The insomnia and suicide link: toward an enhanced understanding of this relationship

Woznica, Andrea; Carney, Colleen E.; Kuo, Janice R.; Moss, Taryn G.

doi:10.1016/j.smrv.2014.10.004

Cited by 96 publications

(67 citation statements)

References 132 publications

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“…First, the reference sections within all papers identified for inclusion within the review were scrutinised for omissions. Second, the reference sections of existing review and position papers on the relationship between sleep and suicide were also checked for omissions (Agargun and Besiroglu, 2005, Bernert and Joiner, 2007, Bernert et al, 2015, Bernert and Nadorff, 2015, Liu and Buysse, 2006, Malik et al, 2014, McCall and Black, 2013, Norra et al, 2011, Pigeon and Caine, 2010, Pigeon et al, 2012, Singareddy and Balon, 2001, Winsper and Tang, 2014, Woznica et al, 2015). Furthermore, the publication history of prominent researchers actively investigating the sleep suicide relationship, were reviewed for additional papers which could be included (i.e., Agargun, Bernert, McCall, Nadorff, Pigeon and Hochard).…”

Section: Methodsmentioning

confidence: 99%

“…Understanding psychological mechanisms that underpin suicidal pathways is crucial to the development of clinical interventions to prevent subsequent suicide attempts and deaths (Johnson et al, 2008, O'Connor and Nock, 2014, Tarrier et al, 2013). Previous reviews have proposed possible psychological processes and mechanisms which may influence the sleep/suicide relationship (McCall and Black, 2013, Winsper and Tang, 2014, Woznica et al, 2015). However, no previous review has systematically evaluated and critically appraised the empirical evidence base relating to the role of specific psychological processes and mechanisms in the sleep/suicide relationship.…”

Section: Introductionmentioning

confidence: 99%

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Examining the role of psychological factors in the relationship between sleep problems and suicide

Littlewood

Kyle

Pratt

et al. 2017

Clinical Psychology Review

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We sought to conduct the first systematic review of empirical evidence investigating the role of psychological factors in the relationship between sleep problems and suicidal thoughts and behaviours. Twelve studies were identified which examined psychological factors grouped into four categories of cognitive appraisals, psychosocial factors, emotion regulation strategies, and risk behaviours. Although there was substantial heterogeneity across studies with respect to measurement, sampling, and analysis, preliminary evidence indicated that negative cognitive appraisals, perceived social isolation, and unhelpful emotion regulation strategies may contribute to the association between sleep problems and suicidal thoughts and behaviours. Given that findings in this area are currently restricted to studies with cross-sectional designs, the directionality of the interrelationships between these psychological factors, sleep problems and suicidality, remains unclear. We integrate the findings of our review with contemporary psychological models of suicidal behaviour to develop a clear research agenda. Identified pathways should now be tested with longitudinal and experimental designs. In addition, a more thorough investigation of the complexities of sleep, psychological factors, and suicidal thoughts and behaviours is crucial for the development of targeted psychological interventions.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Examining the role of psychological factors in the relationship between sleep problems and suicide

Littlewood

Kyle

Pratt

et al. 2017

Clinical Psychology Review

View full text Add to dashboard Cite

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“…However, those MDD patients who present with clinically significant insomnia complaints comprise a particularly challenging group to treat. For many such patients, insomnia represents a long-standing and problematic condition that can: (1) predate the onset of MDD, 6,7 (2) increase the risk of suicide, 8,9 (3) show a suboptimal response to traditional depression treatment, 10,11 (4) remain after successful depression treatment, 12,13 and (5) increase risk for MDD relapse (e.g., Nierenberg et al 14 ). Perhaps because the insomnia of MDD patients traditionally has been viewed as an MDD symptom rather than a comorbid disorder, the sleep-specific treatment needs of MDD patients have been largely ignored until recently.…”

