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Britton PC, Bohnert KM, Denneson LM, Ganoczy D, Ilgen MA. Psychiatric diagnoses, somatic disorders, and emergency dispatches among individuals who used a national suicide crisis line. J Psychiatr Res 2024; 174:114-120. [PMID: 38626561 DOI: 10.1016/j.jpsychires.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 03/19/2024] [Accepted: 04/09/2024] [Indexed: 04/18/2024]
Abstract
Crisis line responders initiate emergency dispatches by activating 911 or other local emergency services when individuals are determined to be at imminent risk for undesired outcomes. This study examined the association of characteristics, psychiatric diagnoses, and somatic symptoms with emergency dispatches in a national sample. Veterans Crisis Line data were used to identify contacts (i.e., calls, texts, chats, emails) that were linked with medical records and had a medical encounter in the year prior to contact. Hierarchical logistic regression clustered by responders was used to identify the association among demographics, psychiatric diagnoses, and somatic disorders, and emergency dispatches. Analyses examined 247,340 contacts from 2017 to 2020, with 27,005 (10.9%) emergency dispatches. Odds of an emergency dispatch increased with each diagnosis (three diagnoses Adjusted Odds Ratio [AOR] (95% CI) = 1.88 [1.81,1.95]). Odds were highest among individuals with substance use disorders (SUD) (alcohol AOR (95% CI) = 1.85 [1.80,1.91]; drugs AOR (95% CI) = 1.63 [1.58, 1.68]), which may be a result of intoxication or overdose during contact, requiring further research. Having more psychiatric and somatic conditions was associated with greater odds of an emergency dispatch, indicating that comorbidity contributed to the need for acute care.
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Affiliation(s)
- Peter C Britton
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veteran Affairs, Finger Lakes Healthcare System, Canandaigua, NY, USA; Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA.
| | - Kipling M Bohnert
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA; Department of Veteran Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Lauren M Denneson
- VA HSR&D Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, OR, USA; Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Dara Ganoczy
- Department of Veteran Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Mark A Ilgen
- Department of Veteran Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
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2
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Khalifian CE, Titone M, Wooldridge JS, Knopp K, Seibert G, Monson C, Morland L. The role of veterans' PTSD symptoms in veteran couples' insomnia. FAMILY PROCESS 2023; 62:1725-1739. [PMID: 36347178 DOI: 10.1111/famp.12835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 09/14/2022] [Accepted: 09/25/2022] [Indexed: 06/16/2023]
Abstract
Insomnia contributes to individual mental and physical health and relationship well-being. Veterans' PTSD symptoms are associated with their own insomnia. However, research has not explored whether and how veterans' PTSD symptoms are associated with their partners' insomnia. The present study examined the association between veterans' PTSD symptom severity and veterans' and partners' insomnia. Veterans (n = 192) and their partners (n = 192; total N = 384) completed baseline assessments in a PTSD treatment study for veterans with PTSD and their partners. Path analysis was used to examine the relation between veterans' PTSD symptom severity, as measured by the PTSD symptom checklist-5 (PCL-5) and veterans' and partners' insomnia, as measured by the Insomnia Severity Index (ISI). Veterans' full-scale PCL-5 was positively related to veterans' and partners' insomnia. For veterans, intrusion and arousal symptoms were positively related to their own insomnia severity, while veterans' negative alterations in cognition and mood were associated with partners' insomnia severity. In exploratory analyses, partners' depressive symptoms fully mediated the relation between veterans' negative cognitions and mood and partners' insomnia. PTSD symptoms impact both veterans' and partners' insomnia. However, different PTSD symptom clusters were related to insomnia for each partner, and the link for partners was explained by their own depression symptoms. PTSD, insomnia, and integrated treatments should consider strategies for including partners in treatment to address these interconnected problems.
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Affiliation(s)
- Chandra E Khalifian
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Madison Titone
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Jennalee S Wooldridge
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Kayla Knopp
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Gregory Seibert
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | | | - Leslie Morland
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
- National Center for PTSD -Pacific Islands division, Honolulu, Hawaii, USA
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3
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Reffi AN, Kalmbach DA, Cheng P, Drake CL. The sleep response to stress: how sleep reactivity can help us prevent insomnia and promote resilience to trauma. J Sleep Res 2023; 32:e13892. [PMID: 37020247 DOI: 10.1111/jsr.13892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 04/07/2023]
Abstract
Sleep reactivity is a predisposition to sleep disturbance during environmental perturbations, pharmacological challenges, or stressful life events. Consequently, individuals with highly reactive sleep systems are prone to insomnia disorder after a stressor, engendering risk of psychopathology and potentially impeding recovery from traumatic stress. Thus, there is tremendous value in ameliorating sleep reactivity to foster a sleep system that is robust to stress exposure, ultimately preventing insomnia and its downstream consequences. We reviewed prospective evidence for sleep reactivity as a predisposition to insomnia since our last review on the topic in 2017. We also reviewed studies investigating pre-trauma sleep reactivity as a predictor of adverse post-traumatic sequelae, and clinical trials that reported the effect of behavioural treatments for insomnia on mitigating sleep reactivity. Most studies measured sleep reactivity via self-report using the Ford Insomnia Response to Stress Test (FIRST), demonstrating high scores on this scale reliably indicate a sleep system with a lower capacity to tolerate stress. Nascent evidence suggests elevated sleep reactivity prior to trauma increases the risk of negative posttraumatic outcomes, namely acute stress disorder, depression, and post-traumatic stress disorder. Lastly, sleep reactivity appears most responsive to behavioural insomnia interventions when delivered early during the acute phase of insomnia. Overall, the literature strongly supports sleep reactivity as a premorbid vulnerability to incident acute insomnia disorder when faced with an array of biopsychosocial stressors. The FIRST identifies individuals at risk of insomnia a priori, thereby guiding early interventions toward this vulnerable population to prevent insomnia and promote resilience to adversity.
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Affiliation(s)
- Anthony N Reffi
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health, Detroit, Michigan, USA
| | - David A Kalmbach
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health, Detroit, Michigan, USA
| | - Philip Cheng
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health, Detroit, Michigan, USA
| | - Christopher L Drake
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health, Detroit, Michigan, USA
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Nazem S, Barnes SM, Forster JE, Hostetter TA, Monteith LL, Kramer EB, Gaeddert LA, Brenner LA. Efficacy of an Internet-Delivered Intervention for Improving Insomnia Severity and Functioning in Veterans: Randomized Controlled Trial. JMIR Ment Health 2023; 10:e50516. [PMID: 37999953 DOI: 10.2196/50516] [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: 07/03/2023] [Revised: 09/26/2023] [Accepted: 10/06/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Despite a growing evidence base that internet-delivered cognitive behavioral therapy for insomnia (iCBT-I) is associated with decreased insomnia severity, its efficacy has been minimally examined in veterans. OBJECTIVE The objective of this study was to evaluate the efficacy of an unguided iCBT-I (Sleep Healthy Using the Internet [SHUTi]) among veterans. METHODS We conducted a single-blind, randomized controlled trial in Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn veterans eligible for Veterans Health Administration care. Participants were randomly assigned (1:1) to receive SHUTi (a self-guided and interactive program) or an Insomnia Education Website (IEW) that provided nontailored and fixed insomnia information. Web-based assessments were administered at baseline, postintervention, 6 months postintervention, and 1 year postintervention. The primary outcome was self-reported insomnia severity (Insomnia Severity Index [ISI]). Secondary outcomes were self-reported mental and physical health functioning (Veterans RAND 36-item Health Survey). Exploratory outcomes comprised sleep diary parameters. RESULTS Of the 231 randomized participants (mean age 39.3, SD 7.8 years; 170/231, 73.5% male sex; 26/231, 11.3% Black; 172/231, 74.5% White; 10/231, 4.3% multiracial; and 17/231, 7.4% other; 36/231, 15.6% Hispanic) randomized between April 2018 and January 2019, a total of 116 (50.2%) were randomly assigned to SHUTi and 115 (49.8%) to the IEW. In intent-to-treat analyses, SHUTi participants experienced significantly larger ISI decreases compared with IEW participants at all time points (generalized η2 values of 0.13, 0.12, and 0.10, respectively; all P<.0001). These corresponded to estimated larger differences in changes of -3.47 (95% CI -4.78 to -2.16), -3.80 (95% CI -5.34 to -2.27), and -3.42 (95% CI -4.97 to 1.88) points on the ISI for the SHUTi group. SHUTi participants experienced significant improvements in physical (6-month generalized η2=0.04; P=.004) and mental health functioning (6-month and 1-year generalized η2=0.04; P=.009 and P=.005, respectively). Significant sleep parameter improvements were noted for SHUTi (all P<.05), though the pattern and magnitude of these reductions varied by parameter. No adverse events were reported. CONCLUSIONS Self-administered iCBT-I was associated with immediate and long-term improvements in insomnia severity. Findings suggest that leveraging technology to meet insomnia treatment demands among veterans may be a promising approach. TRIAL REGISTRATION ClinicalTrials.gov NCT03366870; https://clinicaltrials.gov/ct2/show/NCT03366870.
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Affiliation(s)
- Sarra Nazem
- Dissemination & Training Division, National Center for Posttraumatic Stress Disorder, Menlo Park, CA, United States
- Veterans Affairs Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, CO, United States
| | - Sean M Barnes
- Veterans Affairs Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, CO, United States
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Jeri E Forster
- Veterans Affairs Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, CO, United States
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Trisha A Hostetter
- Veterans Affairs Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, CO, United States
| | - Lindsey L Monteith
- Veterans Affairs Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, CO, United States
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Emily B Kramer
- Veterans Affairs Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, CO, United States
| | - Laurel A Gaeddert
- Veterans Affairs Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, CO, United States
| | - Lisa A Brenner
- Veterans Affairs Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, CO, United States
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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Bramoweth AD, Hough CE, McQuillan AD, Spitznogle BL, Thorpe CT, Lickel JJ, Boudreaux-Kelly M, Hamm ME, Germain A. Reduction of Sleep Medications via a Combined Digital Insomnia and Pharmacist-Led Deprescribing Intervention: Protocol for a Feasibility Trial. JMIR Res Protoc 2023; 12:e47636. [PMID: 37471122 PMCID: PMC10401195 DOI: 10.2196/47636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/16/2023] [Accepted: 06/20/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Chronic insomnia is one of the most common health problems among veterans and negatively impacts their health, function, and quality of life. Although cognitive behavioral therapy for insomnia (CBT-I) is the first-line recommended treatment, sedative-hypnotic medications remain the most common. Sedative-hypnotics, however, have mixed effectiveness, are frequently prescribed longer than recommended, and are associated with numerous risks and adverse effects that negatively impact veteran function. Meeting the treatment needs of veterans impacted by insomnia requires delivering gold standard behavioral care, like CBT-I, and the reduction of sedative-hypnotics through innovative methods. OBJECTIVE The objective of this feasibility clinical trial is to test a digital CBT-I approach combined with deprescribing to improve the success of sedative-hypnotic reduction among veterans. The intervention combines Noctem Health Clinician Operated Assistive Sleep Technology (COAST), an effective and efficient, scalable, and adaptable digital platform to deliver CBT-I, with clinical pharmacy practitioner (CPP)-led deprescribing of sedative-hypnotic medications. METHODS In this nonrandomized single-group clinical trial, 50 veterans will be recruited and enrolled to receive CBT-I delivered via Noctem COAST and CPP-led deprescribing for up to 12 weeks. Assessments will occur at baseline, posttreatment, and 3-month follow-up. The aims are to (1) assess the feasibility of recruiting veterans with chronic sedative-hypnotic use to participate in the combined intervention, (2) evaluate veterans' acceptability and usability of the COAST platform, and (3) measure changes in veterans' sleep, sedative-hypnotic use, and function at baseline, posttreatment, and 3-month follow-up. RESULTS The institutional review board approved the study in October 2021 and the trial was initiated in May 2022. Recruitment and data collection began in September 2022 and is anticipated to be completed in April 2024. Aim 1 will be measured by tracking the response to a mail-centric recruitment approach using electronic medical records to identify potentially eligible veterans based on sedative-hypnotic use. Aim 2 will be measured using the Post-Study System Usability Questionnaire, assessing overall usability as well as system usefulness, information quality, and interface quality. Aim 3 will use the Insomnia Severity Index and sleep diaries to measure change in insomnia outcomes, the Patient-Reported Outcome Measurement Information System Profile to measure change in physical function, anxiety, depression, fatigue, sleep disturbance, participation in social roles, pain, cognitive function, and self-reported sedative-hypnotic use to measure change in dose and frequency of use. CONCLUSIONS Findings will inform the utility of a combined digital CBT-I and CPP-led deprescribing intervention and the development of an adequately powered clinical trial to test the effectiveness in a diverse sample of veterans. Further, findings will help inform potential new approaches to deliver care and improve access to care for veterans with insomnia, many of whom use sedative-hypnotics that may be ineffective and increase the risk for negative outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT05027438; https://classic.clinicaltrials.gov/ct2/show/NCT05027438. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/47636.
