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Williamson C, Croak B, Simms A, Fear NT, Sharp ML, Stevelink SAM. Risk and protective factors for self-harm and suicide behaviours among serving and ex-serving personnel of the UK Armed Forces, Canadian Armed Forces, Australian Defence Force and New Zealand Defence Force: A systematic review. PLoS One 2024; 19:e0299239. [PMID: 38669252 PMCID: PMC11051630 DOI: 10.1371/journal.pone.0299239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/06/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Self-harm and suicide behaviours are a major public health concern. Several factors are associated with these behaviours among military communities. Identifying these factors may have important implications for policy and clinical services. The aim of this review was to identify the risk and protective factors associated with self-harm and suicide behaviours among serving and ex-serving personnel of the United Kingdom Armed Forces, Canadian Armed Forces, Australian Defence Force and New Zealand Defence Force. METHODS A systematic search of seven online databases (PubMed, Web of Science, Embase, Global Health, PsycINFO, PTSDpubs and CINAHL) was conducted alongside cross-referencing, in October 2022. Following an a priori PROSPERO approved protocol (CRD42022348867), papers were independently screened and assessed for quality. Data were synthesised using a narrative approach. RESULTS Overall, 28 papers were included: 13 from Canada, 10 from the United Kingdom, five from Australia and none from New Zealand. Identified risk factors included being single/ex-relationship, early service leavers, shorter length of service (but not necessarily early service leavers), junior ranks, exposure to deployment-related traumatic events, physical and mental health diagnoses, and experience of childhood adversity. Protective factors included being married/in a relationship, higher educational attainment, employment, senior ranks, and higher levels of perceived social support. CONCLUSION Adequate care and support are a necessity for the military community. Prevention and intervention strategies for self-harm and suicide behaviours may be introduced early and may promote social networks as a key source of support. This review found a paucity of peer-reviewed research within some populations. More peer-reviewed research is needed, particularly among these populations where current work is limited, and regarding modifiable risk and protective factors.
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Affiliation(s)
- Charlotte Williamson
- King’s Centre for Military Health Research, King’s College London, London, United Kingdom
| | - Bethany Croak
- King’s Centre for Military Health Research, King’s College London, London, United Kingdom
| | - Amos Simms
- Academic Department of Military Mental Health, King’s College London, London, United Kingdom
- British Army, London, United Kingdom
| | - Nicola T. Fear
- King’s Centre for Military Health Research, King’s College London, London, United Kingdom
- Academic Department of Military Mental Health, King’s College London, London, United Kingdom
| | - Marie-Louise Sharp
- King’s Centre for Military Health Research, King’s College London, London, United Kingdom
| | - Sharon A. M. Stevelink
- King’s Centre for Military Health Research, King’s College London, London, United Kingdom
- Department of Psychological Medicine, King’s College London, London, United Kingdom
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2
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Germain A, Wolfson M, Brock MS, O'Reilly B, Hearn H, Knowles S, Mysliwiec V, Wallace ML. Digital CBTI hubs as a treatment augmentation strategy in military clinics: study protocol for a pragmatic randomized clinical trial. Trials 2023; 24:648. [PMID: 37803393 PMCID: PMC10557157 DOI: 10.1186/s13063-023-07686-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 09/28/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Chronic insomnia is the most prevalent sleep disorder among military service members, and it compromises readiness, performance, and physical and mental health. Cognitive behavioral treatment for insomnia (CBTI) is the standard of care for the treatment of insomnia recommended by the VA/DoD Clinical Practice Guideline, the American Academy of Sleep Medicine, and the American College of Physicians. CBTI is highly effective but has limited scalability. It is often unavailable in clinical settings where service members receive sleep care. Digital technologies offer unique opportunities to scale and broaden the geographic reach of CBTI services and support increased patient access and engagement in behavioral sleep care. This study aims to evaluate the impact and acceptability of digital CBTI hubs to augment military treatment facilities' capabilities in behavioral sleep medicine. METHODS This is a multi-site, non-inferiority randomized clinical trial designed to compare the effects of in-person (face-to-face or virtual) insomnia care as usual at three military sleep clinics versus CBTI delivered remotely and asynchronously through digital CBTI hubs. Digital CBTI hubs are led by licensed, certified clinicians who use NOCTEM's® evidence-based clinical decision support platform COAST™ (Clinician Operated Assistive Sleep Technology). Changes in insomnia severity and daytime symptoms of depression and anxiety will be compared at baseline, at 6-8 weeks, and at 3-month follow-up. Patient satisfaction with insomnia care as usual versus digital CBTI hubs will also be examined. We hypothesize that digital CBTI hubs will be non-inferior to insomnia care as usual for improvements in insomnia and daytime symptoms as well as patient satisfaction with insomnia care. DISCUSSION Digital technology has a high potential to scale CBTI accessibility and delivery options required to meet the insomnia care needs of military service members. Digital CBTI hubs using COAST offer a novel approach to broaden service members' access to CBTI and to serve as an augmentation strategy for existing sleep services at military treatment facilities. The pragmatic approach leveraging technology in this trial has the potential to rapidly inform clinical practice within the Defense Health Agency as well as other healthcare systems. TRIAL REGISTRATION ClinicalTrials.gov NCT05490550. Registered on 14 July 2023.
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Affiliation(s)
- Anne Germain
- NOCTEM, LLC, 218 Oakland Avenue, Pittsburgh, PA, 15213, USA.
| | - Megan Wolfson
- NOCTEM, LLC, 218 Oakland Avenue, Pittsburgh, PA, 15213, USA
| | - Matthew S Brock
- Department of Sleep Medicine, Wilford Hall Ambulatory Surgical Center, 1100 Wilford Hall Loop, Lackland AFB, San Antonio, TX, 78236, USA
| | - Brian O'Reilly
- Madigan Army Medical Center, Joint Base Lewis-McChord, WA, 9040 Jackson Ave., Joint Base Lewis-McChord, WA, 98431, USA
| | - Hunter Hearn
- Carl R. Darnall Army Medical Center, Sleep Disorder Center, 36065 Santa Fe Ave., Fort Hood, Fort Cavazos, TX, 76544, USA
| | - Shelley Knowles
- Carl R. Darnall Army Medical Center, Sleep Disorder Center, 36065 Santa Fe Ave., Fort Hood, Fort Cavazos, TX, 76544, USA
| | - Vincent Mysliwiec
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, 78229, USA
| | - Meredith L Wallace
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, USA
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Hando BR, Bryant J, Pav V, Haydu L, Hogan K, Mata J, Butler C. Musculoskeletal injuries in US Air Force Tactical Air Control Party trainees: an 11-year longitudinal retrospective cohort study and presentation of a musculoskeletal injury classification matrix. BMJ Mil Health 2023:military-2023-002417. [PMID: 37220991 DOI: 10.1136/military-2023-002417] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/05/2023] [Indexed: 05/25/2023]
Abstract
INTRODUCTION Little is known of the epidemiology of musculoskeletal injuries (MSKIs) in US Air Force Special Warfare (AFSPECWAR) Tactical Air Control Party trainees. The purpose of this longitudinal retrospective cohort study was to (1) report the incidence and type of MSKI sustained by AFSPECWAR trainees during and up to 1 year following training, (2) identify factors associated with MSKI, and (3) develop and present the MSKI classification matrix used to identify and categorise injuries in this study. METHODS Trainees in the Tactical Air Control Party Apprentice Course between fiscal years 2010-2020 were included. Diagnosis codes were classified as MSKI or non-MSKI using a classification matrix. Incidence rates and incidence proportion for injury types and regions were calculated. Measures were compared for differences between those who did and did not sustain an MSKI during training. A Cox proportional hazards model was used to identify factors associated with MSKI. RESULTS Of the 3242 trainees, 1588 (49%) sustained an MSKI during training and the cohort sustained MSKIs at a rate of 16 MSKI per 100 person-months. Overuse/non-specific lower extremity injuries predominated. Differences were seen in some baseline measures between those who did and did not sustain an MSKI. Factors retained in the final Cox regression model were age, 1.5-mile run times and prior MSKI. CONCLUSION Slower run times and higher age were associated with an increased likelihood of MSKI. Prior MSKI was the strongest predictor of MSKI during training. Trainees sustained MSKIs at a higher rate than graduates in their first year in the career field. The MSKI matrix was effective in identifying and categorising MSKI over a prolonged (12-year) surveillance period and could be useful for future injury surveillance efforts in the military or civilian settings. Findings from this study could inform future injury mitigation efforts in military training environments.
