Hostname: page-component-76fb5796d-vfjqv Total loading time: 0 Render date: 2024-04-25T22:17:18.925Z Has data issue: false hasContentIssue false
  • English
  • Français

Insomnia is associated with suicide attempt in middle-aged and older adults with depression

Published online by Cambridge University Press:  10 November 2015

Daniel B. Kay ,
Alexandre Y. Dombrovski ,
Daniel J. Buysse ,
Charles F. Reynolds III ,
Amy Begley  and
Katalin Szanto
Daniel B. Kay
Affiliation:
Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, 15213, USA
Alexandre Y. Dombrovski
Affiliation:
Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, 15213, USA
Daniel J. Buysse
Affiliation:
Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, 15213, USA
Charles F. Reynolds III
Affiliation:
Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, 15213, USA
Amy Begley
Affiliation:
Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, 15213, USA
Katalin Szanto*
Affiliation:
Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, 15213, USA
*
Correspondence should be addressed to: Katalin Szanto, M.D., Department of Psychiatry, University of Pittsburgh School of Medicine, 100 N Bellefield Avenue, Rm. 736, Pittsburgh, PA 15213, USA. Phone: (412) 586-9601; Fax: 412-246-6030. Email: szantok@upmc.edu.
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Insomnia increases in prevalence with age, is strongly associated with depression, and has been identified as a risk factor for suicide in several studies. The aim of this study was to determine whether insomnia severity varies between those who have attempted suicide (n = 72), those who only contemplate suicide (n = 28), and those who are depressed but have no suicidal ideation or attempt history (n = 35).

Methods:

Participants were middle-aged and older adults (age 44–87, M = 66 years) with depression. Insomnia severity was measured as the sum of the early, middle, and late insomnia items from the Hamilton Rating Scale for Depression. General linear models examined relations between group status as the independent variable and insomnia severity as the dependent variable.

Results:

The suicide attempt group suffered from more severe insomnia than the suicidal ideation and non-suicidal depressed groups (p < 0.05). Differences remained after adjusting for potential confounders including demographics, cognitive ability, alcohol dependence in the past month, severity of depressed mood, anxiety, and physical health burden. Moreover, greater insomnia severity in the suicide attempt group could not be explained by interpersonal difficulties, executive functioning, benzodiazepine use, or by the presence of post-traumatic stress disorder.

Conclusions:

Our results suggest that insomnia may be more strongly associated with suicidal behavior than with the presence of suicidal thoughts alone. Accordingly, insomnia is a potential treatment target for reducing suicide risk in middle-aged and older adults.