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Affiliation(s)
- Adam D Bramoweth
- Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States
| | - Caroline E Hough
- Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States
| | - Amanda D McQuillan
- Pharmacy Services, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States
| | | | - Carolyn T Thorpe
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, United States
| | - James J Lickel
- Behavioral Health, William S Middleton Memorial Veterans' Hospital, Madison, WI, United States
| | | | - Megan E Hamm
- Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Anne Germain
- Noctem Health Inc, Pittsburgh, PA, United States
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6
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El-Solh AA, Lawson Y, Attai P. Cardiovascular events in insomnia patients with post-traumatic stress disorder. Sleep Med 2022; 100:24-30. [PMID: 35994935 DOI: 10.1016/j.sleep.2022.07.014] [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: 01/22/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Both post-traumatic stress disorder (PTSD) and insomnia are independently associated with a greater risk of cardiovascular mortality. The objective of this study is to determine whether PTSD plus insomnia is associated with a higher risk of major adverse cardiovascular events (MACEs) than either condition alone in a large cohort of veterans. METHODS We conducted a retrospective analysis of the national Veterans Health Administration (VHA) electronic medical records covering veterans 18 years or older with the diagnosis of PTSD, insomnia, or both from January 1, 2015, to December 31, 2020. MACE was defined as new-onset myocardial infarction (MI), transient ischemic attack (TIA) or stroke, based on ICD-9 and ICD-10 diagnosis codes from inpatient or outpatient encounters. RESULTS A total of 19,080 veterans, 1840 with PTSD plus insomnia and 17,240 with either PTSD or insomnia, were included in the analysis. Baseline mean (SD) age was 46.3 (11.5) years. During median follow-up of 3.9 (interquartile range, 2.4-5.1) years, 206 (1%) veterans developed incident MACE. Cumulative incidence for MI, TIA and/or stroke was larger in veterans with PTSD plus insomnia compared to PTSD and insomnia alone (p=0.008). In a Cox proportional hazards model, PTSD plus insomnia was significantly associated with greater risk of developing MACEs (hazard ratio [HR], 1.44; 95% CI, 1.38-1.50, p=0.01) than either condition after adjusting for multiple covariates including age, gender, smoking, hypertension, depression, and burden of comorbidities. CONCLUSIONS This cohort study found that PTSD plus insomnia is a risk factor for MACEs of greater magnitude than PTSD- or insomnia-alone.
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Affiliation(s)
- Ali A El-Solh
- VA Western New York Healthcare System, Research and Development, Buffalo, NY, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Jacob School of Medicine, USA; Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA.
| | - Yolanda Lawson
- VA Western New York Healthcare System, Research and Development, Buffalo, NY, USA
| | - Parveen Attai
- VA Western New York Healthcare System, Research and Development, Buffalo, NY, USA
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Hunt C, Stout DM, Tie Z, Acheson D, Colvonen PJ, Nievergelt CM, Yurgil KA, Baker DG, Risbrough VB. Pre-deployment threat learning predicts increased risk for post-deployment insomnia: Evidence from the Marine Resiliency Study. Behav Res Ther 2022; 159:104223. [PMID: 36327523 PMCID: PMC9893737 DOI: 10.1016/j.brat.2022.104223] [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: 06/29/2022] [Revised: 10/18/2022] [Accepted: 10/21/2022] [Indexed: 02/04/2023]
Abstract
Insomnia is a common and impairing consequence of military deployment, but little is known about pre-deployment risk factors for post-deployment insomnia. Abnormal threat learning tendencies are commonly observed in individuals with insomnia and maladaptive responses to stress have been implicated in the development of insomnia, suggesting that threat learning could be an important risk factor for post-deployment insomnia. Here, we examined pre-deployment threat learning as a predictor of post-deployment insomnia and the potential mechanisms underlying this effect. Male servicemembers (N = 814) completed measures of insomnia, psychiatric symptoms, and a threat learning task before and after military deployment. Threat learning indices that differentiated participants with versus withoutinsomnia at post-deployment were tested as pre-deployment predictors of post-deployment insomnia. Post-deployment insomnia was linked to elevations on several threat learning indices at post-deployment, but only higher threat conditioning, as indexed by higher threat expectancy ratings to the danger cue, emerged as a pre-deployment predictor of post-deployment insomnia. This effect was independent of combat exposure levels and partially mediated by greater post-deployment nightmares. The tendency to acquire stronger expectations of aversive events following encounters with danger cues may increase risk for post-deployment insomnia, in part due to the development of more severe nightmares.
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Affiliation(s)
- Christopher Hunt
- VA San Diego Healthcare System, Center of Excellence for Stress and Mental Health, United States; University of California San Diego, Department of Psychiatry, United States
| | - Daniel M Stout
- VA San Diego Healthcare System, Center of Excellence for Stress and Mental Health, United States; University of California San Diego, Department of Psychiatry, United States
| | - Ziyun Tie
- University of California San Diego, Department of Psychiatry, United States
| | - Dean Acheson
- VA San Diego Healthcare System, Center of Excellence for Stress and Mental Health, United States; University of California San Diego, Department of Psychiatry, United States
| | - Peter J Colvonen
- VA San Diego Healthcare System, Center of Excellence for Stress and Mental Health, United States; University of California San Diego, Department of Psychiatry, United States
| | - Caroline M Nievergelt
- VA San Diego Healthcare System, Center of Excellence for Stress and Mental Health, United States; University of California San Diego, Department of Psychiatry, United States
| | - Kate A Yurgil
- Department of Psychological Sciences, Loyola University New Orleans, United States
| | - Dewleen G Baker
- VA San Diego Healthcare System, Center of Excellence for Stress and Mental Health, United States; University of California San Diego, Department of Psychiatry, United States
| | - Victoria B Risbrough
- VA San Diego Healthcare System, Center of Excellence for Stress and Mental Health, United States; University of California San Diego, Department of Psychiatry, United States.
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8
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Jones MB, Agrawal R, Sharafkhaneh A, Kunik ME, Jorge RE, Marsh L. Dream Enactment Behaviors Associated With Posttraumatic Stress Disorder. J Neuropsychiatry Clin Neurosci 2022; 34:124-131. [PMID: 34763524 DOI: 10.1176/appi.neuropsych.21050115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The investigators aimed to draw attention to current debates surrounding the etiologies of dream enactment behaviors in patients with posttraumatic stress disorder (PTSD). The phenomenological overlap between PTSD-related nocturnal symptoms, rapid eye movement sleep behavior disorder (RBD), and trauma-associated sleep disorder (TASD) is discussed. Strategies used to diagnose and manage dream enactment behaviors, whether due to RBD or another confounding sleep disorder, are considered. Finally, the need for further research on the pathophysiological overlap and integrated treatment of PTSD, RBD, and, possibly, TASD is highlighted.
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Affiliation(s)
- Melissa B Jones
- Michael E. DeBakey VA Medical Center, Houston (Jones, Agrawal, Sharafkhaneh, Kunik, Jorge, Marsh); Menninger Department of Psychiatry and Behavioral Sciences, Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, Houston (Jones, Kunik, Jorge, Marsh); and Department of Pulmonary, Critical Medicine and Sleep Medicine, Baylor College of Medicine, Houston (Agrawal, Sharafkhaneh)
| | - Ritwick Agrawal
- Michael E. DeBakey VA Medical Center, Houston (Jones, Agrawal, Sharafkhaneh, Kunik, Jorge, Marsh); Menninger Department of Psychiatry and Behavioral Sciences, Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, Houston (Jones, Kunik, Jorge, Marsh); and Department of Pulmonary, Critical Medicine and Sleep Medicine, Baylor College of Medicine, Houston (Agrawal, Sharafkhaneh)
| | - Amir Sharafkhaneh
- Michael E. DeBakey VA Medical Center, Houston (Jones, Agrawal, Sharafkhaneh, Kunik, Jorge, Marsh); Menninger Department of Psychiatry and Behavioral Sciences, Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, Houston (Jones, Kunik, Jorge, Marsh); and Department of Pulmonary, Critical Medicine and Sleep Medicine, Baylor College of Medicine, Houston (Agrawal, Sharafkhaneh)
| | - Mark E Kunik
- Michael E. DeBakey VA Medical Center, Houston (Jones, Agrawal, Sharafkhaneh, Kunik, Jorge, Marsh); Menninger Department of Psychiatry and Behavioral Sciences, Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, Houston (Jones, Kunik, Jorge, Marsh); and Department of Pulmonary, Critical Medicine and Sleep Medicine, Baylor College of Medicine, Houston (Agrawal, Sharafkhaneh)
| | - Ricardo E Jorge
- Michael E. DeBakey VA Medical Center, Houston (Jones, Agrawal, Sharafkhaneh, Kunik, Jorge, Marsh); Menninger Department of Psychiatry and Behavioral Sciences, Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, Houston (Jones, Kunik, Jorge, Marsh); and Department of Pulmonary, Critical Medicine and Sleep Medicine, Baylor College of Medicine, Houston (Agrawal, Sharafkhaneh)
| | - Laura Marsh
- Michael E. DeBakey VA Medical Center, Houston (Jones, Agrawal, Sharafkhaneh, Kunik, Jorge, Marsh); Menninger Department of Psychiatry and Behavioral Sciences, Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, Houston (Jones, Kunik, Jorge, Marsh); and Department of Pulmonary, Critical Medicine and Sleep Medicine, Baylor College of Medicine, Houston (Agrawal, Sharafkhaneh)
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9
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Reilly ED, Robinson SA, Petrakis BA, Gardner MM, Wiener RS, Castaneda-Sceppa C, Quigley KS. Mobile Intervention to Improve Sleep and Functional Health of Veterans With Insomnia: Randomized Controlled Trial. JMIR Form Res 2021; 5:e29573. [PMID: 34889746 PMCID: PMC8704109 DOI: 10.2196/29573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 10/22/2021] [Accepted: 10/28/2021] [Indexed: 01/14/2023] Open
Abstract
Background Insomnia is a prevalent and debilitating disorder among veterans. Cognitive behavioral therapy for insomnia (CBTI) can be effective for treating insomnia, although many cannot access this care. Technology-based solutions and lifestyle changes, such as physical activity (PA), offer affordable and accessible self-management alternatives to in-person CBTI. Objective This study aims to extend and replicate prior pilot work to examine whether the use of a mobile app for CBTI (cognitive behavioral therapy for insomnia coach app [CBT-i Coach]) improves subjective and objective sleep outcomes. This study also aims to investigate whether the use of the CBT-i Coach app with adjunctive PA improves sleep outcomes more than CBT-i Coach alone. Methods A total of 33 veterans (mean age 37.61 years, SD 9.35 years) reporting chronic insomnia were randomized to use either the CBT-i Coach app alone or the CBT-i Coach app with a PA intervention over 6 weeks, with outcome measures of objective and subjective sleep at pre- and posttreatment. Results Although the PA manipulation was unsuccessful, both groups of veterans using the CBT-i Coach app showed significant improvement from baseline to postintervention on insomnia (P<.001), sleep quality (P<.001), and functional sleep outcomes (P=.002). Improvements in subjective sleep outcomes were similar in those with and without posttraumatic stress disorder and mild-to-moderate sleep apnea. We also observed a significant but modest increase in objective sleep efficiency (P=.02). Conclusions These findings suggest that the use of a mobile app–delivered CBTI is feasible and beneficial for improving sleep outcomes in veterans with insomnia, including those with comorbid conditions such as posttraumatic stress disorder or mild-to-moderate sleep apnea. Trial Registration ClinicalTrials.gov NCT03305354; https://clinicaltrials.gov/ct2/show/NCT03305354
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Affiliation(s)
- Erin Dawna Reilly
- Mental Illness Research, Education, and Clinical Center, VA Bedford Healthcare System, Bedford, MA, United States.,Social and Community Reintegration Research, VA Bedford Healthcare System, Bedford, MA, United States.,University of Massachusetts Medical School, Worcester, MA, United States
| | - Stephanie A Robinson
- Center for Healthcare Outcomes and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States.,Pulmonary Division, Boston University School of Medicine, Boston, MA, United States
| | - Beth Ann Petrakis
- Center for Healthcare Outcomes and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States
| | | | - Renda Soylemez Wiener
- Center for Healthcare Outcomes and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States.,Pulmonary Division, Boston University School of Medicine, Boston, MA, United States
| | | | - Karen S Quigley
- Social and Community Reintegration Research, VA Bedford Healthcare System, Bedford, MA, United States.,Center for Healthcare Outcomes and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States.,Northeastern University, Boston, MA, United States
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10
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Sleep problems predict next-day suicidal thinking among adolescents: A multimodal real-time monitoring study following discharge from acute psychiatric care. Dev Psychopathol 2021. [DOI: 10.1017/s0954579421000699] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AbstractSuicidal thoughts and behaviors (STBs) are major public health concerns among adolescents, and research is needed to identify how risk is conferred over the short term (hours and days). Sleep problems may be associated with elevated risk for STBs, but less is known about this link in youth over short time periods. The current study utilized a multimodal real-time monitoring approach to examine the association between sleep problems (via daily sleep diary and actigraphy) and next-day suicidal thinking in 48 adolescents with a history of STBs during the month following discharge from acute psychiatric care. Results indicated that specific indices of sleep problems assessed via sleep diary (i.e., greater sleep onset latency, nightmares, ruminative thoughts before sleep) predicted next-day suicidal thinking. These effects were significant even when daily sadness and baseline depression were included in the models. Moreover, several associations between daily-level sleep problems and next-day suicidal thinking were moderated by person-level measures of the construct. In contrast, sleep indices assessed objectively (via actigraphy) were either not related to suicidal thinking or were related in the opposite direction from hypothesized. Together, these findings provide some support for sleep problems as a short-term risk factor for suicidal thinking in high-risk adolescents.