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Affiliation(s)
- Ben R Hando
- Kennell and Associates Inc, Falls Church, Virginia, USA
| | - J Bryant
- Human Performance Squadron, Special Warfare Training Wing, US Air Force, San Antonio, Texas, USA
| | - V Pav
- Kennell and Associates Inc, Falls Church, Virginia, USA
| | - L Haydu
- Special Warfare Training Wing, Human Performance Squadron, US Air Force, San Antonio, Texas, USA
| | - K Hogan
- Special Warfare Training Wing, Human Performance Squadron, US Air Force Education and Training Command, San Antonio, Texas, USA
| | - J Mata
- Special Warfare Training Wing, Human Performance Squadron, US Air Force, San Antonio, Texas, USA
| | - C Butler
- Special Warfare Training Wing, Human Performance Squadron, US Air Force Education and Training Command, San Antonio, Texas, USA
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4
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Farah N, Obeid S, Malaeb D, Haddad C, Fekih-Romdhane F, Hallit S. Mediation effect of insomnia symptoms between positive psychotic like experiences and suicidal ideation among Lebanese young adults. BMC Psychiatry 2023; 23:272. [PMID: 37081441 PMCID: PMC10116113 DOI: 10.1186/s12888-023-04778-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 04/12/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Psychotic symptoms reported by healthy individuals in the general population are referred to as psychotic-like experiences (PLEs) and have been proven to increase the risk of suicidal ideation (SI) in these individuals. As it is well established that PLEs and insomnia share a bidirectional association and also that insomnia is linked to SI, we hypothesized that insomnia may represent a mediator underlying the relationship between PLEs and SI. Our aim was to validate this hypothesis among Lebanese young adults. METHODS A total of 3103 young adults (mean age 21.73 ± 3.80 years; 63.6% females) recruited from all Lebanese governorates completed a self-administered online questionnaire. PLEs were assessed using the CAPE-42 scale, SI using the Columbia Suicide Rating Scale, and insomnia using the Insomnia Severity Index). We conducted a mediation analysis using SPSS PROCESS v3.4 model 4 with three pathways. Variables that showed a p < 0.25 in the bivariate analysis were entered in the path analysis. RESULTS A total of 1378 participants (44.4%) had insomnia; 18.8% had SI; 42.5% reported at least one positive PE 'nearly always', and 30.5% reported at least one negative PE with this frequency. The results of the mediation analysis showed that insomnia severity partially mediated the association between positive dimension and SI; higher positive dimension was significantly associated with more insomnia severity, which was, in turn, significantly associated with more SI. Finally, more positive dimension was significantly and directly associated with more SI. CONCLUSION These preliminary findings might encourage the implementation of new preventive measures to reduce SI among PLEs patients. Treating symptoms of insomnia might help reduce the risk of suicide.
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Affiliation(s)
- Nour Farah
- Faculty of Science, Lebanese University, Fanar, Lebanon
| | - Sahar Obeid
- School of Arts and Sciences, Social and Education Sciences Department, Lebanese American University, Jbeil, Lebanon
| | - Diana Malaeb
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
| | - Chadia Haddad
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
- School of Health Sciences, Modern University for Business and Science, Beirut, Lebanon
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique Et de Toxicologie-Liban), Beirut, Lebanon
| | - Feten Fekih-Romdhane
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry "Ibn Omrane", Razi Hospital, 2010, Manouba, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Souheil Hallit
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
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5
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Kramer EB, Gaeddert LA, Jackson CL, Hostetter TA, Forster JE, Nazem S. The association among insomnia symptom severity, comorbid symptoms, and suicidal ideation in two veteran cohorts meeting diagnostic criteria for insomnia disorder. J Clin Psychol 2023; 79:1420-1433. [PMID: 36696685 DOI: 10.1002/jclp.23488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 12/15/2022] [Accepted: 01/10/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Examine the association between insomnia symptom severity and suicidal ideation (SI), after adjusting for clinical comorbidity in veterans meeting diagnostic criteria for insomnia disorder. METHODS Secondary data analyses of psychometrically validated baseline assessments of depression, posttraumatic stress disorder (PTSD), and anxiety symptoms from two online insomnia intervention randomized clinical trials (n = 232; n = 80) were conducted. Multiple linear regression was used to determine the association between insomnia symptom severity and SI, after controlling for clinical comorbidity and demographics. RESULTS Insomnia symptom severity was significantly correlated with comorbid depression, PTSD, and anxiety symptoms in both cohorts and significantly correlated with SI in one. After controlling for demographics and clinical comorbidity, insomnia symptom severity was not significantly associated with SI in linear regression models. CONCLUSION Findings extend insomnia-suicide research by providing evidence that insomnia symptom severity may not confer a unique risk for SI above comorbid mental health symptoms in veterans meeting diagnostic criteria for insomnia disorder.
