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Insomnia associated with increased risk for suicidal thoughts

Patients with insomnia are more likely to report thoughts of suicide and death during the past 30 days than those without insomnia, according to findings from two different studies presented at Sleep 2017, the Annual Meeting of the Associated Professional Sleep Societies.

“Previous research has demonstrated a link between insomnia and suicidal ideation,” Ivan Vargas, PhD, research fellow, University of Pennsylvania, and colleagues wrote. “Most of these studies, however, have treated suicidal ideation as a single construct. Recently, it has been suggested that ideation be considered dimensionally.”

To obtain more data, researchers conducted an archival analysis of 2,617 members of the army that had been evaluated for suicidality and insomnia. Suicidal ideation over the last 30 days was assessed according to thoughts of death, thoughts of suicide, suicidal plan, suicidal intent and suicidal communication. Depression was assessed by whether the participant met criteria for a depressive episode during the past 30 days. Insomnia was defined as difficulties initiating and/or maintaining sleep within the last 30 days. The researchers conducted a stepwise logistic regression model to ascertain the connection between insomnia and the dimensional measures of suicidality.

Vargas and colleagues found that when controlling for depression, insomnia emerged as a significant predictor for suicidal communication (OR = 2.59; P < .01), thoughts of death (OR = 2.36; P < .001), suicidal plan (OR = 1.88; P < .01) and thoughts of suicide (OR = 1.66; P < .01). Only suicidal intent was not found to be significantly associated with insomnia.

“[These] findings suggest that insomnia may be differentially associated with dimensional aspects of suicidal ideation,” Vargas and colleagues wrote. “A more refined delineation of suicidality may serve to clarify the nature of the association between insomnia and suicidal ideation, and potentially offer some clues as to the mechanisms behind this association.”

In the second study, Amy Gencarelli, MS, clinical research coordinator, behavioral sleep medicine, University of Pennsylvania, and colleagues evaluated connections between frequent awakenings; early, middle and late insomnia; and suicidal ideation.

“Few studies ... have parsed insomnia into its respective subtypes (ie, early, middle and late insomnia) to assess if one of the subtypes confers more risk for suicidal ideation than the others,” researchers wrote.

As in the first study, Gencarelli and colleagues used data from the 2,617 members of the army that had been evaluated for suicidality and had a depressive episode in the past 30 days. Suicidal ideation was determined by whether participants endorsed any form of suicidal ideation during the same time period. They conducted a stepwise logistic regression to ascertain the independent effect of each insomnia variable on suicidal ideation, and used depression and insomnia as independent variables and suicidal ideation as the dependent variable.

Gencarelli and colleagues found that when controlling for depression (OR = 7.05; P < .001), only early insomnia (OR = 1.13; P = .02) and frequent awakenings (OR = 1.23; P < .001) were significant predictors of suicidal ideation.

“[These] data provide some insight into the specific nature of the relationship between insomnia and suicidal ideation, in that early insomnia (ie, difficulty initiating sleep) and frequent awakenings were distinctly associated with a global measure of suicidal ideation,” researchers wrote. “If these results are found to be reliable (over subsequent studies with similar and/or different populations and/or using prospective measures) such data may serve to focus future investigations on how insomnia confers risk for suicidality.” – by Janel Miller

References:

Vargas I, et al. “Insomnia predicts multiple dimensions of suicidal ideation among Army service members.” Presented at: Sleep 2017, the Annual Meeting of the Associated Professional Sleep Societies; June 3-7; Boston.

Gencarelli A, et al. “Evaluating the association between insomnia subtypes and suicidal ideation among Army service members.” Presented at: Sleep 2017, the Annual Meeting of the Associated Professional Sleep Societies; June 3-7; Boston.

Disclosure: Healio Family Medicine was unable to determine researchers’ relevant financial disclosures prior to publication.