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11
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Jernelöv S, Pallesen S, Bjorvatn B. Editorial: Insomnia: A Heterogenic Disorder Often Comorbid With Other Disorders and Diseases. Front Psychol 2021; 12:758189. [PMID: 34594289 PMCID: PMC8476875 DOI: 10.3389/fpsyg.2021.758189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 08/19/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Susanna Jernelöv
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Region Stockholm, Huddinge Hospital, Stockholm, Sweden.,Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Ståle Pallesen
- Department of Psychosocial Science, University of Bergen, Bergen, Norway.,Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Bjørn Bjorvatn
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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12
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McCarthy E, DeViva JC, Southwick SM, Pietrzak RH. Self-rated sleep quality predicts incident suicide ideation in US military veterans: Results from a 7-year, nationally representative, prospective cohort study. J Sleep Res 2021; 31:e13447. [PMID: 34328228 DOI: 10.1111/jsr.13447] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/29/2021] [Accepted: 07/04/2021] [Indexed: 11/30/2022]
Abstract
Sleep disturbance is a risk factor for future suicidal behaviours (e.g. suicidal ideation, suicide attempt, death by suicide), and military veterans are at increased risk for both poor sleep and death by suicide relative to civilians. The purpose of this study was to evaluate whether self-reported sleep quality was associated with risk of new-onset suicidal ideation in a 7-year prospective nationally representative cohort study of US military veterans. Multivariable logistic regression analyses were conducted to identify the relation between self-rated sleep quality and incident suicidal ideation in 2,059 veterans without current suicidal ideation or lifetime suicide attempt history at baseline. Relative importance analyses were then conducted to identify the relative variance explained by sleep quality and other significant determinants of incident suicidal ideation. A total of 169 (weighted 8.9%, 95% confidence interval =7.7%-10.3%) veterans developed suicidal ideation over the 7-year study period. Poor self-rated sleep quality was associated with a more than 60% greater likelihood of developing suicidal ideation (relative risk ratio = 1.62, 95% confidence interval = 1.11-2.36), even after adjustment for well-known suicide risk factors such as major depressive disorder. Relative importance analysis revealed that poor self-rated sleep quality accounted for 44.0% of the explained variance in predicting incident suicidal ideation. These results underscore the importance of assessing, monitoring and treating sleep difficulties as part of suicide prevention efforts in military veterans.
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Affiliation(s)
- Elissa McCarthy
- US Department of Veterans Affairs National Center for PTSD, White River Junction, VT, USA
| | - Jason C DeViva
- Veterans Affairs Connecticut Health Care System, West Haven, CT, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | | | - Robert H Pietrzak
- Veterans Affairs Connecticut Health Care System, West Haven, CT, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.,US Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA.,Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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13
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Sleep Duration Is Closely Associated with Suicidal Ideation and Suicide Attempt in Korean Adults: A Nationwide Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115594. [PMID: 34073804 PMCID: PMC8197181 DOI: 10.3390/ijerph18115594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/21/2021] [Accepted: 05/22/2021] [Indexed: 12/02/2022]
Abstract
Introduction: Suicidal ideation and suicide attempts are major risk factors for suicidal death, and sleep problems are associated with an increased risk for mental disorders. We investigated the relationship between sleep duration and suicidal ideation and suicide attempts in a representative sample of the Korean general population from a nationwide survey. Methods: We analyzed data collected from the Korea National Health and Nutrition Examination Survey VI and VII (2013–2018). Suicidal ideation was identified via self-report, and we accessed suicide attempt history. Sleep duration was divided into three categories: short sleep duration (SSD) (≤5 h), normal sleep duration (NSD) (>5 and <9 h), and long sleep duration (LSD) (≥9 h). Sampling weights were applied to obtain estimates for the general Korean population. Results: Overall, 4015 (12.0%), 25,609 (76.5%), and 3857 (11.5%) participants were in the SSD, NSD, and LSD groups, respectively. Among these groups, 7.2%, 2.8%, and 3.3% reported suicidal ideation; while 1.2%, 0.4%, and 0.7% reported a history of suicide attempts. Multiple regression analyses revealed that SSD was significantly more strongly associated with suicidal ideation (adjusted odds ratio (AOR) 1.46, p < 0.001) and attempts (AOR 2.05, p = 0.003) than NSD. No association was found between LSD and suicidal ideation/attempts. Conclusion: Sleep duration is significantly associated with suicidal behavior, and SSD was particularly closely related with an increased risk for suicidal ideation and suicide attempt. Clinicians should carefully consider sleep duration in suicidal patients.
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14
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Tubbs AS, Fernandez FX, Perlis ML, Hale L, Branas CC, Barrett M, Chakravorty S, Khader W, Grandner MA. Suicidal ideation is associated with nighttime wakefulness in a community sample. Sleep 2021; 44:5866613. [PMID: 32614967 DOI: 10.1093/sleep/zsaa128] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 06/19/2020] [Indexed: 12/20/2022] Open
Abstract
STUDY OBJECTIVES Nocturnal wakefulness is a risk factor for suicide and suicidal ideation in clinical populations. However, these results have not been demonstrated in general community samples or compared to sleep duration or sleep quality. The present study explored how the timing of wakefulness was associated with suicidal ideation for weekdays and weekends. METHODS Data were collected from 888 adults aged 22-60 as part of the Sleep and Healthy Activity, Diet, Environment, and Socialization study. Suicidal ideation was measured by the Patient Health Questionnaire-9, while timing of wakefulness was estimated from the Sleep Timing Questionnaire. Binomial logistic regressions estimated the association between nocturnal (11 pm-5 am) and morning (5 am-11 am) wakefulness and suicidal ideation. RESULTS Nocturnal wakefulness was positively associated with suicidal ideation on weekdays (OR: 1.44 [1.28-1.64] per hour awake between 11:00 pm and 05:00 am, p < 0.0001) and weekends (OR: 1.22 [1.08-1.39], p = 0.0018). Morning wakefulness was negatively associated with suicidal ideation on weekdays (OR: 0.82 [0.72-0.92] per hour awake between 05:00 am and 11:00 am, p = 0.0008) and weekends (OR: 0.84 [0.75-0.94], p = 0.0035). These associations remained significant when adjusting for sociodemographic factors. Additionally, nocturnal wakefulness on weekdays was associated with suicidal ideation when accounting for insomnia, sleep duration, sleep quality, and chronotype (OR 1.25 [1.09-1.44] per hour awake, p = 0.002). CONCLUSION Wakefulness at night was consistently associated with suicidal ideation. Additionally, morning wakefulness was negatively associated with suicidal ideation in some models. Although these findings are drawn from a non-clinical sample, larger longitudinal studies in the general population are needed to confirm these results.
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Affiliation(s)
- Andrew S Tubbs
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona, Tucson, AZ
| | - Fabian-Xosé Fernandez
- Department of Psychology, BIO5 and McKnight Brain Research Institutes, University of Arizona, Tucson, AZ
| | - Michael L Perlis
- Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - Lauren Hale
- Program in Public Health, Department of Family, Population, and Preventative Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY
| | | | - Marna Barrett
- Mood and Anxiety Disorders Treatment Research Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - Subhajit Chakravorty
- Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - Waliuddin Khader
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona, Tucson, AZ
| | - Michael A Grandner
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona, Tucson, AZ
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15
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Alter S, Wilson C, Sun S, Harris RE, Wang Z, Vitale A, Hazlett EA, Goodman M, Ge Y, Yehuda R, Galfalvy H, Haghighi F. The association of childhood trauma with sleep disturbances and risk of suicide in US veterans. J Psychiatr Res 2021; 136:54-62. [PMID: 33561736 DOI: 10.1016/j.jpsychires.2021.01.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 12/14/2020] [Accepted: 01/16/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Sleep dysregulation is prevalent among veterans and is associated with increased risk of suicidal ideation and behaviors. A confluence of risk factors have been identified to date that contribute to increase risk for suicidal behavior. How these risk factors including childhood trauma, comorbid psychopathology, impulsivity, and hostility together with sleep disturbance contribute to suicide risk remains an open question. These factors have never been examined simultaneously in a unified mediation model, as investigated in the present study, to determine their relative contribution to suicide risk. METHODS Veterans (N = 105) were recruited across 3-groups, including Major Depressive Disorder (MDD) with/without a history of a suicide attempt (n = 35 and n = 37, respectively), and non-psychiatric controls, who had no history of mental illness or suicidal behavior (n = 33). The participants were assessed using validated self-report assessments with in-depth phenotyping for relevant risk factors associated with suicidal behavior including childhood adversity, depression severity, impulsivity, hostility, and sleep quality. These factors were included in mediation models using path analysis. RESULTS Across all subjects including those with MDD and non-psychiatric controls, mediation analysis showed that higher levels of childhood trauma had an indirect effect on poor sleep quality (p = 0.001). This effect was orthogonal, being independently mediated by both MDD psychopathology (p = 0.003), and higher traits of impulsivity (p = 0.001) and hostility (p = 0.015). Amongst MDD veterans, childhood trauma was directly associated with increased suicide risk (p = 0.034), irrespective of their severity of depression, or their degree of hostility and impulsivity. LIMITATIONS include use of self-report data, and the inability to establish causal inferences with cross-sectional design. CONCLUSION Childhood adversity as a significant pre-deployment risk factor for disturbed sleep and elevated suicide risk, potentially important for incorporation in clinical practice for suicide.
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Affiliation(s)
| | | | - Shengnan Sun
- Icahn School of Medicine at Mount Sinai, New York, USA
| | | | - Zhaoyu Wang
- Icahn School of Medicine at Mount Sinai, New York, USA
| | - Amanda Vitale
- Icahn School of Medicine at Mount Sinai, New York, USA
| | - Erin A Hazlett
- James J. Peters VA Medical Center, Bronx, USA; Icahn School of Medicine at Mount Sinai, New York, USA
| | - Marianne Goodman
- James J. Peters VA Medical Center, Bronx, USA; Icahn School of Medicine at Mount Sinai, New York, USA
| | - Yongchao Ge
- Icahn School of Medicine at Mount Sinai, New York, USA
| | - Rachel Yehuda
- James J. Peters VA Medical Center, Bronx, USA; Icahn School of Medicine at Mount Sinai, New York, USA
| | | | - Fatemeh Haghighi
- James J. Peters VA Medical Center, Bronx, USA; Icahn School of Medicine at Mount Sinai, New York, USA.