Keywords

suicide attemptsuicidal ideationinsomnia symptomsdepression
Type
Research Article
Information
International Psychogeriatrics , Volume 28 , Issue 4 , April 2016 , pp. 613 - 619
Copyright
Copyright © International Psychogeriatric Association 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Agargun, M. Y. et al. (2007). Nightmares, suicide attempts, and melancholic features in patients with unipolar major depression. Journal of Affective Disorders, 98, 267–270. doi:10.1016/j.jad.2006.08.005.Google Scholar
Beck, A. T., Kovacs, M. and Weissman, A. (1979). Assessment of suicidal intention: the Scale for Suicidal Ideation. Journal of Consulting and Clinical Psychology, 47, 343–352. doi:10.1037/0022-006X.47.2.343.Google Scholar
Beck, R. W., Morris, J. B. and Beck, A. T. (1974). Cross-validation of the Suicidal Intent Scale. Psychological Reports, 34, 445–446. doi:10.2466/pr0.1974.34.2.445.CrossRefGoogle ScholarPubMed
Bernert, R. A., Joiner, T. E. Jr., Cukrowicz, K. C., Schmidt, N. B. and Krakow, B. (2005). Suicidality and sleep disturbances. Sleep, 28, 1135–1141.Google Scholar
Bernert, R. A., Turvey, C. L., Conwell, Y. and Joiner, T. E. Jr. (2014). Association of poor subjective sleep quality with risk for death by suicide during a 10-year period: a longitudinal, population-based study of late life. JAMA Psychiatry, 71, 1129–1137. doi:10.1001/jamapsychiatry.2014.1126.Google Scholar
Bostwick, J. M. and Pankratz, V. S. (2000). Affective disorders and suicide risk: a reexamination. American Journal of Psychiatry, 157, 1925–1932. doi:10.1176/appi.ajp.157.12.1925.Google Scholar
Centers for Disease Control and Prevention (2012). Suicide: Facts at a Glance. Avaialable at: www.cdc.gov/ViolencePrevention/pdf/Suicide_DataSheet-a.pdf.html; last accessed 12 August 2015.Google Scholar
Fawcett, J. et al. (1990). Time-related predictors of suicide in major affective disorder. American Journal of Psychiatry, 147, 1189–1194. doi:10.1176/ajp.147.9.1189.Google Scholar
Fleck, M. P. et al. (2004). Depression in France and Brazil: factorial structure of the 17-item Hamilton Depression Rating Scale in inpatients. The Journal of Nervous and Mental Disease, 192, 103–110. doi:10.1097/01.nmd.0000110281.35970.33.Google Scholar
Fortier-Brochu, E., Beaulieu-Bonneau, S., Ivers, H. and Morin, C. M. (2012). Insomnia and daytime cognitive performance: a meta-analysis. Sleep Medicine Reviews, 16, 83–94. doi:10.1016/j.smrv.2011.03.008.Google Scholar
Hamilton, M. (1980). Rating depressive patients. Journal of Clinical Psychiatry, 41, 21–24.Google ScholarPubMed
Horowitz, L. M., Rosenberg, S. E., Baer, B. A., Ureño, G. and Villaseñor, V. S. (1988). Inventory of Interpersonal Problems: psychometric properties and clinical applications. Journal of Consulting and Clinical Psychology, 56, 885–892. doi:10.1037/0022-006x.56.6.885.Google Scholar
IBM Corp. (2013). IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp.Google Scholar
Levenson, J. C., Kay, D. B. and Buysse, D. J. (2015). The pathophysiology of insomnia. Chest, 147, 1179–1192. doi:10.1378/chest.14-1617.CrossRefGoogle ScholarPubMed
Li, S. X., Lam, S. P., Yu, M. W. M., Zhang, J. and Wing, Y. K. (2010). Nocturnal sleep disturbances as a predictor of suicide attempts among psychiatric outpatients: a clinical, epidemiologic, prospective study. Journal of Clinical Psychiatry, 71, 1440–1446. doi:10.4088/JCP.09m05661gry.Google Scholar
Malik, S. et al. (2014). The association between sleep disturbances and suicidal behaviors in patients with psychiatric diagnoses: a systematic review and meta-analysis. Systematic Reviews, 3, 18. doi:10.1186/2046-4053-3-18.Google Scholar
McCall, W. V. and Black, C. G. (2013). The link between suicide and insomnia: theoretical mechanisms. Current Psychiatry Reports, 15, 389. doi:10.1007/s11920-013-0389-9.Google Scholar
McCall, W. V. et al. (2013). Nightmares and dysfunctional beliefs about sleep mediate the effect of insomnia symptoms on suicidal ideation. Journal of Clinical Sleep Medicine, 9, 135–140. doi:10.5664/jcsm.2408.Google Scholar
McCrae, C. S., Dzierzewski, J. M. and Kay, D. (2009). Treatment of late-life insomnia. Sleep Medicine Clinics, 4, 593–604. doi:10.1016/j.jsmc.2009.07.006.CrossRefGoogle ScholarPubMed
McGirr, A. et al. (2007). An examination of DSM-IV depressive symptoms and risk for suicide completion in major depressive disorder: a psychological autopsy study. Journal of Affective Disorders, 97, 203–209. doi:10.1016/j.jad.2006.06.016.CrossRefGoogle ScholarPubMed
Miller, M. D. et al. (1992). Rating chronic medical illness burden in geropsychiatric practice and research: application of the Cumulative Illness Rating Scale. Psychiatry Research, 41, 237–248. doi:10.1016/0165-1781(92)90005-n.Google Scholar
Nadorff, M. R., Fiske, A., Sperry, J. A., Petts, R. and Gregg, J. J. (2013). Insomnia symptoms, nightmares, and suicidal ideation in older adults. The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 68, 145–152. doi:10.1093/geronb/gbs061.Google Scholar
Nadorff, M. R., Nazem, S. and Fiske, A. (2011). Insomnia symptoms, nightmares, and suicidal ideation in a college student sample. Sleep, 34, 93–98.Google Scholar
Périco, C. A. et al. (2005). Relationship between regional cerebral blood flow and separate symptom clusters of major depression: a single photon emission computed tomography study using statistical parametric mapping. Neuroscience Letters, 384, 265–270. doi:10.1016/j.neulet.2005.04.088.Google Scholar
Pigeon, W. R., Pinquart, M. and Conner, K. (2012). Meta-analysis of sleep disturbance and suicidal thoughts and behaviors. Journal of Clinical Psychiatry, 73, e1160–e1167. doi:10.4088/JCP.11r07586.Google Scholar
Richardson, J. D., Cyr, K. S., Nelson, C., Elhai, J. D. and Sareen, J. (2014). Sleep disturbances and suicidal ideation in a sample of treatment-seeking Canadian Forces members and veterans. Psychiatry Research, 218, 118–123. doi:10.1016/j.psychres.2014.04.008.Google Scholar
Roth, T. and Ancoli-Israel, S. (1999). Daytime consequences and correlates of insomnia in the United States: results of the 1991 National Sleep Foundation Survey II. Sleep, 22, S354–S358.Google ScholarPubMed
Royall, D. R., Mahurin, R. K. and Gray, K. F. (1992). Bedside assessment of executive cognitive impairment: the executive interview. Journal of the American Geriatrics Society, 40, 1221–1226.Google Scholar
Sjöström, N., Waern, M. and Hetta, J. (2007). Nightmares and sleep disturbances in relation to suicidality in suicide attempters. Sleep, 30, 91–95.CrossRefGoogle ScholarPubMed
Szanto, K. et al. (2014). The cost of social punishment and high-lethality suicide attempts in the second half of life. Psychology and Aging, 29, 84–94. doi:10.1037/a0035339.Google Scholar
Trockel, M., Karlin, B. E., Taylor, C. B., Brown, G. K. and Manber, R. (2015). Effects of cognitive behavioral therapy for insomnia on suicidal ideation in veterans. Sleep, 38, 259–265. doi:10.5665/sleep.4410.Google Scholar
Turvey, C. L. et al. (2002). Risk factors for late-life suicide: a prospective, community-based study. American Journal of Geriatric Psychiatry, 10, 398–406.Google Scholar
Wojnar, M. et al. (2009). Sleep problems and suicidality in the National Comorbidity Survey Replication. Journal of Psychiatric Research, 43, 526–531. doi:10.1016/j.jpsychires.2008.07.006.Google Scholar