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Don Richardson J, King L, St. Cyr K, Shnaider P, Roth ML, Ketcheson F, Balderson K, Elhai JD. Depression and the relationship between sleep disturbances, nightmares, and suicidal ideation in treatment-seeking Canadian Armed Forces members and veterans. BMC Psychiatry 2018; 18:204. [PMID: 29921268 PMCID: PMC6011186 DOI: 10.1186/s12888-018-1782-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 06/11/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Research on the relationship between insomnia and nightmares, and suicidal ideation (SI) has produced variable findings, especially with regard to military samples. This study investigates whether depression mediated the relationship between: 1) sleep disturbances and SI, and 2) trauma-related nightmares and SI, in a sample of treatment-seeking Canadian Armed Forces (CAF) personnel and veterans (N = 663). METHOD Regression analyses were used to investigate associations between sleep disturbances or trauma-related nightmares and SI while controlling for depressive symptom severity, posttraumatic stress disorder (PTSD) symptom severity, anxiety symptom severity, and alcohol use severity. Bootstrapped resampling analyses were used to investigate the mediating effect of depression. RESULTS Approximately two-thirds of the sample (68%; N = 400) endorsed sleep disturbances and 88% (N = 516) reported experiencing trauma-related nightmares. Although sleep disturbances and trauma-related nightmares were both significantly associated with SI on their own, these relationships were no longer significant when other psychiatric conditions were included in the models. Instead, depressive symptom severity emerged as the only variable significantly associated with SI in both equations. Bootstrap resampling analyses confirmed a significant mediating role of depression for sleep disturbances. CONCLUSIONS The findings suggest that sleep disturbances and trauma-related nightmares are associated with SI as a function of depressive symptoms in treatment-seeking CAF personnel and veterans. Treating depression in patients who present with sleep difficulties may subsequently help mitigate suicide risk.
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Affiliation(s)
- J. Don Richardson
- Parkwood Institute Operational Stress Injury Clinic, London, ON Canada
- Department of Psychiatry, Western University, London, ON Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON Canada
| | - Lisa King
- Parkwood Institute Operational Stress Injury Clinic, London, ON Canada
| | - Kate St. Cyr
- Parkwood Institute Operational Stress Injury Clinic, London, ON Canada
| | - Philippe Shnaider
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON Canada
- Anxiety Treatment and Research Centre, St. Joseph’s Healthcare Hamilton, Hamilton, ON Canada
| | - Maya L. Roth
- Parkwood Institute Operational Stress Injury Clinic, London, ON Canada
- Department of Graduate Studies, Ryerson University, Toronto, ON Canada
| | - Felicia Ketcheson
- Parkwood Institute Operational Stress Injury Clinic, London, ON Canada
| | - Ken Balderson
- Parkwood Institute Operational Stress Injury Clinic, London, ON Canada
- Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | - Jon D. Elhai
- Departments of Psychology and Psychiatry, University of Toledo, Toledo, OH USA
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Stein MB, Ware EB, Mitchell C, Chen C, Borja S, Cai T, Dempsey CL, Fullerton CS, Gelernter J, Heeringa SG, Jain S, Kessler RC, Naifeh JA, Nock MK, Ripke S, Sun X, Beckham JC, Kimbrel NA, Ursano RJ, Smoller JW. Genomewide association studies of suicide attempts in US soldiers. Am J Med Genet B Neuropsychiatr Genet 2017; 174:786-797. [PMID: 28902444 PMCID: PMC5685938 DOI: 10.1002/ajmg.b.32594] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 08/11/2017] [Indexed: 12/19/2022]
Abstract
Suicide is a global public health problem with particular resonance for the US military. Genetic risk factors for suicidality are of interest as indicators of susceptibility and potential targets for intervention. We utilized population-based nonclinical cohorts of US military personnel (discovery: N = 473 cases and N = 9778 control subjects; replication: N = 135 cases and N = 6879 control subjects) and a clinical case-control sample of recent suicide attempters (N = 51 cases and N = 112 control subjects) to conduct GWAS of suicide attempts (SA). Genomewide association was evaluated within each ancestral group (European-, African-, Latino-American) and study using logistic regression models. Meta-analysis of the European ancestry discovery samples revealed a genomewide significant locus in association with SA near MRAP2 (melanocortin 2 receptor accessory protein 2) and CEP162 (centrosomal protein 162); 12 genomewide significant SNPs in the region; peak SNP rs12524136-T, OR = 2.88, p = 5.24E-10. These findings were not replicated in the European ancestry subsamples of the replication or suicide attempters samples. However, the association of the peak SNP remained significant in a meta-analysis of all studies and ancestral subgroups (OR = 2.18, 95%CI 1.70, 2.80). Polygenic risk score (PRS) analyses showed some association of SA with bipolar disorder. The association with SNPs encompassing MRAP2, a gene expressed in brain and adrenal cortex and involved in neural control of energy homeostasis, points to this locus as a plausible susceptibility gene for suicidality that should be further studied. Larger sample sizes will be needed to confirm and extend these findings.
