/fpubh.2023.1157419] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/17/2023] [Indexed: 07/04/2023] Open
Abstract
Background There is a need for evidence-informed guidance on the use of complementary and alternative medicine (CAM) for insomnia because of its widespread utilization and a lack of guidance on the balance of benefits and harms. This systematic review aimed to identify and summarize the CAM recommendations associated with insomnia treatment and care from existing comprehensive clinical practice guidelines (CPGs). The quality of the eligible guidelines was appraised to assess the credibility of these recommendations. Methods Formally published CPGs incorporating CAM recommendations for insomnia management were searched for in seven databases from their inception to January 2023. The NCCIH website and six websites of international guideline developing institutions were also retrieved. The methodological and reporting quality of each included guideline was appraised using the AGREE II instrument and RIGHT statement, respectively. Results Seventeen eligible GCPs were included, and 14 were judged to be of moderate to high methodological and reporting quality. The reporting rate of eligible CPGs ranged from 42.9 to 97.1%. Twenty-two CAM modalities were implicated, involving nutritional or natural products, physical CAM, psychological CAM, homeopathy, aromatherapy, and mindful movements. Recommendations for these modalities were mostly unclear, unambiguous, uncertain, or conflicting. Logically explained graded recommendations supporting the CAM use in the treatment and/or care of insomnia were scarce, with bibliotherapy, Tai Chi, Yoga, and auriculotherapy positively recommended based on little and weak evidence. The only consensus was that four phytotherapeutics including valerian, chamomile, kava, and aromatherapy were not recommended for insomnia management because of risk profile and/or limited benefits. Conclusions Existing guidelines are generally limited in providing clear, evidence-informed recommendations for the use of CAM therapies for insomnia management due to a lack of high-quality evidence and multidisciplinary consultation in CPG development. More well-designed studies to provide reliable clinical evidence are therefore urgently needed. Allowing the engagement of a range of interdisciplinary stakeholders in future updates of CPGs is also warranted. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=369155, identifier: CRD42022369155.
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Affiliation(s)
- Fei-Yi Zhao
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
- Department of Nursing, School of International Medical Technology, Shanghai Sanda University, Shanghai, China
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Peijie Xu
- School of Computing Technologies, RMIT University, Melbourne, VIC, Australia
| | - Gerard A. Kennedy
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
- Institute of Health and Wellbeing, Federation University, Mount Helen, VIC, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia
| | - Russell Conduit
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
| | - Wen-Jing Zhang
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yan-Mei Wang
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qiang-Qiang Fu
- Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zhen Zheng
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
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Farah N, Obeid S, Malaeb D, Haddad C, Fekih-Romdhane F, Hallit S. Mediation effect of insomnia symptoms between positive psychotic like experiences and suicidal ideation among Lebanese young adults. BMC Psychiatry 2023; 23:272. [PMID: 37081441 PMCID: PMC10116113 DOI: 10.1186/s12888-023-04778-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 04/12/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Psychotic symptoms reported by healthy individuals in the general population are referred to as psychotic-like experiences (PLEs) and have been proven to increase the risk of suicidal ideation (SI) in these individuals. As it is well established that PLEs and insomnia share a bidirectional association and also that insomnia is linked to SI, we hypothesized that insomnia may represent a mediator underlying the relationship between PLEs and SI. Our aim was to validate this hypothesis among Lebanese young adults. METHODS A total of 3103 young adults (mean age 21.73 ± 3.80 years; 63.6% females) recruited from all Lebanese governorates completed a self-administered online questionnaire. PLEs were assessed using the CAPE-42 scale, SI using the Columbia Suicide Rating Scale, and insomnia using the Insomnia Severity Index). We conducted a mediation analysis using SPSS PROCESS v3.4 model 4 with three pathways. Variables that showed a p < 0.25 in the bivariate analysis were entered in the path analysis. RESULTS A total of 1378 participants (44.4%) had insomnia; 18.8% had SI; 42.5% reported at least one positive PE 'nearly always', and 30.5% reported at least one negative PE with this frequency. The results of the mediation analysis showed that insomnia severity partially mediated the association between positive dimension and SI; higher positive dimension was significantly associated with more insomnia severity, which was, in turn, significantly associated with more SI. Finally, more positive dimension was significantly and directly associated with more SI. CONCLUSION These preliminary findings might encourage the implementation of new preventive measures to reduce SI among PLEs patients. Treating symptoms of insomnia might help reduce the risk of suicide.
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Affiliation(s)
- Nour Farah
- Faculty of Science, Lebanese University, Fanar, Lebanon
| | - Sahar Obeid
- School of Arts and Sciences, Social and Education Sciences Department, Lebanese American University, Jbeil, Lebanon
| | - Diana Malaeb
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
| | - Chadia Haddad
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
- School of Health Sciences, Modern University for Business and Science, Beirut, Lebanon
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique Et de Toxicologie-Liban), Beirut, Lebanon
| | - Feten Fekih-Romdhane
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry "Ibn Omrane", Razi Hospital, 2010, Manouba, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Souheil Hallit
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
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10
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Chu CS, Huang KL, Bai YM, Su TP, Tsai SJ, Chen TJ, Hsu JW, Liang CS, Chen MH. Risk of suicide after a diagnosis of sleep apnea: A nationwide longitudinal study. J Psychiatr Res 2023; 161:419-425. [PMID: 37028128 DOI: 10.1016/j.jpsychires.2023.03.028] [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: 08/03/2022] [Revised: 02/15/2023] [Accepted: 03/19/2023] [Indexed: 04/09/2023]
Abstract
Previous studies have presented evidence on the association between sleep apnea and suicidal ideation and planning, but the relationship between a clinical diagnosis of sleep apnea and suicide attempts remains unknown. We investigated the risk of suicide after a diagnosis with sleep apnea using data from a nationwide community-based population database, i.e., the Taiwan National Health Insurance Research Database. We recruited 7,095 adults with sleep apnea and 28,380 age-, sex-, and comorbidity-matched controls between 1998 and 2010 and followed them up until the end of 2011. Individuals who exhibited any (once or repeated) suicide attempts were identified during the follow-up period. The E value was calculated for unmeasured bias. Sensitivity analysis was conducted. Patients with sleep apnea were more likely to carry out any suicide attempt (hazard ratio: 4.53; 95% confidence interval: 3.48-5.88) during the follow-up period than the controls after adjusting for demographic data, mental disorders, and physical comorbidities. The hazard ratio remained significant after excluding individuals with mental disorders (4.23; 3.03-5.92). The hazard ratio was 4.82 (3.55-6.56) for male patients and 3.86 (2.33-6.38) for female patients. Consistent findings of increased risk of repeated suicide attempt were found among patients with sleep apnea. No association was found between continuous positive airway pressure treatment and suicide risk. The calculated E values support suicide risk after the diagnosis of sleep apnea. The risk of suicide was 4.53-fold higher in patients diagnosed with sleep apnea than in their counterparts without sleep apnea.
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Affiliation(s)
- Che-Sheng Chu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan; Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan; Non-invasive Neuromodulation Consortium for Mental Disorders, Society of Psychophysiology, Taipei, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kai-Lin Huang
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ya-Mei Bai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tung-Ping Su
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Psychiatry, Cheng Hsin General Hospital, Taiwan
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ju-Wei Hsu
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chih-Sung Liang
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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11
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McHugh CM, Ho N, Iorfino F, Crouse JJ, Nichles A, Zmicerevska N, Scott E, Glozier N, Hickie IB. Predictive modelling of deliberate self-harm and suicide attempts in young people accessing primary care: a machine learning analysis of a longitudinal study. Soc Psychiatry Psychiatr Epidemiol 2023:10.1007/s00127-022-02415-7. [PMID: 36854811 DOI: 10.1007/s00127-022-02415-7] [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: 02/20/2022] [Accepted: 12/21/2022] [Indexed: 03/02/2023]
Abstract
PURPOSE Machine learning (ML) has shown promise in modelling future self-harm but is yet to be applied to key questions facing clinical services. In a cohort of young people accessing primary mental health care, this study aimed to establish (1) the performance of models predicting deliberate self-harm (DSH) compared to suicide attempt (SA), (2) the performance of models predicting new-onset or repeat behaviour, and (3) the relative importance of factors predicting these outcomes. METHODS 802 young people aged 12-25 years attending primary mental health services had detailed social and clinical assessments at baseline and 509 completed 12-month follow-up. Four ML algorithms, as well as logistic regression, were applied to build four distinct models. RESULTS The mean performance of models predicting SA (AUC: 0.82) performed better than the models predicting DSH (AUC: 0.72), with mean positive predictive values (PPV) approximately twice that of the prevalence (SA prevalence 14%, PPV: 0.32, DSH prevalence 22%, PPV: 0.40). All ML models outperformed standard logistic regression. The most frequently selected variable in both models was a history of DSH via cutting. CONCLUSION History of DSH and clinical symptoms of common mental disorders, rather than social and demographic factors, were the most important variables in modelling future behaviour. The performance of models predicting outcomes in key sub-cohorts, those with new-onset or repetition of DSH or SA during follow-up, was poor. These findings may indicate that the performance of models of future DSH or SA may depend on knowledge of the individual's recent history of either behaviour.
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Affiliation(s)
- Catherine M McHugh
- Brain and Mind Centre, University of Sydney, 94 Mallett Street, Camperdown, Sydney, NSW, 2042, Australia. .,Discipline of Psychiatry, University of New South Wales, Sydney, Australia.
| | - Nicholas Ho
- Brain and Mind Centre, University of Sydney, 94 Mallett Street, Camperdown, Sydney, NSW, 2042, Australia
| | - Frank Iorfino
- Brain and Mind Centre, University of Sydney, 94 Mallett Street, Camperdown, Sydney, NSW, 2042, Australia
| | - Jacob J Crouse
- Brain and Mind Centre, University of Sydney, 94 Mallett Street, Camperdown, Sydney, NSW, 2042, Australia
| | - Alissa Nichles
- Brain and Mind Centre, University of Sydney, 94 Mallett Street, Camperdown, Sydney, NSW, 2042, Australia
| | - Natalia Zmicerevska
- Brain and Mind Centre, University of Sydney, 94 Mallett Street, Camperdown, Sydney, NSW, 2042, Australia
| | - Elizabeth Scott
- Brain and Mind Centre, University of Sydney, 94 Mallett Street, Camperdown, Sydney, NSW, 2042, Australia.,St Vincent's Hospital, Sydney, Australia.,School of Medicine, University of Notre Dame Australia, Sydney, Australia
| | - Nick Glozier
- Brain and Mind Centre, University of Sydney, 94 Mallett Street, Camperdown, Sydney, NSW, 2042, Australia.,School of Psychiatry, University of Sydney, Sydney, Australia
| | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, 94 Mallett Street, Camperdown, Sydney, NSW, 2042, Australia
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12
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Richdale AL, Chetcuti L, Hayward SM, Abdullahi I, Morris EMJ, Lawson LP. The impact of sleep quality, fatigue and social well-being on depressive symptomatology in autistic older adolescents and young adults. Autism Res 2023; 16:817-830. [PMID: 36772969 DOI: 10.1002/aur.2899] [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: 10/21/2021] [Accepted: 01/26/2023] [Indexed: 02/12/2023]
Abstract
Depression and poor sleep quality commonly co-occur with autism, and depression has been associated with loneliness and reduced social support. In non-autistic samples, poor sleep quality and daytime fatigue also contribute to depression. However, the contribution of sleep quality and fatigue to depressive symptoms, and how they interact with social factors to influence depression in autism remain unexplored. Our aim was to examine these relationships in 114 young autistic adults aged 15-25 years (57% male) from the SASLA online, longitudinal study (baseline and 2-year follow-up). Hierarchical multiple regression models examined the association between social well-being (social integration and social contribution; T1), sleep quality (T1, T2), and fatigue (T1, T2) on depression (T1, T2). Two mediation models were conducted on T1 data predicting depression from sleep quality though fatigue and sleep quality through social well-being. Depression and fatigue scores did not change over 2 years, but sleep quality worsened. The T1 regression model was significant (R2 = 36%) with fatigue and social contribution individually predicting depression symptomatology. The longitudinal regression model was also significant (adjusted R2 = 57%) with social contribution (T1) as the only significant predictor of depression (T2). Fatigue trended towards mediating the sleep quality-depression relationship, while social well-being was a significant partial mediator of this relationship. Results highlight that sleep quality, fatigue, and social well-being contribute to depression among young autistic adults. Interestingly, fatigue and social well-being were independently associated with depression. Thus, addressing sleep quality and associated fatigue, and social well-being is important when treating depression in autistic individuals.
