Sleep, suicide behaviors, and the protective role of sleep medicine

• Published in: Sleep medicine Vol. 66; pp. 264 - 270
• Main Authors: Bishop, Todd M., Walsh, Patrick G., Ashrafioun, Lisham, Lavigne, Jill E., Pigeon, Wilfred R.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.02.2020
• Subjects: Adult; Aged; Case-Control Studies; Comorbidity; Databases, Factual; Dreams - psychology; Female; Humans; Insomnia; Male; Middle Aged; Nightmare; Patient Acceptance of Health Care - statistics & numerical data; Sleep Initiation and Maintenance Disorders - complications; Sleep medicine; Sleep-related breathing; Suicide; Suicide, Attempted - psychology; Suicide, Attempted - statistics & numerical data; United States; United States Department of Veterans Affairs; Veteran; Veterans - statistics & numerical data; United States; Sleep-related breathing; Nightmare; Suicide; Sleep medicine; Veteran; Insomnia
• ISSN: 1389-9457; 1878-5506
• DOI: 10.1016/j.sleep.2019.07.016

Sleep disturbance is associated with suicidal thoughts and behaviors. The relationship of specific sleep disorders to suicide attempts is less well established. Whether treating sleep disorders reduces suicide attempts remains controversial. Suicide attempts, treatment utilization, and psychiatric diagnoses were extracted from electronic medical records and a suicide attempt database from the U.S. Department of Veterans Affairs. The sample (N = 60,102) consisted of patients with any record of suicide attempt in FY13-14 and a 1:1 case-control of patients with no record of attempt, who were propensity score-matched based on age, gender, and prior year mental health treatment utilization. Associations among sleep disorders and suicide attempt were examined via logistic regression. Covariates included depression, anxiety, posttraumatic stress disorder (PTSD), bipolar, schizophrenia, substance use disorder (SUD), medical comorbidity, and obesity. Insomnia (OR = 5.62; 95% CI, 5.39–5.86), nightmares (odds ratio, OR = 2.49; 95% confidence interval, CI, 2.23–2.77), and sleep-related breathing disorders (OR = 1.37; 95% CI, 1.27–1.48) were positively associated with suicide attempt after accounting for age, gender, treatment utilization, and comorbid sleep disorders. Furthermore, when controlling for depression, anxiety, PTSD, bipolar, schizophrenia, substance use disorder (SUD), medical comorbidity, and obesity, insomnia (OR = 1.51, 95% CI, 1.43–1.59) remained positively associated with suicide attempt nightmares (OR = 0.96; 95% CI, 0.85–1.09) nor sleep-related breathing disorders (OR = 0.87, 95% CI = 0.79–0.94). Additionally, sleep medicine visits 180 days prior to index date were associated with decreased likelihood of suicide attempt for individuals with sleep disorders (OR = 0.86; 95% CI, 0.79–0.94). Insomnia is associated with suicide attempt among veterans. Sleep medicine visits were associated with a reduced risk of suicide attempt in sleep disordered patients. The assessment and treatment of sleep disorders should be considered in context of strategies to augment suicide prevention efforts. •Insomnia is associated with suicide attempt among veterans.•Sleep medicine visits reduce risk of suicide attempt in sleep disordered patients.•Treatment of sleep disorders may be a strategy to augment suicide prevention efforts.