Understanding the role of sleep in suicide risk: qualitative interview study

Abstract

ObjectiveSleep problems are associated with increased risk of suicide, independent of depression. This analysis explores narrative accounts of the role of sleep in relation to suicidal thoughts and behaviours.DesignQualitative study, based on in-depth semistructured interviews which were analysed with an inductive, latent thematic analysis.ParticipantsA maximum variation sample of 18 people with experience of a major depressive episode, and suicidal thoughts and behaviours.SettingPrimary care, North West England.ResultsRespondents emphasised the importance of sleep for recovery and management of their mental well-being. Moreover, three inter-related pathways were identified, whereby beliefs about sleep contributed to suicidal thoughts and behaviours. First, being awake during the biological night heightened risk of suicidal behaviours, as this was perceived to be an opportune time for a suicide attempt due to the decreased chances that a friend of family member would intervene during a suicide attempt. Additionally, the reduction in available support at night added to suicide risk. Second, failure to achieve good sleep was perceived to make life harder through contributing to core features of depression, such as negative thinking, attention difficulties and inactivity. Third, sleep acted as an alternative to suicide, by providing an escape from problems, including mental health problems, in waking life. However, this desire to sleep to escape was associated with excessive daytime sleeping, which subsequently may reinforce disturbed sleeping patterns.ConclusionsSleep problems should be an important treatment target when working with suicidal clients. More broadly, night-time service provision should be considered when developing suicide prevention initiatives.

Short Sleep Duration and Circadian Rhythms: Association with Suicidal Behaviour

“…These psychological effects are corroborated in a qualitative study recently conducted by Littlewood et al [50]. In their study, suicide attempters identified sleep duration as one of the factors influencing the development of suicidal behaviours.…”

“…Additionally, in the qualitative study conducted by Littlewood et al [50], suicide attempters refer that being awake during the biological night made them more prone to focus on negative thoughts (fewer distractions from the outside world), leading to introspectiveness, rumination, and negative self-appraisal.…”

“…Some authors suggest that the simple fact of being awake at night promotes rumination and intensifies feelings of hopelessness, loneliness and distress, aggravated by both the inability to sleep, and the sense of isolation associated with a decreased social support at night (friends and relatives are most likely asleep) [3,46,50]. Additionally, in the qualitative study conducted by Littlewood et al [50], suicide attempters refer that being awake during the biological night made them more prone to focus on negative thoughts (fewer distractions from the outside world), leading to introspectiveness, rumination, and negative self-appraisal.…”

Pathways to Attempted Suicide as Reflected in the Narratives of People with Lived Experience

“…There is some evidence about the relationship between sleep and suicidal behaviour, but some authors state that this relationship needs further investigation. A study involving people with suicidal thoughts or with a history of attempted suicide revealed that at night, when everything is quiet, it is difficult to keep from having negative thoughts (Littlewood et al 2016). Another study found that problems with falling asleep and excessive sleeping may be associated with an increased risk of depression.…”

“…Sleeping well means that people can manage everyday life, but if sufficient sleep is not achieved, life can become more difficult (Littlewood et al 2016). One study concluded that suicide attempts could be reduced by treating sleep disorders.…”