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Affiliation(s)
- Amanda L Richdale
- Olga Tennison Autism Research Centre, La Trobe University, Victoria, Australia.,Cooperative Research Centre for Living with Autism (Autism CRC), The University of Queensland, Queensland, Australia
| | - Lacey Chetcuti
- Olga Tennison Autism Research Centre, La Trobe University, Victoria, Australia.,Cooperative Research Centre for Living with Autism (Autism CRC), The University of Queensland, Queensland, Australia
| | - Susan M Hayward
- Olga Tennison Autism Research Centre, La Trobe University, Victoria, Australia.,Cooperative Research Centre for Living with Autism (Autism CRC), The University of Queensland, Queensland, Australia
| | - Ifrah Abdullahi
- Olga Tennison Autism Research Centre, La Trobe University, Victoria, Australia.,Cooperative Research Centre for Living with Autism (Autism CRC), The University of Queensland, Queensland, Australia
| | - Eric M J Morris
- Department of Psychology and Counselling, La Trobe University, Victoria, Australia
| | - Lauren P Lawson
- Olga Tennison Autism Research Centre, La Trobe University, Victoria, Australia.,Cooperative Research Centre for Living with Autism (Autism CRC), The University of Queensland, Queensland, Australia
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13
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Hu CJ, Chen YJ, Hong RM. Insomnia among female flight attendants: Related factors and its association with mental health. Work 2023; 76:1455-1463. [PMID: 37393471 DOI: 10.3233/wor-220431] [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] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND Sleep and mental health are very important in the aviation industry. Reports show that gender is one of the risk factors of insomnia, and most Asian flight attendants are female. Therefore, it is necessary to understand insomnia, and the correction to mental health among female flight attendants. OBJECTIVE To investigate the prevalence of insomnia in female flight attendants and its association with mental health. METHODS We used a cross-sectional design. We recruited 412 female flight attendants with more than 3 months of working experience. We collected the socio-demographic and work-related data, measured insomnia and mental health by the Athens Insomnia and Brief Symptom Rating Scales. Descriptive statistics, single-factor analysis of variance, Pearson's correlation analysis, and structural equation modeling were performed to analyze the relationships. RESULTS There are 45.4% of female flight attendants having insomnia, and 24.8% had suspicious insomnia. The most considerable and serious insomnia problem was falling asleep (15.3%, 4.9%). Factors related to insomnia include smoking, drinking, family load (e.g., housekeeping and caring for family), economic stress and late-night/early morning workdays during last month. Also, insomnia had a direct association with mental health (T = 17.11, p < 0.001). CONCLUSION We found that insomnia is negatively correlated with the above factors and mental health. We recommend that airline industries can run their sleep-education programs and provide relevant mental-health-promotion programs for flight attendants.
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Affiliation(s)
- Chia Jung Hu
- Department of Nursing, Da-Yeh University, Changhua, Taiwan
| | - Yen Ju Chen
- Department of Nursing, Da-Yeh University, Changhua, Taiwan
| | - Rei Mei Hong
- Chang Gung University of Science and Technology, Chiayi Campus, Chiayi, Taiwan
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14
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Yamamoto M, Lim CT, Huang H, Spottswood M, Huang H. Insomnia in primary care: Considerations for screening, assessment, and management. THE JOURNAL OF MEDICINE ACCESS 2023; 7:27550834231156727. [PMID: 36938324 PMCID: PMC10021100 DOI: 10.1177/27550834231156727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 01/25/2023] [Indexed: 03/17/2023]
Abstract
Insomnia, including insomnia disorder, is a common but often overlooked complaint in primary care settings. It is a risk factor for various medical and psychiatric diagnoses and is associated with substantial health care costs. While cognitive behavioral therapy for insomnia (CBT-I) is the first-line treatment for insomnia disorder, access to CBT-I is limited. This article provides a pragmatic approach to screening, assessment, and treatment of insomnia in the primary care setting, promoting a population health approach. The authors review the role of CBT-I, treatment of comorbid conditions, and pharmacologic recommendations in working with primary care patients with insomnia. In addition, the authors highlight the potential utility of technology in improving access to insomnia care.
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Affiliation(s)
- Mari Yamamoto
- Department of Family Medicine,
University of Washington School of Medicine, Seattle, WA, USA
- Mari Yamamoto, Department of Family
Medicine, University of Washington School of Medicine, Seattle, WA 98125, USA.
| | - Christopher T Lim
- Department of Psychiatry, Boston
Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Heather Huang
- Departments of Internal Medicine and
Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison,
WI, USA
| | - Margaret Spottswood
- Department of Psychiatry, University of
Vermont College of Medicine, Burlington, VT, USA
- Community Health Centers of Burlington,
Burlington, VT, USA
| | - Hsiang Huang
- Department of Psychiatry, Cambridge
Health Alliance, Cambridge, MA, USA
- Harvard Medical School, Boston, MA,
USA
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15
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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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16
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Valladares-Garrido MJ, Picón-Reátegui CK, Zila-Velasque JP, Grados-Espinoza P, Hinostroza-Zarate CM, Failoc-Rojas VE, Pereira-Victorio CJ. Suicide Risk in Military Personnel during the COVID-19 Health Emergency in a Peruvian Region: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13502. [PMID: 36294081 PMCID: PMC9603104 DOI: 10.3390/ijerph192013502] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/11/2022] [Accepted: 10/14/2022] [Indexed: 06/16/2023]
Abstract
Military personnel represent a frontline group exposed to multiple stressors. These factors have increased during the COVID-19 pandemic, predisposing to the development of suicidal risk (SR). Given the few studies conducted in this population, we evaluated the prevalence of SR and its associated factors during the health emergency. A cross-sectional survey study was conducted in person among 514 participants in Lambayeque, Peru in 2021. The outcome was SR, and the exposures were depression (PHQ-9), anxiety (GAD-7), PTSD (PCL-C), and other sociodemographic variables. The prevalence of SR was 14.0% (95% CI: 11.12-17.31%) and was significantly higher in people with a family history of mental health (PR: 2.16; 95% CI: 1.13-4.15) and in those with moderate clinical insomnia (PR: 2.21; 95% CI: 1.19-4.12). Military personnel with high resilience had a lower prevalence of SR (PR: 0.54, CI: 0.31-0.95). Anxiety was associated with a higher prevalence of SR (PR: 3.27; 95% CI: 1.76-6.10). Our findings show that at least 1 out of 10 military personnel are at risk of suicide. Special attention should be paid to the associated factors to develop interventions and reverse their consequences. These results may be useful in policy implementation and general statistics of SR in the local and regional context.
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Affiliation(s)
- Mario J. Valladares-Garrido
- South American Center for Education and Research in Public Health, Universidad Norbert Wiener, Lima 02002, Peru
- Epidemiology Office, Hospital Regional Lambayeque, Chiclayo 14000, Peru
| | | | - J. Pierre Zila-Velasque
- Facultad de Medicina Humana, Universidad Nacional Daniel Alcides Carrion, Pasco 19001, Peru
- Red Latinoamericana de Medicina en la Altitud e Investigación (REDLAMAI), Pasco 19001, Peru
| | - Pamela Grados-Espinoza
- Facultad de Medicina Humana, Universidad Nacional Daniel Alcides Carrion, Pasco 19001, Peru
- Red Latinoamericana de Medicina en la Altitud e Investigación (REDLAMAI), Pasco 19001, Peru
| | | | - Virgilio E. Failoc-Rojas
- Research Unit for Generation and Synthesis Evidence in Health, Universidad San Ignacio de Loyola, Lima 02002, Peru
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17
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Cáceda R, Kim DJ, Carbajal JM, Hou W. The Experience of Pain is Strongly Associated With Poor Sleep Quality and Increased Risk for Suicide. Arch Suicide Res 2022; 26:1572-1586. [PMID: 34126041 DOI: 10.1080/13811118.2021.1939208] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Effective suicide prevention is hindered by a limited understanding of the neurobiology leading to suicide. We aimed to examine the association between changes in the experience of pain and disturbances in sleep quantity and quality in patients with elevated risk for suicide. METHODS Three groups of adult depressed individuals, including patients following a recent suicide attempt (n = 79), patients experiencing current suicidal ideation (n = 131), and patients experiencing depression but no suicidal ideation or behavior in at least 6 months (n = 51), were examined in a case-control study for sleep quantity and quality, physical and psychological pain, pressure pain threshold, suicidal ideation, and recent suicidal behavior. RESULTS Sleep quality, physical and psychological pain were positively associated with suicidal ideation severity. In both cases in which sleep quality was added to a model with either physical or psychological pain, physical or psychological pain became more significantly associated with suicidal ideation severity. Pressure pain threshold was elevated in patients suffering from any type of insomnia. There was no significant association between pressure pain threshold and suicidal ideation severity. CONCLUSIONS The impact of these findings lies in the identification of both psychological and physical pain, and sleep quality as potential biological mechanisms underlying suicidal risk. HIGHLIGHTSWe assessed the association between pain and sleep quality in suicidal patients.Sleep quality, physical and psychological pain were associated with suicide risk.Pain perception may mediate the progression to suicidal behavior.
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18
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Gazor A, Brown WD, Naqvi SK, Kennard B, Stewart S. Persistent suicidal ideation in a large intensive outpatient adolescent population sample: A preliminary report on the role of sleep disturbance. Bull Menninger Clin 2022; 86:113-123. [PMID: 35647777 DOI: 10.1521/bumc.2022.86.2.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Sleep disturbance is a unique, yet understudied, risk factor for suicidal thoughts and behaviors (STBs). The present study sought to explore the relationship between suicidal ideation (SI) and self-reported sleep disturbance in a sample of adolescents in an intensive outpatient program targeting suicidality (N = 691). Analyses conducted include paired samples t tests, multiple linear regression, and analysis of variance to examine group differences in sleep disturbance over time. Sleep disturbance and SI were associated at each timepoint, and sleep disturbance at admission predicted SI at discharge. Those with the most severe SI at discharge indicated increased sleep disturbance relative to admission, whereas those reporting no SI at discharge nearly resolved all sleep difficulties. Future studies should utilize objective sleep measures, longitudinal assessments, and include a more diverse sample to better inform the relationship of sleep and SI. These findings suggest that directly managing sleep disturbance during treatment could decrease the risk of STBs.
