Insomnia tied to increased risk for suicidality in people with schizophrenia

Individuals with schizophrenia and co-morbid insomnia were at increased risk for suicidal ideation, recent suicide attempt and greater psychopathology, according to study results published in Journal of Clinical Psychiatry.

“Given the relative paucity of studies on insomnia and suicidal thinking and behavior in schizophrenia, we attempted to replicate previous findings, as positive associations would underscore the importance of recognition and treatment of insomnia in these patients,” Brian J. Miller, MD, PhD, MPH, of the department of psychiatry and health behavior at Augusta University’s Medical College of Georgia, and colleagues wrote.

The investigators used regression models to evaluate associations between current insomnia; suicidal ideation over the past 2 weeks; suicide attempt in the past 6 months evaluated via either the Calgary Depression Scale for Schizophrenia or self-report; and current psychopathology for individuals with baseline data from the Clinical Antipsychotic trials of Intervention Effectiveness.

Results showed terminal insomnia was linked to a 2.7 times increased risk for current suicidal ideation (OR = 2.7; 95% CI, 2-3.6) after the researchers controlled for multiple potential confounding factors. They noted a 5.5 times increased risk for suicide attempt in the past 6 months (OR = 5.5; 95% CI, 1.4-21.1) among those with initial/middle insomnia. Presence of terminal insomnia significantly indicated higher Positive and Negative Syndrome Scale total, positive subscale and general psychopathology subscale scores.

Miller and colleagues reported no other significant links between insomnia, suicidal thinking or behavior and psychopathology.

“Our findings provide additional evidence that formal assessment of insomnia is relevant to the clinical care of patients with schizophrenia as an indicator of suicidal thinking and behavior, as well as symptom severity,” the researchers wrote. “More broadly, the findings underscore the need for comprehensive suicide risk assessment in patients with schizophrenia, including identification and vigilant monitoring of risk factors, treatment of affective symptoms and substance use comorbidity and promotion of treatment adherence.”