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Affiliation(s)
- Murray B. Stein
- Department of PsychiatryUniversity of California San Diego and VA San Diego Healthcare SystemLa JollaCalifornia
- Department of Family Medicine and Public HealthUniversity of California San DiegoLa JollaCalifornia
| | - Erin B. Ware
- Institute for Social ResearchUniversity of MichiganAnn ArborMichigan
| | - Colter Mitchell
- Institute for Social ResearchUniversity of MichiganAnn ArborMichigan
| | - Chia‐Yen Chen
- Department of Psychiatry, Massachusetts General HospitalHarvard Medical SchoolBostonMassachusetts
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic MedicineMassachusetts General HospitalBostonMassachusetts
- Stanley Center for Psychiatric ResearchBroad Institute of MIT and HarvardCambridgeMassachusetts
| | - Susan Borja
- National Institute of Mental HealthBethesdaMaryland
| | - Tianxi Cai
- Harvard T.H. Chan School of Public HealthBostonMassachusetts
| | | | | | - Joel Gelernter
- Departments of Psychiatry, Genetics, and NeurobiologyYale UniversityNew HavenConnecticut
| | | | - Sonia Jain
- Department of Family Medicine and Public HealthUniversity of California San DiegoLa JollaCalifornia
| | - Ronald C. Kessler
- Department of Health Care PolicyHarvard Medical SchoolBostonMassachusetts
| | - James A. Naifeh
- Uniformed Services University of the Health SciencesBethesdaMaryland
| | - Matthew K. Nock
- Department of PsychologyHarvard UniversityCambridgeMassachusetts
| | - Stephan Ripke
- Stanley Center for Psychiatric ResearchBroad Institute of MIT and HarvardCambridgeMassachusetts
| | - Xiaoying Sun
- Department of Family Medicine and Public HealthUniversity of California San DiegoLa JollaCalifornia
| | - Jean C. Beckham
- Durham Veterans Affairs Health Care System and Duke University Health SystemDurhamNorth Carolina
- VA MIRECCDurhamNorth Carolina
| | - Nathan A. Kimbrel
- Durham Veterans Affairs Health Care System and Duke University Health SystemDurhamNorth Carolina
- VA MIRECCDurhamNorth Carolina
| | - Robert J Ursano
- Uniformed Services University of the Health SciencesBethesdaMaryland
| | - Jordan W. Smoller
- Department of Psychiatry, Massachusetts General HospitalHarvard Medical SchoolBostonMassachusetts
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic MedicineMassachusetts General HospitalBostonMassachusetts
- Stanley Center for Psychiatric ResearchBroad Institute of MIT and HarvardCambridgeMassachusetts
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Richardson JD, Thompson A, King L, Corbett B, Shnaider P, St. Cyr K, Nelson C, Sareen J, Elhai J, Zamorski M. Insomnia, psychiatric disorders and suicidal ideation in a National Representative Sample of active Canadian Forces members. BMC Psychiatry 2017; 17:211. [PMID: 28583100 PMCID: PMC5460415 DOI: 10.1186/s12888-017-1372-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 05/26/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Past research on the association between insomnia and suicidal ideation (SI) has produced mixed findings. The current study explored the relationship between insomnia, SI, and past-year mental health status among a large Canadian Forces (CF) sample. METHOD Data was obtained from the 2013 Canadian Forces Mental Health Survey (CFMHS), and included a large representative sample of Canadian Regular Forces personnel (N = 6700). A series of univariate logistic regressions were conducted to test individual associations between past-year mental health status, insomnia, and potential