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Affiliation(s)
- Afsoon Gazor
- Clinical Psychology doctoral student, University of Texas Southwestern Medical Center, Dallas, Texas
| | - William David Brown
- Assistant Professor, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas.,Sleep Psychologist, Children's Health Systems of Texas, Dallas, Texas
| | - S Kamal Naqvi
- Associate Professor, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas.,Director, Sleep Disorders Center, Children's Health Systems of Texas, Dallas, Texas
| | - Beth Kennard
- Professor, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas.,Program Director, Suicide Prevention and Resilience Program, Children's Health Systems of Texas, Dallas, Texas
| | - Sunita Stewart
- Professor, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas.,Director of Psychological Services, Children's Health Systems of Texas, Dallas, Texas
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19
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Siddiqui M, Al-Amin H, Rabeh MA, Meedany M, Hamdi Y, Ghuloum S. Self-reported sleep and exercise patterns in patients admitted with suicidal attempts: a cross-sectional comparative study. BMC Psychiatry 2022; 22:326. [PMID: 35534838 PMCID: PMC9082909 DOI: 10.1186/s12888-022-03929-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 03/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is evidence that sleep disturbances and exercise are risk factors for suicide attempts; however, whether sleep disturbances are independently associated with suicide attempts is debatable. We compared the sleep and exercise patterns of individuals who attempted suicide to those of the general population and investigated whether sleep disturbances were independently associated with suicide attempts. METHODS Over a year, individuals presented to the emergency department at Hamad General Hospital and Mental Health Services in Doha with suicide attempts (n = 127) filled out questionnaires on sleep and exercise, demographics, and clinical measures. A control group (n = 126) from two primary care centers filled out the same questionnaires during the same period. RESULTS Subjects in the suicide group were significantly younger, single, had a lower level of education, and showed considerably more early insomnia, daytime tiredness, interrupted sleep, and no regular exercise. The most common diagnoses seen with suicidality were adjustment disorder and major depression, and the most common method used to attempt suicide was an overdose. After multiple regression analysis, being Arab, belonging to the category "other nationalities," unemployment, and early insomnia were significantly associated with an increased risk of suicide attempts. CONCLUSION This is the first comparative study on suicide in the Arabian Gulf. Individuals in Qatar with acute stress, depressive symptoms, sleep disturbances, and lack of exercise are at increased risk of attempting suicide. Thus, clinicians need to routinely screen for sleep and physical activity because of their significant contribution to physical and mental well-being.
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Affiliation(s)
- Manaal Siddiqui
- grid.416973.e0000 0004 0582 4340Qatar Foundation, Weill Cornell Medicine-Qatar, Education City, 24144 Doha, Qatar
| | - Hassen Al-Amin
- grid.416973.e0000 0004 0582 4340Qatar Foundation, Weill Cornell Medicine-Qatar, Education City, 24144 Doha, Qatar
| | - Mahmoud Abu Rabeh
- grid.413548.f0000 0004 0571 546XDepartment of Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - Mahmoud Meedany
- grid.413548.f0000 0004 0571 546XDepartment of Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - Yasmin Hamdi
- grid.413548.f0000 0004 0571 546XDepartment of Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - Suhaila Ghuloum
- Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar.
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20
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Mansuri Z, Reddy A, Vadukapuram R, Thootkur M, Trivedi C. Does Insomnia Increase the Risk of Suicide in Hospitalized Patients with Major Depressive Disorder? A Nationwide Inpatient Analysis from 2006 to 2015. Behav Sci (Basel) 2022; 12:117. [PMID: 35621414 PMCID: PMC9137701 DOI: 10.3390/bs12050117] [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: 10/05/2021] [Revised: 04/06/2022] [Accepted: 04/08/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction. Insomnia is an important symptom associated with major depressive disorder (MDD). In addition, it is one of the risk factors for suicide. Studies have shown the relationship be-tween insomnia and suicidal behavior in patients with MDD. However, this association has not been evaluated in a large sample of hospitalized patients. Objectives. To evaluate the suicidal be-havior in MDD patients with insomnia compared to those without insomnia. Methods. From the National Inpatient Sample (NIS 2006−2015) database using the ICD-9 code, patients’ data were obtained with the primary diagnosis of MDD and comorbid diagnosis of insomnia disorders (MDD+I). These patients were compared with MDD patients without insomnia disorders (MDD−I) by performing a 1:2 match for the primary diagnosis code. Suicidal ideation/attempt da-ta were compared between the groups by multivariate logistic regression analysis. Results. After the diagnostic code matching, 139061 patients were included in the MDD+I group and 276496 patients in the MDD−I group. MDD+I patients were older (47 years vs. 45 years, p < 0.001) com-pared to the MDD−I group. The rate of suicidal ideation/attempt was 56.0% in the MDD+I group and 42.0% in the MDD−I group (p < 0.001). After adjusting for age, sex, race, borderline personal-ity disorders, anxiety disorders, and substance use disorders, ‘insomnia’ was associated with 1.71 times higher odds of suicidal behavior among MDD patients admitted to the hospital. (Odds ratio: 1.71, 95% confidence interval 1.60−1.82, p < 0.001). Conclusions. Insomnia among MDD patients is significantly associated with the risk of suicide. MDD patients with insomnia need to be closely monitored for suicidal behavior.
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Affiliation(s)
- Zeeshan Mansuri
- Department of Psychiatry, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Abhishek Reddy
- Department of Psychiatry, Virginia Tech Carilion School of Medicine, Roanoke, VA 24016, USA;
| | - Ramu Vadukapuram
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
| | - Mounica Thootkur
- Department of Psychiatry, Virginia Tech Carilion School of Medicine, Roanoke, VA 24016, USA;
| | - Chintan Trivedi
- Department of Psychiatry, Texas Tech University Health Science Center at Permian Basin, Odessa, TX 79763, USA;
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21
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Efficacy and Safety of Acupuncture in the Treatment of Poststroke Insomnia: A Systematic Review and Meta-Analysis of Twenty-Six Randomized Controlled Trials. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:5188311. [PMID: 35345621 PMCID: PMC8957466 DOI: 10.1155/2022/5188311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 09/27/2021] [Accepted: 01/27/2022] [Indexed: 12/03/2022]
Abstract
Objective To evaluate the efficacy and safety of acupuncture in the treatment of poststroke insomnia. Methods PubMed, the Cochrane Library, Embase, Web of Science, China Biology Medicine (CBM), CNKI, VIP, and Wanfang databases were searched by computer from their inception to April 29, 2021, for collecting all randomized controlled trials of acupuncture in the treatment of poststroke insomnia. After two reviewers independently screened the literature, extracted the data, and evaluated the risk of bias in the included studies, the data were analyzed by RevMan 5.3 and STATA 16.0. The quality of outcomes was evaluated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results A total of 26 studies with 1874 cases were included, which had 942 cases in the treatment group and 932 cases in the control group. Meta-analysis results showed that, compared with oral medications alone, acupuncture alone or acupuncture combined with oral medications could improve the clinical effective rate and the sleep quality of patients, and the combined effects were RR = 1.21; 95% CI: 1.15, 1.27; P < 0.00001 and MD = 3.41; 95% CI: 2.40, 4.41; P < 0.00001, respectively. As for adverse reactions, the incidence of acupuncture alone or acupuncture combined with oral drugs was lower than that of oral drugs alone, which was safer and the combined effect was RR = 0.21; 95% CI: 0.09, 0.48; P=0.0002. Sensitivity analysis showed that the results were stable. We evaluated the quality of evidence with the GRADE system; the clinical effective rate was rated as “LOW,” the evidence grade of PSQI score was “LOW,” and the evidence grade of adverse reactions was “Very LOW.” Conclusion Acupuncture alone or acupuncture combined with oral drugs is more effective and safer than oral drugs alone in the treatment of poststroke insomnia, which is suitable to promote in clinical practice.
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22
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Tang YW, Teoh SL, Yeo JHH, Ngim CF, Lai NM, Durrant SJ, Lee SWH. Music-based Intervention for Improving Sleep Quality of Adults without Sleep Disorder: A Systematic Review and Meta-analysis. Behav Sleep Med 2022; 20:241-259. [PMID: 33896299 DOI: 10.1080/15402002.2021.1915787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Listening to music is often used as a self-help intervention to improve sleep quality, but its efficacy among individuals without sleep disorder remains unclear. METHODS A search was performed on five databases to identify for studies that examined the use of music-based intervention to improve sleep quality among individuals without sleep disorder. Random-effects meta-analysis was performed, and the certainty of evidence was evaluated using GRADE (Grading of Recommendations Assessment, Development and Evaluation). RESULTS Twenty-two articles which recruited 1,514 participants were included for review. Meta-analysis of six studies including 424 participants did not find an improvement in sleep quality among recipients of music-based intervention compared to those with standard care (mean difference: -0.80; 95% CI: -2.15 to 0.54, low-quality evidence). Subgroup analysis showed a clear improvement in sleep quality when interventions were administered for at least 3 weeks (-2.09; -3.84 to -0.34, n = 3). No difference in terms of sleep onset latency (standardized mean difference (SMD) -0.32; 95% CI -0.88 to 0.25, n = 4, very-low quality evidence) and sleep efficiency (SMD: -0.59; 95% CI -3.15 to 1.97, n = 2, very-low quality evidence) were observed. The effect of music-based intervention on anxiety, depression and quality of life were mixed with suggestions of possible benefits. CONCLUSION Music-based intervention in addition to standard care appears to be a promising strategy to improve sleep quality when delivered for 3 week or longer. However, effects are inconsistent across studies and larger randomized controlled studies reporting long-term outcomes are needed before it can be recommended for routine use. PROSPERO REGISTRATION CRD42018081193.
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Affiliation(s)
- Yee Woon Tang
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia.,Hospital Dutchess of Kent, Sandakan
| | - Siew Li Teoh
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia
| | - Julie Hsiao Hui Yeo
- School of Medicine, Taylor's University Lakeside Campus, Subang Jaya, Malaysia.,Hospital Sultanah Bahiyah,Ministry of Health, Alor Setar, Malaysia
| | - Chin Fang Ngim
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Johor, Malaysia
| | - Nai Ming Lai
- School of Medicine, Taylor's University Lakeside Campus, Subang Jaya, Malaysia.,Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Subang Jaya, Selangor, Malaysia
| | - Simon James Durrant
- Lincoln Sleep Research Centre and School of Psychology, University of Lincoln, Lincoln, UK
| | - Shaun Wen Huey Lee
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia.,Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Subang Jaya, Selangor, Malaysia.,School of Pharmacy, Taylor's University Lakeside Campus, Subang Jaya, Malaysia
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23
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Te T. You lack the season of all natures, sleep. J Clin Sleep Med 2022; 18:343-344. [PMID: 34857085 PMCID: PMC8805017 DOI: 10.5664/jcsm.9826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Tue Te
- Division of Sleep Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;,Division of Sleep Medicine, Penn Medicine—Hospital of the University of Pennsylvania, Penn Sleep Center Market Street, Philadelphia, Pennsylvania,Address correspondence to: Tue Te, MD, Division of Sleep Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Translational Research Laboratories, Suite 2100, 125 South 31st Street, Philadelphia, PA 19104;
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24
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Liu CY, Zhao YN, Wang XQ, Qin S, Wan QY, Zheng SY, Wu WZ. Acupuncture combined with traditional Chinese medicine e-aid cognitive behavioral therapy for insomnia (TCM-eCBT-I) for chronic insomnia: study protocol for a randomized controlled trial. Trials 2022; 23:86. [PMID: 35090540 PMCID: PMC8796488 DOI: 10.1186/s13063-022-06012-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 01/08/2022] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION The incidence of insomnia is getting higher and higher. Long-term insomnia seriously affects people's health. Drug use is usually accompanied with adverse events. Both acupuncture and cognitive behavioral therapy for insomnia (CBT-I) have been proven to be safe and effective non-pharmacological treatments for insomnia. As the insomniacs' bad sleep behavior and wrong cognition have not been effectively corrected, acupuncture has a quick effect, high patient compliance but unstable long-term efficacy, while CBT-I is complex, time-consuming, and expensive; additionally, patient compliance is low, and the number of trained therapists is limited, making it difficult to carry out. Therefore, this study aims to use the insomnia TCM system to construct a convenient and feasible traditional Chinese medicine e-aid cognitive behavioral therapy for insomnia (TCM-eCBT-I) for Chinese people, and combine the advantages of acupuncture and TCM-eCBT-I for maintaining long-term efficacy, and three treatments will be evaluated to provide clinicians with a more effective clinical protocol METHODS AND ANALYSIS: This study is a single-center, open-label, randomized controlled trial. Ninety subjects will be recruited and randomly assigned to three groups: the acupuncture group, the TCM-eCBT-I group, and the acupuncture combined with TCM-eCBT-I group, in a ratio of 1:1:1. We will evaluate the Pittsburgh Sleep Quality Index (PSQI) and Dysfunctional Beliefs and Attitudes About Sleep Scale (DBAS), Insomnia Severity Index (ISI), sleep diary, Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), and Fatigue Scale-14 Scale (FS-14) scales. All adverse reactions will be assessed through the ADVERSE event table. All outcomes will be evaluated online at 0 weeks, 4 weeks, 8 weeks, 16 weeks, and 28weeks. ETHICS AND DISSEMINATION This study has been approved by the Institutional Review Board of the Affiliated Hospital of Nanjing University of Chinese Medicine (2020 NL-018-02). Informed consent will be obtained from all the subjects. The results will be shared with sleep researchers, public, and relevant academic institutions through high-impact peer-reviewed publications. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2000032960. Registered on 17 May 2020.
