Sleep Duration Is Closely Associated with Suicidal Ideation and Suicide Attempt in Korean Adults: A Nationwide Cross-Sectional Study

Associations between multiple sleep dimensions and suicide and non-suicidal self-injury: a cross-sectional study of 3828 Chinese young people

PURPOSE

Suicide and non-suicidal self-injury (NSSI) are preventable concerns in young people. Suicidal ideation (SI), suicidal plans (SP) and suicidal attempt (SA) are closely related to death. Sleep problems are known risk factors for suicide and NSSI. This study aimed to explore the relationship between sleep, suicidality and NSSI.

METHODS

Participants were 3,828 middle school and college students aged 11-23 years from urban and rural areas of Henan Province. Sleep, suicidal phenomena and NSSI were assessed by applying self-reported questionnaires. Chi-squared tests were utilized to demonstrate the demographic data and sleep variables. The correlation between sleep, suicidality and NSSI were explored by using binary logistic regression, while adjusting socio-demographic characteristics with multivariate models.

RESULTS

Sleep variables except mid-sleep time were related to suicidal phenomena (P < 0.05). Greater social jet lag (SJL) [≥ 2 h (h)] was associated with increased risk of SI [Odds ratios (OR) = 1.72, 95% confidence intervals (CI):1.40-2.11], SP (OR = 2.10, 95%CI:1.59-2.79) and SA (OR = 1.50, 95%CI:1.00-2.26). Non-only child participants with SJL (≥ 2 h) had significantly increased odds of SI (OR = 1.75, 95%CI: 1.41-2.18) and SP (OR = 2.25, 95%CI: 1.66-3.05). Eveningness chronotype had the strongest correlation with SI (OR = 3.87, 95%CI:2.78-5.38), SP (OR = 4.72, 95%CI:2.97-7.50), SA (OR = 6.69, 95%CI:3.08-14.52) and NSSI (OR = 1.39, 95%CI:1.02-1.90).

CONCLUSION

Overlong or short sleep duration, SJL, eveningness chronotype and other sleep abnormalities (e.g., daytime dysfunction, low sleep efficiency) were associated with a higher prevalence of SI, SP and SA. Additionally, eveningness was significantly correlated with NSSI among young people. These findings suggested the importance of assessing and intervening in sleep habits to prevent suicide and NSSI in young people.

Sensitivity to thyroid hormones is associated with sleep duration in the euthyroid population with depression degree lower than moderate

We collected thyroid-related hormone index levels, sleep duration, and other basic characteristics of the population with depression from the NHANES 2009-2012 cycles and evaluated the association of Thyroid-Stimulating Hormone Index (TSHI) with sleep duration in the euthyroid population with depression via different analysis methods. We found that the association between TSHI and sleep duration was only found in patients with depression degree < Moderate (score: 1-14) rather than > Moderate group. Among the populations with degree < Moderate (N = 1918), only 4 indexes (parametric Thyroid Feedback Quantile Index, PTFQI, Thyrotroph Thyroxine Resistance Index, TT4RI, Thyroid-Stimulating Hormone TSH, and TSHI) reflecting the sensitivity to thyroid hormones were related to the sleep duration, with a significant non-linear relationship after adjusting for potential confounders (all P < 0.05). Trend analysis indicated that with the level increase of these 4 indexes, the sleep duration increased (all P for trend < 0.001). Further, we found that TSHI was relatively more important among the 4 indexes. Sum up, sensitivity to thyroid hormones is associated with sleep duration in the euthyroid population with depression degree lower than Moderate. Poor sensitivity referred to a longer sleep duration.

Association of sleep duration and risk of mental disorder: a systematic review and meta-analysis

BACKGROUND

The effects of sleep duration on the development of mental illness remain controversial. Therefore, it is necessary to identify the effects of long or short sleep duration on psychological disorders, which could reveal new ways for preventing and treating mental health conditions cheaply.

METHODS

Identifying published papers was accomplished by using the following five English databases on March 16, 2022: PubMed, MEDLINE, Embase, Web of Science databases, and Scopus. Cross-sectional and cohort studies were considered if they evaluated the association of sleep duration with all kinds of mental illness in adults. We excluded case reports, editorials, narrative reviews, and studies without detailed information on sleep duration. Summary effect-size estimates were expressed as risk ratios (RRs) or odds ratios (ORs) with 95% confidence intervals and were evaluated using random-effect models. Mantel-Haenszel's random-effects model was used to estimate the inconsistency index (I2) and Tau2 index (measurement of heterogeneity).