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Affiliation(s)
- Emily B Kramer
- U.S. Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, Colorado, USA
| | - Laurel A Gaeddert
- U.S. Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, Colorado, USA
| | - Christine L Jackson
- U.S. Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, Colorado, USA
| | - Trisha A Hostetter
- U.S. Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, Colorado, USA
| | - Jeri E Forster
- U.S. Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, Colorado, USA.,Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Sarra Nazem
- U.S. Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, Colorado, USA.,U.S. Department of Veterans Affairs, National Center for PTSD, Dissemination & Training Division, Menlo Park, California, USA
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6
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Te T. You lack the season of all natures, sleep. J Clin Sleep Med 2022; 18:343-344. [PMID: 34857085 PMCID: PMC8805017 DOI: 10.5664/jcsm.9826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Tue Te
- Division of Sleep Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;,Division of Sleep Medicine, Penn Medicine—Hospital of the University of Pennsylvania, Penn Sleep Center Market Street, Philadelphia, Pennsylvania,Address correspondence to: Tue Te, MD, Division of Sleep Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Translational Research Laboratories, Suite 2100, 125 South 31st Street, Philadelphia, PA 19104;
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7
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Deng Z, Jiang X, Liu W, Zhao W, Jia L, Sun Q, Xie Y, Zhou Y, Sun T, Wu F, Kong L, Tang Y. The aberrant dynamic amplitude of low-frequency fluctuations in melancholic major depressive disorder with insomnia. Front Psychiatry 2022; 13:958994. [PMID: 36072459 PMCID: PMC9441487 DOI: 10.3389/fpsyt.2022.958994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Insomnia is considered one of the manifestations of sleep disorders, and its intensity is linked to the treatment effect or suicidal thoughts. Major depressive disorder (MDD) is classified into various subtypes due to heterogeneous symptoms. Melancholic MDD has been considered one of the most common subtypes with special sleep features. However, the brain functional mechanisms in melancholic MDD with insomnia remain unclear. MATERIALS AND METHODS Melancholic MDD and healthy controls (HCs, n = 46) were recruited for the study. Patients were divided into patients with melancholic MDD with low insomnia (mMDD-LI, n = 23) and patients with melancholic MDD with high insomnia (mMDD-HI, n = 30), according to the sleep disturbance subscale of the 17-item Hamilton Depression Rating Scale. The dynamic amplitude of low-frequency fluctuation was employed to investigate the alterations of brain activity among the three groups. Then, the correlations between abnormal dALFF values of brain regions and the severity of symptoms were investigated. RESULTS Lower dALFF values were found in the mMDD-HI group in the right middle temporal gyrus (MTG)/superior temporal gyrus (STG) than in the mMDD-LI (p = 0.014) and HC groups (p < 0.001). Melancholic MDD groups showed decreased dALFF values than HC in the right middle occipital gyri (MOG)/superior occipital gyri (SOG), the right cuneus, the bilateral lingual gyrus, and the bilateral calcarine (p < 0.05). Lower dALFF values than HC in the left MOG/SOG and the left cuneus in melancholic MDD groups were found, but no significant difference was found between the mMDD-LI group and HC group (p = 0.079). Positive correlations between the dALFF values in the right MTG/STG and HAMD-SD scores (the sleep disturbance subscale of the HAMD-17) in the mMDD-HI group (r = 0.41, p = 0.042) were found. In the pooled melancholic MDD, the dALFF values in the right MOG/SOG and the right cuneus (r = 0.338, p = 0.019), the left MOG/SOG and the left cuneus (r = 0.299, p = 0.039), and the bilateral lingual gyrus and the bilateral calcarine (r = 0.288, p = 0.047) were positively correlated with adjusted HAMD scores. CONCLUSION The occipital cortex may be related to depressive symptoms in melancholic MDD. Importantly, the right MTG/STG may play a critical role in patients with melancholic MDD with more severe insomnia.
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Affiliation(s)
- Zijing Deng
- Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, China.,Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xiaowei Jiang
- Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, China.,Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Wen Liu
- Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, China.,Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Wenhui Zhao
- Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, China.,Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Linna Jia
- Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, China.,Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Qikun Sun
- Department of Radiation Oncology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yu Xie
- Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yifang Zhou
- Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, China.,Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Ting Sun
- Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, China.,Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Feng Wu
- Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, China.,Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Lingtao Kong
- Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, China.,Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yanqing Tang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China.,Department of Gerontology, The First Affiliated Hospital of China Medical University, Shenyang, China
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8
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Lin YS, Wang CC, Chen CY. GWAS Meta-Analysis Reveals Shared Genes and Biological Pathways between Major Depressive Disorder and Insomnia. Genes (Basel) 2021; 12:genes12101506. [PMID: 34680902 PMCID: PMC8536096 DOI: 10.3390/genes12101506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/17/2021] [Accepted: 09/24/2021] [Indexed: 11/27/2022] Open
Abstract
Major depressive disorder (MDD) is one of the most prevalent and disabling mental disorders worldwide. Among the symptoms of MDD, sleep disturbance such as insomnia is prominent, and the first reason patients may seek professional help. However, the underlying pathophysiology of this comorbidity is still elusive. Recently, genome-wide association studies (GWAS) have begun to unveil the genetic background of several psychiatric disorders, including MDD and insomnia. Identifying the shared genomic risk loci between comorbid psychiatric disorders could be a valuable strategy to understanding their comorbidity. This study seeks to identify the shared genes and biological pathways between MDD and insomnia based on their shared genetic variants. First, we performed a meta-analysis based on the GWAS summary statistics of MDD and insomnia obtained from Psychiatric Genomics Consortium and UK Biobank, respectively. Next, we associated shared genetic variants to genes using two gene mapping strategies: (a) positional mapping based on genomic proximity and (b) expression quantitative trait loci (eQTL) mapping based on gene expression linkage across multiple tissues. As a result, a total of 719 shared genes were identified. Over half (51%) of them are protein-coding genes. Functional enrichment analysis shows that the most enriched biological pathways are related to epigenetic modification, sensory perception, and immunologic signatures. We also identified druggable targets using a network approach. Together, these results may provide insights into understanding the genetic predisposition and underlying biological pathways of comorbid MDD and insomnia symptoms.
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Affiliation(s)
- Yi-Sian Lin
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan; (Y.-S.L.); (C.-C.W.)
| | - Chia-Chun Wang
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan; (Y.-S.L.); (C.-C.W.)
| | - Cho-Yi Chen
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan; (Y.-S.L.); (C.-C.W.)
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Correspondence:
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9
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Anna Karin H, Hössjer O, Bellocco R, Ye W, Trolle LY, Åkerstedt T. Insomnia in the context of short sleep increases suicide risk. Sleep 2021; 44:5995546. [PMID: 33216134 PMCID: PMC8033451 DOI: 10.1093/sleep/zsaa245] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 02/28/2020] [Indexed: 01/25/2023] Open
Abstract
Study Objectives The relationship between insomnia and suicide risk is not completely understood. We aimed to investigate the influence of insomnia on suicide risk, taking both sleep duration and depression into consideration. Methods The present study is based on a Swedish prospective cohort study of 38,786 participants with a mean follow-up time of 19.2 years. Cox proportional hazards models with attained age as time-scale were used to estimate hazard ratios (HRs) of death by suicide with 95% confidence intervals (CI) for participants categorized by frequency of insomnia symptoms. Causal mediation analysis was performed to assess to what extent the relationship between insomnia and suicide risk is mediated by depression. Results Insomnia was only associated with suicide risk among short sleepers, whereas no significant association was observed among those who slept 7 h/night or more. The total effect of insomnia in the context of short sleep on suicide risk, expressed on the HR scale, was 2.85 (95% CI 1.42–5.74). The direct effect was 2.25 (95% CI 1.12–4.54) and the indirect effect, mediated by depression, was 1.27 (95% CI 1.05–1.53). Of the total effect, 32% was mediated by depression. The association between insomnia and suicide risk became more pronounced with decreasing depressive symptoms (p value for trend <0.05). Conclusions Insomnia in the context of short sleep increases suicide risk, both directly and indirectly by affecting the risk of depression. Abnormalities of sleep duration and insomnia symptoms should be evaluated when assessing suicide risk.
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Affiliation(s)
- Hedström Anna Karin
- Department of Clinical Neuroscience and Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ola Hössjer
- Mathematical Statistics, Stockholm University, Stockholm, Sweden
| | - Rino Bellocco
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Weimin Ye
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Lagerros Ylva Trolle
- Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.,Obesity Center, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
| | - Torbjörn Åkerstedt
- Stress Research, Stockholm University, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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10
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Wang XQ, Wang DQ, Bao YP, Liu JJ, Chen J, Wu SW, Luk HN, Yu L, Sun W, Yang Y, Wang XH, Lu L, Deng JH, Li SX. Preliminary Study on Changes of Sleep EEG Power and Plasma Melatonin in Male Patients With Major Depressive Disorder After 8 Weeks Treatment. Front Psychiatry 2021; 12:736318. [PMID: 34867527 PMCID: PMC8632954 DOI: 10.3389/fpsyt.2021.736318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/29/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To clarify the effects of escitalopram on sleep EEG power in patients with Major depressive disorder (MDD). Method: Polysomnography (PSG) was detected overnight, and blood samples were collected at 4 h intervals over 24 h from 13 male healthy controls and 13 male MDD patients before and after treatment with escitalopram for 8 weeks. The outcome measures included plasma melatonin levels, sleep architecture, and the sleep EEG power ratio. Results: Compared with healthy controls, MDD patients presented abnormalities in the diurnal rhythm of melatonin secretion, including peak phase delayed 3 h and a decrease in plasma melatonin levels at night and an increase at daytime, accompanied by sleep disturbances, a decrease in low-frequency bands and an increase in high-frequency bands, and the dominant right-side brain activity. Several of these abnormalities (abnormalities in the diurnal rhythm of melatonin secretion, partial sleep architecture parameters) persisted for at least the 8-week testing period. Conclusions: Eight weeks of treatment with escitalopram significantly improved subjective sleep perception and depressive symptoms of patients with MDD, and partially improved objective sleep parameters, while the improvement of circadian rhythm of melatonin was limited.