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Affiliation(s)
- Cheng-Yong Liu
- Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155, Hanzhong Road, Qinhuai District, Nanjing, Jiangsu, China
| | - Ya-Nan Zhao
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiao-Qiu Wang
- Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155, Hanzhong Road, Qinhuai District, Nanjing, Jiangsu, China
| | - Shan Qin
- Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155, Hanzhong Road, Qinhuai District, Nanjing, Jiangsu, China
| | - Qing-Yun Wan
- Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155, Hanzhong Road, Qinhuai District, Nanjing, Jiangsu, China
| | - Shi-Yu Zheng
- Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155, Hanzhong Road, Qinhuai District, Nanjing, Jiangsu, China
| | - Wen-Zhong Wu
- Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155, Hanzhong Road, Qinhuai District, Nanjing, Jiangsu, China.
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25
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AlHadi AN, Alhuwaydi AM. Insomnia Prevalence and Associated Factors Among University Students in Saudi Arabia During the COVID-19 Pandemic and Lockdown: A Large-Scale Survey. Nat Sci Sleep 2022; 14:1651-1663. [PMID: 36164410 PMCID: PMC9507980 DOI: 10.2147/nss.s380972] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 09/14/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The coronavirus disease 2019 (COVID-19) pandemic has many psychological and physical effects to which university students are vulnerable. We aimed in this study to assess the prevalence of insomnia among university students in Saudi Arabia during the COVID-19 pandemic and lockdown and associated factors. PATIENTS AND METHODS We conducted a cross-sectional study using a questionnaire to collect the responses of 5140 students from Saudi universities between April 24 and 30, 2020. Responders completed demographic questions and psychological scales, including the Insomnia Severity Scale (ISI), during the national lockdown period in Saudi Arabia. RESULTS Approximately, 41% of the sample suffered from moderate to severe insomnia. The mean ISI score was recorded as 12.9 (SD 6.62). Insomnia was associated with female sex, younger age, students from new universities, junior students, if a relative suffered from COVID-19, having a chronic medical illness, and having a psychiatric disorder. Insomnia was associated also with suicidal ideation. CONCLUSION Insomnia prevalence was very high among Saudi university students during the COVID-19 pandemic lockdown. There were sociodemographic and medical factors associated with high insomnia prevalence. Universities need to plan and implement protective and intervention strategies to deal with this important issue.
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Affiliation(s)
- Ahmad N AlHadi
- Department of Psychiatry, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,SABIC Psychological Health Research & Applications Chair (SPHRAC), Department of Psychiatry, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed M Alhuwaydi
- SABIC Psychological Health Research & Applications Chair (SPHRAC), Department of Psychiatry, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Medicine, College of Medicine, Jouf University, Sakaka, Saudi Arabia
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26
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Wisłowska-Stanek A, Kołosowska K, Maciejak P. Neurobiological Basis of Increased Risk for Suicidal Behaviour. Cells 2021; 10:cells10102519. [PMID: 34685499 PMCID: PMC8534256 DOI: 10.3390/cells10102519] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/21/2021] [Accepted: 09/21/2021] [Indexed: 12/25/2022] Open
Abstract
According to the World Health Organization (WHO), more than 700,000 people die per year due to suicide. Suicide risk factors include a previous suicide attempt and psychiatric disorders. The highest mortality rate in suicide worldwide is due to depression. Current evidence suggests that suicide etiopathogenesis is associated with neuroinflammation that activates the kynurenine pathway and causes subsequent serotonin depletion and stimulation of glutamate neurotransmission. These changes are accompanied by decreased BDNF (brain-derived neurotrophic factor) levels in the brain, which is often linked to impaired neuroplasticity and cognitive deficits. Most suicidal patients have a hyperactive hypothalamus–pituitary–adrenal (HPA) axis. Epigenetic mechanisms control the above-mentioned neurobiological changes associated with suicidal behaviour. Suicide risk could be attenuated by appropriate psychological treatment, electroconvulsive treatment, and drugs: lithium, ketamine, esketamine, clozapine. In this review, we present the etiopathogenesis of suicide behaviour and explore the mechanisms of action of anti-suicidal treatments, pinpointing similarities among them.
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Affiliation(s)
- Aleksandra Wisłowska-Stanek
- Centre for Preclinical Research and Technology (CEPT), Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, 1B Banacha Street, 02-097 Warsaw, Poland;
- Correspondence: ; Tel.: +48-221166160
| | - Karolina Kołosowska
- Department of Neurochemistry, Institute of Psychiatry and Neurology, 9 Sobieskiego Street, 02-957 Warsaw, Poland;
| | - Piotr Maciejak
- Centre for Preclinical Research and Technology (CEPT), Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, 1B Banacha Street, 02-097 Warsaw, Poland;
- Department of Neurochemistry, Institute of Psychiatry and Neurology, 9 Sobieskiego Street, 02-957 Warsaw, Poland;
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27
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Dong M, Lu L, Sha S, Zhang L, Zhang Q, Ungvari GS, Balbuena L, Xiang YT. Sleep Disturbances and the Risk of Incident Suicidality: A Systematic Review and Meta-Analysis of Cohort Studies. Psychosom Med 2021; 83:739-745. [PMID: 34267092 DOI: 10.1097/psy.0000000000000964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The association between sleep disturbances and suicidality is not well understood partly because of the variability in research results. This meta-analysis aimed to investigate the predictive value of sleep disturbances for incident suicidality. METHODS A systematic search was conducted in PubMed, EMBASE, PsycINFO, and Web of Science databases for studies examining sleep disturbances and incident suicidality. Cohort studies were screened following a registered protocol, and the eligible ones were meta-analyzed. RESULTS Seven studies comprising 1,570,181 individuals at baseline, with 1407 attempting suicide and 1023 completing suicide during follow-up, were included. Individuals with baseline sleep disturbances had a significantly higher incidence of suicidality than did those without (relative risk = 2.17, 95% confidence interval [CI] = 1.45-3.24, I2 = 82.50%, p < .001). The risk of an incident suicide attempt was 3.54-fold higher (95% CI = 3.07-4.09, I2 = 0%, p = .44), whereas the risk of incident completed suicide was 1.80-fold higher (95% CI = 1.32-2.44, I2 = 59.33%, p = .01) in individuals with baseline sleep disturbances. CONCLUSIONS Incident suicide attempts and deaths are higher among people with sleep disturbances. Regular screening and preventive measures should be undertaken for people with sleep disturbances to prevent progression into suicide attempts and deaths.Clinical Trial Registration:CRD42019136397.
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Affiliation(s)
- Min Dong
- From the Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Dong), Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China; Team IETO, Bordeaux Population Health Research Center, UMR U1219, INSERM (Lu), Université de Bordeaux, Bordeaux, France; The National Clinical Research Center for Mental Disorders, the Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, and the Advanced Innovation Center for Human Brain Protection (Sha, L. Zhang, Q. Zhang), Capital Medical University, Beijing, China; Division of Psychiatry, School of Medicine (Ungvari), University of Western Australia/Graylands Hospital, Perth; University of Notre Dame Australia (Ungvari), Fremantle, Australia; Department of Psychiatry, University of Saskatchewan (Balbuena), Saskatoon, Saskatchewan, Canada; Unit of Psychiatry, Department of Public Health and Medicinal Administration, Faculty of Health Sciences (Xiang), Centre for Cognitive and Brain Sciences (Xiang), and Institute of Advanced Studies in Humanities and Social Sciences (Xiang), University of Macau, Macao SAR, China
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Simmons Z, Burlingame G, Korbanka J, Eastman K, Thomas D, Christensen J, Jenson M, Nadorff MR, Kay DB. Insomnia symptom severity is associated with increased suicidality and death by suicide in a sample of patients with psychiatric disorders. Sleep 2021; 44:6133425. [PMID: 33571373 DOI: 10.1093/sleep/zsab032] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/06/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Insomnia is a risk factor for suicidal behavior including attempts and death by suicide. We investigated whether insomnia symptom severity was associated with suicidality and death by suicide in patients with psychiatric disorders. METHODS The sample included 180 deceased patients with psychiatric disorders seen at Weber Human Services between 2008 and 2018 who completed the Outpatient Questionnaire-45.2 (OQ) prior to death. Insomnia symptom severity was assessed using item 41 from the OQ. Manner of death was determined by death records and autopsy reports. History of suicidality was determined through electronic medical records. Cases were grouped into four lifetime categories: non-suicidal (n = 30), suicidal ideation (n = 36), suicide attempt (n = 95), and death by suicide (n = 19). Demographic, medical, and psychiatric features of each group were compared using linear regression. Logistic regression was used to determine whether insomnia symptom severity was associated with lifetime suicidality severity grouping, adjusting for psychiatric disorders commonly linked to suicidality. RESULTS Lifetime suicidality was associated with sleep problems, fatigue, headaches, and psychiatric disorders (i.e. depressive, personality, and trauma-related disorders). Referenced to the non-suicidal group, greater insomnia symptom severity was significantly associated with suicide attempts and death by suicide, with odds ratios (OR) of OR = 2.67, p = 0.011, and OR = 5.53, p = 0.002, respectively, even after adjusting important psychiatric diagnoses. CONCLUSIONS Results suggest that insomnia symptom severity endorsed during a clinical visit is associated with heightened suicidality, especially suicidal behavior. The presence of insomnia symptoms in patients with psychiatric disorders may indicate risk for suicide and is a target for suicide prevention.