RESULTS

A total of 52 studies were included in this analysis, consisting of 14 cohort studies and 38 cross-sectional studies. These studies involved a combined sample size of 1,407,891 participants who met the inclusion criteria. Cohort (adjusted RR = 1.42, 95% CI: 1.26-1.60, P < .001, I2 = 37.6%, Tau2 = 0.014) and cross-sectional studies (adjusted OR = 1.67, 95% CI: 1.57-1.77, P < .001, I2 = 79.7%, Tau2 = 0.060) concluded that short sleep duration increased mental disorder risks. The same conclusions were acquired in the subgroup analysis, especially for depression (adjusted RR = 1.43, 95% CI: 1.24-1.65, P < .001, I2 = 80.4%, Tau2 = 0.082), anxiety (adjusted RR = 1.30, 95% CI: 1.04-1.63, P = .002, I2 = 0.0%, Tau2 = 0.000), and PTSD (adjusted RR = 1.35, 95% CI: 1.04-1.76, P = .022, I2 = 24.1%, Tau2 = 0.013) in cohort studies. The results of subgroup analysis indicated that long sleep duration was not a risk factor for depression (adjusted RR = 1.15, 95% CI: 0.98-1.34, P = .088, I2 = 63.4%, Tau2 = 0.045) and anxiety (adjusted RR = 1.37, 95% CI: 0.93-2.03, P = .114, I2 = 0.0%, Tau2 = 0.000).

CONCLUSIONS

Short sleep duration, not long sleep duration, is an independent predictor of developing mental disorders, particularly anxiety and depression.

Interventions to improve the sleep quality of adults with personality disorder: A systematic review

Poor quality sleep is common for people who have a diagnosis of personality disorder (PD). Core cognitive and behavioral features of PD may cause and perpetuate poor sleep, but to date, no review has collated the evidence on the efficacy of interventions to improve sleep quality for people with PD. Structured searches for interventional studies among adults with PD and reporting validated measures of sleep quality were conducted up to November 2022 in multiple databases. Single-case reports were excluded. Study quality was assessed with standardized risk of bias tools. Unreported data was sought systematically from authors. This review was pre-registered with an international prospective register of systematic reviews (PROSPERO) (CRD42021282105). Of the 3503 identified studies, nine met inclusion criteria, representing a range of psychological, pharmaceutical, and other interventions and outcome measures. Meta-analytic methods were not feasible because of the serious risk of bias in all studies, and results were therefore synthesized narratively. There is limited and low-quality evidence of the effects of a variety of interventions to improve the sleep quality of people living with PD. Further research might consider specifically including people diagnosed with PD in trials of sleep interventions and using sleep outcome measures in trials of established PD treatments.

Psychosocial predictors of persistent suicidal ideation among Chinese adolescents: A longitudinal study

BACKGROUND

Suicide is the fourth leading cause of death among adolescents. Studies have shown that persistent suicidal ideation has a more important effect on suicidal behavior. The objective of this study was to identify predictors of persistent suicidal ideation.

METHODS

Data were collected from 4225 Chinese middle and high school students. These adolescents were assessed for suicidal ideation at baseline and the second year. We used multinomial logistic regression (n = 4171) for the predictive effect of these factors on persistent suicidal ideation. We controlled for gender, residence, clinical diagnosis, clinical diagnosis family, suicide planning, and suicide attempts.

RESULTS

Depressive symptoms are essential in predicting persistent suicidal ideation (OR = 14.0; p < 0.001). Persistent suicidal ideation was predicted by sleep disorders, such as poor sleep quality (OR = 2.3; p = 0.008), difficulty falling asleep (OR = 2.4; p = 0.005), frequently midnight awakening (OR = 1.9; p = 0.044), and frequent nightmares (OR = 2.1; p = 0.040). There was a significant association between concern with persistent ideation and parental-peer alienation (OR for father, 1.9[p = 0.024]; OR for mother, 3.1[p < 0.001]; OR for peer, 2.3[p = 0.003]).

LIMITATIONS

All measures are based on self-report rather than objective assessment or clinical diagnostic assessment.

CONCLUSIONS

Persistent suicidal ideation had a more important role in influencing suicide planning and attempt. Interventions targeting sleep disorders and attention to attachments in the home and school are particularly important in preventing persistent suicidal ideation in adolescents.