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Affiliation(s)
- Xue-Qin Wang
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Institute of Mental Health, Peking University Sixth Hospital, Beijing, China
| | - De-Quan Wang
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
| | - Yan-Ping Bao
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
| | - Jia-Jia Liu
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Institute of Mental Health, Peking University Sixth Hospital, Beijing, China
| | - Jie Chen
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Institute of Mental Health, Peking University Sixth Hospital, Beijing, China
| | - Shao-Wei Wu
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, China.,Key Laboratory of Molecular Cardiovascular Sciences, Peking University, Ministry of Education, Beijing, China
| | - Hsuan-Nu Luk
- Peking University Health Science Center, Beijing, China
| | - Ling Yu
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Institute of Mental Health, Peking University Sixth Hospital, Beijing, China
| | - Wei Sun
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Institute of Mental Health, Peking University Sixth Hospital, Beijing, China
| | - Yong Yang
- School of Automation, Hangzhou Dianzi University, Hangzhou, China
| | | | - Lin Lu
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Institute of Mental Health, Peking University Sixth Hospital, Beijing, China.,National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China.,Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
| | - Jia-Hui Deng
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Institute of Mental Health, Peking University Sixth Hospital, Beijing, China
| | - Su-Xia Li
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China.,Department of Pharmacology, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
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11
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Akkaoui MA, Lejoyeux M, d’Ortho MP, Geoffroy PA. Nightmares in Patients with Major Depressive Disorder, Bipolar Disorder, and Psychotic Disorders: A Systematic Review. J Clin Med 2020; 9:E3990. [PMID: 33317105 PMCID: PMC7763994 DOI: 10.3390/jcm9123990] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/24/2020] [Accepted: 11/27/2020] [Indexed: 12/16/2022] Open
Abstract
Chronic nightmares are very common in psychiatric disorders, affecting up to 70% of patients with personality or post-traumatic stress disorders. In other psychiatric disorders, the relationships with nightmares are poorly known. This review aimed to clarify the relationship between nightmares and both mood and psychotic disorders. We performed a systematic literature search using the PubMed, Cochrane Library and PsycINFO databases until December 2019, to identify studies of patients suffering from either a mood disorder or a psychotic disorder associated with nightmares. From the 1145 articles screened, 24 were retained, including 9 studies with patients with mood disorders, 11 studies with patients with psychotic disorders and 4 studies with either psychotic or mood disorders. Nightmares were more frequent in individuals with mood or psychotic disorders than in healthy controls (more than two-fold). Patients with frequent nightmares had higher suicidality scores and had more frequently a history of suicide attempt. The distress associated with nightmares, rather than the frequency of nightmares, was associated with the severity of the psychiatric disorder. Further studies assessing whether nightmare treatment not only improves patient-sleep perception but also improves underlying psychiatric diseases are needed. In conclusion, nightmares are overrepresented in mood and psychotic disorders, with the frequency associated with suicidal behaviors and the distress associated with the psychiatric disorder severity. These findings emphasize major clinical and therapeutic implications.
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Affiliation(s)
- Marine Ambar Akkaoui
- Department of Psychiatry and Addictive Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Bichat, 46 rue Henri Huchard, 75018 Paris, France; (M.L.); (P.A.G.)
- Centre Psychiatrique d’Orientation et d’Accueil (CPOA), GHU Paris—Psychiatry & Neurosciences, 1 rue Cabanis, 75014 Paris, France
- Etablissement Publique de Santé Mentale de Ville Evrard, 202 Avenue Jean Jaurès Neuilly-Sur-Marne, 93300 Neuilly-sur-Marne, France
| | - Michel Lejoyeux
- Department of Psychiatry and Addictive Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Bichat, 46 rue Henri Huchard, 75018 Paris, France; (M.L.); (P.A.G.)
- Université de Paris, 75018 Paris, France
| | - Marie-Pia d’Ortho
- Université de Paris, NeuroDiderot, Inserm UMR1141, F-75019 Paris, France;
- Department of Physiology and Sleep Center, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Bichat, 46 rue Henri Huchard, 75018 Paris, France
| | - Pierre A. Geoffroy
- Department of Psychiatry and Addictive Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Bichat, 46 rue Henri Huchard, 75018 Paris, France; (M.L.); (P.A.G.)
- Université de Paris, 75018 Paris, France
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12
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Gallo JJ, Hwang S, Truong C, Reynolds CF, Spira AP. Role of persistent and worsening sleep disturbance in depression remission and suicidal ideation among older primary care patients: the PROSPECT study. Sleep 2020; 43:5814941. [PMID: 32239161 DOI: 10.1093/sleep/zsaa063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 01/31/2020] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES We analyzed data from a practice-based randomized controlled trial within 20 primary care practices located in greater New York City, Philadelphia, and Pittsburgh to determine whether persistent or worsening sleep disturbance plays a role in the outcomes of depression and suicidal ideation at 1 year in older adults with depression. METHODS The study sample consisted of 599 adults aged 60 years and older meeting criteria for major depression or clinically significant minor depression. Longitudinal analysis via growth curve mixture modeling was carried out to classify patients as having worsening, persistent, or improving sleep over 1 year. RESULTS At 1-year follow-up, compared with patients with improving sleep, those with worsening sleep were more likely to have a diagnosis of major depression (adjusted odds ratio (aOR) = 28.60, 95% confidence interval (CI) 12.15 to 67.34), a diagnosis of clinically significant minor depression (aOR = 11.88, 95% CI 5.67 to 24.89), and suicidal ideation (aOR = 1.10, 1.005 to 1.199), and were half as likely to achieve remission (aOR = 0.52, 95% CI 0.46 to 0.57). Patients with persistent sleep disturbance showed similar but attenuated results. CONCLUSIONS Older primary care patients with depression who exhibit worsening or persistent sleep disturbance were at increased risk for persistent depression and suicidal ideation 1 year later. The pattern of sleep disturbance over time may be an important signal for exploration by primary care physicians of depression and suicidal ideation among older adults with depression. CLINICAL TRIAL REGISTRATION NCT00279682.