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Affiliation(s)
- Zach Simmons
- Department of Psychology, Brigham Young University, Provo, UT, USA
| | - Gary Burlingame
- Department of Psychology, Brigham Young University, Provo, UT, USA
| | | | | | - Douglas Thomas
- Utah Department of Human Services, Salt Lake City, UT, USA
| | | | | | | | - Daniel B Kay
- Department of Psychology, Brigham Young University, Provo, UT, USA
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Wu H, Lv J, Liu M, Wu Y, Qu Y, Ji L, Lan L. The long-term effect of repetitive transcranial magnetic stimulation in the treatment of intractable insomnia. Sleep Med 2021; 85:309-312. [PMID: 34391006 DOI: 10.1016/j.sleep.2021.07.018] [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: 07/08/2020] [Revised: 06/09/2021] [Accepted: 07/11/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To explore the differences in clinical efficacy of different courses of repetitive transcranial magnetic stimulation (rTMS) in the treatment of intractable insomnia and the duration of clinical efficacy after cessation of treatment. METHOD 70 patients with intractable insomnia were randomly divided into 1 treatment course group and 2 treatment courses group. The rTMS course consisted of daily sessions of 1200 stimuli for the r-DLPFC at a frequency of 1 Hz and 800 stimuli for parietal lobe (CPZ) at a frequency of 1 Hz. The pitchburg sleep index (PSQI), Hamilton depression scale (HAMD), Hamilton anxiety scale (HAMA), and cardiopulmonary coupled sleep (CPC) were assessed for 35 patients in each group at baseline, at 2 weeks, and at 1 and 3 months after treatment. RESULT The scores of PSQI, HAMD and HAMA in the 2 groups were significantly improved after 1 month of follow-up after rTMS treatment (p < 0.01). The long-term effect of different treatment courses is different. After 2 consecutive courses of treatment, there was still a significant difference between the 3-month follow-up and the pre-treatment period (p < 0.05). However, there was no statistical difference between the 3-month follow-up of one course of treatment and the pre-treatment period. The results of CPC test showed that the improvement of total sleep time (TST), and deep sleep time (DST) was basically consistent with the assessment of PSQI, HAMD and HAMA that the clinical efficacy of the 3-month follow-up was better than that of one course of treatment after 2 consecutive courses of treatment. CONCLUSION The treatment of refractory insomnia by rTMS is effective, and the duration of the curative effect is related to the course of treatment. 2 consecutive courses of treatment still have a certain effect after 3 months, which is worthy of clinical promotion.
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Affiliation(s)
- Hongwei Wu
- Department of Neurology, The Sixth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
| | - Jin Lv
- Department of Neurology, The Sixth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
| | - Minfen Liu
- Department of Neurology, The Sixth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
| | - Yu Wu
- Department of Neurology, The Sixth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
| | - Yanzhou Qu
- Department of Neurology, The Sixth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
| | - Liqun Ji
- Department of Neurology, The Sixth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
| | - Likang Lan
- Department of Neurology, The Sixth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China.
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Huang CY, Fang SC, Shao YHJ. Comparison of Long-Acting Injectable Antipsychotics With Oral Antipsychotics and Suicide and All-Cause Mortality in Patients With Newly Diagnosed Schizophrenia. JAMA Netw Open 2021; 4:e218810. [PMID: 33974056 PMCID: PMC8114136 DOI: 10.1001/jamanetworkopen.2021.8810] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Schizophrenia is generally considered to be among the most severe psychiatric disorders because of the excessive mortality associated with it. Research to find means to reduce this excessive mortality is warranted. OBJECTIVE To investigate associations of long-acting injectable antipsychotics (LAIs) with all-cause, natural-cause, and suicide mortality risks as well as the impacts of early use of LAIs in patients with newly diagnosed schizophrenia. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from the Taiwan National Health Insurance Research Database to construct a population-based cohort of patients with schizophrenia who received oral antipsychotics (OAPs) from January 1, 2002, to December 31, 2017. Within this cohort, the LAI group was defined as patients who switched to LAIs and were prescribed LAIs at least 4 times within 1 year. The LAI group was propensity matched 1:1 to patients who continued receiving OAPs of the same compounds. All patients were followed up until switching the antipsychotic administration route, death, or the end of the study (December 31, 2018), whichever occurred first. Data analysis was performed from January 2002 to December 2018. MAIN OUTCOMES AND MEASURES All-cause mortality, natural-cause mortality, suicide mortality, and suicide attempts. RESULTS In total, 2614 patients who switched to LAIs (median [interquartile range] {IQR} age, 30 [23-39] years) and 2614 who received OAPs (median [IQR] age, 30 [23-39] years) were included (1333 male patients [51.0%] in each group). During the 16-year follow-up period (median [IQR] follow-up of 14 [10-17] years), patients who switched to LAIs had lower risks of all-cause mortality (adjusted hazard ratio [aHR], 0.66; 95% CI, 0.54-0.81), natural-cause mortality (aHR, 0.63; 95% CI, 0.52-0.76), and suicide attempts (incidence rate ratio, 0.72; 95% CI, 0.55-0.93) compared with patients who received the corresponding OAPs. A 47% lower suicide mortality risk (aHR, 0.53; 95% CI, 0.30-0.92) was observed in patients who switched to LAIs within the first 2 years of OAP initiation. CONCLUSIONS AND RELEVANCE These findings suggest that LAI use in patients with newly diagnosed schizophrenia is associated with decreased all-cause mortality and suicide risk. Furthermore, early treatment with LAIs within the first 2 years of OAP initiation was associated with a decrease in suicide mortality risk. Thus, LAI use in the early stage of treatment should be actively considered for patients with newly diagnosed schizophrenia.
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Affiliation(s)
- Cheng-Yi Huang
- Department of Community Psychiatry, Bali Psychiatric Center, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Su-Chen Fang
- Department of Nursing, Mackay Medical College, New Taipei City, Taiwan
| | - Yu-Hsuan Joni Shao
- Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan
- Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei, Taiwan
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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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Porras-Segovia A, Cobo A, Díaz-Oliván I, Artés-Rodríguez A, Berrouiguet S, Lopez-Castroman J, Courtet P, Barrigón ML, Oquendo MA, Baca-García E. Disturbed sleep as a clinical marker of wish to die: A smartphone monitoring study over three months of observation. J Affect Disord 2021; 286:330-337. [PMID: 33770541 DOI: 10.1016/j.jad.2021.02.059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 12/29/2020] [Accepted: 02/27/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Smartphone monitoring could contribute to the elucidation of the correlates of suicidal thoughts and behaviors (STB). In this study, we employ smartphone monitoring and machine learning techniques to explore the association of wish to die (passive suicidal ideation) with disturbed sleep, altered appetite and negative feelings. METHODS This is a prospective cohort study carried out among adult psychiatric outpatients with a history of STB. A daily questionnaire was administered through the MEmind smartphone application. Participants were followed-up for a median of 89.8 days, resulting in 9,878 person-days. Data analysis employed a machine learning technique called Indian Buffet Process. RESULTS 165 patients were recruited, 139 had the MEmind mobile application installed on their smartphone, and 110 answered questions regularly enough to be included in the final analysis. We found that the combination of wish to die and sleep problems was one of the most relevant latent features found across the sample, showing that these variables tend to be present during the same time frame (96 hours). CONCLUSIONS Disturbed sleep emerges as a potential clinical marker for passive suicidal ideation. Our findings stress the importance of evaluating sleep as part of the screening for suicidal behavior. Compared to previous smartphone monitoring studies on suicidal behavior, this study includes a long follow-up period and a large sample.
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Affiliation(s)
| | - Aurora Cobo
- Department of Signal Theory, Universidad Carlos III de Madrid, Leganés, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Isaac Díaz-Oliván
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain; Universidad Autónoma de Madrid
| | - Antonio Artés-Rodríguez
- Department of Signal Theory, Universidad Carlos III de Madrid, Leganés, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Sofian Berrouiguet
- Department of Psychiatry, Centre Hospitalier Universitaire De Brest, Brest, France
| | - Jorge Lopez-Castroman
- University of Montpellier & INSERM u1061, Montpellier, France; Nimes University Hospital, Nimes, France; CIBERSAM, Spain
| | | | - Maria Luisa Barrigón
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain; Universidad Autónoma de Madrid; Department of Psychiatry, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - María A Oquendo
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Enrique Baca-García
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain; Department of Signal Theory, Universidad Carlos III de Madrid, Leganés, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.; Universidad Autónoma de Madrid; Department of Psychiatry, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain; Department of Psychiatry, Hospital Universitario Central de Villalba, Madrid; Department of Psychiatry, Hospital Universitario Infanta Elena, Valdemoro, Madrid; Department of Psychiatry, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid; Universidad Católica del Maule, Talca, Chile.
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Haynes ZA, Collen JF, Poltavskiy EA, Walker LE, Janak J, Howard JT, Werner JK, Wickwire EM, Holley AB, Zarzabal LA, Sim A, Gundlapalli A, Stewart IJ. Risk factors of persistent insomnia among survivors of traumatic injury: a retrospective cohort study. J Clin Sleep Med 2021; 17:1831-1840. [PMID: 33928909 DOI: 10.5664/jcsm.9276] [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] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Insomnia is a diagnosis with broad health and economic implications that has been increasingly recognized in military service members. This trend was concurrent with an increase in traumatic wartime injuries. Accordingly, we sought to determine longitudinal predictors of persistent insomnia in combat veterans who sustained traumatic injuries. METHODS Retrospective cohort study of service members deployed to conflict zones from 2002-2016, with longitudinal follow-up in the Veterans Affairs and Military Health Systems. Two cohorts were derived: 1) service members who sustained traumatic injuries and 2) an age, sex, and service component matched cohort of uninjured service members who deployed to a combat zone. Insomnia was defined using International Classification of Diseases Ninth Revision or International Classification of Diseases Tenth Revision Clinical Modification codes. RESULTS The final population of 17,374 service members was followed from date of injury (or date of matched participant's injury) for a median of 8.4 (IQR 5.3-10.7) years. Service members with traumatic injury were at significantly greater risk of developing insomnia than uninjured service members (HR=1.43, 95% CI 1.30-1.58) after adjustment. Traumatic brain injury (TBI) was associated with insomnia when compared to patients without TBI in the multivariable model: mild/unclassified TBI (HR=2.07, 95% CI 1.82-2.35), moderate/severe/penetrating TBI (HR=2.43, 95% CI 2.06-2.86). Additionally, burn injury (HR=1.95, 95% CI 1.47-2.59) and amputation (HR=1.61, 95% CI 1.26-2.06) significantly increased the risk of a diagnosis. CONCLUSIONS Traumatic injuries significantly predicted a diagnosis of insomnia after controlling for mental health disorders. Our findings strongly suggest the need for long-term surveillance of sleep disorders in trauma survivors.