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16
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Vitale A, Byma L, Sun S, Podolak E, Wang Z, Alter S, Galfalvy H, Geraci J, Langhoff E, Klingbeil H, Yehuda R, Haghighi F, Feder A. Effectiveness of Complementary and Integrative Approaches in Promoting Engagement and Overall Wellness Toward Suicide Prevention in Veterans. J Altern Complement Med 2021; 27:S14-S27. [PMID: 33788604 PMCID: PMC8035924 DOI: 10.1089/acm.2020.0245] [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] [Indexed: 02/06/2023] Open
Abstract
Objective: Suicide is a major public health problem, specifically among U.S. veterans, who do not consistently engage in mental health services, often citing stigma as a barrier. Complementary and Integrative Health (CIH) interventions are promising alternatives in promoting patient engagement and further, they may play a critical role in transitioning people into mental health care. Toward this goal, the Resilience and Wellness Center (RWC) was developed to break through the stigma barrier by addressing risk factors of suicide through multimodal CIH interventions via cohort design, promoting social connectedness and accountability among participants. Design: This is a program evaluation study at a large urban VA medical center, where assessments were evaluated from pre- to post-program completion to determine the effectiveness of an intensive multimodal CIH 4-week group outpatient intervention for suicide prevention. Outcome measures: Primary outcomes measured included group connectedness, severity of depression and hopelessness symptoms, suicidal ideation, sleep quality, and diet. Secondary outcomes included measures of post-traumatic stress disorder (PTSD), generalized anxiety severity stress/coping skills, pain, and fatigue. Results: The RWC showed high participant engagement, with an 84%-95% attendance engagement rate depending on suicide risk history. Data from 15 cohorts (N = 126) demonstrate favorable outcomes associated with participation in this comprehensive program, as evidenced by a reduction in suicidal ideation, depression, and hopelessness, but not sleep quality and diet. In addition, in a subset of veterans with a history of suicidal ideation or attempt, significant improvements were noted in pain, PTSD/anxiety symptoms, and stress coping measures. Conclusions: The RWC shows that an intensive complement of CIH interventions is associated with a significant improvement with high veteran engagement. Findings from this program evaluation study can be used to aid health care systems and their providers in determining whether or not to utilize such multimodal CIH integrated interventions as an effective treatment for at-risk populations as a part of suicide prevention efforts.
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Affiliation(s)
| | - Lauren Byma
- James J. Peters VA Medical Center, Bronx, NY, USA
| | - Shengnan Sun
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Evan Podolak
- James J. Peters VA Medical Center, Bronx, NY, USA
| | - Zhaoyu Wang
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sharon Alter
- James J. Peters VA Medical Center, Bronx, NY, USA
| | - Hanga Galfalvy
- Department of Psychiatry, Columbia University, New York, NY, USA
| | | | - Erik Langhoff
- James J. Peters VA Medical Center, Bronx, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Rachel Yehuda
- James J. Peters VA Medical Center, Bronx, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Fatemeh Haghighi
- James J. Peters VA Medical Center, Bronx, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ann Feder
- James J. Peters VA Medical Center, Bronx, NY, USA
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17
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Batterham PJ, Werner-Seidler A, Calear AL, McCallum S, Gulliver A. Specific aspects of sleep disturbance associated with suicidal thoughts and attempts. J Affect Disord 2021; 282:574-579. [PMID: 33440302 DOI: 10.1016/j.jad.2020.12.150] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/08/2020] [Accepted: 12/24/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Previous research suggests that sleep disturbance is associated with suicidal ideation and suicide attempt. However, few studies have accounted for the presence of multiple mental disorders and interpersonal factors associated with suicide risk. Furthermore, limited research has examined which aspects of sleep disturbance are most strongly associated with suicidal thoughts and attempts. METHOD A large community-based sample of Australian adults (n = 3,618; 81% female; 37% reporting ideation) completed a comprehensive survey assessing suicidal thoughts and behaviours, sleep disturbance, common mental disorders and interpersonal risk factors. Sleep disturbance was assessed using the 6-item PROMIS sleep disturbance scale and suicidality was measured using the Psychiatric Symptom Frequency Scale. Analyses were adjusted for age, sex, perceived burdensomeness, thwarted belongingness, and clinical caseness for six mental disorders, including major depression. RESULTS After accounting for mental health, demographic and interpersonal characteristics, increasing sleep disturbance was significantly associated with higher odds of both suicidal ideation (OR=1.17 for one-SD increase in PROMIS-SD), and suicide attempt (OR=1.33 for one-SD increase in PROMIS-SD). Of the specific indicators of sleep disturbance, only sleep onset (difficulties falling asleep) had a significant independent association with both suicidal ideation (p < 0.001) and suicide attempt (p = 0.047). CONCLUSIONS Sleep disturbance is independently associated with greater risk of suicidal thoughts and behaviours. Sleep disturbance is highly modifiable, so sleep interventions for people with suicide risk and sleep problems may provide an effective and efficient approach to suicide prevention in the community.
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Affiliation(s)
- Philip J Batterham
- Centre for Mental Health Research, The Australian National University, Canberra, Australia.
| | | | - Alison L Calear
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
| | - Sonia McCallum
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
| | - Amelia Gulliver
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
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18
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Germain A, Markwald RR, King E, Bramoweth AD, Wolfson M, Seda G, Han T, Miggantz E, O’Reilly B, Hungerford L, Sitzer T, Mysliwiec V, Hout JJ, Wallace ML. Enhancing behavioral sleep care with digital technology: study protocol for a hybrid type 3 implementation-effectiveness randomized trial. Trials 2021; 22:46. [PMID: 33430955 PMCID: PMC7798254 DOI: 10.1186/s13063-020-04974-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 12/14/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Insomnia affects almost one in four military service members and veterans. The first-line recommended treatment for insomnia is cognitive-behavioral therapy for insomnia (CBTI). CBTI is typically delivered in-person or online over one-to-four sessions (brief versions) or five-to-eight sessions (standard versions) by a licensed doctoral or masters-level clinician with extensive training in behavioral sleep medicine. Despite its effectiveness, CBTI has limited scalability. Three main factors inhibit access to and delivery of CBTI including restricted availability of clinical expertise; rigid, resource-intensive treatment formats; and limited capacities for just-in-time monitoring and treatment personalization. Digital technologies offer a unique opportunity to overcome these challenges by providing scalable, personalized, resource-sensitive, adaptive, and cost-effective approaches for evidence-based insomnia treatment. METHODS This is a hybrid type 3 implementation-effectiveness randomized trial using a scalable evidence-based digital health software platform, NOCTEM™'s Clinician-Operated Assistive Sleep Technology (COAST™). COAST includes a clinician portal and a patient app, and it utilizes algorithms that facilitate detection of sleep disordered patterns, support clinical decision-making, and personalize sleep interventions. The first aim is to compare three clinician- and system-centered implementation strategies on the reach, adoption, and sustainability of the COAST digital platform by offering (1) COAST only, (2) COAST plus external facilitation (EF: assistance and consultation to providers by NOCTEM's sleep experts), or (3) COAST plus EF and internal facilitation (EF/IF: assistance/consultation to providers by NOCTEM's sleep experts and local champions). The second aim is to quantify improvements in insomnia among patients who receive behavioral sleep care via the COAST platform. We hypothesize that reach, adoption, and sustainability and the magnitude of improvements in insomnia will be superior in the EF and EF/IF groups relative to the COAST-only group. DISCUSSION Digital health technologies and machine learning-assisted clinical decision support tools have substantial potential for scaling access to insomnia treatment. This can augment the scalability and cost-effectiveness of CBTI without compromising patient outcomes. Engaging providers, stakeholders, patients, and decision-makers is key in identifying strategies to support the deployment of digital health technologies that can promote quality care and result in clinically meaningful sleep improvements, positive systemic change, and enhanced readiness and health among service members. TRIAL REGISTRATION ClinicalTrials.gov NCT04366284 . Registered on 28 April 2020.
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Affiliation(s)
- Anne Germain
- NOCTEM, LLC, 218 Oakland Avenue, Pittsburgh, PA 15213 USA
| | - Rachel R. Markwald
- Warfighter Performance Department, Naval Health Research Center, 140 Sylvester Rd, San Diego, CA 92106 USA
| | - Erika King
- Mental Health Division, Air Force Medical Readiness Agency, 2261 Hughes Ave, Suite 153, JBSA Lackland AFB, TX 78236-9853 USA
| | - Adam D. Bramoweth
- VA Pittsburgh Healthcare System, Research Office Building (151RU), University Drive C, Pittsburgh, PA 15240 USA
| | - Megan Wolfson
- NOCTEM, LLC, 218 Oakland Avenue, Pittsburgh, PA 15213 USA
| | - Gilbert Seda
- Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134 USA
| | - Tony Han
- Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134 USA
| | - Erin Miggantz
- Warfighter Performance Department, Naval Health Research Center, 140 Sylvester Rd, San Diego, CA 92106 USA
- Leidos, Inc., 4161 Campus Point Ct., San Diego, 92121 USA
| | - Brian O’Reilly
- Madigan Army Medical Center, 9040A Jackson Ave, Joint Base Lewis-McChord, WA 98431 USA
| | - Lars Hungerford
- Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134 USA
- Defense and Veterans Brain Injury Center, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134 USA
| | - Traci Sitzer
- Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134 USA
| | - Vincent Mysliwiec
- Division of Behavioral Medicine, Department of Psychiatry, UT Health San Antonio, 7703 Floyd Curl Drive, MC 7747, San Antonio, TX 78229-3900 USA
| | - Joseph J. Hout
- Knowesis, Inc., 816 Camaron St. Suite 231, San Antonio, TX 78212 USA
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19
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Jernelöv S, Forsell E, Kaldo V, Blom K. Initial Low Levels of Suicidal Ideation Still Improve After Cognitive Behavioral Therapy for Insomnia in Regular Psychiatric Care. Front Psychiatry 2021; 12:676962. [PMID: 34262491 PMCID: PMC8273305 DOI: 10.3389/fpsyt.2021.676962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 05/27/2021] [Indexed: 11/13/2022] Open
Abstract
Insomnia disorder is highly prevalent, and has been identified as a risk factor for many psychiatric problems, including depression, suicide ideation and suicide death. Previous studies have found that cognitive behavioral therapy for insomnia (CBT-I) reduce depression and suicidal ideation in samples with high levels of suicidal ideation. This study aims to investigate associations of CBT-I with suicidal ideation in a sample of 522 patients primarily seeking internet-delivered treatment for insomnia in regular psychiatric care. The sample had high pretreatment insomnia severity levels and a relatively high level of comorbid depression symptoms. Suicidal ideation levels were relatively low pretreatment but still improved significantly after CBT-I. Contrary to previous findings, the strongest predictor of changes in suicidal ideation were improvements in depressive symptoms, rather than improvements in insomnia. We conclude that suicidal ideation may not be a major problem in these patients primarily seeking treatment for insomnia, despite comorbid depressive symptoms, but that suicidal ideation still improves following CBT-i. Considering the increased risk for patients with untreated insomnia to develop depression, this finding is of interest for prevention of suicidal ideation.
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Affiliation(s)
- Susanna Jernelöv
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Stockholm, Sweden.,Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Erik Forsell
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Stockholm, Sweden
| | - Viktor Kaldo
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Stockholm, Sweden.,Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
| | - Kerstin Blom
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Stockholm, Sweden
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20
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Barth TM, Lord CG, Thakkar VJ, Brock RN. Effects of Resilience Strength Training on Constructs Associated with Moral Injury among Veterans. JOURNAL OF VETERANS STUDIES 2020. [DOI: 10.21061/jvs.v6i2.199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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21
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Bertrand L, Bourguignon C, Beaulieu S, Storch KF, Linnaranta O. Suicidal Ideation and Insomnia in Bipolar Disorders: Idéation suicidaire et insomnie dans les troubles bipolaires. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:802-810. [PMID: 32856463 PMCID: PMC7564692 DOI: 10.1177/0706743720952226] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Bipolar disorder (BD) confers elevated suicide risk and associates with misaligned circadian rhythm. Real-time monitoring of objectively measured sleep is a novel approach to detect and prevent suicidal behavior. We aimed at understanding associations between subjective insomnia and actigraphy data with severity of suicidal ideation in BDs. METHODS This prospective cohort study comprised 76 outpatients with a BD aged 18 to 65 inclusively. Main measures included 10 consecutive days of wrist actigraphy; the Athens Insomnia Scale (AIS); the Montgomery-Åsberg Depression Rating Scale (MADRS); the Quick Inventory of Depressive Symptoms-16, self-rating (QIDS-SR-16); and the Columbia Suicide Severity Rating Scale. Diagnoses, medications, and suicide attempts were obtained from chart review. RESULTS Suicidal ideation correlated moderately with subjective insomnia (AIS with QIDS-SR-16 item 12 ρ =0.26, P = 0.03; MADRS item 10 ρ = 0.33, P = 0.003). Graphical sleep patterns showed that suicidal patients were enriched among the most fragmented sleep patterns, and this was confirmed by correlations of suicidal ideation with actigraphy data at 2 visits. Patients with lifetime suicide attempts (n = 8) had more varied objective sleep (a higher standard deviation of center of daily inactivity [0.64 vs. 0.26, P = 0.01], consolidation of daily inactivity [0.18 vs. 0.10, P = <0.001], sleep offset [3.02 hours vs. 1.90 hours, P = <0.001], and total sleep [105 vs. 69 minutes, P = 0.02], and a lower consolidation of daily inactivity [0.65 vs. 0.79, P = 0.03]). CONCLUSIONS Subjective insomnia, a nonstigmatized symptom, can complement suicidality screens. Longer follow-ups and larger samples are warranted to understand whether real-time sleep monitoring predicts suicidal ideation in patient subgroups or individually.
