Insomnia Is Associated With Frequency of Suicidal Ideation Independent of Depression: A Replication and Extension of Findings From the National Health and Nutrition Examination Survey

Abstract

Objective: Insomnia is associated with suicidality, although the mechanisms of this association are unclear. This study sought to replicate previous findings showing that insomnia symptoms but not sleep duration are associated with frequency of suicidal ideation in adults. We further investigated whether depression or sleep duration moderates the association between insomnia symptoms and frequency of suicidal ideation. Materials and Methods: We used the 2005-2006 cycle of the National Health and Nutrition Examination Survey to replicate previously reported findings from the 2007-2008 cycle. We used ordered logistic regression to determine whether insomnia symptoms were associated with frequency of suicidal ideation independently of depression and other potential confounds. To extend these findings, we tested whether depression or sleep duration moderated the association between insomnia symptoms and frequency of suicidal ideation. We further replicated these findings in parallel analyses using the combined data from the 2005-2006 and 2007-2008 cycles. Results: This study replicated previous results showing that insomnia symptoms are associated with frequency of suicidal ideation in the NHANES 2005-2006 cycle (OR = 1.09, p < 0.05), even after adjusting for potentially confounding variables, including depression. Neither depression nor sleep duration moderated this association. Difficulty with sleep maintenance insomnia symptoms were most robustly associated with frequency of suicidal ideation (OR ≥ 1.97, p < 0.05). Sleep duration was not robustly associated with suicidal ideation. Conclusions: In this study, we found that insomnia symptoms were uniquely associated with frequency of suicidal ideation. This association cannot be explained by the shared association with depression or sleep duration.

Insomnia Prevalence and Associated Factors Among University Students in Saudi Arabia During the COVID-19 Pandemic and Lockdown: A Large-Scale Survey

“…25 Other risk factors such as medical or psychiatric illnesses or a relative with COVID-19 align with the findings of other studies. 14,18,26 These three variables were statistically significant in the multivariable logistic regression with odds ratio (1.97, 3.21, and 1.61), respectively. Having a psychiatric disorder will increase the insomnia risk by three folds.…”

“…We found a link between insomnia and suicidal ideation among our sample, similar to other studies. 26 , 28 One study found that insomnia is a mediator between COVID-19 anxiety and suicide. 29 Another study found that insomnia is related to suicide directly and indirectly (as a risk factor for depression).…”

Sleep loss suicidal ideation: the role of trait extraversion

“…Insomnia, short sleep, and other sleep disorders are among several of the leading independent risk factors for suicide (Liu, 2004 ; Mccall and Black, 2013 ; Lin et al, 2018 ; Harris et al, 2020 ; Simmons et al, 2020 ). Nevertheless, suicide is a low base rate event relative to the prevalence of clinical sleep disturbance, which means that sleep problems (like most other risk factors) have low specificity and limited practical utility as warning signs for suicide (Harris et al, 2020 ).…”

“…Finally, clinical evidence suggests that sleep disorders contribute indirectly to suicide by virtue of their exacerbating effect on depression, a condition that in-and-of itself increases the likelihood of suicidal behavior (Britton et al, 2019 ). There is, however, growing evidence that sleep disruption can increase suicide risk exclusive of its effects on depression (Simmons et al, 2020 ). Overall, when sleep is disturbed or insufficient, positive mood state declines, and critical neurocognitive processes such as emotional awareness, decision-making, and self-regulatory capacities are degraded, which in concert may increase the propensity to contemplate, and perhaps, act on suicidal thoughts.…”

Lack of Structural Brain Alterations associated with Insomnia: Findings from the ENIGMA-Sleep working group

“…Chronic ID is a persistent medical condition 4 , which is linked to adverse long-term physical and mental outcomes, including low quality of life, poor educational or work performance, memory impairment, higher risk of motor vehicle accidents, cardiovascular and metabolic diseases, anxiety, perinatal depression, major depressive disorder (MDD), bipolar disorder, posttraumatic stress disorder (PTSD), and neurodegenerative disorders [5][6][7][8][9][10][11] . Insomnia, rather than sleep duration, is also an independent risk factor for suicide in patients with MDD across all age ranges 12,13 . The worldwide prevalence of insomnia symptoms is approximately 30-35% and for ID is around 10% 5 .…”