Nightmares and sleep disturbances in relation to suicidality in suicide attempters

Department of Psychiatry and Neurochemistry, University of Gothenburg, Goeteborg, Västra Götaland, 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.

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    • "In another study in 165 suicide attempters, nightmares (but not insomnia ) were significantly associated with a five-fold adjusted increase in risk for high suicidality, on the basis of a dichotomized suicide ideation and behavior subscale (with items on suicidal thoughts, purpose of suicide, wish to die, lack of reason for living, and suicidal actions) of a composite instrument for assessing suicide risk [24]. In this cross-sectional study, consecutive hospitalized suicide attempters were recruited whose medical condition allowed timely interviewing within two weeks post-attempt. "
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    • "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] "
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    • "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. "
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