confounds and SI. Mental health status included three groups: 0, 1, or two or more probable diagnoses of posttraumatic stress disorder (PTSD), major depressive disorder (MDD), generalized anxiety disorder (GAD), panic disorder (PD) and alcohol abuse/dependence. Stepwise multivariate logistic regression was used to assess the relationship between insomnia and SI with mental health status as a moderator. RESULTS 40.8% of respondents reported experiencing insomnia. Both insomnia and number of mental health conditions incrementally increased the risk of SI. However, past-year mental health status was a significant moderator of this relationship, such that for CF personnel with either no (AOR = 1.61, 1.37-1.89) or only one past-year mental health condition (AOR = 1.39, 1.12-1.73), an incremental increase in insomnia was associated with an increased likelihood of SI. However, in personnel with two or more past-year mental health disorders, insomnia was no longer significantly associated with SI (AOR = 1.04, 0.81-1.33). CONCLUSIONS Insomnia significantly increased the odds of SI, but only among individuals with no or one mental health condition. Findings highlight the importance of assessing insomnia among CF members in order to further suicide prevention efforts.
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Affiliation(s)
- J. D. Richardson
- Western University, 1151 Richmond St, London, ON N6A 3K7 Canada
- McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8 Canada
- Parkwood Operational Stress Injury Clinic-Parkwood Institute-St. Joseph’s Health Care London, 550 Wellington Rd, London, ON N6C 0A7 Canada
- Canadian Forces Health Services Group and Department of Family Medicine, University of Ottawa, 75 Laurier Ave E, Ottawa, ON K1N 6N5 Canada
| | - A. Thompson
- Canadian Forces Health Services Group and Department of Family Medicine, University of Ottawa, 75 Laurier Ave E, Ottawa, ON K1N 6N5 Canada
| | - L. King
- Parkwood Operational Stress Injury Clinic-Parkwood Institute-St. Joseph’s Health Care London, 550 Wellington Rd, London, ON N6C 0A7 Canada
| | - B. Corbett
- Western University, 1151 Richmond St, London, ON N6A 3K7 Canada
- Canadian Forces Health Services Group and Department of Family Medicine, University of Ottawa, 75 Laurier Ave E, Ottawa, ON K1N 6N5 Canada
- Stamford International University, Prawet, Bangkok, 10250 Thailand
| | - P. Shnaider
- McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8 Canada
- St. Joseph’s Healthcare Hamilton, 2757 King Street East, Hamilton, ON L8G 5E4 Canada
- Ryerson University, 350 Victoria St, Toronto, ON M5B 2K3 Canada
| | - K. St. Cyr
- Parkwood Operational Stress Injury Clinic-Parkwood Institute-St. Joseph’s Health Care London, 550 Wellington Rd, London, ON N6C 0A7 Canada
| | - C. Nelson
- Western University, 1151 Richmond St, London, ON N6A 3K7 Canada
- Parkwood Operational Stress Injury Clinic-Parkwood Institute-St. Joseph’s Health Care London, 550 Wellington Rd, London, ON N6C 0A7 Canada
| | - J. Sareen
- University of Manitoba, 66 Chancellors Cir, Winnipeg, MB R3T 2N2 Canada
- Deer Lodge Centre Operational Stress Injury Clinic, 2109 Portage Avenue, Winnipeg, MB R3J 0L3 Canada
| | - J. Elhai
- University of Toledo, 2801 W Bancroft St, Toledo, OH 43606 USA
| | - M. Zamorski
- Canadian Forces Health Services Group and Department of Family Medicine, University of Ottawa, 75 Laurier Ave E, Ottawa, ON K1N 6N5 Canada
