Nocturnal Sleep Disturbances as a Predictor of Suicide Attempts Among Psychiatric Outpatients

Abstract

Nocturnal sleep disturbances, particularly frequent insomnia and recurrent nightmares, were independently associated with enhanced suicidal risk among psychiatric patients. Future studies are warranted to investigate the underlying pathophysiologic mechanism and interventional responses.

Insomnia in Alcohol Dependence: Predictors of Symptoms in a Sample of Veterans Referred from Primary Care

“…Prior research has shown that suicidal ideation is independently related to alcohol dependence 30,31 and insomnia. 8,9 Limitations of this study include the retrospective, non-randomized, uncontrolled nature of the study; the subjective insomnia assessment; the BHL assessment did not differentiate between primary or substance-induced psychiatric disorders; the lack of more detailed data on substance use and disorders; and the relatively small sample size. Although we did not use polysomnography to assess sleep disturbances, insomnia is commonly assessed using subjective measures.…”

“…[4][5][6] Many psychiatric disorders such as depression, and symptoms such as suicidal ideation, are also independently associated with insomnia. [7][8][9] Because alcohol dependence often cooccurs with other psychiatric disorders, 4 it is unclear whether individuals who present with comorbid alcohol dependence and other psychiatric conditions are more likely to experience sleep disturbances than those with alcohol dependence alone. Moreover, there is an association between sleep parameters and various socio-demographic factors (eg, age, 10 race/ethnicity, 11 and marital status 12 ) in relatively healthy participants, which may also confound this relationship.…”

Nightmares in United States Military Personnel With Sleep Disturbances

“…2,9,[11][12][13][14][15] Additionally, nightmares are associated with a heightened risk of suicidal ideation in both military and civilian populations. 16,17 As sleep and psychiatric disorders are frequently reported in United States military personnel, this population may have a high prevalence of nightmare disorder (NDO).…”

Looking Beyond the Sleep Complaints

“…Of particular note in the research on sleep disturbances and suicidality is another large-scale clinical epidemiologic follow-up study 3 we conducted, which unfortunately was not listed in this meta-analytic review. It was conducted among a consecutive cohort of psychiatric outpatients (N = 1,231) with a broad spectrum of psychopathologies (eg, depressive spectrum disorders, bipolar spectrum disorders, anxiety spectrum disorders, psychotic spectrum disorders).…”

“…5,6 In this regard, our recent 4-year naturalistic follow-up study 7 in a cohort of psychiatric outpatients with major depressive disorder also found that sleep disturbances, especially residual nightmares, were significantly associated with an elevated risk of suicidal ideation in remitted depressed patients. In other words, despite the resolution of most daytime depressive symptoms in the remitted patients, the persistence of nightmare disturbances will still lead to an enhanced risk of suicidal thoughts, 7 which argues for the need of targeted treatment strategies for a sustained resolution of both daytime and nocturnal symptoms.Of particular note in the research on sleep disturbances and suicidality is another large-scale clinical epidemiologic follow-up study 3 we conducted, which unfortunately was not listed in this meta-analytic review. It was conducted among a consecutive cohort of psychiatric outpatients (N = 1,231) with a broad spectrum of psychopathologies (eg, depressive spectrum disorders, bipolar spectrum disorders, anxiety spectrum disorders, psychotic spectrum disorders).…”