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Affiliation(s)
| | - Jacob F Collen
- Walter Reed National Military Medical Center, Bethesda, MD.,Uniformed Services University of the Health Sciences, Bethesda, MD
| | | | | | | | | | - J Kent Werner
- Walter Reed National Military Medical Center, Bethesda, MD.,Uniformed Services University of the Health Sciences, Bethesda, MD
| | | | - Aaron B Holley
- Walter Reed National Military Medical Center, Bethesda, MD.,Uniformed Services University of the Health Sciences, Bethesda, MD
| | | | - Alan Sim
- Defense Health Agency/J6, San Antonio, TX
| | - Adi Gundlapalli
- Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT
| | - Ian J Stewart
- Uniformed Services University of the Health Sciences, Bethesda, MD
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Tubbs AS, Fernandez FX, Perlis ML, Hale L, Branas CC, Barrett M, Chakravorty S, Khader W, Grandner MA. Suicidal ideation is associated with nighttime wakefulness in a community sample. Sleep 2021; 44:5866613. [PMID: 32614967 DOI: 10.1093/sleep/zsaa128] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 06/19/2020] [Indexed: 12/20/2022] Open
Abstract
STUDY OBJECTIVES Nocturnal wakefulness is a risk factor for suicide and suicidal ideation in clinical populations. However, these results have not been demonstrated in general community samples or compared to sleep duration or sleep quality. The present study explored how the timing of wakefulness was associated with suicidal ideation for weekdays and weekends. METHODS Data were collected from 888 adults aged 22-60 as part of the Sleep and Healthy Activity, Diet, Environment, and Socialization study. Suicidal ideation was measured by the Patient Health Questionnaire-9, while timing of wakefulness was estimated from the Sleep Timing Questionnaire. Binomial logistic regressions estimated the association between nocturnal (11 pm-5 am) and morning (5 am-11 am) wakefulness and suicidal ideation. RESULTS Nocturnal wakefulness was positively associated with suicidal ideation on weekdays (OR: 1.44 [1.28-1.64] per hour awake between 11:00 pm and 05:00 am, p < 0.0001) and weekends (OR: 1.22 [1.08-1.39], p = 0.0018). Morning wakefulness was negatively associated with suicidal ideation on weekdays (OR: 0.82 [0.72-0.92] per hour awake between 05:00 am and 11:00 am, p = 0.0008) and weekends (OR: 0.84 [0.75-0.94], p = 0.0035). These associations remained significant when adjusting for sociodemographic factors. Additionally, nocturnal wakefulness on weekdays was associated with suicidal ideation when accounting for insomnia, sleep duration, sleep quality, and chronotype (OR 1.25 [1.09-1.44] per hour awake, p = 0.002). CONCLUSION Wakefulness at night was consistently associated with suicidal ideation. Additionally, morning wakefulness was negatively associated with suicidal ideation in some models. Although these findings are drawn from a non-clinical sample, larger longitudinal studies in the general population are needed to confirm these results.
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Affiliation(s)
- Andrew S Tubbs
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona, Tucson, AZ
| | - Fabian-Xosé Fernandez
- Department of Psychology, BIO5 and McKnight Brain Research Institutes, University of Arizona, Tucson, AZ
| | - Michael L Perlis
- Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - Lauren Hale
- Program in Public Health, Department of Family, Population, and Preventative Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY
| | | | - Marna Barrett
- Mood and Anxiety Disorders Treatment Research Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - Subhajit Chakravorty
- Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - Waliuddin Khader
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona, Tucson, AZ
| | - Michael A Grandner
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona, Tucson, AZ
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Anna Karin H, Hössjer O, Bellocco R, Ye W, Trolle LY, Åkerstedt T. Insomnia in the context of short sleep increases suicide risk. Sleep 2021; 44:5995546. [PMID: 33216134 PMCID: PMC8033451 DOI: 10.1093/sleep/zsaa245] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 02/28/2020] [Indexed: 01/25/2023] Open
Abstract
Study Objectives The relationship between insomnia and suicide risk is not completely understood. We aimed to investigate the influence of insomnia on suicide risk, taking both sleep duration and depression into consideration. Methods The present study is based on a Swedish prospective cohort study of 38,786 participants with a mean follow-up time of 19.2 years. Cox proportional hazards models with attained age as time-scale were used to estimate hazard ratios (HRs) of death by suicide with 95% confidence intervals (CI) for participants categorized by frequency of insomnia symptoms. Causal mediation analysis was performed to assess to what extent the relationship between insomnia and suicide risk is mediated by depression. Results Insomnia was only associated with suicide risk among short sleepers, whereas no significant association was observed among those who slept 7 h/night or more. The total effect of insomnia in the context of short sleep on suicide risk, expressed on the HR scale, was 2.85 (95% CI 1.42–5.74). The direct effect was 2.25 (95% CI 1.12–4.54) and the indirect effect, mediated by depression, was 1.27 (95% CI 1.05–1.53). Of the total effect, 32% was mediated by depression. The association between insomnia and suicide risk became more pronounced with decreasing depressive symptoms (p value for trend <0.05). Conclusions Insomnia in the context of short sleep increases suicide risk, both directly and indirectly by affecting the risk of depression. Abnormalities of sleep duration and insomnia symptoms should be evaluated when assessing suicide risk.
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Affiliation(s)
- Hedström Anna Karin
- Department of Clinical Neuroscience and Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ola Hössjer
- Mathematical Statistics, Stockholm University, Stockholm, Sweden
| | - Rino Bellocco
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Weimin Ye
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Lagerros Ylva Trolle
- Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.,Obesity Center, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
| | - Torbjörn Åkerstedt
- Stress Research, Stockholm University, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Valero-Cantero I, Wärnberg J, Carrión-Velasco Y, Martínez-Valero FJ, Casals C, Vázquez-Sánchez MÁ. Predictors of sleep disturbances in caregivers of patients with advanced cancer receiving home palliative care: A descriptive cross-sectional study. Eur J Oncol Nurs 2021; 51:101907. [PMID: 33636585 DOI: 10.1016/j.ejon.2021.101907] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 01/30/2021] [Accepted: 02/02/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE To evaluate the quality of sleep in caregivers of patients with advanced cancer receiving home palliative care, basing the analysis on subjective and objective measures, and to develop a predictive model of sleep disturbances among this population. METHOD A descriptive cross-sectional study was conducted in six clinical management units within primary healthcare centres. Data were obtained during a period of six months, from a sample population of 41 caregivers. The Pittsburgh Sleep Quality Index (PSQI) and a 7-day accelerometry evaluation were performed to assess sleep quality. Daytime sleepiness, caregiver strain and quality of life were also evaluated. RESULTS According to the PSQI, 90.2% of participants had poor sleep quality. The average duration of night-time sleep, measured by accelerometry and the PSQI, was 6 h. Taking PSQI as the dependent variable, the study model predicted 40.7% of the variability (p < 0.01). The variables "Caregiver strain" and "Daily hours dedicated to care" produced the following results: B coefficient 0.645; p = 0.001; and B coefficient 0.230; p = 0.010, respectively. CONCLUSIONS The caregivers presented significant health-related alterations, including sleep disturbances, which were directly related to two variables: the index of caregiver strain and the number of hours per day dedicated to providing care.
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Affiliation(s)
- Inmaculada Valero-Cantero
- Nurse Case Manager, Puerta Blanca Clinical Management Unit, Malaga-Guadalhorce Health District, Malaga, Spain.
| | - Julia Wärnberg
- Professor at the Department of Nursing, Faculty of Health Sciences, University of Malaga and Malaga Biomedical Research Institute (IBIMA), Malaga, Spain; CIBER Fisiopatología de La Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
| | - Yolanda Carrión-Velasco
- Nurse Case Manager, Tiro Pichón Clinical Management Unit, Malaga-Guadalhorce Health District, Malaga, Spain.
| | | | - Cristina Casals
- Professor at the Department of Physical Education, MOVE-IT Research Group, University of Cadiz, Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, Cadiz, Spain.
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Zhao FY, Fu QQ, Kennedy GA, Conduit R, Zhang WJ, Wu WZ, Zheng Z. Can acupuncture improve objective sleep indices in patients with primary insomnia? A systematic review and meta-analysis. Sleep Med 2021; 80:244-259. [PMID: 33610071 DOI: 10.1016/j.sleep.2021.01.053] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/20/2021] [Accepted: 01/27/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND The efficacy of acupuncture for treating primary insomnia (PI) has been explored in several meta-analyses where the outcomes measures were based on subjective self-reported sleep rating scales. Sleep state misperception is common in PI and self-reports underestimate sleep duration and quality. No systematic reviews or meta-analyses have investigated the efficacy of acupuncture in improving objective sleep measures in PI. OBJECTIVE To perform a systematic review to determine whether objective sleep parameters are improved by acupuncture in patients with PI. METHODS Randomized controlled trials treating PI via verum-acupuncture versus sham-/placebo-acupuncture or waitlist control were searched for in English [MEDLINE (via PubMed), Sciverse ScienceDirect, Cochrane Central Register of Controlled Trials (CENTRAL), AMED, Springer, EMBASE (Elsevier), Ebsco Medline, and PsycINFO (ProQuest)] and Chinese (SinoMed, CNKI, Wanfang and CQVIP) databases, from the dates of the databases' inception to January 2020. The parameters of polysomnography (PSG), actigraphy, or micromovement sensitive mattress/pillow sleep monitoring systems were considered as the primary outcome measures. Revman 5.3 and Stata 16.0 software were used to conduct the meta-analysis. Heterogeneity was examined by using I2 statistics and publication bias was assessed via Egger's test. RESULTS Eleven studies involving 775 patients met the inclusion criteria. The results of meta-analysis suggested that acupuncture can increase total sleep time [MD = 55.29, 95%CI (29.16, 81.42), p < 0.01], increase sleep efficiency [MD = 8.96, 95%CI (3.97, 13.95), p < 0.01], decrease wake after sleep onset [MD = -49.54, 95%CI (-82.98, -16.09), p < 0.01], and reduce number of awakening times [MD = -6.29, 95%CI (-10.75, -1.82), p < 0.01] compared with either sham-/placebo-acupuncture or waitlist control. Subsequent analysis indicated a superior effect for verum-acupuncture in comparison with sham-/placebo-acupuncture or waitlist-control when the recommended lowest threshold dosage (12 sessions) was met. Despite positive outcomes, most studies reviewed were heterogeneous and at risk of bias due to methodological issues. CONCLUSIONS Despite limited evidence, acupuncture was significantly associated with improvements in several objective sleep parameters (increases in total sleep time and sleep efficiency, and reductions in wake after sleep onset and number of awakening times) as well as subjective sleep quantity and quality in patients with PI. A minimum therapeutic threshold dosage (≥12 sessions) is recommended. Well-designed RCTs using PSG are required to clarify the influence of acupuncture on sleep architecture/structure and to promote better application of acupuncture as a treatment for PI.
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Affiliation(s)
- Fei-Yi Zhao
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, 3083, Australia; Department of Nursing, School of International Medical Technology, Shanghai Sanda University, Shanghai, China
| | - Qiang-Qiang Fu
- Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Gerard A Kennedy
- School of Science, Psychology and Sport, Federation University, Mount Helen, Victoria, 3350, Australia; School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, 3083, Australia; Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, 3084, Australia
| | - Russell Conduit
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, 3083, Australia
| | - Wen-Jing Zhang
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wen-Zhong Wu
- Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu China
| | - Zhen Zheng
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, 3083, Australia.
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Zhang Y, Fang X, Tang B, Fan K, Wen N, Zhao K, Xu W, Tang W, Chen Y. Childhood Trauma and Insomnia Increase Suicidal Ideation in Schizophrenia Patients: A Cross-Sectional Study. Front Psychiatry 2021; 12:769743. [PMID: 34858237 PMCID: PMC8631870 DOI: 10.3389/fpsyt.2021.769743] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 10/19/2021] [Indexed: 11/23/2022] Open
Abstract
Objectives: This study aimed to investigate the effect of childhood trauma, especially its specific dimensions, and clinical risk factors for suicidal ideation in patients with schizophrenia. Methods: A total of 83 inpatients with schizophrenia were enrolled and divided into two groups: with suicidal ideation (n = 33) and without suicidal ideation (n = 50). All participants were administered the Childhood Trauma Questionnaire-Short Form, the Insomnia Severity Index, the Beck Scale for Suicide Ideation, the Modified Overt Aggression Scales, the auditory hallucination rating scale, the Hamilton Rating Scale of Depression and the Positive and Negative Syndrome Scale. Results: In our sample, 39.8% of the subjects had suicidal ideation, and 60.6% of them had suffered from childhood trauma. Patients with suicidal ideation had a higher Insomnia Severity Index score, Physical neglect score, the Childhood Trauma Questionnaire-Short Form total score (all P < 0.05) compared to those without. The logistic regression analysis revealed that physical neglect in Childhood Trauma Questionnaire was significantly associated with suicidal ideation (OR = 5.46, P < 0.05, 95% CI = 0.007-0.483). Further stepwise multiple linear regression identified that insomnia (β = 0.272, P = 0.011) and physical neglect (β = 0.257, P = 0.017) were strong risk factors for the severity of suicidal ideation in patients with schizophrenia. Mediation analysis showed that insomnia played a complete mediating role between physical neglect and suicidal ideation. Conclusion: Our results indicate that childhood maltreatment of physical neglect is a strong independent risk factor for suicidal ideation in schizophrenia. The risk is probably aggravated by the poor quality of sleep. Early screening and psychosocial treatment are recommended for psychotic individuals with a trauma history.
