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Tsai YT, Chuang TJ, Mudiyanselage SPK, Ku HC, Wu YL, Li CY, Ko NY. The impact of sleep disturbances on suicide risk among people living HIV: An eleven-year national cohort. J Affect Disord 2024; 346:122-132. [PMID: 37890538 DOI: 10.1016/j.jad.2023.10.045] [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: 05/05/2023] [Revised: 09/22/2023] [Accepted: 10/08/2023] [Indexed: 10/29/2023]
Abstract
OBJECTIVES The suicide rate among individuals who experience sleep disturbances is five times higher than in the general population. Up to 70 % of people living with HIV (PLHIV) experience sleep disturbances. This study's purpose was to determine whether this population has higher rates of suicide compared to those without sleep disorders. Possible risk factors were also explored. METHODS A secondary analysis of nationwide data on all males and females over 15 years old with HIV living in Taiwan was conducted from January 1, 2005, to December 31, 2016. Sleep disturbances were identified through recorded diagnoses and medical treatments. Cox proportional hazard models and hazard ratios (HRs) and mediation analysis were employed to estimate the association between sleep disturbances and suicide risk during the follow-up period. RESULTS Of the 5680 PLHIV, 72 suicide events were reported. The suicide incidence rate among PLHIV suffering from sleep disturbances was 769 per 100,000 person-years. Sleep disturbances were associated with a significantly increased risk of suicide (AHR = 1.75, 95 % CI 1.02-3.02, p = 0.0429). A premium-based monthly salary of <24,000 (NT $) was also associated with an increased hazard of suicide (AHR = 4.14, 95 % CI 1.60-10.75, p = 0.0035). The pathway effect analysis using potential outcomes showed that depression did not mediate the effect of sleep disturbance on suicide. CONCLUSIONS Sleep disturbances were associated with higher suicide rates, even after adjusting for pre-existing depression. These findings suggest that paying attention to suicidal ideation among PLHIV suffering from sleep disturbances is necessary.
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Affiliation(s)
- Yi-Tseng Tsai
- Department of Nursing, An Nan Hospital, China Medical University, Tainan, Taiwan
| | - Tzu-Jung Chuang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | | | - Han-Chang Ku
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Yi-Lin Wu
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Nai-Ying Ko
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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2
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Gilmore GR, Dyche J. Sleep/wake regularity and cognition in college students using antidepressants. Physiol Behav 2024; 273:114414. [PMID: 37992793 DOI: 10.1016/j.physbeh.2023.114414] [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: 08/21/2023] [Revised: 11/11/2023] [Accepted: 11/18/2023] [Indexed: 11/24/2023]
Abstract
The current project examined sleep, sleep/wake regularity, and cognition in college students diagnosed with depression and using serotonergic antidepressants and in those without a depression diagnosis. Forty participants either using antidepressants (n = 20, 24.75 ± 6.82 years) or without a depression diagnosis (n = 20, 21.70 ± 2.74 years) wore actigraphs for two consecutive weeks (14 days). Cognitive tasks were completed on day 1 (along with demographic surveys) and day 14. Effect sizes indicated that compared to non-clinically depressed peers, participants using antidepressants exhibited slightly greater wake after sleep onset (d = 0.36) and lower sleep efficiency (d = 0.40); however, these differences were likely not noticed by the sleeper. No sleep regularity or cognitive differences were present between groups. Within the antidepressant group, higher dosage predicted greater time in bed (R2 = 0.77), but less total sleep time (R2 = 0.86). The time of day that participants took their antidepressant exhibited differential effects on certain cognitive parameters, such as procedural reaction time and spatial processing, and interactions with years of antidepressant use were found. Self-reported wake episodes also predicted better reaction time and inhibition in the antidepressant group. This study is the first to demonstrate that sleep/wake regularity is comparable between people using antidepressants and non-clinically depressed human samples. For individuals using antidepressants, years of use, dosage, and time of day of use have predictive qualities for reaction times, spatial processing, and inhibition.