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Affiliation(s)
- Joseph J Gallo
- Department of Mental Health, Johns Hopkins University, Baltimore, MD.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD.,Johns Hopkins Center on Aging and Health, Johns Hopkins University, Baltimore, MD
| | - Seungyoung Hwang
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.,American Psychiatric Association, Washington, D.C
| | - Christine Truong
- Department of Mental Health, Johns Hopkins University, Baltimore, MD
| | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Adam P Spira
- Department of Mental Health, Johns Hopkins University, Baltimore, MD.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD.,Johns Hopkins Center on Aging and Health, Johns Hopkins University, Baltimore, MD
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13
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Lake S, Kerr T, Buxton J, Walsh Z, Marshall BD, Wood E, Milloy MJ. Does cannabis use modify the effect of post-traumatic stress disorder on severe depression and suicidal ideation? Evidence from a population-based cross-sectional study of Canadians. J Psychopharmacol 2020; 34:181-188. [PMID: 31684805 DOI: 10.1177/0269881119882806] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Post-traumatic stress disorder sharply increases the risk of depression and suicide. Individuals living with post-traumatic stress disorder frequently use cannabis to treat associated symptoms. We sought to investigate whether cannabis use modifies the association between post-traumatic stress disorder and experiencing a major depressive episode or suicidal ideation. METHODS We used data from the 2012 Canadian Community Health Survey-Mental Health, a nationally representative cross-sectional survey of non-institutionalized Canadians aged ⩾15 years. The relationship between post-traumatic stress disorder and each outcome was modelled using logistic regression with an interaction term for cannabis and post-traumatic stress disorder, controlling for demographic characteristics, mental health, and substance use comorbidities. The ratio of odds ratios and relative excess risk due to interaction was calculated to measure interaction on the multiplicative and additive scales, respectively. RESULTS Among 24,089 eligible respondents, 420 (1.7%) reported a current clinical diagnosis of post-traumatic stress disorder. In total, 106 (28.2%) people with post-traumatic stress disorder reported past-year cannabis use, compared to 11.2% of those without post-traumatic stress disorder (p < 0.001). In multivariable analyses, post-traumatic stress disorder was significantly associated with recent major depressive episode (adjusted odds ratio = 7.18, 95% confidence interval: 4.32-11.91) and suicidal ideation (adjusted odds ratio = 4.76, 95% confidence interval: 2.39-9.47) among cannabis non-users. post-traumatic stress disorder was not associated with either outcome among cannabis-using respondents (both p > 0.05). CONCLUSIONS This study provides preliminary epidemiological evidence that cannabis use may contribute to reducing the association between post-traumatic stress disorder and severe depressive and suicidal states. There is an emerging need for high-quality experimental investigation of the efficacy of cannabis/cannabinoids for the treatment of post-traumatic stress disorder.
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Affiliation(s)
- Stephanie Lake
- British Columbia Centre on Substance Use, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada
| | - Jane Buxton
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.,British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Zach Walsh
- Department of Psychology, University of British Columbia, Kelowna, BC, Canada
| | - Brandon Dl Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Evan Wood
- British Columbia Centre on Substance Use, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada
| | - M-J Milloy
- British Columbia Centre on Substance Use, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada
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14
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Weber FC, Norra C, Wetter TC. Sleep Disturbances and Suicidality in Posttraumatic Stress Disorder: An Overview of the Literature. Front Psychiatry 2020; 11:167. [PMID: 32210854 PMCID: PMC7076084 DOI: 10.3389/fpsyt.2020.00167] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 02/21/2020] [Indexed: 12/11/2022] Open
Abstract
A causal relationship between sleep disturbances and suicidal behavior has been previously reported. Insomnia and nightmares are considered as hallmarks of posttraumatic stress disorder (PTSD). In addition, patients with PTSD have an increased risk for suicidality. The present article gives an overview about the existing literature on the relationship between sleep disturbances and suicidality in the context of PTSD. It aims to demonstrate that diagnosing and treating sleep problems as still underestimated target symptoms may provide preventive strategies with respect to suicidality. However, heterogeneous study designs, different samples and diverse outcome parameters hinder a direct comparison of studies and a causal relationship cannot be shown. More research is necessary to clarify this complex relationship and to tackle the value of treatment of sleep disturbances for suicide prevention in PTSD.
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Affiliation(s)
- Franziska C Weber
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Christine Norra
- LWL Hospital Paderborn, Psychiatry-Psychotherapy-Psychosomatics, Ruhr University of Bochum, Bochum, Germany
| | - Thomas C Wetter
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
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15
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Wang HE, Campbell-Sills L, Kessler RC, Sun X, Heeringa SG, Nock MK, Ursano RJ, Jain S, Stein MB. Pre-deployment insomnia is associated with post-deployment post-traumatic stress disorder and suicidal ideation in US Army soldiers. Sleep 2019; 42:5228726. [PMID: 30508139 DOI: 10.1093/sleep/zsy229] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Indexed: 01/22/2023] Open
Abstract
Study Objectives Insomnia is prevalent among military personnel and may increase risk of mental disorders and suicidal ideation. This study examined associations of pre-deployment insomnia with post-deployment post-traumatic stress disorder (PTSD) and suicidal ideation among US Army soldiers. Methods Soldiers from three Brigade Combat Teams completed surveys 1-2 months before deploying to Afghanistan in 2012 (T0), on return from deployment (T1), 3 months later (T2), and 9 months later (T3). Logistic regression was performed to estimate associations of pre-deployment (T0) insomnia with post-deployment (T2 or T3) PTSD and suicidal ideation among respondents who completed surveys at all waves (n = 4645). A hierarchy of models incorporated, increasing controls for pre-deployment risk factors and deployment experiences. Results Pre-deployment insomnia was associated with increased risk of post-deployment PTSD (adjusted odds ratio [AOR] = 3.14, 95% confidence interval [CI] = 2.58% to 3.82%, p < .0005) and suicidal ideation (AOR = 2.78, 95% CI = 2.07% to 3.74%, p < .0005) in models adjusting for sociodemographic characteristics and prior deployment history. Adjustment for other pre-deployment risk factors and deployment experiences attenuated these associations; however, insomnia remained significantly associated with post-deployment PTSD (AOR = 1.50, 95% CI = 1.19% to 1.89%, p = .001) and suicidal ideation (AOR = 1.43, 95% CI = 1.04% to 1.95%, p = .027). Subgroup models showed that pre-deployment insomnia was associated with incident PTSD (AOR = 1.55, 95% CI = 1.17% to 2.07%, p = .003) and suicidal ideation (AOR = 1.67, 95% CI = 1.16% to 2.40%, p = .006) among soldiers with no pre-deployment history of these problems. Conclusions Pre-deployment insomnia contributed to prediction of post-deployment PTSD and suicidal ideation in Army soldiers, suggesting that detection of insomnia could facilitate targeting of risk mitigation programs. Future studies should investigate whether treatment of insomnia helps prevent PTSD and suicidal ideation among deployed service members.
