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Palagini L, Cipriani E, Miniati M, Bramante A, Gemignani A, Geoffroy PA, Riemann D. Insomnia, poor sleep quality and perinatal suicidal risk: A systematic review and meta-analysis. J Sleep Res 2024; 33:e14000. [PMID: 37448156 DOI: 10.1111/jsr.14000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023]
Abstract
Suicidal risk in mothers is a public health priority. Risk factors include biological, psychological and psychosocial factors. Among the biological factors, the role of sleep disturbances as potential contributors to increased suicidal risk during the peripartum period is becoming apparent. To explore this further, we conducted a systematic review following the PRISMA criteria. Currently, 10 studies have examined the role of insomnia and poor sleep quality in suicidal risk during the peripartum period and have involved 807,760 women. The data showed that disturbed sleep and poor sleep quality increase the risk of suicidal ideation in both pregnant women with and without perinatal depression. The results of the meta-analysis indicated that insomnia and poor sleep quality increase the odds of suicidal risk in pregnant women by more than threefold (OR = 3.47; 95% CI: 2.63-4.57). Specifically, the odds ratio (OR) for poor sleep quality was 3.72 (95% CI: 2.58-5.34; p < 0.001), and for insomnia symptoms, after taking into account perinatal depression, was 4.76 (95% CI: 1.83-12.34; p < 0.001). These findings emphasise the importance of assessing and addressing sleep disturbances during the peripartum period to mitigate their adverse effects on peripartum psychopathology and suicidal risk.
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Affiliation(s)
- Laura Palagini
- Department of Experimental and Clinical Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Enrico Cipriani
- President of the Italian Section of the Marcè Society for Perinatal Psychopathology, Milan, Italy
| | - Mario Miniati
- Department of Experimental and Clinical Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Alessandra Bramante
- President of the Italian Section of the Marcè Society for Perinatal Psychopathology, Milan, Italy
| | - Angelo Gemignani
- Department of Surgical, Medical, Molecular, and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - Pierre A Geoffroy
- Department of Psychiatry and Addiction, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, Paris, France
- Centre ChronoS, GHU Paris - Psychiatry & Neurosciences, Paris, France
- Université Paris Cité, NeuroDiderot, Inserm, Paris, France
- CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, Strasbourg, France
| | - Dieter Riemann
- Department of Psychiatry and Psychotherapy, Medical Center- University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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McCall WV, Ribbens LT, Looney SW. Relationships among insomnia, executive function, and suicidal ideation in depressed outpatients: A mediation analysis. Scand J Psychol 2023; 64:105-112. [PMID: 36214265 DOI: 10.1111/sjop.12872] [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: 02/24/2022] [Revised: 08/29/2022] [Accepted: 09/08/2022] [Indexed: 12/01/2022]
Abstract
Insomnia is a risk factor for suicide, and both are associated with cognitive problems. However, prior research has not examined insomnia, cognition, and suicidal ideation within one sample. We describe cross-sectional associations among insomnia, psychomotor speed, set shifting, and suicidal ideation in 85 depressed adults. Greater insomnia was associated with slower psychomotor speed, while slower psychomotor speed was associated with a greater level (i.e., elaboration of suicide planning) and intensity of suicidal ideation in the past week. Slower set shifting was associated with a greater level and intensity of suicidal ideation in the past week. Mediation analysis indicated that psychomotor speed and set shifting both had a significant total effect on the intensity of suicidal ideation in the past week; set shifting also had a significant total effect on the sum of intensity and suicidal ideation level in the past week. The level of insomnia explained only small percentages of the total effect of either psychomotor speed or set shifting on the intensity of suicidal ideation and the sum of intensity and suicidal ideation level. The findings in this sample demonstrate significant associations of slower psychomotor speed and set shifting with suicidal ideation, with negligible contribution from insomnia.
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Affiliation(s)
- William V McCall
- Department of Psychiatry and Health Behavior; Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Lucas T Ribbens
- Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Stephen W Looney
- Department of Population Health Sciences; Medical College of Georgia, Augusta University, Augusta, Georgia, USA
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Reid HE, Pratt D, Edge D, Wittkowski A. Maternal Suicide Ideation and Behaviour During Pregnancy and the First Postpartum Year: A Systematic Review of Psychological and Psychosocial Risk Factors. Front Psychiatry 2022; 13:765118. [PMID: 35401283 PMCID: PMC8987004 DOI: 10.3389/fpsyt.2022.765118] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
Suicide is a leading cause of maternal death during pregnancy and up to a year after birth (perinatal period). Many psychological and psychosocial risk factors for maternal suicidal ideation and behaviour have been investigated. Despite this, there have been no attempts to systematically search the literature on these risk factors. Additionally, few studies have described how the risk factors for suicidal ideation, attempted suicides and suicide deaths differ, which is essential for the development of tools to detect and target suicidal ideation and behaviour. Seven databases were searched up to June 2021 for studies that investigated the association between suicidal ideation and/or suicidal behaviour and psychological/psychosocial risk factors in pregnant and postpartum women. The search identified 17,338 records, of which 59 were included. These 59 studies sampled a total of 49,929 participants and investigated 32 different risk factors. Associations between abuse, experienced recently or during childhood, and maternal suicide ideation, attempted suicide and death were consistently reported. Social support was found to be less associated with suicide ideation but more so with suicide attempts. Identifying women who have experienced domestic violence or childhood abuse and ensuring all women have adequate emotional and practical support during the perinatal period may help to reduce the likelihood of suicidal behaviour.