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Affiliation(s)
- Yaoyao Zhang
- Department of Psychiatry, Wenzhou Medical University, Wenzhou, China
| | - Xinyu Fang
- Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Bei Tang
- Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Kaili Fan
- Department of Psychiatry, Wenzhou Medical University, Wenzhou, China
| | - Na Wen
- Department of Psychiatry, The Affiliated Kangning Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ke Zhao
- Department of Psychiatry, Wenzhou Medical University, Wenzhou, China
| | - Weiqian Xu
- Department of Psychiatry, The Second People's Hospital of Taizhou, Taizhou, China
| | - Wei Tang
- Department of Psychiatry, Wenzhou Medical University, Wenzhou, China.,Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Yi Chen
- Department of Psychiatry, The Affiliated Kangning Hospital of Wenzhou Medical University, Wenzhou, China
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Abstract
Sleep disturbances, particularly insomnia, nightmares, and excessive daytime sleepiness (EDS), are significant, proximal, and modifiable risk factors for suicidal ideation and behaviors (SIB) and could be targeted for preventative interventions. In this chapter, we review the evidence supporting the association of insomnia, nightmares, and EDS with SIB. We also describe these sleep disturbances in the general population, as well as their association with psychiatric disorders. A PubMed search was conducted to identify the relevant literature. Insomnia is very frequent across mental disorders, but SIB patients are particularly exposed. Specific interventions focused on insomnia are useful in contending suicidal ideation. Nightmares seem to constitute an independent risk factor for SIB, beyond insomnia, particularly in young people and when experienced frequently. The evidence regarding the association of EDS and SIB is less clear and probably explained by the reduction of health-related quality of life and comorbid depression. The mechanisms underlying the relationship between sleep disturbances and SIB as well as the role of potential confounders and future perspectives in this field are also discussed.
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Affiliation(s)
- Jorge Lopez-Castroman
- PSNREC, University of Montpellier, INSERM, Montpellier, France. .,Nimes University Hospital, Nimes, France. .,CIBERSAM, Madrid, Spain.
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Steine IM, Nielsen B, Porter PA, Krystal JH, Winje D, Grønli J, Milde AM, Bjorvatn B, Nordhus IH, Pallesen S. Predictors and correlates of lifetime and persistent non-suicidal self-injury and suicide attempts among adult survivors of childhood sexual abuse. Eur J Psychotraumatol 2020; 11:1815282. [PMID: 33312451 PMCID: PMC7717684 DOI: 10.1080/20008198.2020.1815282] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background: Childhood sexual abuse (CSA) is a well-established risk factor for non-suicidal self-injury (NSSI) and suicide attempts (SA); still few studies have examined predictors of individual differences in NSSI/SA amongst CSA survivors. Objective: To examine predictors of NSSI and SA among adult CSA-survivors. Methods: In a sample of 516, primarily female adult CSA-survivors recruited from support centres for sexual abuse survivors in Norway, we examined the role of abuse/perpetrator characteristics, and the degree/severity of exposure to other types of childhood maltreatment (cumulative childhood maltreatment; CCM), as predictors of lifetime NSSI and SA. In a subsample of 138 individuals responding to follow-up waves two- and four years later, these same distal factors, as well as previous NSSI and proximal factors in the form of symptoms of mental health disorders (posttraumatic stress, anxiety, depression, sleep disturbances, and eating disorders), relational problems, and perceived social support, were examined as predictors of persistent NSSI. Finally, those attempting new SA during the follow-up period were compared to those who did not on these variables. Results: Higher CCM scores and having had an unknown perpetrator positively predicted lifetime NSSI scores. Higher CCM scores, violent abuse, and having had an unknown perpetrator predicted lifetime SA. Higher CCM scores, previous NSSI, having had a known perpetrator, as well as higher depression-, anxiety- and eating disorder scores, positively predicted persistent NSSI during the four-year follow-up period. Compared to those with no new SA, those reporting new SA during the follow-up period had higher CCM, lifetime NSSI, mental health symptoms and relational problem scores, lower perceived social support scores, and were more likely to have done a past SA and to have experienced abuse involving physical violence. Conclusions: A broad range of both distal and proximal factors should be assessed as potential predictors of NSSI and SA among adult CSA-survivors.
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Affiliation(s)
- Iris M Steine
- Department of Psychology, UC Berkeley, Berkeley, CA, USA.,Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | | | | | - John H Krystal
- Clinical Neuroscience Division, VA National Center for PTSD, West Haven, CT, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Dagfinn Winje
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Janne Grønli
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Anne Marita Milde
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway.,NORCE AS - Regional Centre for Child and Youth Mental Health and Child Welfare, Bergen, Norway
| | - Bjørn Bjorvatn
- Department of Global Public Health and Primary Health Care, University of Bergen, Bergen, Norway.,Norwegian Competence Center of Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Inger Hilde Nordhus
- Department of Clinical Psychology, University of Bergen, Bergen, Norway.,Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Ståle Pallesen
- Department of Psychosocial Science, University of Bergen, Bergen, Norway.,Norwegian Competence Center of Sleep Disorders, Haukeland University Hospital, Bergen, Norway
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Jahrami H, Alekri E, BaHammam AS, Alsalman A, Bragazzi NL, Alhaj O, Saif Z. The association between micronutrient status and sleep quality in patients with depression: a case-control study. Sleep Breath 2020; 25:1571-1579. [PMID: 33070286 DOI: 10.1007/s11325-020-02228-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/07/2020] [Accepted: 10/13/2020] [Indexed: 01/05/2023]
Abstract
PURPOSE Few previous studies estimated the association between micronutrient status and sleep quality; no previous work was done in patients with depression compared with healthy controls. METHODS Using a case-control design, 96 patients with depression were age- and sex-matched with 96 healthy controls. Dietary assessment utilized a standardized questionnaire, and analysis focused comprehensively on 18 micronutrient items. Sleep quality was measured using the Pittsburg Sleep Quality Index (PSQI). Descriptive statistics were used to summarize findings. Logistic regression analysis was used to identify predictors of poor sleep quality. RESULTS Patients with depression had a significantly lower sleep quality than controls with PSQI scores of 7.3 ± 2.7 and 5.1 ± 2.5, respectively. The prevalence of poor sleep quality in patients with depression was almost double the prevalence of poor sleep quality in the general population. The micronutrient status of vitamin B12 and Mg successfully predicted sleep quality in healthy controls. However, in patients with depression, micronutrient status failed to predict sleep quality. CONCLUSIONS The current research showed that sleep quality was positively associated with Mg intake, and negatively associated with vitamin B12 in healthy adults. For patients with depression in this study sample, sleep quality was not associated with micronutrient intake status. Further research is needed to determine if intake of micronutrients can improve sleep and/or depressive symptoms in patients with depression.
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Affiliation(s)
- Haitham Jahrami
- Ministry of Health, P.O. Box 12, Manama, Bahrain.
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain.
| | - Eman Alekri
- Ministry of Health, P.O. Box 12, Manama, Bahrain
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Ahmed S BaHammam
- Department of Medicine, College of Medicine, Respiratory Medicine/University Sleep Disorders Center, King Saud University, Box 225503, Riyadh, 11324, Saudi Arabia
- The Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation in the Kingdom of Saudi Arabia, Riyadh, Saudi Arabia
| | - Ali Alsalman
- Ministry of Health, P.O. Box 12, Manama, Bahrain
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON, Canada
| | - Omar Alhaj
- Department of Nutrition, Faculty of Pharmacy and Medical Sciences, University of Petra, Amman, Jordan
| | - Zahra Saif
- Ministry of Health, P.O. Box 12, Manama, Bahrain
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ter Heege FM, Mijnster T, van Veen MM, Pijnenborg GHM, de Jong PJ, Boersma GJ, Lancel M. The clinical relevance of early identification and treatment of sleep disorders in mental health care: protocol of a randomized control trial. BMC Psychiatry 2020; 20:331. [PMID: 32580724 PMCID: PMC7313112 DOI: 10.1186/s12888-020-02737-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/15/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Sleep disorders are a risk factor for developing a variety of mental disorders, have a negative impact on their remission rates and increase the risk of relapse. Early identification and treatment of sleep disorders is therefore of paramount importance. Unfortunately, in mental health care sleep disorders are often poorly recognized and specific treatment frequently occurs late or not at all. This protocol-paper presents a randomized controlled trial investigating the clinical relevance of early detection and treatment of sleep disorders in mental health care. The two aims of this project are 1) to determine the prevalence of sleep disorders in different mental disorders, and 2) to investigate the contribution of early identification and adequate treatment of sleep disorders in individuals with mental disorders to their sleep, mental disorder symptoms, general functioning, and quality of life. METHODS Patients newly referred to a Dutch mental health institute for psychiatric treatment will be screened for sleep disorders with the self-assessment Holland Sleep Disorders Questionnaire (HSDQ). Patients scoring above the cut-off criteria will be invited for additional diagnostic evaluation and, treatment of the respective sleep disorder. Participants will be randomly assigned to two groups: Immediate sleep diagnostics and intervention (TAU+SI-T0), or delayed start of sleep intervention (TAU+SI-T1; 6 months after inclusion). The effect of sleep treatment as add-on to treatment as usual (TAU) will be tested with regard to sleep disorder symptoms, general functioning, and quality of life (in collaboration with a psychiatric sleep centre). DISCUSSION This trial will examine the prevalence of different sleep disorders in a broad range of mental disorders, providing information on the co-occurrence of specific sleep and mental disorders. Further, this study is the first to investigate the impact of early treatment of sleep disorders on the outcome of many mental disorders. Moreover, standard sleep interventions will be tailored to specific mental disorders, to increase their efficacy. The results of this trial may contribute considerably to the improvement of mental health care. TRIAL REGISTRATION This clinical trial has been retrospectively registered in the Netherlands Trial Register (NL8389; https://www.trialregister.nl/trial/8389) on February 2th, 2020.
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Affiliation(s)
- Fiona M. ter Heege
- grid.468637.80000 0004 0465 6592GGZ Drenthe Mental Health Institute, 9404 LA Assen, The Netherlands
| | - Teus Mijnster
- grid.468637.80000 0004 0465 6592GGZ Drenthe Mental Health Institute, 9404 LA Assen, The Netherlands
| | - Maaike M. van Veen
- grid.468637.80000 0004 0465 6592GGZ Drenthe Mental Health Institute, 9404 LA Assen, The Netherlands
| | - Gerdina H. M. Pijnenborg
- grid.468637.80000 0004 0465 6592GGZ Drenthe Mental Health Institute, 9404 LA Assen, The Netherlands ,grid.4830.f0000 0004 0407 1981Department of clinical and Developmental Neuropsychology, University of Groningen, Groningen, the Netherlands
| | - Peter J. de Jong
- grid.4830.f0000 0004 0407 1981Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
| | - Gretha J. Boersma
- grid.468637.80000 0004 0465 6592GGZ Drenthe Mental Health Institute, 9404 LA Assen, The Netherlands
| | - Marike Lancel
- GGZ Drenthe Mental Health Institute, 9404 LA, Assen, The Netherlands. .,Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, the Netherlands.
