Insomnia as an independent predictor of suicide attempts: a nationwide population-based retrospective cohort study

Abstract

BackgroundNumerous studies have verified that insomnia is associated with suicidal ideation, suicide attempts, and death by suicide. Limited population-based cohort studies have been conducted to examine the association. The present study aimed to analyze whether insomnia increases the risk of suicide attempts and verify the effects of insomnia on suicide risk.MethodsThis study is a cohort study using 2000–2013 hospitalization data from the National Health Insurance Research Database (NHIRD) to track the rate of suicide attempts among insomnia patients aged 15 years or older. In addition, a 1:2 pairing based on sex, age, and date of hospitalization was conducted to identify the reference cohort (patients without insomnia). Cox proportional hazard model was used to assess the effects of insomnia on suicide risk.ResultsThe total number of hospitalized patients aged 15 years or older was 479,967 between 2000 and 2013 (159,989 patients with insomnia and 319,978 patients without insomnia). After adjusting for confounders, suicide risk in insomnia patients was 3.533-fold that of patients without insomnia (adjusted hazard ratio [HR] = 3.533, 95% confidence interval [CI] = 3.059–4.080, P < 0.001). Suicide risk in low-income patients was 1.434-fold (adjusted HR = 1.434, 95% CI = 1.184–1.736, P < 0.001) that of non-low-income patients. Suicide risk in patients with drug dependence and with mental disorders was 1.592-fold (adjusted HR = 1.592, 95% CI = 1.220–2.077, P < 0.001) and 4.483-fold (adjusted HR = 4.483, 95% CI = 3.934–5.109, P < 0.001) that of patients without drug dependence and without mental disorders, respectively. In the female population, suicide risk in insomnia patients was 4.186-fold (adjusted HR = 4.186, 95% CI = 3.429–5.111, P < 0.001) that of patients without insomnia. Among patients aged 25–44 years, suicide risk in insomnia patients was 5.546-fold (adjusted HR = 5.546, 95% CI = 4.236–7.262, P < 0.001) that of patients without insomnia. Furthermore, the suicide risk of insomnia patients with mental disorders was 18.322-fold that of patients without insomnia and mental disorders (P < 0.001).ConclusionInsomnia, low income, drug dependence, and mental disorders are independent risk factors for suicide attempts. Female patients and those aged 25–44 years are at high risk of suicide due to insomnia. Insomnia, mental disorders, and low income exhibit a synergistic effect on suicide attempts. Clinicians should pay attention to mental status and income level of insomnia patients.Electronic supplementary materialThe online version of this article (10.1186/s12888-018-1702-2) contains supplementary material, which is available to authorized users.

Short‐ and long‐term mortality following hypnotic use

“…Pooled results from logistic regression analyses with estimated odds ratio (OR) and 95% confidence interval (CI) for all-cause and cause-specific mortality within 2 years after collecting a first prescription of hypnotics between January 2005 and December 2015, compared with subjects who never collected prescriptions of hypnotics concluded that insomnia increases the risk of incident depression (Fang, Tu, Sheng, & Shao, 2019) and suicide (Bjorngaard, Bjerkeset, Romundstad, & Gunnell, 2011;Lin, Lai, & Perng, 2018).…”

Suicidality and associated social, demographic and clinical factors in Thai patients with acutely treated depressive disorder: a cross-sectional study

“…Recent studies reported that somatic symptoms such as insomnia are associated with suicide [43,44]. In addition, receiving benzodiazepines may be associated with increased aggression [45] and may result in disinhibition [46], which may be the factors that contribute to suicidal behavior.…”

The clinical relevance of early identification and treatment of sleep disorders in mental health care: protocol of a randomized control trial

“…For instance, insomnia has been shown to have prognostic validity for the development of posttraumatic stress disorder (PTSD) [6,8] and depression [9,10]. Moreover, the already high vulnerability for suicidal behavior in individuals with mental health problems is further increased in those with poor sleep [11,12]. Thus, early and adequate treatment of sleep disorders in individuals with mental disorders may be of paramount importance, and might well lead to better mental health outcomes and improved quality of life.…”