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Affiliation(s)
- Holly E. Reid
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Daniel Pratt
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Dawn Edge
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Anja Wittkowski
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
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Abstract
PURPOSE OF REVIEW Suicide is a leading cause of death in the perinatal period (pregnancy and 1 year postpartum). We review recent findings on prevalence, risk factors, outcomes, and prevention and intervention for suicide during pregnancy and the first year postpartum. RECENT FINDINGS Standardization of definitions and ascertainment of maternal deaths have improved identification of perinatal deaths by suicide and risk factors for perinatal suicide. Reports of a protective effect of pregnancy and postpartum on suicide risk may be inflated. Clinicians must be vigilant for risk of suicide among their perinatal patients, especially those with mental health diagnoses or prior suicide attempts. Pregnancy and the year postpartum are a time of increased access to healthcare for many, offering many opportunities to identify and intervene for suicide risk. Universal screening for suicide as part of assessment of depression and anxiety along with improved access to mental health treatments can reduce risk of perinatal suicide.
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Affiliation(s)
- Kathleen Chin
- Department of Psychiatry and Behavioral Sciences, University of Washington, 1959, NE Pacific Street, Box 356560, Seattle, WA 98195 USA
| | - Amelia Wendt
- Department of Psychiatry and Behavioral Sciences, University of Washington, 1959, NE Pacific Street, Box 356560, Seattle, WA 98195 USA
| | - Ian M. Bennett
- Department of Psychiatry and Behavioral Sciences, University of Washington, 1959, NE Pacific Street, Box 356560, Seattle, WA 98195 USA ,Department of Family Medicine, University of Washington, Seattle, WA USA ,Department of Global Health, University of Washington, Seattle, WA USA
| | - Amritha Bhat
- Department of Psychiatry and Behavioral Sciences, University of Washington, 1959, NE Pacific Street, Box 356560, Seattle, WA, 98195, USA.
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Arditi-Arbel B, Hamdan S, Winterman M, Gvion Y. Suicidal ideation and behavior among perinatal women and their association with sleep disturbances, medical conditions, and known risk factors. Front Psychiatry 2022; 13:987673. [PMID: 36741562 PMCID: PMC9893018 DOI: 10.3389/fpsyt.2022.987673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 12/28/2022] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE Suicide is considered one of the leading causes of maternal mortality, especially among women with postpartum depression. In the current systematic review, we conducted a qualitative data synthesis of recent studies exploring novel risk factors including sleep disturbances and medical conditions, alongside known and significant risk factors for perinatal suicidality. EVIDENCE ACQUISITION We conducted a systematic search of the literature according to PRISMA guidelines on PubMed, PsycNET, and Scopus databases. Search terms were "pregnancy" "OR" "postpartum" "OR" "peripartum" "OR" "perinatal" "OR" "postnatal" combined with the Boolean "AND" operator with "suicide" "OR" "suicidality" "OR" "suicidal ideation" "OR" "suicidal behavior." EVIDENCE SYNTHESIS The initial search yielded 1,458 records, of which 51 research reports that met inclusion criteria were analyzed. These 51 studies sampled a total of 45,942 participants. Clinically, sleep disturbance, psychopathology, and social support have been identified as dominant risk factors for suicidal behavior among pregnant and postpartum women, as well as medical conditions and aversive life events. CONCLUSION Monitoring sleep disturbance, depression, and perceived social support is critical given that they are significant risk factors for suicide among perinatal women. Early identification of perinatal women who may be at risk of suicide, although not depressed, is crucial. LIMITATIONS The use of tools designed to identify depression to identify suicidal risk, fail to identify women who are at risk but who do not suffer from depression. Other methodological limitations are the lack of longitudinal studies and the complexity of examining suicidal behavior in sample studies.
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Affiliation(s)
- Bar Arditi-Arbel
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
| | - Sami Hamdan
- Department of Psychology, The Academic College of Tel Aviv-Yaffo, Tel Aviv-Yafo, Israel
| | - May Winterman
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
| | - Yari Gvion
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
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