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Richardson D, King L, Shnaider P, Elhai JD. Adverse combat experiences, feeling responsible for death, and suicidal ideation in treatment-seeking Veterans and actively serving Canadian Armed Forces members. JOURNAL OF MILITARY, VETERAN AND FAMILY HEALTH 2017. [DOI: 10.3138/jmvfh.4105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Don Richardson
- Parkwood Operational Stress Injury Clinic, London, Ontario, Canada
| | - Lisa King
- Parkwood Operational Stress Injury Clinic, London, Ontario, Canada
| | - Philippe Shnaider
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Jon D. Elhai
- Department of Psychology, University of Toledo, Toledo, Ohio, USA
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Don Richardson J, Cyr KS, Nelson C, Elhai JD, Sareen J. Sleep disturbances and suicidal ideation in a sample of treatment-seeking Canadian Forces members and veterans. Psychiatry Res 2014; 218:118-23. [PMID: 24755040 DOI: 10.1016/j.psychres.2014.04.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 03/31/2014] [Accepted: 04/04/2014] [Indexed: 10/25/2022]
Abstract
This study examines the association between suicidal ideation and sleep disturbances in a sample of treatment-seeking Canadian Forces members and veterans, after controlling for probable posttraumatic stress disorder (PTSD), major depressive disorder (MDD), generalised anxiety disorder (GAD), and alcohol use disorder (AUD). Subjects included members and veterans of Canadian Forces seeking treatment at a hospital-based Operational Stress Injury Clinic (n=404). Sleep disturbances and nightmares were measured using individual items on the PTSD Checklist - Military Version (PCL - M), while the suicidality item of the Patient Health Questionnaire (PHQ-9) was used as a stand-alone item to assess presence or absence of suicidal ideation. Regression analyses were used to determine the respective impact of (1) insomnia and (2) nightmares on suicidal ideation, while controlling for presence of probable PTSD, MDD, GAD, and AUD. We found that 86.9% of patients reported having problems falling or staying asleep and 67.9% of patients reported being bothered by nightmares related to military-specific traumatic events. Neither sleep disturbances nor nightmares significantly predicted suicidal ideation; instead, probable MDD emerged as the most significant predictor. The clinical implications of these findings and their potential impact on treatment guidelines are discussed.
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Affiliation(s)
- J Don Richardson
- Parkwood Hospital Operational Stress Injury Clinic, St. Joseph׳s Health Care London, London, Ontario, Canada; Department of Psychiatry, Western University, London, Ontario, Canada; Department of Psychiatry and Behavioral Neuroscience, McMaster University, Hamilton, Ontario, Canada.
| | - Kate St Cyr
- Parkwood Hospital Operational Stress Injury Clinic, St. Joseph׳s Health Care London, London, Ontario, Canada
| | - Charles Nelson
- Parkwood Hospital Operational Stress Injury Clinic, St. Joseph׳s Health Care London, London, Ontario, Canada; Department of Psychology, Western University, London, Ontario, Canada
| | - Jon D Elhai
- Department of Psychology, University of Toledo, Toleldo, OH, USA; Department of Psychiatry, University of Toledo, Toleldo, OH, USA
| | - Jitender Sareen
- Deer Lodge Operational Stress Injury Clinic, Winnipeg, Manitoba, Canada; Department of Psychiatry,University of Manitoba, Winnipeg, Manitoba, Canada; Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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