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Affiliation(s)
- Hohui E Wang
- Department of Psychiatry, University of California San Diego, La Jolla, CA
| | | | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Xiaoying Sun
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA
| | - Steven G Heeringa
- Institute for Social Research, University of Michigan, Ann Arbor, MI
| | - Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, MA
| | - Robert J Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Sonia Jain
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA
| | - Murray B Stein
- Department of Psychiatry, University of California San Diego, La Jolla, CA.,Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA.,VA San Diego Healthcare System, San Diego, CA
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16
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Attentional bias and the Suicide Status Form: Behavioral perseveration of written responses. Behav Res Ther 2019; 120:103403. [DOI: 10.1016/j.brat.2019.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 04/04/2019] [Accepted: 04/11/2019] [Indexed: 10/26/2022]
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17
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Porras-Segovia A, Pérez-Rodríguez MM, López-Esteban P, Courtet P, Barrigón M ML, López-Castromán J, Cervilla JA, Baca-García E. Contribution of sleep deprivation to suicidal behaviour: A systematic review. Sleep Med Rev 2019; 44:37-47. [DOI: 10.1016/j.smrv.2018.12.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/03/2018] [Accepted: 12/05/2018] [Indexed: 12/11/2022]
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18
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Rolland-Harris E. More Than Just Counting Deaths: The Evolution of Suicide Surveillance in the Canadian Armed Forces. Mil Med 2019; 184:37-42. [PMID: 30901452 DOI: 10.1093/milmed/usy353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/31/2018] [Indexed: 11/15/2022] Open
Abstract
Suicide prevention and surveillance are of primary concern to the Canadian Armed Forces (CAF) and to the CAF Health Services (CFHS). Suicide surveillance has been conducted on behalf of the CFHS by the Directorate of Force Health Protection for nearly 30 years. Over time, multiple changes have occurred within CAF: changes in its military role (from a primarily peacekeeping role to one also involving active combat), changes in operational tempo, temporal changes in at-risk subpopulations, as well as increased awareness and concern with suicide and suicide prevention. This has resulted in the annual reporting of CAF suicide rates and the evolution of the report's content to respond to the needs of its end users. More recently, Regular Force Army and Combat Arms males have been identified as being at significantly higher risk of suicide, relative to their counterparts, as well as to the Canadian general population. However, this trend has been fairly stable. To optimize the use of limited epidemiologic resources and to shift the focus from the rates themselves towards a better understanding of what they represent and how they can be modified, the suicide surveillance portfolio is evolving to include complementary data sources and elements. This paper describes the different data sources that constitute the CAF's enhanced suicide surveillance portfolio, the value-added evidence generated by the use of complementary data collection methods and sources, and how this evidence is used by CAF leadership in their efforts to prevent suicide amongst those who serve.
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Affiliation(s)
- Elizabeth Rolland-Harris
- Directorate of Force Health Protection, Department of National Defence, 101 Colonel By Drive, Carling Campus, Bldg 9S.1, Ottawa, ON, Canada
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19
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Tsai CH, Cheng WJ, Muo CH, Lin TL. Fractures as a suicidal behavior risk factor: A nationwide population-based cohort study. Medicine (Baltimore) 2019; 98:e14148. [PMID: 30653150 PMCID: PMC6370150 DOI: 10.1097/md.0000000000014148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
This study aimed to evaluate the association between fracture history and sequential risk of suicidal behavior.A total of 82,804 patients with fractures and 82,804 control subjects without fractures were matched. The influence of fractures on the risk of suicidal behavior-related hospital visit was analyzed using a Cox proportional hazards model.The overall adjusted hazard ratio (aHR) of suicidal behavior-related hospital visit was 2.21 in fracture cohort. The aHR declined from 2.90 at the 1-year follow-up to 2.00 after 5 years or more. In fracture patients, the risk of suicidal behavior-related hospital visit was higher at age <35 years, with comorbidities of stroke and sleep disorder. Patients with multiple fractures had a 1.69-fold risk.Fractures are an independent risk factor for suicidal behavior. Individuals aged younger than 35 years, with comorbidities of stroke and sleep disorder, and those who have suffered multiple fractures have elevated risk of suicidal behavior among subjects in the fracture group. Furthermore, this increased risk remained even after 5 years had passed since the fracture incident.
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Affiliation(s)
- Chun-Hao Tsai
- Department of Orthopedics, China Medical University Hospital
- School of Medicine, China Medical University
| | - Wan-Ju Cheng
- Department of Psychiatry, China Medical University Hospital
- Department of Public Health, China Medical University
| | - Chih-Hsin Muo
- Management Office for Health Data, China Medical University Hospital
| | - Tsung-Li Lin
- Department of Orthopedics, China Medical University Hospital
- Department of Sports Medicine, China Medical University, Taichung, Taiwan
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20
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Acheson DT, Kwan B, Maihofer AX, Risbrough VB, Nievergelt CM, Clark JW, Tu XM, Irwin MR, Baker DG. Sleep disturbance at pre-deployment is a significant predictor of post-deployment re-experiencing symptoms. Eur J Psychotraumatol 2019; 10:1679964. [PMID: 31723377 PMCID: PMC6830277 DOI: 10.1080/20008198.2019.1679964] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 08/30/2019] [Accepted: 09/03/2019] [Indexed: 12/20/2022] Open
Abstract
Background: Insomnia is common in service members and associated with many mental and physical health problems. Recently, longitudinal data have been used to assess the impact of disturbed sleep on mental health outcomes. These studies have consistently shown relationships between sleep disturbance and development of mental illness. Objective: The present study examined the longitudinal relationship between sleep disturbance and PTSD symptomatology in a cohort of Marines and Navy Corpsmen deployed to Iraq and Afghanistan (n = 2,404) assessed prior to deployment, as well as at -3 and 6 months post-deployment. Additionally, we aimed to investigate the extent to which these relationships are moderated by combat-stress severity, and to what extent these findings are replicated in a second, separate cohort of Marines and Navy corpsmen (n = 938) assessed with identical measures prior to deployment and within 3 months of return. Method: The present study employed latent variable path models to examine the relationships between pre-deployment sleep disturbance and post-deployment re-experiencing symptoms. Initial cross-lagged path models were conducted on discovery and replication samples to validate the hypothesized predictive relationships. Follow up moderation path models were then conducted to include the effect of combat-stress severity on these relationships. Results: Initial cross-lagged models supported a significant relationship between pre-deployment sleep disturbance and future re-experiencing PTSD symptoms at all time points. Initial moderation models showed a small moderator effect of combat-stress severity, though the main predictive relationship between pre-deployment sleep disturbance and PTSD symptoms remained significant. The moderator effect was not significant in the replication sample. Conclusions: The results of this study support pre-deployment sleep disturbance as a risk factor for development of post-deployment PTSD symptoms. Interventions aimed at normalizing sleep may be important in preventive measures for PTSD.
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Affiliation(s)
- Dean T Acheson
- Center for Excellence in Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Brian Kwan
- Division of Biostatistics and Bioinformatics, Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA, USA
| | - Adam X Maihofer
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Victoria B Risbrough
- Center for Excellence in Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Caroline M Nievergelt
- Center for Excellence in Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Jacob W Clark
- Monash Institute for Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Xin M Tu
- Division of Biostatistics and Bioinformatics, Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA, USA
| | - Michael R Irwin
- Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience at University of California, Los Angeles, CA, USA
| | - Dewleen G Baker
- Center for Excellence in Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California San Diego, San Diego, CA, USA
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21
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Paul MA, Love RJ, Jetly R, Richardson JD, Lanius RA, Miller JC, MacDonald M, Rhind SG. Blunted Nocturnal Salivary Melatonin Secretion Profiles in Military-Related Posttraumatic Stress Disorder. Front Psychiatry 2019; 10:882. [PMID: 31866882 PMCID: PMC6910089 DOI: 10.3389/fpsyt.2019.00882] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 11/08/2019] [Indexed: 12/16/2022] Open
Abstract
Background: Sleep disturbances are a hallmark of posttraumatic stress disorder (PTSD), yet few studies have evaluated the role of dysregulated endogenous melatonin secretion in this condition. Methods: This study compared the sleep quality and nocturnal salivary melatonin profiles of Canadian Armed Forces (CAF) personnel diagnosed with PTSD, using the Clinician Administered PTSD Scale (CAPS score ≥50), with two healthy CAF control groups; comprising, a "light control" (LC) group with standardized evening light exposure and "normal control" (NC) group without light restriction. Participants were monitored for 1-week using wrist actigraphy to assess sleep quality, and 24-h salivary melatonin levels were measured (every 2h) by immunoassay on the penultimate day in a dim-light (< 5 lux) laboratory environment. Results: A repeated measures design showed that mean nocturnal melatonin concentrations for LC were higher than both NC (p = .03) and PTSD (p = .003) with no difference between PTSD and NC. Relative to PTSD, NC had significantly higher melatonin levels over a 4-h period (01 to 05 h), whereas the LC group had higher melatonin levels over an 8-h period (23 to 07 h). Actigraphic sleep quality parameters were not different between healthy controls and PTSD patients, likely due to the use of prescription sleep medications in the PTSD group. Conclusions: These results indicate that PTSD is associated with blunted nocturnal melatonin secretion, which is consistent with previous findings showing lower melatonin after exposure to trauma and suggestive of severe chronodisruption. Future studies targeting the melatonergic system for therapeutic intervention may be beneficial for treatment-resistant PTSD.
