Insomnia brings soldiers into mental health treatment, predicts treatment engagement, and outperforms other suicide-related symptoms as a predictor of major depressive episodes

Abstract

Given the high rates of suicide among military personnel and the need to characterize suicide risk factors associated with mental health service use, this study aimed to identify suicide-relevant factors that predict: (1) treatment engagement and treatment adherence, and (2) suicide attempts, suicidal ideation, and major depressive episodes in a military sample. Army recruiters (N = 2596) completed a battery of self-report measures upon study enrollment. Eighteen months later, information regarding suicide attempts, suicidal ideation, major depressive episodes, and mental health visits were obtained from participants' military medical records. Suicide attempts and suicidal ideation were very rare in this sample; negative binomial regression analyses with robust estimation were used to assess correlates and predictors of mental health treatment visits and major depressive episodes. More severe insomnia and agitation were significantly associated with mental health visits at baseline and over the 18-month study period. In contrast, suicide-specific hopelessness was significantly associated with fewer mental health visits. Insomnia severity was the only significant predictor of major depressive episodes. Findings suggest that assessment of sleep problems might be useful in identifying at-risk military service members who may engage in mental health treatment. Additional research is warranted to examine the predictive validity of these suicide-related symptom measures in a more representative, higher suicide risk military sample.

Differentiating Single and Multiple Suicide Attempters: What Nightmares Can Tell Us That Other Predictors Cannot

“…Further, asking about sleep disturbances may provide a less threatening way to assess for the presence of suicidal ideation or intent and open the door to disclosure of previous attempts. 22 It is possible that sleep disturbances may be viewed as less stigmatized than suicidality, and therefore people may be more willing to disclose nightmares than suicide risk.…”

Thwarted belongingness as an explanatory link between insomnia symptoms and suicidal ideation: Findings from three samples of military service members and veterans

“…In addition to being effective in addressing insomnia complaints (Edinger et al, 2009, 2001; Koffel et al, 2015), studies also suggest that CBT-I reduces symptoms of depression and suicidality in the general population (Manber et al, 2011, 2008) and veterans (Trockel et al, 2015). Furthermore, since sleep problems appear to predict soldiers’ treatment engagement above and beyond other psychiatric symptoms (e.g., suicidal ideation, hopelessness; Hom et al, 2016), a focus on assessing and treating insomnia may represent a strategic suicide prevention approach among service members. Findings from our study also indicate that assessment of loneliness, social isolation, and social connectedness, particularly among service members and veterans with sleep problems, may be clinically useful.…”

Implicit Measures of Suicide Risk in a Military Sample

“…Though it was not feasible to obtain information regarding when the clinical assessments were completed in relation to the time of the present study, research has provided support for using chart diagnostic information in research studies conducted at a later point in time (e.g., Fennig, Craig, Tanenberg-Karant, & Bromet, 1994; Joiner & Lonigan, 2000; Lonigan, Carey, & Finch, 1994). Studies have also supported this methodology in military contexts (e.g., Chu et al, 2016; Hom et al, 2016)…”