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Affiliation(s)
- Lia Bertrand
- Faculty of Medicine, 5620McGill University, Montreal, Quebec, Canada
| | - Clément Bourguignon
- Douglas Centre for Sleep and Biological Rhythms, 26632Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Integrated Program in Neuroscience, 5620McGill University, Montreal, Quebec, Canada
| | - Serge Beaulieu
- Douglas Centre for Sleep and Biological Rhythms, 26632Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, 5620McGill University, Montreal, Quebec, Canada
| | - Kai-Florian Storch
- Douglas Centre for Sleep and Biological Rhythms, 26632Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, 5620McGill University, Montreal, Quebec, Canada
| | - Outi Linnaranta
- Douglas Centre for Sleep and Biological Rhythms, 26632Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, 5620McGill University, Montreal, Quebec, Canada.,National Institute for Health and Welfare, Helsinki, Finland
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22
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Pigeon WR, Funderburk JS, Cross W, Bishop TM, Crean HF. Brief CBT for insomnia delivered in primary care to patients endorsing suicidal ideation: a proof-of-concept randomized clinical trial. Transl Behav Med 2020; 9:1169-1177. [PMID: 31271210 DOI: 10.1093/tbm/ibz108] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Insomnia co-occurs frequently with major depressive disorder (MDD) and posttraumatic stress disorder (PTSD); all three conditions are prevalent among primary care patients and associated with suicidal ideation (SI). The purpose of the article was to test the effects of a brief cognitive behavioral therapy for insomnia (bCBTi) and the feasibility of delivering it to primary care patients with SI and insomnia in addition to either MDD and/or PTSD. Fifty-four patients were randomized to receive either bCBTi or treatment-as-usual for MDD and/or PTSD. The primary outcome was SI intensity as measured by the Columbia-Suicide Severity Rating Scale; secondary clinical outcomes were measured by the Insomnia Severity Index, Patient Health Questionnaire for depression, and PTSD Symptom Checklist. Effect sizes controlling for baseline values and sample size were calculated for each clinical outcome comparing pre-post differences between the two conditions with Hedge's g. The effect size of bCBTi on SI intensity was small (0.26). Effects were large on insomnia (1.91) and depression (1.16) with no effect for PTSD. There was a marginally significant (p = .069) effect of insomnia severity mediating the intervention's effect on SI. Findings from this proof-of-concept trial support the feasibility of delivering bCBTi in primary care and its capacity to improve mood and sleep in patients endorsing SI. The results do not support bCBTi as a stand-alone intervention to reduce SI, but this or other insomnia interventions may be considered as components of suicide prevention strategies.
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Affiliation(s)
- Wilfred R Pigeon
- VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, USA.,Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA.,Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA
| | - Jennifer S Funderburk
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA.,Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA.,Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Wendi Cross
- VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, USA.,Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Todd M Bishop
- VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, USA.,Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA.,Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA
| | - Hugh F Crean
- VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, USA.,Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
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23
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Roberge EM, Bryan CJ. An integrated model of chronic trauma-induced insomnia. Clin Psychol Psychother 2020; 28:79-92. [PMID: 32761851 DOI: 10.1002/cpp.2495] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/15/2020] [Accepted: 08/01/2020] [Indexed: 01/10/2023]
Abstract
Insomnia is the most commonly reported symptom of posttraumatic stress disorder (PTSD), with at least 70% of patients with PTSD reporting disturbed sleep. Although posttraumatic insomnia has traditionally been conceptualized as a consequence of PTSD, it is the most likely symptom to not remit following otherwise successful PTSD treatment. This suggests that the relationship between PTSD and insomnia is more complex, such that they likely share underlying pathological mechanisms and that factors non-specific to PTSD maintain chronic trauma-induced insomnia. Although several theories and hypotheses have been presented to explain the relationship between PTSD and insomnia, neurobiological and psychological models have not been integrated, thereby limiting their comprehensiveness and abilities to inform effective intervention. Further, existing models have not addressed how acute trauma-induced insomnia becomes chronic. The present review examined models of PTSD and insomnia separately, as well as existing theorized mechanisms of their co-morbidity. The distinct characteristics of trauma-induced insomnia were also reviewed and presented to describe the unique clinical presentation of trauma-induced insomnia. Review and integration of the literature were used to propose an integrated model of chronic trauma-induced insomnia informed by a neuropsychobiological framework. Clinical implications and future research directions are presented and discussed.
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Affiliation(s)
- Erika M Roberge
- National Center for Veterans Studies, The University of Utah, Salt Lake City, UT, USA.,Mental Health Service, George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - Craig J Bryan
- National Center for Veterans Studies, The University of Utah, Salt Lake City, UT, USA
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24
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Brief Behavioral Treatment for Insomnia vs. Cognitive Behavioral Therapy for Insomnia: Results of a Randomized Noninferiority Clinical Trial Among Veterans. Behav Ther 2020; 51:535-547. [PMID: 32586428 DOI: 10.1016/j.beth.2020.02.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 02/06/2020] [Accepted: 02/14/2020] [Indexed: 12/17/2022]
Abstract
The goal of this study was to compare a brief behavioral treatment for insomnia (BBTI), which has fewer sessions (4), shorter duration (<30-45 minutes), and delivers treatment in-person plus phone calls to cognitive behavioral therapy for insomnia (CBTI), which has 5 in-person sessions. The hypothesis was BBTI would be noninferior to CBTI. The Reliable Change Index was used to establish a noninferiority margin (NIM) of 3.43, representing the maximum allowable difference between groups on the pre-post Insomnia Severity Index change (ΔISI). Sixty-three veterans with chronic insomnia were randomized to either BBTI or CBTI and veterans in both groups had significant reductions of their insomnia severity per the ISI and improved their sleep onset latency, total wake time, sleep efficiency, and sleep quality per sleep diaries. While CBTI had a larger pre-post ΔISI, this was not significantly different than ΔISI BBTI and was less than the NIM. However, the 95% confidence interval of the between group pre-post ΔISI extended beyond the NIM, and thus BBTI was inconclusively noninferior to CBTI. Limitations, such as small sample size and high rate of dropout, indicate further study is needed to compare brief, alternative yet complementary behavioral insomnia interventions to CBTI. Still, evidence-based brief and flexible treatment options will help to further enhance access to care for veterans with chronic insomnia, especially in non-mental-health settings like primary care.
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25
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Rugo KF, Tabares JV, Crowell SE, Baucom BR, Rudd MD, Bryan CJ. The role of depression and suicidal cognitions as contributors to suicide risk among active duty soldiers reporting symptoms of posttraumatic stress disorder. J Affect Disord 2020; 265:333-341. [PMID: 32090757 DOI: 10.1016/j.jad.2020.01.095] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 11/12/2019] [Accepted: 01/20/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Military suicide rates have risen across all service branches, with the overall rate surpassing that of the general population for the first time in history in 2008. Service members with posttraumatic stress disorder (PTSD) are at a substantially higher risk for suicidal ideation, suicide attempts, and death by suicide than their peers without PTSD. While the link between PTSD and suicide is well established in the literature, less is known about the precise nature of that connection. Several constructs have been implicated as potential mediators of this relation, such as depression, alcohol use, suicidal cognitions, and sleep disturbance. Yet, to our knowledge, these constructs have never been examined simultaneously in a single model to determine mediational influence for suicide risk among soldiers with PTSD. METHODS A sample of 172 active duty Army soldiers completed a series of measures targeting the aforementioned constructs. Data were analyzed using mediation model analyses. RESULTS Suicidal cognitions fully mediated the relation between PTSD symptoms and current suicide risk severity. The indirect effect for suicidal cognitions was significantly larger than indirect effects for alcohol use, depression, and sleep disturbance. Exploratory analyses suggest serial mediation of the relation between PTSD and current suicide risk by depression and suicidal cognitions. LIMITATIONS These results should be interpreted within the context of study limitations, to include use of self-report data and inability to firmly establish temporal sequencing assumed in mediation. CONCLUSIONS Implications of this study include the improvement of suicide risk assessment and individualized treatment planning for suicidal military personnel with PTSD.
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Affiliation(s)
- Kelsi F Rugo
- National Center for Veterans Studies, The University of Utah, Salt Lake City, UT, USA; Department of Psychology, The University of Utah, Salt Lake City, UT, USA.
| | - Jeffrey V Tabares
- National Center for Veterans Studies, The University of Utah, Salt Lake City, UT, USA; Department of Psychology, The University of Utah, Salt Lake City, UT, USA
| | - Sheila E Crowell
- Department of Psychology, The University of Utah, Salt Lake City, UT, USA
| | - Brian R Baucom
- Department of Psychology, The University of Utah, Salt Lake City, UT, USA
| | - M David Rudd
- National Center for Veterans Studies, The University of Utah, Salt Lake City, UT, USA; Department of Psychology, University of Memphis, Memphis, TN, USA
| | - Craig J Bryan
- National Center for Veterans Studies, The University of Utah, Salt Lake City, UT, USA; Department of Psychology, The University of Utah, Salt Lake City, UT, USA
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26
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Mysliwiec V, Brock MS. Time to recognize trauma associated sleep disorder as a distinct parasomnia. Sleep 2020; 43:5799152. [DOI: 10.1093/sleep/zsaa019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Vincent Mysliwiec
- Division of Behavioral Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Matthew S Brock
- Department of Sleep Medicine, San Antonio Military Health System, JBSA-Lackland, TX
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27
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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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28
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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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29
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Drapeau CW, Nadorff MR, McCall WV, Titus CE, Barclay N, Payne A. Screening for suicide risk in adult sleep patients. Sleep Med Rev 2019; 46:17-26. [DOI: 10.1016/j.smrv.2019.03.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 03/07/2019] [Accepted: 03/22/2019] [Indexed: 01/10/2023]
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30
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Sleep, suicide behaviors, and the protective role of sleep medicine. Sleep Med 2019; 66:264-270. [PMID: 31727433 DOI: 10.1016/j.sleep.2019.07.016] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 06/26/2019] [Accepted: 07/12/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE/BACKGROUND Sleep disturbance is associated with suicidal thoughts and behaviors. The relationship of specific sleep disorders to suicide attempts is less well established. Whether treating sleep disorders reduces suicide attempts remains controversial. METHODS Suicide attempts, treatment utilization, and psychiatric diagnoses were extracted from electronic medical records and a suicide attempt database from the U.S. Department of Veterans Affairs. The sample (N = 60,102) consisted of patients with any record of suicide attempt in FY13-14 and a 1:1 case-control of patients with no record of attempt, who were propensity score-matched based on age, gender, and prior year mental health treatment utilization. Associations among sleep disorders and suicide attempt were examined via logistic regression. Covariates included depression, anxiety, posttraumatic stress disorder (PTSD), bipolar, schizophrenia, substance use disorder (SUD), medical comorbidity, and obesity. RESULTS Insomnia (OR = 5.62; 95% CI, 5.39-5.86), nightmares (odds ratio, OR = 2.49; 95% confidence interval, CI, 2.23-2.77), and sleep-related breathing disorders (OR = 1.37; 95% CI, 1.27-1.48) were positively associated with suicide attempt after accounting for age, gender, treatment utilization, and comorbid sleep disorders. Furthermore, when controlling for depression, anxiety, PTSD, bipolar, schizophrenia, substance use disorder (SUD), medical comorbidity, and obesity, insomnia (OR = 1.51, 95% CI, 1.43-1.59) remained positively associated with suicide attempt nightmares (OR = 0.96; 95% CI, 0.85-1.09) nor sleep-related breathing disorders (OR = 0.87, 95% CI = 0.79-0.94). Additionally, sleep medicine visits 180 days prior to index date were associated with decreased likelihood of suicide attempt for individuals with sleep disorders (OR = 0.86; 95% CI, 0.79-0.94). CONCLUSION Insomnia is associated with suicide attempt among veterans. Sleep medicine visits were associated with a reduced risk of suicide attempt in sleep disordered patients. The assessment and treatment of sleep disorders should be considered in context of strategies to augment suicide prevention efforts.