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Hedström AK, Hössjer O, Trolle Lagerros Y, Åkerstedt T. Short‐ and long‐term mortality following hypnotic use. J Sleep Res 2020; 29:e13061. [DOI: 10.1111/jsr.13061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 04/01/2020] [Accepted: 04/09/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Anna Karin Hedström
- Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden
- Institute of Environmental Medicine Karolinska Institutet Stockholm Sweden
| | - Ola Hössjer
- Mathematical Statistics Stockholm University Stockholm Sweden
| | - Ylva Trolle Lagerros
- Clinical Epidemiology Division Department of Medicine Karolinska Institutet Stockholm Sweden
- Center for Obesity Academic Specialist Center Stockholm Health Services Stockholm Sweden
| | - Torbjörn Åkerstedt
- Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden
- Stress Research Stockholm University Stockholm Sweden
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44
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The association between baseline insomnia symptoms and future suicide attempts within an intensive outpatient treatment program for suicide. Psychiatry Res 2020; 287:112527. [PMID: 31447234 DOI: 10.1016/j.psychres.2019.112527] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 08/16/2019] [Accepted: 08/17/2019] [Indexed: 11/22/2022]
Abstract
This study examines the prospective relationship between insomnia symptoms and suicide attempts in high-risk youth. We obtained depressive symptoms, insomnia symptoms, and suicide ideation measures from clinical records of 206 adolescents ages 12-17 at entry and discharge from a suicide prevention intensive outpatient program. Information about whether the participant made a suicide attempt was available through six months after discharge. Patients were mainly girls (79.1%; n = 163) with depression (89.8%; n = 185). Associations between insomnia symptoms, attempts within 6 months of discharge, persistent insomnia symptoms, and suicide ideation at discharge were tested with multiple regression analyses. Entry insomnia symptoms were prospectively associated with attempts when controlling for age, sex, and previous attempts, but insomnia symptoms at discharge were not. Suicide ideation at discharge was associated both with entry insomnia symptoms and attempts within 6 months of discharge. When entry and discharge suicide ideation were controlled, the association between entry insomnia symptoms and attempts lost significance. However, the association between discharge ideation and attempts remained significant. Insomnia symptoms contribute indirectly to suicide attempt risk after discharge. Intensive treatment for ideation and reducing insomnia symptoms could reduce discharge suicide risk and subsequent suicide attempts.
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Tubbs AS, Perlis ML, Basner M, Chakravorty S, Khader W, Fernandez F, Grandner MA. Relationship of Nocturnal Wakefulness to Suicide Risk Across Months and Methods of Suicide. J Clin Psychiatry 2020; 81:19m12964. [PMID: 32097547 PMCID: PMC8121668 DOI: 10.4088/jcp.19m12964] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 09/11/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Insomnia is a risk factor for suicide, and the risk of suicide after accounting for population wakefulness is disproportionately highest at night. This study investigated whether this risk varied across months and/or methods of suicide. METHODS Time, date, method (eg, firearm, poisoning), and demographic information for 35,338 suicides were collected from the National Violent Death Reporting System for the years 2003-2010. Time of fatal injury was grouped into 1-hour bins and compared to the estimated hourly proportion of the population awake from the American Time Use Survey for 2003-2010. Negative binomial modeling then generated hourly incidence risk ratios (IRRs) of suicide. Risks were then aggregated into 4 categories: morning (6:00 am to 11:59 am), afternoon (noon to 5:59 pm), evening (6:00 pm to 11:59 pm), and night (midnight to 5:59 am). RESULTS The risk of suicide was higher at night across all months (P < .001) and methods (P < .001). The mean nocturnal IRR across months was 3.18 (SD = 0.314), with the highest IRR in May (3.90) and the lowest in November (2.74). The mean (SD) nocturnal IRR across methods was 3.09 (0.472), with the highest IRR for fire (3.75) and the lowest for drowning (2.44). Additionally, nocturnal risk was elevated within all demographics (all P < .001). However, there were no month-by-time or method-by-time interactions across demographics (all P > .05). CONCLUSIONS Regardless of month or method, the incidence risk of suicide at night is higher than at any other time of day. Additionally, demographic subgroups did not differentially experience higher risks across months or mechanisms at night.
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Affiliation(s)
- Andrew S Tubbs
- Department of Psychiatry, University of Arizona, College of Medicine, PO Box 245002, Tucson, AZ 85724-5002. .,Sleep and Health Research Program, Department of Psychiatry, University of Arizona, Tucson, Arizona, USA
| | - Michael L Perlis
- University of Pennsylvania, Department of Psychiatry, Philadelphia, Pennsylvania, USA
| | - Mathias Basner
- University of Pennsylvania, Department of Psychiatry, Philadelphia, Pennsylvania, USA
| | - Subhajit Chakravorty
- University of Pennsylvania, Department of Psychiatry, Philadelphia, Pennsylvania, USA
| | - Waliuddin Khader
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona, Tucson, Arizona, USA,Department of Psychology, University of Arizona, Tucson, Arizona, USA
| | - Fabian Fernandez
- Department of Psychology, University of Arizona, Tucson, Arizona, USA
| | - Michael A Grandner
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona, Tucson, Arizona, USA
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Lu YC, Wu MK, Zhang L, Zhang CL, Lu YY, Wu CH. Association between suicide risk and traumatic brain injury in adults: a population based cohort study. Postgrad Med J 2020; 96:747-752. [PMID: 32015186 PMCID: PMC7788485 DOI: 10.1136/postgradmedj-2019-136860] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 12/01/2019] [Accepted: 12/31/2019] [Indexed: 12/16/2022]
Abstract
Background Traumatic brain injury (TBI) is a major cause of death and disability worldwide, and its treatment is potentially a heavy economic burden. Suicide is another global public health problem and the second leading cause of death in young adults. Patients with TBI are known to have higher than normal rates of non-fatal deliberate self-harm, suicide and all-cause mortality. The aim of this study was to explore the association between TBI and suicide risk in a Chinese cohort. Method This study analysed data contained in the Taiwan National Health Insurance Research Database for 17 504 subjects with TBI and for 70 016 subjects without TBI matched for age and gender at a ratio of 1 to 4. Cox proportional hazard regression analysis was used to estimate subsequent suicide attempts in the TBI group. Probability of attempted suicide was determined by Kaplan-Meier method. Results The overall risk of suicide attempts was 2.23 times higher in the TBI group compared with the non-TBI group (0.98 vs 0.29 per 1000 person-years, respectively) after adjustment for covariates. Regardless of gender, age or comorbidity, the TBI group tended to have more suicide attempts, and the risk attempted suicide increased with the severity of TBI. Depression and alcohol attributed disease also increased the risk of attempted suicide in the TBI group. Conclusion Suicide is preventable if risk factors are recognised. Hence, TBI patients require special attention to minimise their risk of attempted suicide.
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Affiliation(s)
- Yueh-Chien Lu
- Department of Family Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ming-Kung Wu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Li Zhang
- Department of Neurosurgery, The Affiliated Zhangjiagang Hospital of Soochow University, Zhangjiagang, China
| | - Cong-Liang Zhang
- Department of Cardiology, Hebei Quyang Renji Hospital, Quyang, China
| | - Ying-Yi Lu
- Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chieh-Hsin Wu
- Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan .,Department of Surgery, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Abstract
PURPOSE OF REVIEW As a global pandemic, COVID-19 has profoundly disrupted the lives of individuals, families, communities, and nations. This report summarizes the expected impact of COVID-19 on behavioral health, as well as strategies to address mental health needs during the COVID-19 pandemic and its aftermath. The state of Michigan in the USA is used to illustrate the complexity of the mental health issues and the critical gaps in the behavioral health infrastructure as they pertain to COVID-19. Scoping review was conducted to identify potential mental health needs and issues during the COVID-19 pandemic and its aftermath. RECENT FINDINGS The ramifications of COVID-19 on mental health are extensive, with the potential to negatively impact diverse populations including healthcare providers, children and adolescents, older adults, the LGBTQ community, and individuals with pre-existing mental illness. Suicide rates, alone, are expected to rise for Michiganders due to the economic downturn, isolation and quarantine, increased substance use, insomnia, and increased access to guns associated with the COVID-19 pandemic. This report promotes awareness of a behavioral health crisis due to COVID-19. Increasing access to behavioral health care should minimize COVID-19's negative influence on mental health in Michigan. We propose a three-prong approach to access: awareness, affordability, and technology. Addressing workforce development and fixing gaps in critical behavioral health infrastructure will also be essential. These actions need to be implemented immediately to prepare for the expected "surge" of behavioral health needs in the ensuing months.
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Provencher T, Lemyre A, Vallières A, Bastien CH. Insomnia in personality disorders and substance use disorders. Curr Opin Psychol 2019; 34:72-76. [PMID: 31778972 DOI: 10.1016/j.copsyc.2019.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 10/05/2019] [Accepted: 10/21/2019] [Indexed: 11/30/2022]
Abstract
The relationship between certain personality disorders (PDs) and insomnia has been the object of few studies in recent years. Even though it is not indicated to use polysomnography to diagnose insomnia, objective measures have shown sleep abnormalities in individuals with a personality disorder and insomnia. Interestingly, there is increasing evidence that emotion dysregulation is involved in a mutually aggravating relationship between Borderline Personality Disorder (BPD) and insomnia. While BPD traits are highly associated with suicide ideation and attempts, these behaviors could be potentiated or enhanced in individuals presenting sleep disturbances. Because BPD and other mental disorders are often linked with the use of medication or other substances, it is also important to review the association between substance use disorders (SUD) and insomnia. SUD can disrupt sleep and foster insomnia, which in turn might increase motivation to use substances. Insomnia has also been shown to precede (i.e., predict) SUD, and can be present during withdrawal as well. These results highlight the need to assess and treat insomnia when working with patients who present a PD or SUD.
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Affiliation(s)
| | | | - Annie Vallières
- School of Psychology, Université Laval, Québec, QC, Canada; CERVO Brain Research Center, Québec, QC, Canada; Psycho- Socio- Cultural Sleep Laboratory, School of Psychology, Université Laval, Québec, QC, Canada; CHU Research Center - Université Laval, Québec, QC, Canada
| | - Célyne H Bastien
- School of Psychology, Université Laval, Québec, QC, Canada; CERVO Brain Research Center, Québec, QC, Canada; Psycho- Socio- Cultural Sleep Laboratory, School of Psychology, Université Laval, Québec, QC, Canada; CHU Research Center - Université Laval, Québec, QC, Canada; Research Laboratory on Human Neurophysiology and Sleep, School of psychology, Université Laval, Québec, QC, Canada.
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Abstract
Purpose of Review To evaluate and summarize recent research articles pertaining to insomnia in older adults that can guide healthcare providers on factors to consider when assessing and managing insomnia. Recent Findings Up to 75% of older adults experience symptoms of insomnia. Insomnia is associated with socioeconomic status, racial and ethnic classification, family relationships, medical and mental health disorders, cognitive function, and dementia. Although one-fifth of older adults are still prescribed sleep medications, cognitive behavioral therapy for insomnia is the first line treatment for insomnia, resulting in short-term and long-term benefits. Summary To manage insomnia safely and effectively, healthcare providers need to consistently assess for insomnia during baseline and annual assessments, evaluate medical and social factors associated with insomnia, minimize the use of sleep medications, and provide referrals to and/or collaborate with providers who perform cognitive behavioral therapy for insomnia. Insomnia screening is important as it facilitates early intervention with behavioral management, reduces the potential for pharmacological management, which increases fall risk in older adults, and enables further assessment and early identification of outcomes such as cognitive impairment.
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