Pilot Study of a Brief Sleep Intervention for Suicidal Ideation in Bipolar Disorder

Poor subjective sleep quality and trait impulsivity in patients with bipolar disorder

BACKGROUND

Sleep disturbance and impulsivity are key components of mood vulnerability in bipolar disorder (BD), but few studies have assessed the association between these two symptoms among patients with BD.

METHODS

Forty-seven euthymic patients with bipolar I disorder (BDI) or bipolar II disorder (BDII) and 58 age- and sex-matched healthy controls were enrolled in this cross-sectional study. Trait impulsivity was measured using the Barratt Impulsiveness Scale Version 11 (BIS-11), which yielded 3 second-order factors: attention, motor, and non-planning. Subjective sleep quality was assessed using the self-reported Pittsburgh Sleep Quality Index (PSQI). General linear models (GLMs) were used to assess the associations between subjective poor sleep and trait impulsivity with multiple testing corrections.

RESULTS

Patients with BD scored higher in BIS-11 and PSQI than healthy controls. PSQI total scores positively correlated with BIS-11 total scores, while sleep disturbance and daytime dysfunction were associated with attentional impulsiveness after controlling for covariates. Participants with higher PSQI total scores (>10) had higher scores in BIS-11 total, attention, and non-planning than those with low PSQI scores (≤5).

CONCLUSION

These findings support the hypothesis that poor sleep quality might lead to impulsivity and add to the growing evidence that improving sleep quality may be a therapeutic target for patients with BD.

A systematic review and meta-analysis on the efficacy of sleep interventions to treat suicidal ideation

Researchers at the intersection of sleep and suicide research have advocated for investigation of sleep disturbances as a therapeutic target for the purposes of treating and preventing suicide. This study aims to provide the first systematic review and meta-analysis on the efficacy of sleep interventions to treat suicidal ideation. This systematic review and meta-analysis, registered with the International Prospective Register of Systematic Reviews, was conducted in PsycINFO, through Ovid. A sample of eight articles were deemed eligible and a total of 21 effect sizes were included. Egger's test suggested that no publication bias was present (b = 0.3695; p = 0.0852). The pooled effect size for sleep treatments on suicidal ideation was small (g = -0.0931, p = 0.3047). Significant heterogeneity was present (I2  = 44.13%), indicating the need for moderator analyses. Treatment type (medication versus psychotherapy; g = -0.2487, p = 0.3368), sex (g = -0.0007; p = 0.9263), and race (g = -0.0081; p = 0.1624) were all considered as moderators and were all found to be insignificant. This meta-analysis revealed that initial studies exploring the efficacy of sleep interventions on suicidal ideation demonstrate small effect sizes. Despite this, the handful of studies included in this review nonetheless highlight this as an important area for continued exploration. The use of larger and more diverse samples, as well as intentionally designing sleep-related interventions to improve ideation and behaviour, have the potential to enhance the efficacy of sleep interventions for this novel purpose.