The association between sleep disturbances and suicidal behaviors in patients with psychiatric diagnoses: a systematic review and meta-analysis

Abstract

BackgroundIdentifying patients with increased risk of suicidal behaviors is a constant challenge and concern for clinicians caring for patients with psychiatric conditions. We conducted a systematic review to assess the association between suicidal behaviors and sleep disturbances in psychiatric patients.MethodsA systematic literature search of Ovid Medline In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, Ovid PsycInfo, Ovid Cochrane Database of Systematic Reviews, Ovid Cochrane Central Register of Controlled Trials, and Scopus was conducted using earliest inclusive dates to 28 June 2013. Eligible studies were comparative observational studies that reported sleep disturbances in psychiatric patients and the outcome of interest (any type of suicidal behaviors). Pairs of reviewers extracted descriptive data, study quality, and outcomes. Odds ratios (OR) and 95% confidence intervals (CI) were pooled across studies using the random-effects model. Newcastle-Ottawa scale was used to critically appraise study quality.ResultsNineteen studies met the inclusion criteria. Compared to those without sleep disturbances, patients with psychiatric diagnoses and co-morbid sleep disturbances were significantly more likely to report suicidal behaviors (OR = 1.99, 95% CI 1.72, 2.30, P <0.001). The association was also demonstrated across several psychiatric conditions including depression (OR = 3.05, 95% CI 2.07, 4.48, P <0.001), post-traumatic stress disorder (PTSD) (OR = 2.56, 95% CI 1.91, 3.43, P <0.001), panic disorder (OR = 3.22, 95% CI 1.09, 9.45, P = 0.03), and schizophrenia (OR = 12.66, 95% CI 1.40, 114.44, P = 0.02). In subgroup analysis based on the type of sleep disorder, we also found suicidal behavior to be significantly associated with the presence of insomnia, parasomnias, and sleep-related breathing disorders, but not hypersomnias.ConclusionsThis systematic review and meta-analysis suggests that in patients with psychiatric diagnoses, sleep disturbances are associated with the increased risk of suicidal behaviors.

Mental disorders and medical comorbidities: Association rule mining approach

“…Sleep problems can both predict and be predicted by a diagnostic of mental illness . Whether it is the side effects caused by psychotropic substances, compared to those without sleep disturbances, psychiatric patients with comorbid sleep disturbances were more likely to report suicidal behaviors . The physician should be aware of the risk of comorbid sleep disorders in mental disorders patients and provide appropriate treatment.…”

The role of lateral habenula–dorsal raphe nucleus circuits in higher brain functions and psychiatric illness

“…The occurrence of sleep is controlled jointly by a set of homeostatic mechanisms that determine the duration of sleep and by the circadian system that regulates its timing [75]. Disruption of the normal patterns of sleep occurs in many clinical conditions, and is a prominent feature of depression, bipolar disorder and schizophrenia [76,77], as well as an indicator of increased risk of suicidality in many psychiatric conditions [78]. The Hb may contribute to the regulation of sleep and the organization of circadian rhythms in several ways.…”

Cognitive Behavioral Insomnia Therapy for Those With Insomnia and Depression: A Randomized Controlled Clinical Trial

“…[1][2][3] Antidepressant medications (for review see 4 ) and psychological interventions (for review see 5 ) have well-established efficacy for treating MDD and restoring normal functioning in many with this condition. However, those MDD patients who present with clinically significant insomnia complaints comprise a particularly challenging group to treat.…”