The association among childhood maltreatment, sleep duration and suicide behaviors in Chinese young people

BACKGROUND

Substantial evidence shows that childhood maltreatment and sleep duration play important roles in the development of suicide. However, the role of sleep duration in the relationship between childhood maltreatment and suicide behaviors, including suicide ideation, plan and attempt, was not fully understood. This study investigated the association among childhood maltreatment, sleep duration and suicide behaviors.

METHODS

13,454 students from a polytechnic college in Shenzhen of China participated in this cross-sectional study. Multivariate logistic regression model was established to analyze the relationship among childhood maltreatment, sleep duration and suicide behaviors.

RESULTS

The most reported subtype of childhood maltreatment was physical neglect, which were reported by 41.57 % of males, 28.59 % of females. The positive association of physical abuse with suicide behaviors was observed. In females, emotional abuse and neglect were positively associated with suicide behaviors. In addition, almost all childhood maltreatment was significantly associated to decreased sleep duration. Moreover, compared to the sleep duration <6 h group, sleep duration was inversely associated to suicide behaviors.

CONCLUSION

Childhood maltreatment was positively associated with suicide ideation, plan and attempt in Chinese young adults. Meanwhile, childhood maltreatment was negatively associated with sleep duration, which were negatively associated with suicide ideation, plan and attempt.

Effects of sleep quality on suicide risk in COVID-19 patients: The chain mediating of anxiety and depressive symptoms

Background

Although current studies have identified sleep disorders as an independent risk factor for suicide, the relationship between sleep disorders and suicide risk has not been well established. This study explored whether anxiety and depressive symptoms are used as mediators to participate in the impact of sleep quality on suicide risk.

Methods

This is a cross-sectional study. We administered a psychological questionnaire to the participants, using a combination of self-assessment and psychiatrist assessment.Sleep quality, suicide risk, level of anxiety and depressive symptoms were assessed by PSQI, NGASR, SAS and SDS.The study subjects were 391 hospitalized COVID-19 patients from Wuhan hospitals. We used model 6 in the PROCESS (version 3.5) plug-in of SPSS software to conduct mediation test with sleep quality as the independent variable, suicide risk as the dependent variable, level of anxiety and depressive symptoms as intermediate variables.

Results

The severity of anxiety and depressive symptoms and the risk of suicide in the sleep disorder group (63.15 ± 13.71, 59.85 ± 13.38, 6.52 ± 3.67) were higher than those in the non-sleep disorder group (49.83 ± 13.14, 44.87 ± 10.19, 2.87 ± 3.26) (P < 0.001). The mediation model works well, The total indirect effect was 0.22 (95%CI = [0.17, 0.28]), and the direct effect was 0.16 (95%CI = [0.08, 0.24]).

Limitations

This study used a self-assessment scale.

Conclusions

Anxiety and depressive symptoms played a chain mediating role between sleep quality and suicide risk.

Association between the number of hours of sleep during weekdays and suicidality among Korean adolescents: Mediating role of depressive and anxiety symptoms

BACKGROUND

Adolescent suicide is a serious concern worldwide. Sleep problems are a risk factor for suicide. Therefore, the aim of this study was to evaluate associations between sleep duration and suicidal ideation/suicide attempts and determine the extent to which depressive and anxiety symptoms mediate these associations.

METHODS

Data from 54,948 middle and high school students in South Korea were collected by the stratified cluster method through the Korea Youth Risk Behavior Web-based Survey.

RESULTS

The weighted prevalences of short and long sleep durations were 19.5 % (95 % confidence interval [CI] = 18.9-20.2) and 4.6 % (95 % CI = 4.3-4.8), respectively. Short sleep duration (<5 h/day) increased the odds of suicidal ideation and suicide attempts by 1.43 (95 % CI = 1.29-1.58) and 1.78 (95 % CI = 1.41-2.25), respectively. Long sleep duration (>9 h/day) increased the odds of suicide attempts by 1.5 (95 % CI = 1.02-2.21). Depressive and anxiety symptoms significantly mediated the relationship between sleep duration and suicidal intensity with a satisfactory goodness of fit.

LIMITATIONS

Causal relationships could not be examined due to the cross-sectional study design. Information on other psychopathologies, besides depression and anxiety, was unavailable.

CONCLUSIONS

Short sleep duration was associated with suicidal ideation and suicide attempts among Korean adolescents. Long sleep duration was associated with suicide attempts only. Both depressive and anxiety symptoms mediated the association between sleep duration and suicidal intensity; therefore, both sleep hour restoration and treatment of depressive/anxiety symptoms should be the goals of suicide prevention strategies.