Section: Introductionmentioning

confidence: 99%

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

Carney

Edinger

Kuchibhatla

et al. 2017

Sleep

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153

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Study Objective: To compare cognitive behavioral therapy for insomnia (CBT-I) + antidepressant medication (AD) against treatments that target solely depression or solely insomnia. Design: A blinded, randomized split-plot experimental study. Setting: Two urban academic clinical centers. Participants: 107 participants (68% female, mean age 42 ± 11) with major depressive disorder and insomnia. Interventions: Randomization was to one of three groups: antidepressant (AD; escitalopram) + CBT-I (4 sessions), CBT-I + placebo pill, or AD + 4-session sleep hygiene control (SH). Measurements and Results: Subjective sleep was assessed via 2 weeks of daily sleep diaries (use of medication was covaried in all analyses); although there were no statistically significant group differences detected, all groups improved from baseline to posttreatment on subjective sleep efficiency (SE) and total wake time (TWT) and the effect sizes were large. Objective sleep was assessed via overnight polysomnographic monitoring at baseline and posttreatment; analyses revealed both CBT groups improved on TWT (p = .03), but the AD + SH group worsened. There was no statistically significant effect for PSG SE (p = .07). There was a between groups medium effect observed for the AD + SH and CBT + placebo group differences on diary TWT and both PSG variables. All groups improved significantly from baseline to posttreatment on the Hamilton Rating Scale for Depression (HAMD-17); the groups did not differ. Conclusions: Although all groups self-reported sleeping better after treatment, only the CBT-I groups improved on objective sleep, and AD + SH's sleep worsened. This suggests that we should be treating sleep in those with depression with an effective insomnia treatment and relying on self-report obscures sleep worsening effects. All groups improved on depression, even a group with absolutely no depression-focused treatment component (CBT-I + placebo). The depression effect in CBT-I only group has been reported in other studies, suggesting that we should further investigate the antidepressant properties of CBT-I.

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“…An association between sleep problems and suicidal behaviors has been widely documented [17–19]. But systematic analyses of insomnia and suicide-related thoughts and behaviors are still inconsistent across studies and there is a lack of empirical studies focusing on mediating factors in the insomnia and suicide relationship [20]. Similar to these numerous studies on sleep problems and suicidality in the last 10 years, the negative impact of internet use as an internet addiction has been continuously researched [2, 21–24].…”

Section: Introductionmentioning

confidence: 99%

Poor sleep quality and suicide attempt among adults with internet addiction: A nationwide community sample of Korea

et al. 2017

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PurposeInternet addiction (IA) is defined as a psychological dependence on the internet, regardless of the type of activities once logged on, and previous studies have focused on adolescents and young adults. The aim of this study was to investigate the association between suicide attempts and sleep among community-dwelling adults with IA.MethodsThe Young’s Internet Addiction Test (IAT), the Korean version of the Composite International Diagnostic Interview (K-CIDI) and a suicide questionnaire were used in this cross-sectional multistage, cluster sampling population-based study. A total of 3212 adults aged 18–64 years were interviewed face-to-face, and they had been randomly selected through a one-person-per-household method.ResultsOf the 3212 adults, 204 were assessed as having IA (6.35%). Adults with IA were younger, and more frequently male, unmarried, and unemployed, and had poorer sleep quality than adults without IA (32.8% vs. 19.8%), whereas there was no significant difference in the absolute duration of sleep between the two groups. Adults with IA showed more frequent difficulty initiating and maintaining sleep, non-restorative sleep, daytime functional impairment, and duration of sleep more than 10 hours on weekdays than adults without IA. IA with poor sleep quality was significantly associated with lifetime suicide attempts (AOR = 3.34, 95% CI 1.38–8.05) after adjusting for demographic covariates. Adults with IA who had more sleep problems showed more severe IA, especially those who experienced a previous suicidal attempt. Among mental disorders, IA with poor sleep quality was significantly associated with anxiety disorder and overall psychiatric disorders.ConclusionsAmong adults with IA, poor sleep quality was found to be associated with more severe IA and lifetime suicide attempt.

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The insomnia and suicide link: toward an enhanced understanding of this relationship

Cited by 96 publications

References 132 publications

Examining the role of psychological factors in the relationship between sleep problems and suicide

Examining the role of psychological factors in the relationship between sleep problems and suicide

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

Poor sleep quality and suicide attempt among adults with internet addiction: A nationwide community sample of Korea

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