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Affiliation(s)
- Gabriel R Gilmore
- Department of Psychology, University of Kentucky, 106-B Kastle Hall, Lexington, KY, 40506, United States.
| | - Jeff Dyche
- Department of Psychology, James Madison University, Miller Hall, MSC 7704, 91 E. Grace Street, Harrisonburg, VA, United States
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3
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Seo J, Lee S, Lee J, Jeon S, Hwang Y, Kim J, Kim SJ. Effects of sleep and impulsivity on suicidality in shift and non-shift workers. J Affect Disord 2023; 338:554-560. [PMID: 37393955 DOI: 10.1016/j.jad.2023.06.066] [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: 09/25/2022] [Revised: 06/06/2023] [Accepted: 06/27/2023] [Indexed: 07/04/2023]
Abstract
INTRODUCTION Shift workers are known to have a higher suicide risk than non-shift workers. Sleep disturbance and impulsivity are also risk factors for suicidality. This study investigated the effects of poor sleep and impulsivity on suicidality in shift and non-shift workers. METHODS In total, 4572 shift workers (37.0 ± 9.84 years, 2150 males) and 2093 non-shift workers (37.8 ± 9.73 years, 999 males) participated in an online self-report survey. Suicidality was assessed using the Suicidal Behaviors Questionnaire. The Pittsburgh Sleep Quality Index was employed to explore subjective sleep quality, the Insomnia Severity Index to detect insomnia, the Epworth Sleepiness Scale (ESS) to evaluate excessive daytime sleepiness (EDS), the Center for Epidemiological Studies-Depression (CES-D) Scale to assess depressive symptoms, and the Impulsive Behavior Scale (UPPS-P) to explore impulsivity. RESULTS Shift workers showed poorer sleep quality, and greater impulsivity and suicidality, than non-shift workers. Impulsivity, sleep duration, sleep quality, and insomnia were significantly associated with suicidality, independent of depression. For both shift and non-shift workers, sleep quality moderated the association between impulsivity and suicidality. However, the moderating effects of sleep duration and EDS on the association between impulsivity and suicidality were apparent only in non-shift workers, while a moderating effect of insomnia was observed only in shift workers. CONCLUSION Shift work, sleep disturbances and impulsivity may exacerbate suicide risk. In addition, the interrelationships among insomnia, EDS, impulsivity, and suicidality may differ between shift and non-shift workers.
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Affiliation(s)
- Jihyo Seo
- Department of Psychiatry, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Somi Lee
- Department of Psychiatry, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Jooyoung Lee
- Department of Psychiatry, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Sehyun Jeon
- Department of Psychiatry, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Yunjee Hwang
- Department of Brain and Cognitive Engineering, Korea University, Seoul, Republic of Korea
| | - Jichul Kim
- Department of Psychiatry, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Seog Ju Kim
- Department of Psychiatry, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, Republic of Korea.
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4
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Liu Y, Ge X, Zhang J, Xu L, Hu F, Wang S, Liu J, Yang X, Shi D, Cai Y. Sleep disturbance and anxiety symptoms among asymptomatic COVID-19 carriers in Shanghai, China: the mediating role of entrapment and defeat. BMC Public Health 2023; 23:993. [PMID: 37248465 PMCID: PMC10225749 DOI: 10.1186/s12889-023-15803-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 05/03/2023] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic increases the risk of psychological problems, especially for the infected population. Sleep disturbance and feelings of defeat and entrapment are well-documented risk factors of anxiety symptoms. Exploring the psychological mechanism of the development of anxiety symptoms is essential for effective prevention. This study aimed to examine the mediating effects of entrapment and defeat in the association between sleep disturbance and anxiety symptoms among asymptomatic COVID-19 carriers in Shanghai, China. METHODS A cross-sectional study was conducted from March to April, 2022. Participants were 1,283 asymptomatic COVID-19 carriers enrolled from the Ruijin Jiahe Fangcang Shelter Hospital, Shanghai (59.6% male; mean age = 39.6 years). Questionnaire measures of sleep disturbance, entrapment, defeat, anxiety symptoms, and background characteristics were obtained. A mediation model was constructed to test the mediating effects of entrapment and defeat in the association between sleep disturbance and anxiety symptoms. RESULTS The prevalence rates of sleep disturbance and anxiety symptoms were 34.3% and 18.8%. Sleep disturbance was positively associated with anxiety symptoms (OR [95%CI] = 5.013 [3.721-6.753]). The relationship between sleep disturbance and anxiety symptoms (total effect: Std. Estimate = 0.509) was partially mediated by entrapment (indirect effect: Std. Estimate = 0.129) and defeat (indirect effect: Std. Estimate = 0.126). The mediating effect of entrapment and defeat accounted for 50.3% of the association between sleep disturbance and anxiety symptoms. CONCLUSION Sleep disturbance and anxiety symptoms were prevalent among asymptomatic COVID-19 carriers. Entrapment and defeat mediate the association between sleep disturbance and anxiety symptoms. More attention is needed to monitoring sleep conditions and feelings of defeat and entrapment to reduce the risk of anxiety.
