Nightmares and sleep disturbances in relation to suicidality in suicide attempters

Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy at Göteborg University, Blå Stråket 15, SE 413 45 Göteborg, Sweden.
Sleep (Impact Factor: 4.59). 02/2007; 30(1):91-5.
Source: PubMed


To study the prevalence of specific sleep disturbances in suicide attempters and to examine the association between specific sleep disturbances and suicidality.
A cross-sectional study in suicide attempters during the period October 1, 2001, to June 30, 2004.
One hundred sixty-five patients aged 18 to 68 years who were admitted to medical units or psychiatric wards at Sahlgrenska University Hospital after a suicide attempt.
The face-to-face interview included Structured Clinical Interview for DSM-IV-IV and the Suicide Assessment Scale. Two self-report instruments were employed, the Uppsala Sleep Inventory and Comprehensive Psychopathological Self-rating Scale for Affective Syndromes. The latter assessed symptom burden. Using multiple logistic regression analyses, we examined associations between sleep complaints and suicidality.
Eighty-nine percent of subjects reported some kind of sleep disturbance. The most common complaint was difficulties initiating sleep (73%). Other complaints included difficulties maintaining sleep (69%), nightmares (66%) and early morning awakening (58%). Nightmares were associated with a 5-fold increase in risk for high suicidality. This relationship remained after adjustment for psychiatric diagnosis and psychiatric symptom intensity.
Sleep disturbances are common among suicide attempters. Nightmares are associated with suicidality. Our findings suggest that questions concerning sleep disturbance and nightmares should be addressed in the clinical assessment of suicidal patients.

Full-text preview

Available from:
    • "When measured prospectively in a sample of psychiatric patients, agitation (i.e., " psychic anxiety " ), insomnia, and the presence of panic attacks were significant predictors of suicide attempts within a 1-year follow-up period (Fawcett et al., 1990). Similarly, nightmares have been shown to be highly prevalent in adults presenting at medical units following a suicide attempt (Sjöström et al., 2007). Although this link remains unexamined, scholars theorize that feelings of disgust toward the self and others/the world may play an important role in suicidal behavior as this cognitive style likely influences the development of a host of important psychological predictors of suicide, such as perceptions of burdensomeness, self-criticism, and social alienation (Brunstein-Klomek et al., 2008; Chu et al., 2013; O'Connor & Noyce, 2008). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: The current study presents initial support for the construct validity of Acute Suicidal Affective Disturbance (ASAD), a clinical entity consisting of acute suicide risk and several related features. Methods: Participants (N=195) were university students who were recruited for a history of suicide attempt(s), history of suicidal ideation, or no history of suicide attempts or suicidal ideation. Participants completed study measures online. Results: Factor analytic results indicated a one factor solution for a lifetime measure of ASAD symptoms. The measure demonstrated strong convergent and divergent validity with common correlates of suicide-related outcomes and incremental predictive validity, as lifetime occurrence of ASAD symptoms predicted number of past suicide attempts above and beyond a host of suicide risk factors. Lifetime ASAD symptoms differed between those with multiple suicide attempts, those with a single attempt, and participants without a history of attempts, as well as between participants with a history of both suicidal ideation and attempts and those with a history of suicidal ideation but not suicide attempts. Limitations: The cross-sectional research design limits the ability to infer causation between ASAD symptoms and suicidal behavior. Only past ASAD symptoms (not current symptoms) were measured. Conclusions: ASAD appears to be a unified clinical entity that characterizes acute suicide risk which may assist clinicians in determining a client's potential for death by suicide.
    Journal of Affective Disorders 09/2015; 189. DOI:10.1016/j.jad.2015.07.049 · 3.38 Impact Factor
  • Source
    • "843 Psychiatric inpatients AIS SI based on psychiatric interview PWI less frequently attempted suicide* and more frequently used a violent method** compared to PNI Ribeiro et al., 2012 [12] 239 Military personnel BDI insomnia items; SPS [64] fatigue and listlessness items MSSI [65] Insomnia symptoms predicted attempts at one-month follow-up when controlling for depression and hopelessness (OR ¼ 1.45**) but not when controlling for PTSD, anxiety, and substance abuse (OR ¼ 1.33) Sjostrom et al., 2007 [66] 165 Inpatient suicide attempters USI [67] SUAS [68] "
    [Show abstract] [Hide abstract]
    ABSTRACT: Despite current knowledge of risk factors for suicidal behaviors, suicide remains a leading cause of death worldwide. This suggests a strong need to identify and understand additional risk factors. A number of recent studies have identified insomnia as a modifiable, independent suicide risk factor. Although a link between insomnia and suicide is emerging, further research is required in order to understand the nature of the relationship. Accordingly, this paper presents an overview of the insomnia and suicide literature to-date, and a discussion of two major limitations within this literature that hinder its progress. First, the classification and assessment of insomnia and suicide-related thoughts and behaviors are inconsistent across studies; and second, there is a lack of empirical studies focused on investigating mediators of the insomnia and suicide relationship. Suggestions are offered within this paper for future studies to address these issues and facilitate new developments in this important research area. Following these suggested lines of research will ultimately inform whether insomnia treatments, particularly cognitive-behavioral therapy for insomnia, can be used to target suicide risk prevention and intervention. Copyright © 2014 Elsevier Ltd. All rights reserved.
    Sleep Medicine Reviews 10/2014; 22. DOI:10.1016/j.smrv.2014.10.004 · 8.51 Impact Factor
  • Source
    • "Insomnia may be a risk factor for suicidal ideation, suicide attempts, and death by suicide.84 Conflicting results have been reported on whether both insomnia and nightmares increase the risk of suicidal ideation.85,86 A confounder is that post-traumatic stress disorder (PTSD) may account for these associations. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Daytime sleepiness, sleep deprivation, and irregular sleep schedules are highly prevalent among college students, as 50% report daytime sleepiness and 70% attain insufficient sleep. The consequences of sleep deprivation and daytime sleepiness are especially problematic to college students and can result in lower grade point averages, increased risk of academic failure, compromised learning, impaired mood, and increased risk of motor vehicle accidents. This article reviews the current prevalence of sleepiness and sleep deprivation among college students, contributing factors for sleep deprivation, and the role of sleep in learning and memory. The impact of sleep and sleep disorders on academics, grade point average, driving, and mood will be examined. Most importantly, effective and viable interventions to decrease sleepiness and sleep deprivation through sleep education classes, online programs, encouragement of naps, and adjustment of class time will be reviewed. This paper highlights that addressing sleep issues, which are not often considered as a risk factor for depression and academic failure, should be encouraged. Promotion of university and college policies and class schedules that encourage healthy and adequate sleep could have a significant impact on the sleep, learning, and health of college students. Future research to investigate effective and feasible interventions, which disseminate both sleep knowledge and encouragement of healthy sleep habits to college students in a time and cost effective manner, is a priority.
    Nature and Science of Sleep 06/2014; 6:73-84. DOI:10.2147/NSS.S62907
Show more