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Soberay KA, Hanson JE, Dwyer M, Plant EA, Gutierrez PM. The Relationship between Suicidal Responses and Traumatic Brain Injury and Severe Insomnia in Active Duty, Veteran, and Civilian Populations. Arch Suicide Res 2019; 23:391-410. [PMID: 29792569 DOI: 10.1080/13811118.2018.1479322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
This study examined how a positive traumatic brain injury (TBI) screening and insomnia severity relate to suicidal outcomes across active duty, veteran, and civilian samples. Data were used from 3,993 participants from 19 studies. We conducted a series of analyses by group to identify which significantly differed on the variables of interest. TBI and insomnia each had independent relationships with outcomes over and above the impact of the other factor. Veterans presented as clinically worse across the outcomes. However, the relationship between insomnia and suicidal responses was stronger for active duty military compared to veterans. Continued research on TBIs and insomnia severity across groups will improve quality of care for those at risk of suicide.
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Affiliation(s)
- Kelly A Soberay
- a Military Suicide Research Consortium , Denver , CO , USA.,b Department of Veterans Affairs , Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC) , Denver , CO 80206 , USA
| | - Jetta E Hanson
- a Military Suicide Research Consortium , Denver , CO , USA.,b Department of Veterans Affairs , Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC) , Denver , CO 80206 , USA
| | - Megan Dwyer
- a Military Suicide Research Consortium , Denver , CO , USA.,b Department of Veterans Affairs , Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC) , Denver , CO 80206 , USA
| | - E Ashby Plant
- a Military Suicide Research Consortium , Denver , CO , USA.,c Florida State University , Tallahassee , FL , USA
| | - Peter M Gutierrez
- a Military Suicide Research Consortium , Denver , CO , USA.,b Department of Veterans Affairs , Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC) , Denver , CO 80206 , USA.,d University of Colorado School of Medicine , Denver , CO , USA
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32
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McCarthy MS, Hoffmire C, Brenner LA, Nazem S. Sleep and timing of death by suicide among U.S. Veterans 2006–2015: analysis of the American Time Use Survey and the National Violent Death Reporting System. Sleep 2019; 42:5513337. [DOI: 10.1093/sleep/zsz094] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 01/28/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study Objectives
Suicide is a top public health priority, and U.S. Veterans are recognized to be at particularly elevated risk. Sleep disturbances are an independent risk factor for suicide; recent empirical data suggest that nocturnal wakefulness may be a key mechanism underlying this association. Given higher rates of sleep disturbances among U.S. Veterans compared with civilians, we examined associations between nocturnal wakefulness and timing of death by suicide in U.S. Veterans and civilians to determine whether temporal suicide patterns differed.
Methods
The American Time Use Survey and the National Violent Death Reporting System were analyzed (2006–2015) to determine whether sleep and temporal suicide patterns differed between age-stratified groups (18–39, 40–64, and ≥65) of U.S. Veterans and civilians. Observed temporal suicide patterns were reported and standardized incidence ratios (SIRs) calculated to compare the percentage of suicides observed with those expected, given the proportion of the population awake, across clock hours.
Results
The raw proportion of Veteran suicides peaks between the hours of 1000–1200; however, the peak prevalence of suicide after accounting for the population awake is between 0000 and 0300 hr (p < .00001, ϕ = .88). The highest SIR was at midnight; U.S. Veterans were eight times more likely to die by suicide than expected given the population awake (SIR = 8.17; 95% CI = 7.45–8.94).
Conclusions
Nocturnal wakefulness is associated with increased risk for suicide in U.S. Veterans. Overall patterns of observed suicides by clock hour were similar between U.S. Veterans and civilians. However, Veteran-specific SIRs suggest differences in magnitude of risk by clock hour across age groups. Future research examining female and Post-9/11 U.S. Veterans is warranted.
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Affiliation(s)
| | - Claire Hoffmire
- Rocky Mountain Mental Illness Research Education and Clinical Center, Veterans Administration, Aurora, CO
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO
| | - Lisa A Brenner
- Rocky Mountain Mental Illness Research Education and Clinical Center, Veterans Administration, Aurora, CO
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO
| | - Sarra Nazem
- Rocky Mountain Mental Illness Research Education and Clinical Center, Veterans Administration, Aurora, CO
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO
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Bishop TM, Crean HF, Hoff RA, Pigeon WR. Suicidal ideation among recently returned veterans and its relationship to insomnia and depression. Psychiatry Res 2019; 276:250-261. [PMID: 31125902 DOI: 10.1016/j.psychres.2019.05.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 05/09/2019] [Accepted: 05/10/2019] [Indexed: 11/25/2022]
Abstract
Suicide is a significant public health problem associated with numerous health factors such as insomnia. Suicidal ideation is common among veterans, who often present with multiple comorbidities. The present study examined direct and indirect relationships among suicidal ideation, insomnia, depression, and alcohol use. U.S. veterans (n = 850) recently separated from military service completed phone-based interviews covering multiple domains. Tests of indirect effects and bias-corrected confidence intervals were used to conduct a cross-sectional analysis of baseline data from a larger parent study examining relationships among the latent variables of suicidal ideation, insomnia, alcohol use, and depression. In this analysis insomnia did not have direct associations with suicidal ideation (Β = 0.06, t = 0.29, p = .772) or alcohol use (Β = 0.07, t = 1.73, p = .084). Insomnia severity was, however, significantly and positively related to depression severity (Β = 0.58, t = 21.70, p < .001). Additionally, more severe depression was associated with greater intensity of suicidal ideation (Β = 0.59, t = 3.64, p < .001). Notably, insomnia's indirect effect on suicidal ideation was driven by depression. In this sample of returning veterans, insomnia appears to indirectly impact suicidal ideation through its relationship with depression. This finding suggests the potential utility of addressing insomnia as part of an overall approach to reducing depressive symptomatology and indirectly, suicidal ideation.
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Affiliation(s)
- Todd M Bishop
- VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, United States; Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States.
| | - Hugh F Crean
- VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, United States; Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States
| | - Rani A Hoff
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States; VISN 1 MIRECC, VA Connecticut Healthcare System, West Haven, CT, United States
| | - Wilfred R Pigeon
- VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, United States; Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States
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Roberge EM, Bryan CJ, Peterson A, Rudd MD. Variables associated with reductions in insomnia severity among acutely suicidal patients receiving brief cognitive behavioral therapy for suicide prevention. J Affect Disord 2019; 252:230-236. [PMID: 30986738 DOI: 10.1016/j.jad.2019.04.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/13/2019] [Accepted: 04/07/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION This study compared changes in sleep disturbance over time across brief cognitive behavioral therapy for suicide prevention and treatment as usual and examined the mechanisms that link sleep disturbance with several suicide risk factors. METHOD Active duty U.S. Army soldiers (N = 152) completed a randomized controlled trial to test the efficacy of brief cognitive behavioral therapy (n = 76) or treatment as usual (n = 76). Six assessments of insomnia symptoms, hopelessness, coping, and suicide beliefs were tracked over 24 months. RESULTS Brief cognitive behavioral therapy patients reported a significant decrease in sleep disturbance symptoms over time while treatment as usual patients did not. These improvements were initially observed during treatment and carried over through 12-months. Changes in sleep disturbance predicted changes in suicide risk. Longitudinal growth modeling was used to assess potential mechanisms of this effect. Results suggested that changes in cognitive flexibility, as defined by measures of hopelessness and suicide beliefs, predicted change in sleep disturbance symptoms. These relationships did not differ across treatment groups. LIMITATIONS The participants were active duty military personnel. Therefore, the results may not generalize to other patient populations. A greater number of assessment periods in closer proximity as well as additional measures of constructs of interest would have improved the internal validity of this study. CONCLUSIONS Brief cognitive behavioral therapy significantly reduces sleep disturbance and suicide risk. Changes in cognitive flexibility, in part, explain change in sleep disturbance across both treatments.
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Affiliation(s)
- Erika M Roberge
- National Center for Veterans Studies, Salt Lake City, UT, United States; The University of Utah, Salt Lake City, UT, United States.
| | - Craig J Bryan
- National Center for Veterans Studies, Salt Lake City, UT, United States; The University of Utah, Salt Lake City, UT, United States
| | - Alan Peterson
- University of Texas Health Science Center at San Antonio, San Antonio, TX, United States; South Texas Veterans Health Care System, San Antonio, TX, United States; University of Texas at San Antonio, San Antonio, TX, United States
| | - M David Rudd
- National Center for Veterans Studies, Salt Lake City, UT, United States; University of Memphis, Memphis, TN, United States
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Corona CC, Zhang M, Wadhawan A, Daue ML, Groer MW, Dagdag A, Lowry CA, Hoisington AJ, Ryan KA, Stiller JW, Fuchs D, Mitchell BD, Postolache TT. Toxoplasma gondii IgG associations with sleep-wake problems, sleep duration and timing. Pteridines 2019; 30:1-9. [PMID: 30918422 PMCID: PMC6433149 DOI: 10.1515/pteridines-2019-0001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Evidence links Toxoplasmagondii (T. gondii), a neurotropic parasite, with schizophrenia, mood disorders and suicidal behavior, all of which are associated and exacerbated by disrupted sleep. Moreover, low-grade immune activation and dopaminergic overstimulation, which are consequences of T. gondii infection, could alter sleep patterns and duration. Methods: Sleep data on 833 Amish participants [mean age (SD) = 44.28 (16.99) years; 59.06% women] were obtained via self-reported questionnaires that assessed sleep problems, duration and timing. T. gondii IgG was measured with ELISA. Data were analyzed using multivariable logistic regressions and linear mixed models, with adjustment for age, sex and family structure. Results: T. gondii seropositives reported less sleep problems (p < 0.005) and less daytime problems due to poor sleep (p < 0.005). Higher T. gondii titers were associated with longer sleep duration (p < 0.05), earlier bedtime (p< 0.005) earlier mid-sleep time (p < 0.05). Conclusions: It seems unlikely that sleep mediates the previously reported associations between T. gondii and mental illness. Future longitudinal studies with objective measures are necessary to replicate our findings.