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Affiliation(s)
- Michel A Paul
- Defence Research & Development Canada, Toronto Research Centre, Operational Health and Performance Section, Toronto, ON, Canada
| | - Ryan J Love
- Defence Research & Development Canada, Toronto Research Centre, Operational Health and Performance Section, Toronto, ON, Canada
| | - Rakesh Jetly
- Directorate of Mental Health, Canadian Forces Health Services, Ottawa, ON, Canada
| | - J Donald Richardson
- Department of Psychiatry, Western University, London, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.,Operational Stress Injury Clinic, Parkwood Institute, London, ON, Canada.,MacDonald Franklin Operational Stress Injury Research Centre, Lawson Research Institute, London, ON, Canada
| | - Ruth A Lanius
- Department of Psychiatry, Western University, London, ON, Canada.,Department of Neuroscience, Western University, London, ON, Canada
| | - James C Miller
- Department of Life Sciences, Texas A&M University Corpus Christi, Corpus Christi, TX, United States
| | - Michael MacDonald
- Directorate of Mental Health, Canadian Forces Health Services, Ottawa, ON, Canada
| | - Shawn G Rhind
- Defence Research & Development Canada, Toronto Research Centre, Operational Health and Performance Section, Toronto, ON, Canada
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22
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Liao SJ, Wu BJ, Liu TT, Chou CP, Rong JR. Prevalence and characteristics of suicidal ideation among 2199 elderly inpatients with surgical or medical conditions in Taiwan. BMC Psychiatry 2018; 18:397. [PMID: 30577782 PMCID: PMC6303983 DOI: 10.1186/s12888-018-1981-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 12/11/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Worldwide, the elderly are at a greater risk of suicide than other age groups. There is a paucity of research exploring risk factors for suicide in hospitalized elderly patients. Therefore, a study designed to explore the prevalence and characteristic of suicidal ideation (SI), such as QOL (quality of life), a wish to die (WTD), and other factors in elderly inpatients with medical or surgical conditions in Taiwan was warranted. METHODS A total of 2199 hospitalized elderly patients over age 65 were enrolled. Demographic data, 5-item Brief Symptom Rating Scale (BSRS-5), and the World Health Organization Quality of Life-BREF (WHOQOL-BREF) data were collected. Logistic regression models were used to find the SI-related factors for all participants and to investigate the covariates correlated with WTD in patients with SI. Receiver operating characteristic (ROC) curve analysis was used to find the most important items of the BSRS-5 predictive of SI in this population. RESULTS SI was found in 3.1% (68/2199) of the elderly. The statistically significantly factors associated with SI were: BSRS-5 item 2 (depression) (odds ratio [OR] = 2.15, 95% confidence interval [CI] = 1.56-2.98), item 4 (inferiority) (OR = 1.62, 1.23-2.13), item 5 (insomnia) (OR = 1.52, 1.13-2.05), and physical domain of WHOQOL (OR = 0.84, 0.72-0.99). QOL15 (mobility) (OR = 0.64, 0.46-0.90) and QOL 16 (satisfaction with sleep) (OR = 0.62, 0.44-0.88) were also significantly associated with SI. The status of living alone (OR = 4.44, 1.24-15.87), QOL 26 (absence of negative feeling) (OR = 0.38, 0.15-0.98), and QOL 27 (being respected/accepted) (OR = 0.43, 0.20-0.92) were significantly associated with WTD among inpatients with SI. The ROC curve analysis revealed that depression, inferiority, and insomnia were the most important items in the BSRS-5 significantly associated with SI among the elderly inpatients. CONCLUSION To provide physical recovery and maintain mental health for physically ill elderly inpatients, setting up a multi-faceted approach targeting the aforementioned determinants of SI and WTD for reducing the risk of suicide attempt, and exploring other factors correlated with suicidal behaviors, are important topics and directions for clinical practice and further research.
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Affiliation(s)
- Su-Jung Liao
- grid.490600.bDepartment of Nursing, Ministry of Health and Welfare, Yuli Hospital, 448 Chung-Hua Road, Yuli Township, Hualien County 981 Taiwan, Republic of China ,Department of Nursing, National Taipei University of Nursing Health Science, No.365, Mingde Rd., Beitou Dist., Taipei City, 112 Taiwan, Republic of China
| | - Bo-Jian Wu
- grid.490600.bDepartment of Psychiatry, Ministry of Health and Welfare, Yuli Hospital, 448 Chung-Hua Road, Yuli Township, Hualien County 981 Taiwan, Republic of China
| | - Tse-Tsung Liu
- 0000 0004 0639 3300grid.415323.2Department of Geriatrics, Mennonite Christian Hospital, 44, Minquan Rd., Hualien City, Hualien County 970 Taiwan, Republic of China
| | - Chao-Ping Chou
- 0000 0004 0639 3300grid.415323.2Department of Psychiatry, Mennonite Christian Hospital, 44, Minquan Rd., Hualien City, Hualien County 970 Taiwan, Republic of China
| | - Jiin-Ru Rong
- Department of Nursing, National Taipei University of Nursing Health Science, No.365, Mingde Rd., Beitou Dist., Taipei City, 112, Taiwan, Republic of China.
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Guo JC, Yang YJ, Zheng XA, Jiang XL, Guo M, Wang XD, Gao YS, Fu LQ, Chen XS. CpG methylation of brain-derived the neurotrophic factor gene promoter as a potent diagnostic and prognostic biomarker for post-traumatic stress disorder. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2018; 11:5101-5109. [PMID: 31949588 PMCID: PMC6962936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 03/15/2018] [Indexed: 06/10/2023]
Abstract
Posttraumatic stress disorder (PTSD) is a common response to traumatic events. Many PTSD patients recover in the next few months, but in a significant subgroup, the symptoms persist, often for years. The present study shows that brain-derived neurotrophic factor (BDNF) gene is related to the pathological mechanism of a variety of mental diseases. Here we investigate the effect of methylation of BDNF gene and different loci on the occurrence and development of PTSD. Initially, using case-control method, 322 PTSD patients as well as 215 normal controls were selected as the subjects. Following peripheral venous blood being collected from the subjects, genomic DNA was extracted. Methylation of the cytosine-guanine dinucleotide (CpG) island in BDNF gene promoter was then modified by bisulfite and detected through direct sequencing. Methylation of CpG in BDNF gene promoter was closely related to PTSD, and the methylation level of CpG in BDNF gene promoter may serve as a biomarker for PTSD diagnosis. Types of trauma of PTSD patients may have a certain effect on the methylation level of BDNF gene promoter. Methylation level of the BDNF promoter, depressive degree score, poor sleep quality score, early trauma score, mental stress score, and trauma type were closely related to the occurrence and development of PTSD. Taken together, our data support the notion that stressful life events may directly cause CpG methylation in the BDNF promoter of PTSD patients. Stress types may be associated with methylation levels of CpG1, CpG7, and CpG18 in the BDNF promoter of PTSD patients. These findings provide a new way for the diagnosis and treatment of PTSD.