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Affiliation(s)
- Yujie Liu
- Hongqiao International Institute of Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200335, China
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Xin Ge
- Hongqiao International Institute of Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200335, China
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Jinxin Zhang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Lulu Xu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Fan Hu
- Hongqiao International Institute of Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200335, China
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Suping Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Jialin Liu
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Xiaodong Yang
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Dake Shi
- Department of Infection Control, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
| | - Yong Cai
- Hongqiao International Institute of Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200335, China.
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
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5
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Liu P, Huang W, Chen S, Xiang H, Lin W, Wang H, Wang Y. The association among childhood maltreatment, sleep duration and suicide behaviors in Chinese young people. J Affect Disord 2023; 327:190-196. [PMID: 36586614 DOI: 10.1016/j.jad.2022.12.136] [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: 03/29/2022] [Revised: 09/24/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Substantial evidence shows that childhood maltreatment and sleep duration play important roles in the development of suicide. However, the role of sleep duration in the relationship between childhood maltreatment and suicide behaviors, including suicide ideation, plan and attempt, was not fully understood. This study investigated the association among childhood maltreatment, sleep duration and suicide behaviors. METHODS 13,454 students from a polytechnic college in Shenzhen of China participated in this cross-sectional study. Multivariate logistic regression model was established to analyze the relationship among childhood maltreatment, sleep duration and suicide behaviors. RESULTS The most reported subtype of childhood maltreatment was physical neglect, which were reported by 41.57 % of males, 28.59 % of females. The positive association of physical abuse with suicide behaviors was observed. In females, emotional abuse and neglect were positively associated with suicide behaviors. In addition, almost all childhood maltreatment was significantly associated to decreased sleep duration. Moreover, compared to the sleep duration <6 h group, sleep duration was inversely associated to suicide behaviors. CONCLUSION Childhood maltreatment was positively associated with suicide ideation, plan and attempt in Chinese young adults. Meanwhile, childhood maltreatment was negatively associated with sleep duration, which were negatively associated with suicide ideation, plan and attempt.
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Affiliation(s)
- Peiyi Liu
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, No. 3012 Fuqiang Road, Futian District, Shenzhen 518028, China
| | - Weikang Huang
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, No. 3012 Fuqiang Road, Futian District, Shenzhen 518028, China
| | - Siqi Chen
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, No. 3012 Fuqiang Road, Futian District, Shenzhen 518028, China
| | - Haishan Xiang
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, No. 3012 Fuqiang Road, Futian District, Shenzhen 518028, China
| | - Wei Lin
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, No. 3012 Fuqiang Road, Futian District, Shenzhen 518028, China
| | - He Wang
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, No. 3012 Fuqiang Road, Futian District, Shenzhen 518028, China
| | - Yueyun Wang
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, No. 3012 Fuqiang Road, Futian District, Shenzhen 518028, China.
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6
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Shepard CA, Rufino KA, Lee J, Tran T, Paddock K, Wu C, Oldham JM, Mathew SJ, Patriquin MA. Nighttime Sleep Quality and Daytime Sleepiness Predicts Suicide Risk in Adults Admitted to an Inpatient Psychiatric Hospital. Behav Sleep Med 2023; 21:129-141. [PMID: 35296204 DOI: 10.1080/15402002.2022.2050724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
As sleep problems have been identified as an important, yet understudied, predictor of suicide risk, the present study analyzed the relationship between daytime sleepiness and nighttime sleep disturbance in a high-risk population of adults admitted to an inpatient psychiatric hospital. Objectives were to (1) examine the time course of subjective daytime sleepiness, nighttime sleep disturbance, and suicide risk throughout inpatient psychiatric treatment, (2) examine pre- to post-treatment changes in sleep disturbance with treatment as usual in an inpatient psychiatric setting, and (3) investigate whether daytime sleepiness and nighttime sleep disturbance predicted suicide risk above and beyond anxiety and depression. Participants were 500 consecutively admitted adults admitted to an intermediate length of stay (4-6 weeks) inpatient psychiatric hospital (47% female; 18-87 years of age). Measures of sleep, suicide risk, depression, and anxiety were completed at admission, weeks 1 through 4, and at discharge. Latent growth curve modeling (LGM) and hierarchal linear modeling (HLM) were conducted. The LGM analysis demonstrated that daytime sleepiness, nighttime sleep disturbance, and suicide risk all improved throughout inpatient treatment. Further, HLM showed that daytime sleepiness predicted suicide risk above and beyond symptoms of anxiety, depression, major sleep medications, and prior suicidal ideation and attempts, while nighttime sleep disturbance predicted suicide risk above and beyond symptoms of anxiety, major sleep medications, and prior suicidal ideation and attempts. Findings indicate the need to reevaluate safety protocols that may impact sleep, particularly that may increase daytime sleepiness, and to develop evidence-based sleep interventions for individuals admitted to inpatient psychiatric hospitals.