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Affiliation(s)
- Celine C Corona
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Man Zhang
- Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimers, MD 21201, USA
| | - Abhishek Wadhawan
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA, Saint Elizabeths Hospital, Psychiatry Residency Program, Washington, DC 20032, USA
| | - Melanie L Daue
- Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimers, MD 21201, USA, Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA, Geriatrics Research and Education Clinical Center, Veteran Affairs Medical Center, Baltimore, MD 21201, USA
| | - Maureen W Groer
- College of Nursing, University of South Florida College of Nursing, Tampa, FL 33612, USA
| | - Aline Dagdag
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA, Psychiatry Adult Inpatient & Behavioral Health, University of Maryland Medical Center, Baltimore, MD 21201, USA
| | - Christopher A Lowry
- Department of Integrative Physiology and Center for Neuroscience, University of Colorado Boulder, Boulder, CO 80309, USA; Department of Physical Medicine and Rehabilitation and Center for Neuroscience, University of Colorado Anschutz Medical Campus, Aurora, CO80045, USA, Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 19, Military and Veteran. Microbiome: Consortium for Research and Education (MVM-CoRE), Aurora, CO80 045, USA
| | - Andrew J Hoisington
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 19, Military and Veteran. Microbiome: Consortium for Research and Education (MVM-CoRE), Aurora, CO80 045, USA, Department of Systems Engineering and Management, Air Force Institute of Technology, Wright-Patterson AFB, OH 45433, USA
| | - Kathleen A Ryan
- Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimers, Md 21201, USA, Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - John W Stiller
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA, Saint Elizabeths Hospital, Department of Neurology, Washington DC 20032, USA; Maryland State Athletic Commission, Baltimore, MD 21202, USA
| | - Dietmar Fuchs
- Division of Biological Chemistry, Biocenter, Innsbruck Medical University, Innsbruck, Austria
| | - Braxton D Mitchell
- Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimers, MD 21201, USA, Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA, Geriatrics Research and Education Clinical Center, Veteran Affairs Medical Center, Baltimore, MD 21201, USA
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Britton PC, McKinney JM, Bishop TM, Pigeon WR, Hirsch JK. Insomnia and risk for suicidal behavior: A test of a mechanistic transdiagnostic model in veterans. J Affect Disord 2019; 245:412-418. [PMID: 30423469 DOI: 10.1016/j.jad.2018.11.044] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 09/28/2018] [Accepted: 11/03/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Insomnia has been shown to have direct and indirect associations with suicidal ideation, attempts, and death in U.S. military and veteran populations. However, transdiagnostic models of insomnia and psychopathology have not been used to examine the contribution of psychopathology. METHOD The present study is a secondary analysis examining the associations among insomnia symptoms, posttraumatic stress disorder (PTSD) and depressive symptoms, interpersonal theory of suicide variables, and risk for suicidal behavior in community veterans (n = 392). Serial mediation was used to test sequential associations, allowing for examination of direct and indirect associations. RESULTS The model with insomnia, PTSD, and depressive symptoms, and thwarted belongingness, accounted for 29% of the variance in risk. Insomnia symptoms had an indirect association through PTSD and depressive symptoms, and thwarted belongingness. The model with insomnia, PTSD, and depressive symptoms, and perceived burdensomeness accounted for 35% of the variance in risk. Insomnia symptoms had an indirect association through PTSD and depressive symptoms, and perceived burdensomeness. LIMITATIONS Data are cross-sectional, precluding the testing of causal associations. CONCLUSIONS In veterans, insomnia symptoms may be associated with increased PTSD and depressive symptoms, which may be associated with increased risk for suicidal behavior directly and indirectly through relationship disruptions.
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Affiliation(s)
- Peter C Britton
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veteran Affairs Medical Center, Canandaigua, NY, United States; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States.
| | | | - Todd M Bishop
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veteran Affairs Medical Center, Canandaigua, NY, United States; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Wilfred R Pigeon
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veteran Affairs Medical Center, Canandaigua, NY, United States; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Jameson K Hirsch
- East Tennessee State University, Johnson City, TN, United States
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Borderline personality disorder traits and suicide risk: The mediating role of insomnia and nightmares. J Affect Disord 2019; 244:85-91. [PMID: 30326346 DOI: 10.1016/j.jad.2018.10.097] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/10/2018] [Accepted: 10/08/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Borderline personality disorder (BPD) is associated with high rates of suicide risk and problems related to sleep, including insomnia and nightmares. The purpose of the current study was to assess the potential indirect effect of BPD traits on suicide risk through both/either insomnia and nightmares. METHODS Participants (N = 281) were recruited via Amazon's Mechanical Turk to complete the study remotely online. Participants completed measures of BPD traits and symptoms, suicide risk (history of suicidal thoughts and behaviors), insomnia symptoms, and distress and impairment related to nightmares. RESULTS BPD traits and symptoms were moderately to highly correlated to suicide risk, insomnia, and nightmares. In parallel mediation models, BPD traits had a significant indirect effect on suicide risk through insomnia symptoms but not nightmares. LIMITATIONS The current study assessed problems within the general population and not in a clinical sample. Second, the study relied solely on self-report measures. Futures studies would benefit from investigating these relations in clinical samples utilizing observer-report and interview methods. CONCLUSIONS BPD traits appear to relate to increased risk for suicide through the relation with sleep concerns, particularly insomnia symptoms. Therefore, assessing and treating sleep problems within individuals with BPD may result in a lower risk for suicide.
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Iovine-Wong PE, Nichols-Hadeed C, Thompson Stone J, Gamble S, Cross W, Cerulli C, Levandowski BA. Intimate Partner Violence, Suicide, and Their Overlapping Risk in Women Veterans: A Review of the Literature. Mil Med 2019; 184:e201-e210. [DOI: 10.1093/milmed/usy355] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 10/17/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Paige E Iovine-Wong
- Department of Community Health and Health Behavior, University of Buffalo School of Public Health and Health Professions, 401 Goodyear Road, Buffalo, NY
| | - Corey Nichols-Hadeed
- Laboratory of Interpersonal Violence and Victimization, Department of Psychiatry, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY
| | - Jennifer Thompson Stone
- Laboratory of Interpersonal Violence and Victimization, Department of Psychiatry, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY
| | - Stephanie Gamble
- Laboratory of Interpersonal Violence and Victimization, Department of Psychiatry, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, 400 Fort Hill Ave, Canandaigua, NY
| | - Wendi Cross
- Laboratory of Interpersonal Violence and Victimization, Department of Psychiatry, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, 400 Fort Hill Ave, Canandaigua, NY
| | - Catherine Cerulli
- Laboratory of Interpersonal Violence and Victimization, Department of Psychiatry, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY
| | - Brooke A Levandowski
- Department of Obstetrics and Gynecology, Clinical and Translational Science Institute, University of Rochester Medical Center, 300 Crittenden Boulevard, Rochester, NY
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Grandner MA. The Cost of Sleep Lost: Implications for Health, Performance, and the Bottom Line. Am J Health Promot 2018; 32:1629-1634. [PMID: 30099900 PMCID: PMC6530553 DOI: 10.1177/0890117118790621a] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Don Richardson J, King L, St. Cyr K, Shnaider P, Roth ML, Ketcheson F, Balderson K, Elhai JD. Depression and the relationship between sleep disturbances, nightmares, and suicidal ideation in treatment-seeking Canadian Armed Forces members and veterans. BMC Psychiatry 2018; 18:204. [PMID: 29921268 PMCID: PMC6011186 DOI: 10.1186/s12888-018-1782-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 06/11/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Research on the relationship between insomnia and nightmares, and suicidal ideation (SI) has produced variable findings, especially with regard to military samples. This study investigates whether depression mediated the relationship between: 1) sleep disturbances and SI, and 2) trauma-related nightmares and SI, in a sample of treatment-seeking Canadian Armed Forces (CAF) personnel and veterans (N = 663). METHOD Regression analyses were used to investigate associations between sleep disturbances or trauma-related nightmares and SI while controlling for depressive symptom severity, posttraumatic stress disorder (PTSD) symptom severity, anxiety symptom severity, and alcohol use severity. Bootstrapped resampling analyses were used to investigate the mediating effect of depression. RESULTS Approximately two-thirds of the sample (68%; N = 400) endorsed sleep disturbances and 88% (N = 516) reported experiencing trauma-related nightmares. Although sleep disturbances and trauma-related nightmares were both significantly associated with SI on their own, these relationships were no longer significant when other psychiatric conditions were included in the models. Instead, depressive symptom severity emerged as the only variable significantly associated with SI in both equations. Bootstrap resampling analyses confirmed a significant mediating role of depression for sleep disturbances. CONCLUSIONS The findings suggest that sleep disturbances and trauma-related nightmares are associated with SI as a function of depressive symptoms in treatment-seeking CAF personnel and veterans. Treating depression in patients who present with sleep difficulties may subsequently help mitigate suicide risk.
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Affiliation(s)
- J. Don Richardson
- Parkwood Institute Operational Stress Injury Clinic, London, ON Canada
- Department of Psychiatry, Western University, London, ON Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON Canada
| | - Lisa King
- Parkwood Institute Operational Stress Injury Clinic, London, ON Canada
| | - Kate St. Cyr
- Parkwood Institute Operational Stress Injury Clinic, London, ON Canada
| | - Philippe Shnaider
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON Canada
- Anxiety Treatment and Research Centre, St. Joseph’s Healthcare Hamilton, Hamilton, ON Canada
| | - Maya L. Roth
- Parkwood Institute Operational Stress Injury Clinic, London, ON Canada
- Department of Graduate Studies, Ryerson University, Toronto, ON Canada
| | - Felicia Ketcheson
- Parkwood Institute Operational Stress Injury Clinic, London, ON Canada
| | - Ken Balderson
- Parkwood Institute Operational Stress Injury Clinic, London, ON Canada
- Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | - Jon D. Elhai
- Departments of Psychology and Psychiatry, University of Toledo, Toledo, OH USA
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Sleep Disorders in Patients With Posttraumatic Stress Disorder. Chest 2018; 154:427-439. [PMID: 29684315 DOI: 10.1016/j.chest.2018.04.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 03/27/2018] [Accepted: 04/03/2018] [Indexed: 02/05/2023] Open
Abstract
A growing body of evidence supports a bidirectional relationship between posttraumatic stress disorder (PTSD) and sleep disturbances. Fragmented sleep induced by sleep-related breathing disorders, insomnia, and nightmares impacts recovery and treatment outcomes and worsens PTSD symptoms. Despite recent attention, management of these disorders has been unrewarding in the setting of PTSD. This review summarizes the evidence for empirically supported treatments of these sleep ailments, including psychotherapeutic and pharmacologic interventions, as it relates to PTSD. Recent advances in positive airway pressure technology have made treatment of OSA more acceptable; however, adherence to CPAP therapy presents a substantial challenge. Concomitant insomnia, which engenders psychiatric and medical conditions, including depression, suicide, and alcohol and substance abuse, can be managed with cognitive behavioral therapy. Hypnotic agents are considered an alternative therapy, but concerns about adverse events and lack of high-level evidence supporting their efficacy in PTSD treatment have limited their use to resistant cases or as adjuncts to behavioral therapy when the response is less than desirable. Intrusion of nightmares can complicate PTSD treatment and exert serious strain on social, occupational, and marital relations. Imagery rehearsal therapy has shown significant reduction in nightmare intensity and frequency. The success of noradrenergic blocking agents has not been consistent among studies, with one-half reporting treatment failure. An integrated stepped care approach that includes components of both behavioral and pharmacologic interventions customized to patients' sleep-maladaptive behaviors may offer a solution to delivering accessible, effective, and efficient services for individuals with PTSD.
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Morrow CE, Bryan CJ, Stephenson JA, Bryan AO, Haskell J, Staal M. Posttraumatic Stress, Depression, and Insomnia Among U.S. Air Force Pararescuemen. MILITARY PSYCHOLOGY 2017. [DOI: 10.1037/mil0000021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
| | - Craig J. Bryan
- National Center for Veterans Studies, Salt Lake City, Utah and Department of Psychology, University of Utah
| | | | - AnnaBelle O. Bryan
- National Center for Veterans Studies, Salt Lake City, Utah and Department of Social and Behavioral Science, University of Utah
| | | | - Mark Staal
- Pope Army Air Field, Fayetteville, North Carolina
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Kashiwa A, Sweetman MM, Helgeson L. Occupational Therapy and Veteran Suicide: A Call to Action. Am J Occup Ther 2017; 71:7105100010p1-7105100010p6. [PMID: 28809646 DOI: 10.5014/ajot.2017.023358] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Suicide in the U.S. military veteran population is an epidemic with a wide-ranging impact on individuals, families, and society. Death by suicide is preventable. The purpose of this article is to ignite a professional discussion about veteran suicide, a serious mental health issue that is underrepresented in the occupational therapy research literature. Occupational therapy practitioners respond to the changing needs of populations and promote preventive measures to improve health. Actively exploring occupational therapy's role in suicide prevention is a professional responsibility aligned with tenets of the Centennial Vision and Vision 2025. Applying the concept of the scholarship of integration, the authors present a case for the inclusion of suicide prevention training as a professional competency and explore opportunities to address suicide risk through the use of evidence-based interventions for posttraumatic stress disorder, combat stress, and depression. Professional implications include the need to advance professional knowledge through education, advocacy, and intervention research targeting the veteran population.
