Nocturnal Sleep Disturbances as a Predictor of Suicide Attempts Among Psychiatric Outpatients: A Clinical, Epidemiologic, Prospective Study

• Published in: The journal of clinical psychiatry Vol. 71; no. 11; pp. 1440 - 1446
• Main Authors: LI, Shirley X, LAM, Siu P, YU, Mandy W. M, JIHUI ZHANG, WING, Yun K
• Format: Journal Article
• Language: English
• Published: Memphis, TN Physicians Postgraduate Press 01-11-2010
• Subjects: Adolescent; Adult; Adult and adolescent clinical studies; Aged; Antidepressive Agents - adverse effects; Antidepressive Agents - therapeutic use; Biological and medical sciences; Chi-Square Distribution; Disorders of higher nervous function. Focal brain diseases. Central vestibular syndrome and deafness. Brain stem syndromes; Female; Humans; Hypnotics and Sedatives - adverse effects; Hypnotics and Sedatives - therapeutic use; Logistic Models; Male; Medical sciences; Mental Disorders - complications; Mental Disorders - drug therapy; Mental Disorders - psychology; Middle Aged; Nervous system (semeiology, syndromes); Neurology; Night Terrors - complications; Night Terrors - drug therapy; Night Terrors - psychology; Prospective Studies; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Risk Factors; Sleep Initiation and Maintenance Disorders - complications; Sleep Initiation and Maintenance Disorders - drug therapy; Sleep Initiation and Maintenance Disorders - psychology; Sleep Wake Disorders - complications; Sleep Wake Disorders - psychology; Suicide; Suicide, Attempted - psychology; Suicide, Attempted - statistics & numerical data; Surveys and Questionnaires; Young Adult; Nervous system diseases; Follow up study; Sleep disorder; Mental disorder; Neurological disorder; Predictive factor; Epidemiology; Public health; Suicide attempt
• ISSN: 0160-6689; 1555-2101
• DOI: 10.4088/JCP.09m05661gry

Nocturnal sleep disturbances, including insomnia and recurrent nightmares, represent common distressing sleep complaints that might have important prognostic and therapeutic implications in psychiatric patients. The present study aimed at investigating nocturnal sleep disturbances in relation to the risk of suicide attempts in a consecutive cohort of psychiatric outpatients.
Participants attending a psychiatric outpatient clinic in Hong Kong were recruited into the study with a detailed sleep questionnaire assessment. The questionnaire was distributed between May and June 2006. Relevant clinical information, with a comprehensive clinical history of patients since their attendance at psychiatric services and 1 year after completion of their questionnaires, was reviewed.
The final study population consisted of 1,231 psychiatric outpatients with a mean age of 42.5 years (SD = 11.3; range, 18-65). Both frequent insomnia and recurrent nightmares were significantly and independently associated with an increased incidence of suicide attempts 1 year after questionnaire assessment (insomnia: OR = 6.96; 95% CI, 1.21-39.97; recurrent nightmares: OR = 8.17; 95% CI, 1.06-63.13) and an increase in lifetime prevalence of suicide attempts (insomnia: OR = 1.55; 95% CI, 1.06-2.25; recurrent nightmares: OR = 2.43; 95% CI, 1.51-3.91). Comorbid insomnia and nightmares had increased odds of lifetime prevalence (OR = 2.43; 95% CI, 1.53-3.85) and 1-year incidence of suicidal risk (OR = 17.08; 95% CI, 2.64-110.40). Antidepressants, particularly selective serotonin reuptake inhibitors (OR = 1.52; 95% CI, 1.02-2.25), serotonin-norepinephrine reuptake inhibitors (OR = 2.10; 95% CI, 1.15-3.83), heterocyclics (OR = 2.78; 95% CI, 1.21-6.42), and non-benzodiazepine hypnotics (OR = 1.54; 95% CI, 1.02-2.33) were independently associated with recurrent nightmares after adjustment for confounding variables.
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.