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Affiliation(s)
| | - Katrina A Rufino
- The Menninger Clinic, Houston, TX, USA.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.,University of Houston-Downtown, Houston, TX, USA
| | - Jaehoon Lee
- Department of Educational Psychology & Leadership, Texas Tech University, Lubbock, TX, USA
| | | | | | - Chester Wu
- The Menninger Clinic, Houston, TX, USA.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - John M Oldham
- The Menninger Clinic, Houston, TX, USA.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Sanjay J Mathew
- The Menninger Clinic, Houston, TX, USA.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.,Michael E. Debakey VA Medical Center, Houston, TX, USA
| | - Michelle A Patriquin
- The Menninger Clinic, Houston, TX, USA.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.,Michael E. Debakey VA Medical Center, Houston, TX, USA
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7
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Oesterling CF, Borg C, Juhola E, Lancel M. The influence of sexual activity on sleep: A diary study. J Sleep Res 2023:e13814. [PMID: 36646500 DOI: 10.1111/jsr.13814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 11/08/2022] [Accepted: 12/13/2022] [Indexed: 01/18/2023]
Abstract
Aiming to promote overall health and well-being through sleep, the present studies examine to what extent sexual activity serves as a behavioural mechanism to improve sleep. The relation between sexual activity, i.e., partnered sex and masturbation with or without orgasm, and subjective sleep latency and sleep quality is examined by means of a cross-sectional and a longitudinal (diary) study. Two hundred fifty-six male and female participants, mainly students, completed a pre-test set of questionnaires and, thereafter, a diary during 14 consecutive days. The cross-sectional study was analysed using analysis of covariance and demonstrated that both men and women perceive partnered sex and masturbation with orgasm to improve sleep latency and sleep quality, while sexual activity without orgasm is perceived to exert negative effects on these sleep parameters, most strongly by men. Accounting for the repeated measurements being nested within participants, the diary data were analysed using multilevel linear modelling (MLM). Separate models for subjective sleep latency and sleep quality were constructed, which included 2076 cases at level 1, nested within 159 participants at level 2. The analyses revealed that only partnered sex with orgasm was associated with a significantly reduced sleep latency (b = -0.08, p < 0.002) and increased sleep quality (b = 0.19, p < 0.046). Sexual activity without orgasm and masturbation with and without orgasm were not associated with changes in sleep. Further, no gender differences emerged. The present studies confirm and significantly substantiate findings indicating that sexual activity and intimacy may improve sleep and overall well-being in both men and women and serve as a directive for future research.
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Affiliation(s)
| | - Charmaine Borg
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Elina Juhola
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Marike Lancel
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands.,Centre of Expertise on Sleep and Psychiatry, GGZ Drenthe Mental Health Institute, Assen, The Netherlands.,Forensic Psychiatric Hospital, GGZ Drenthe, Mental Health Institute, Assen, The Netherlands
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8
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Tubbs AS, Taneja K, Ghani SB, Nadorff MR, Drapeau CW, Karp JF, Fernandez FX, Perlis ML, Grandner MA. Sleep continuity, timing, quality, and disorder are associated with suicidal ideation and suicide attempts among college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023:1-9. [PMID: 36596225 DOI: 10.1080/07448481.2022.2155828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 09/12/2022] [Accepted: 10/23/2022] [Indexed: 06/17/2023]
Abstract
Objective: To evaluate sleep continuity, timing, quality, and disorder in relation to suicidal ideation and attempts among college students. Participants: Eight hundred eighty-five undergraduates aged 18-25 in the southwestern United States. Methods: Participants completed questionnaires on sleep, suicide risk, mental health, and substance use. Differences in sleep variables were compared by lifetime and recent suicidal ideation and suicide attempts using covariate-adjusted and stepwise regression models. Results: A total of 363 (41.0%) individuals reported lifetime suicidal ideation, of whom 172 (47.4%) reported suicidal ideation in the last 3 months and 97 (26.7%) had attempted suicide in their lifetime. Sleep disturbances were prevalent among those with lifetime suicidal ideation or a lifetime suicide attempt. Insomnia was identified as the best predictor of recent suicidal ideation, but this relationship did not survive adjustment for covariates. Conclusions: Sleep continuity, quality, and sleep disorders are broadly associated with suicidal thoughts and behaviors among college students.