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Affiliation(s)
- Amy Kashiwa
- Amy Kashiwa, OTD, OTR/L, is Clinical Occupational Therapist, Fairfax Behavioral Health, Monroe, WA;
| | - Melissa M Sweetman
- Melissa M. Sweetman, PhD, OTD, OTR/L, is Founding Program Director and Associate Professor, Wingate University, Wingate, NC
| | - Loriann Helgeson
- Loriann Helgeson, OTD, OTR/L, CLA, is Program Director, Ameritech College of Healthcare, Draper, UT, and Adjunct Professor, Rocky Mountain University of Health Professions, Provo, UT
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Fisher K, Houtsma C, Assavedo BL, Green BA, Anestis MD. Agitation as a Moderator of the Relationship Between Insomnia and Current Suicidal Ideation in the Military. Arch Suicide Res 2017; 21:531-543. [PMID: 27435680 DOI: 10.1080/13811118.2016.1193077] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Research has established a link between agitation and insomnia, both of which are considered to be risk factors for suicide. The present study aimed to investigate the moderating role of agitation within the relationship between insomnia and current suicidal ideation in a sample of U.S. military personnel. Consistent with hypotheses, the relationship between insomnia and current suicidal ideation was significant only at high levels of agitation. Results support previous findings indicating that both insomnia and agitation are suicide risk factors. These findings clarify the role of known risk factors in the pathway to suicide and may contribute to the advancement of suicide detection and prevention, as these factors may be more easily identified in individuals unwilling to admit thoughts of death and suicide, such as many military personnel.
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Abstract
Sleep disturbances are associated with suicide-related thoughts and behaviors, and the incidence of sleep concerns and suicide has increased recently in the US. Most published research exploring the sleep-suicidality relation is focused on select sleep disorders, with few reviews offering a comprehensive overview of the sleep-suicidality literature. This narrative review broadly investigates the growing research literature on sleep disorders and suicidality, noting the prevalence of suicide ideation and nonfatal and fatal suicide attempts, the impact of several sleep disorders on suicide risk, and potential sleep-disorder management strategies for mitigating suicide risk. Aside from insomnia symptoms and nightmares, there exist opportunities to learn more about suicide risk across many sleep conditions, including whether sleep disorders are associated with suicide risk independently of other psychiatric conditions or symptoms. Generally, there is a lack of randomized controlled trials examining the modification of suicide risk via evidence-based sleep interventions for individuals with sleep disorders.
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Affiliation(s)
| | - Michael R Nadorff
- Department of Psychology, Mississippi State University, Mississippi State, MS, USA
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Suicide mortality among male veterans discharged from Veterans Health Administration acute psychiatric units from 2005 to 2010. Soc Psychiatry Psychiatr Epidemiol 2017; 52:1081-1087. [PMID: 28401273 DOI: 10.1007/s00127-017-1377-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 03/20/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of this study was to calculate suicide rates and identify correlates of risk in the year following discharge from acute Veterans Health Administration psychiatric inpatient units among male veterans discharged from 2005 to 2010 (fiscal years). METHODS Suicide rates and standardized mortality ratios were calculated. Descriptive analyses were used to describe suicides and non-suicides and provide base rates for interpretation, and unadjusted and adjusted proportional hazard models were used to identify correlates of suicide. RESULTS From 2005 to 2010, 929 male veterans died by suicide in the year after discharge and the suicide rate was 297/100,000 person-years (py). The suicide rate significantly increased from 234/100,000 py (95% CI = 193-282) in 2005 to 340/100,000 py (95% CI = 292-393) in 2008, after which it plateaued. Living in a rural setting, HR (95% CI) = 1.20 (1.05, 1.36), and being diagnosed with a mood disorder such as major depression, HR (95% CI) = 1.60 (1.36, 1.87), or other anxiety disorder, HR (95% CI) = 1.52 (1.24, 1.87), were associated with increased risk for suicide. CONCLUSIONS Among male veterans, the suicide rate in the year after discharge from acute psychiatric hospitalization increased from 2005 to 2008, after which it plateaued. Prevention efforts should target psychiatrically hospitalized veterans who live in rural settings and/or are diagnosed with mood or other anxiety disorders.
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Suh S, Ryu H, Chu C, Hom M, Rogers ML, Joiner T. Validation of the Korean Depressive Symptom Inventory-Suicidality Subscale. Psychiatry Investig 2017; 14:577-584. [PMID: 29042882 PMCID: PMC5639125 DOI: 10.4306/pi.2017.14.5.577] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/18/2016] [Accepted: 09/26/2016] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE The present study aimed to validate a Korean version of the self-report Depressive Symptom Inventory-Suicidality Subscale (DSI-SS). METHODS 553 South Korean undergraduate students (aged 18-34 years, 74.8% females) completed questionnaires. Participants completed Korean versions of the self-report Depressive Symptom Inventory-Suicidality Subscale (DSI-SS), Beck Depression Inventory-II (BDI-II), Insomnia Severity Index (ISI), Beck Scale for Suicide Ideation (BSS), and a measure of suicide-related symptom history. RESULTS Results indicated that the DSI-SS demonstrated excellent internal consistency (α=0.93) and strong convergent validity with the BDI (r=0.57, p<0.01), ISI (r=0.27, p<0.01), and BSS (r=0.70, p<0.01). DSI-SS scores also significantly differentiated between those reporting a history of suicide attempts compared to non-suicide attempters [t (38.80)=-3.28, p<0.05]. CONCLUSION Given the brevity of this measure, and evidence for its validity, the Korean version of the DSI-SS may be particularly promising for clinical and empirical use as a screening tool among South Korean undergraduates.
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Affiliation(s)
- Sooyeon Suh
- Department of Psychology, Sungshin Women's University, Seoul, Republic of Korea
- Department of Psychiatry, Stanford University, Palo Alto, CA, USA
| | - Hyera Ryu
- Department of Psychology, Sungshin Women's University, Seoul, Republic of Korea
| | - Carol Chu
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Melanie Hom
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Megan L. Rogers
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Thomas Joiner
- Department of Psychology, Florida State University, Tallahassee, FL, USA
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Rek S, Sheaves B, Freeman D. Nightmares in the general population: identifying potential causal factors. Soc Psychiatry Psychiatr Epidemiol 2017; 52:1123-1133. [PMID: 28712041 PMCID: PMC5581821 DOI: 10.1007/s00127-017-1408-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 06/15/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Nightmares are inherently distressing, prevent restorative sleep, and are associated with a number of psychiatric problems, but have rarely been the subject of empirical study. Negative affect, linked to stressful events, is generally considered the key trigger of nightmares; hence nightmares have most often been considered in the context of post-traumatic stress disorder (PTSD). However, many individuals with heightened negative affect do not have nightmares. The objective of this study was to identify mechanistically plausible factors, beyond negative affect, that may explain why individuals experience nightmares. METHOD 846 participants from the UK general population completed an online survey about nightmare occurrence and severity (pre-occupation, distress, and impairment), negative affect, worry, depersonalisation, hallucinatory experiences, paranoia, alcohol use, sleep duration, physical activity levels, PTSD symptoms, and stressful life events. Associations of nightmares with the putative predictive factors were tested controlling for levels of negative affect. Analyses were also repeated controlling for levels of PTSD and the recent occurrence of stressful life events. RESULTS Nightmare occurrence, adjusting for negative affect, was associated with higher levels of worry, depersonalisation, hallucinatory experiences, paranoia, and sleep duration (odds ratios 1.25-1.45). Nightmare severity, controlling for negative affect, was associated with higher levels of worry, depersonalisation, hallucinatory experiences, and paranoia (R 2s: 0.33-0.39). Alcohol use and physical activity levels were not associated with nightmares. DISCUSSION The study identifies a number of potential predictors of the occurrence and severity of nightmares. Causal roles require testing in future longitudinal, experimental, and treatment studies.
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Affiliation(s)
- Stephanie Rek
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.
| | - Bryony Sheaves
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
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Abstract
The objective of this study was to test the hypothesis that sleep quality mediates the association between traumatic brain injury (TBI) history and current suicidal ideation. Measures of TBI history, sleep quality, and suicidal ideation were administered to 130 Iraq/Afghanistan veterans. As expected, sleep quality mediated the effect of TBI history on current suicidal ideation (indirect effect, 0.0082; 95% confidence interval, 0.0019-0.0196), such that history of TBI was associated with worse sleep quality, which was, in turn, associated with increased suicidal ideation. These findings highlight the importance of assessing TBI history and sleep quality during suicide risk assessments for veterans.
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Richardson JD, Thompson A, King L, Corbett B, Shnaider P, St. Cyr K, Nelson C, Sareen J, Elhai J, Zamorski M. Insomnia, psychiatric disorders and suicidal ideation in a National Representative Sample of active Canadian Forces members. BMC Psychiatry 2017; 17:211. [PMID: 28583100 PMCID: PMC5460415 DOI: 10.1186/s12888-017-1372-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 05/26/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Past research on the association between insomnia and suicidal ideation (SI) has produced mixed findings. The current study explored the relationship between insomnia, SI, and past-year mental health status among a large Canadian Forces (CF) sample. METHOD Data was obtained from the 2013 Canadian Forces Mental Health Survey (CFMHS), and included a large representative sample of Canadian Regular Forces personnel (N = 6700). A series of univariate logistic regressions were conducted to test individual associations between past-year mental health status, insomnia, and potential confounds and SI. Mental health status included three groups: 0, 1, or two or more probable diagnoses of posttraumatic stress disorder (PTSD), major depressive disorder (MDD), generalized anxiety disorder (GAD), panic disorder (PD) and alcohol abuse/dependence. Stepwise multivariate logistic regression was used to assess the relationship between insomnia and SI with mental health status as a moderator. RESULTS 40.8% of respondents reported experiencing insomnia. Both insomnia and number of mental health conditions incrementally increased the risk of SI. However, past-year mental health status was a significant moderator of this relationship, such that for CF personnel with either no (AOR = 1.61, 1.37-1.89) or only one past-year mental health condition (AOR = 1.39, 1.12-1.73), an incremental increase in insomnia was associated with an increased likelihood of SI. However, in personnel with two or more past-year mental health disorders, insomnia was no longer significantly associated with SI (AOR = 1.04, 0.81-1.33). CONCLUSIONS Insomnia significantly increased the odds of SI, but only among individuals with no or one mental health condition. Findings highlight the importance of assessing insomnia among CF members in order to further suicide prevention efforts.
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Affiliation(s)
- J. D. Richardson
- Western University, 1151 Richmond St, London, ON N6A 3K7 Canada
- McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8 Canada
- Parkwood Operational Stress Injury Clinic-Parkwood Institute-St. Joseph’s Health Care London, 550 Wellington Rd, London, ON N6C 0A7 Canada
- Canadian Forces Health Services Group and Department of Family Medicine, University of Ottawa, 75 Laurier Ave E, Ottawa, ON K1N 6N5 Canada
| | - A. Thompson
- Canadian Forces Health Services Group and Department of Family Medicine, University of Ottawa, 75 Laurier Ave E, Ottawa, ON K1N 6N5 Canada
| | - L. King
- Parkwood Operational Stress Injury Clinic-Parkwood Institute-St. Joseph’s Health Care London, 550 Wellington Rd, London, ON N6C 0A7 Canada
| | - B. Corbett
- Western University, 1151 Richmond St, London, ON N6A 3K7 Canada
- Canadian Forces Health Services Group and Department of Family Medicine, University of Ottawa, 75 Laurier Ave E, Ottawa, ON K1N 6N5 Canada
- Stamford International University, Prawet, Bangkok, 10250 Thailand
| | - P. Shnaider
- McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8 Canada
- St. Joseph’s Healthcare Hamilton, 2757 King Street East, Hamilton, ON L8G 5E4 Canada
- Ryerson University, 350 Victoria St, Toronto, ON M5B 2K3 Canada
| | - K. St. Cyr
- Parkwood Operational Stress Injury Clinic-Parkwood Institute-St. Joseph’s Health Care London, 550 Wellington Rd, London, ON N6C 0A7 Canada
| | - C. Nelson
- Western University, 1151 Richmond St, London, ON N6A 3K7 Canada
- Parkwood Operational Stress Injury Clinic-Parkwood Institute-St. Joseph’s Health Care London, 550 Wellington Rd, London, ON N6C 0A7 Canada
| | - J. Sareen
- University of Manitoba, 66 Chancellors Cir, Winnipeg, MB R3T 2N2 Canada
- Deer Lodge Centre Operational Stress Injury Clinic, 2109 Portage Avenue, Winnipeg, MB R3J 0L3 Canada
| | - J. Elhai
- University of Toledo, 2801 W Bancroft St, Toledo, OH 43606 USA
| | - M. Zamorski
- Canadian Forces Health Services Group and Department of Family Medicine, University of Ottawa, 75 Laurier Ave E, Ottawa, ON K1N 6N5 Canada
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