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Affiliation(s)
- Jun-Cheng Guo
- Central South University Xiangya School of Medical Affiliated Haikou HospitalHaikou, Hainan Province, P. R. China
- Central South UniversityChangsha, P. R. China
| | - Yi-Jun Yang
- Central South University Xiangya School of Medical Affiliated Haikou HospitalHaikou, Hainan Province, P. R. China
| | - Xiao-Ai Zheng
- Psychological Research Center of Hainan General HospitalHaikou, Hainan Province, P. R. China
| | - Xiang-Ling Jiang
- Psychological Research Center of Hainan General HospitalHaikou, Hainan Province, P. R. China
| | - Min Guo
- Psychological Research Center of Hainan General HospitalHaikou, Hainan Province, P. R. China
| | - Xiao-Dan Wang
- School of Public Health, Hainan Medical CollegeHaikou 571199, Hainan Province, P. R. China
| | - Yun-Suo Gao
- Psychological Research Center of Hainan General HospitalHaikou, Hainan Province, P. R. China
| | - Lin-Qiu Fu
- Psychological Research Center of Hainan General HospitalHaikou, Hainan Province, P. R. China
| | - Xian-Shan Chen
- Psychological Research Center of Hainan General HospitalHaikou, Hainan Province, P. R. China
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Lin HT, Lai CH, Perng HJ, Chung CH, Wang CC, Chen WL, Chien WC. Insomnia as an independent predictor of suicide attempts: a nationwide population-based retrospective cohort study. BMC Psychiatry 2018; 18:117. [PMID: 29716570 PMCID: PMC5930777 DOI: 10.1186/s12888-018-1702-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 04/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Numerous studies have verified that insomnia is associated with suicidal ideation, suicide attempts, and death by suicide. Limited population-based cohort studies have been conducted to examine the association. The present study aimed to analyze whether insomnia increases the risk of suicide attempts and verify the effects of insomnia on suicide risk. METHODS This study is a cohort study using 2000-2013 hospitalization data from the National Health Insurance Research Database (NHIRD) to track the rate of suicide attempts among insomnia patients aged 15 years or older. In addition, a 1:2 pairing based on sex, age, and date of hospitalization was conducted to identify the reference cohort (patients without insomnia). Cox proportional hazard model was used to assess the effects of insomnia on suicide risk. RESULTS The total number of hospitalized patients aged 15 years or older was 479,967 between 2000 and 2013 (159,989 patients with insomnia and 319,978 patients without insomnia). After adjusting for confounders, suicide risk in insomnia patients was 3.533-fold that of patients without insomnia (adjusted hazard ratio [HR] = 3.533, 95% confidence interval [CI] = 3.059-4.080, P < 0.001). Suicide risk in low-income patients was 1.434-fold (adjusted HR = 1.434, 95% CI = 1.184-1.736, P < 0.001) that of non-low-income patients. Suicide risk in patients with drug dependence and with mental disorders was 1.592-fold (adjusted HR = 1.592, 95% CI = 1.220-2.077, P < 0.001) and 4.483-fold (adjusted HR = 4.483, 95% CI = 3.934-5.109, P < 0.001) that of patients without drug dependence and without mental disorders, respectively. In the female population, suicide risk in insomnia patients was 4.186-fold (adjusted HR = 4.186, 95% CI = 3.429-5.111, P < 0.001) that of patients without insomnia. Among patients aged 25-44 years, suicide risk in insomnia patients was 5.546-fold (adjusted HR = 5.546, 95% CI = 4.236-7.262, P < 0.001) that of patients without insomnia. Furthermore, the suicide risk of insomnia patients with mental disorders was 18.322-fold that of patients without insomnia and mental disorders (P < 0.001). CONCLUSION Insomnia, low income, drug dependence, and mental disorders are independent risk factors for suicide attempts. Female patients and those aged 25-44 years are at high risk of suicide due to insomnia. Insomnia, mental disorders, and low income exhibit a synergistic effect on suicide attempts. Clinicians should pay attention to mental status and income level of insomnia patients.
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Affiliation(s)
- Han-Ting Lin
- National Defense Medical Center, School of Public Health 4325R, No. 161, Section 6, Min-Chuan East Road, Neihu District, Taipei City, 11490 Taiwan, Republic of China
| | - Chi-Huang Lai
- National Defense Medical Center, School of Public Health 4325R, No. 161, Section 6, Min-Chuan East Road, Neihu District, Taipei City, 11490 Taiwan, Republic of China
| | - Huey-Jen Perng
- National Defense Medical Center, Graduate Institute of Life Sciences 7115R, No. 161, Section 6, Min-Chuan East Road, Neihu District, Taipei City, 11490 Taiwan, Republic of China
| | - Chi-Hsiang Chung
- National Defense Medical Center, Graduate Institute of Life Sciences 7115R, No. 161, Section 6, Min-Chuan East Road, Neihu District, Taipei City, 11490 Taiwan, Republic of China
| | - Chung-Ching Wang
- Department of Family and Community Medicine, National Defense Medical Center, Tri-Service General Hospital Taipei, No. 325, Section 2, Cheng-Kung Road, Taipei City, 11490 Taiwan, Republic of China
| | - Wei-Liang Chen
- Department of Family and Community Medicine, National Defense Medical Center, Tri-Service General Hospital Taipei, No. 325, Section 2, Cheng-Kung Road, Taipei City, 11490 Taiwan, Republic of China
| | - Wu-Chien Chien
- National Defense Medical Center, School of Public Health 4325R, No. 161, Section 6, Min-Chuan East Road, Neihu District, Taipei City, 11490, Taiwan, Republic of China. .,National Defense Medical Center, Graduate Institute of Life Sciences 7115R, No. 161, Section 6, Min-Chuan East Road, Neihu District, Taipei City, 11490, Taiwan, Republic of China. .,Department of Medical Research 7115R, National Defense Medical Center, Tri-Service General Hospital Taipei, No. 325, Section 2, Cheng-Kung Road, Taipei City, 11490, Taiwan, Republic of China.
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Depression, Suicidal Behaviour, and Mental Disorders in Older Aboriginal Australians. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15030447. [PMID: 29510527 PMCID: PMC5876992 DOI: 10.3390/ijerph15030447] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 02/20/2018] [Accepted: 02/28/2018] [Indexed: 12/24/2022]
Abstract
Aboriginal Australians experience higher levels of psychological distress, which may develop from the long-term sequelae of social determinants and adversities in early and mid-life. There is little evidence available on the impact of these on the mental health of older Aboriginal Australians. This study enrolled 336 Aboriginal Australian participants over 60 years from 5 major urban and regional areas in NSW, utilizing a structured interview on social determinants, and life-time history of physical and mental conditions; current psychosocial determinants and mental health. Univariate and multivariate analyses were utilized to examine the link between these determinants and current depressive scores and suicidality. There was a high rate of life-time depression (33.3%), current late-life depression (18.1%), and suicidal ideation (11.1%). Risk factors strongly associated with late-life depression included sleep disturbances, a history of suicidal behaviour, suicidal ideation in late-life and living in a regional location. This study supports certain historical and psychosocial factors predicting later depression in old age, and highlights areas to target for prevention strategies.
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