Monday, April 8, 2013

Dr. Michael J. Breus Blog: Insomnia Increases Suicide Risk

Insomnia and disturbed sleep are common among people with depression and other mental health problems. Research indicates that people with depression are significantly more likely to experience insomnia symptoms. Insomnia also has been linked to an elevated risk for suicide. A recent study offers new details about the relationship between insomnia and suicidal thoughts among people with depression.

Researchers at Georgia Regents University examined the possible influence of insomnia and disturbed sleep among patients with a history of depression and suicide. Their analysis revealed that the connection between insomnia and suicidal thoughts may be influenced by nightmares, and also by the presence of negative attitudes and beliefs about sleep in patients who are suffering from depression.

Their study included 50 patients between the ages 20-84. All had received treatment for depression either as inpatients or outpatients, or in the emergency room. Seventy-two percent of the participants were women, and a majority -- 56 percent -- had attempted suicide at least once. Researchers measured levels of depression and insomnia, feelings of hopelessness, as well as the presence and severity of nightmares and attitudes and beliefs about sleep.

•Participants experienced moderate insomnia, on average.
•As expected, their analysis showed an association between the presence and severity of insomnia and suicidal thoughts.
•Researchers also analyzed data to examine the possible relationship between nightmares and attitudes about sleep with suicidal thoughts, and found significant associations. When these additional sleep problems were included in the analysis, insomnia itself was no longer directly associated with suicidal thoughts. This suggests that insomnia may have an indirect effect on suicidal thoughts, through the presence of these other symptoms, in patients who are depressed.
•Among people with depression, insomnia contributes to a sense of hopelessness about sleep, according to researchers. These negative feelings about sleep, as well as nightmares experienced by people with depression and insomnia, may be critical predictors for suicidal thoughts.
This is important new information in our understanding of the link between insomnia and suicide. The presence of these symptoms -- nightmares and feelings of hopelessness about sleep -- may be a more specific predictor of suicide risk among people with depression than insomnia in general.

Earlier work by some of the same researchers explored the relationship between insomnia and suicide. Their study included 60 patients between the ages 18-70. Two thirds were women, and all suffered from major depression and insomnia symptoms. Researchers found that the severity of insomnia among these patients was linked to degree of suicidal thoughts. More severe insomnia was associated with higher intensity of suicidal thoughts. In their analysis, researchers isolated insomnia from other symptoms of depression, such as low mood and inability to experience pleasure. They determined that insomnia is an independent predictor of suicidal thinking. This latest study built on those findings, looking with greater depth and specificity at how insomnia and related attitudes and behaviors of disrupted sleep may influence suicidal thoughts.

Other research has shown a strong association between insomnia and disrupted sleep and suicide for people with depression and other psychiatric disorders:

•This study examined the relationship of nighttime sleep disturbances -- including insomnia and nightmares -- and the risk of suicide among psychiatric outpatients. Researchers found that both insomnia and nightmares were linked to an elevated risk of suicide.

•This study also investigated sleep disturbances and nightmares as risk factors for suicide. Rather than including only participants with depression or other psychiatric disorders, Hungarian researchers used a broad sample of data, representative of the general population of Hungary. They found that sleep disturbances and nightmares elevated the risk of suicide by as much as four times among men, and as much as three times among women. In this study, frequent nightmares and sleep disorders were associated with a higher risk of suicide than depression.

•Sleep problems have been shown to be strong predictors of suicidal behavior for adolescents. This research reported that sleep problems in early adolescence (ages 12-14) were a significant predictor of suicidal thoughts and self-harming behaviors by later adolescence (ages 15-17). And this study of young adults in the military revealed sleep problems to be a stronger predictor of suicidal thinking than depression or feelings of hopelessness.

•In addition to risks for young adults, there also appear to be particular risks for older adults, in the connection between suicide and insomnia and disrupted sleep. This research showed that older adults with sleep problems were at greater risk for suicide than those in their age group who maintained healthy sleep patterns.

Understanding how insomnia and other sleep problems contribute to hopelessness and thoughts of suicide can provide important new options for suicide prevention and treatment of depression and suicidal thoughts. By identifying nightmares and dysfunctional, negative attitudes about sleep as important predictors of suicidal thinking in people with depression, we may be better able to identify those who are at greater risk for self-harm.

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