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Affiliation(s)
- Andrew S Tubbs
- Department of Psychiatry, University of Arizona College of Medicine - Tucson, Tucson, Arizona, USA
| | - Krishna Taneja
- Department of Psychiatry, University of Arizona College of Medicine - Tucson, Tucson, Arizona, USA
| | - Sadia B Ghani
- Department of Psychiatry, University of Arizona College of Medicine - Tucson, Tucson, Arizona, USA
| | - Michael R Nadorff
- Department of Psychology, Mississippi State University, Mississippi, USA
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Christopher W Drapeau
- Department of Health Policy and Management, School of Public Health, Indiana University, Indianapolis, Indiana, USA
- Division of Mental Health and Addiction, Indiana Family and Social Services Administration, Indianapolis, Indiana, USA
| | - Jordan F Karp
- Department of Psychiatry, University of Arizona College of Medicine - Tucson, Tucson, Arizona, USA
| | | | - Michael L Perlis
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Michael A Grandner
- Department of Psychiatry, University of Arizona College of Medicine - Tucson, Tucson, Arizona, USA
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9
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Self-reported sleep quality and mental health mediate the relationship between chronic diseases and suicidal ideation among Chinese medical students. Sci Rep 2022; 12:18835. [PMID: 36336709 PMCID: PMC9637738 DOI: 10.1038/s41598-022-23207-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 10/26/2022] [Indexed: 11/08/2022] Open
Abstract
High prevalence and strong associations of chronic disease, poor sleep quality, poor mental health, and suicidal ideation (SI) have been reported worldwide. However, the underlying mechanism remains unexamined. The participants were 2646 Chinese medical college students with an average age of 20.13 years. Pittsburgh Sleep Quality Index, the Kessler Psychological Distress Scale, and SI was evaluated. The lifetime SI, past 12-month SI, and chronic disease prevalence rates were 10.0%, 8.4%, and 4.6%, respectively. The results of logistic regression analysis in this study found that chronic disease, self-reported poor sleep quality, poor mental health, gender and scholarship were associated with lifetime SI. Similar results were also found for 12-month SI with an exception of region. This result indicated that the effects of chronic diseases on the SI were mediated by self-reported sleep quality and mental health. Physical diseases, sleep-related concerns, and mental health issues need to be addressed through a multidisciplinary team approach and various delivery systems to prevent SI among medical college students.
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10
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Jenkins CA, Thompson KN, Nicholas CL, Chanen AM. Sleep in Young People With Features of Borderline Personality Disorder: A Scoping Review. J Pers Disord 2022; 36:19-39. [PMID: 34124946 DOI: 10.1521/pedi_2021_35_525] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Sleep disturbance is commonly reported in young people with features of borderline personality disorder (BPD). Examining sleep quality and sleep-wake patterns in young people with features of BPD is essential to inform the development of sleep-improvement interventions. A scoping review was conducted according to the Joanna Briggs Institute methodology. The objectives were to map the literature regarding sleep in young people with features of BPD, highlight areas for further investigation, and provide methodological recommendations for future research. Seven data sets were included in the review. Young people with features of BPD had poorer objective and subjective sleep quality, disturbed sleep architecture (particularly rapid-eye-movement sleep), an increased vulnerability to delayed sleep phase syndrome, and more nightmares and dream anxiety, compared with healthy individuals. Future research should use both objective and subjective sleep measures, include clinical comparison groups, and focus specifically on young people with BPD.
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Affiliation(s)
- Claire A Jenkins
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Victoria, Australia.,Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Katherine N Thompson
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Christian L Nicholas
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Victoria, Australia.,Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
| | - Andrew M Chanen
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
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11
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Scamaldo KM, Tull MT, Gratz KL. The role of sleep disturbance in the associations of borderline personality disorder symptom severity to nonsuicidal self-injury and suicide risk among patients with substance use disorders. Personal Ment Health 2022; 16:59-69. [PMID: 34322997 DOI: 10.1002/pmh.1526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/21/2021] [Accepted: 07/05/2021] [Indexed: 11/10/2022]
Abstract
This study sought to examine the explanatory role of sleep disturbance in the associations of borderline personality disorder (BPD) symptom severity to nonsuicidal self-injury (NSSI) and suicide risk within an at-risk sample of patients with substance use disorders (SUDs), as well as whether emotion regulation (ER) difficulties account for significant variance in the relations of sleep disturbance to NSSI and suicide risk. Patients in a residential SUD treatment facility (N = 166) completed a diagnostic interview and questionnaires. Results revealed significant indirect relations of BPD symptom severity to both NSSI frequency and suicide risk through sleep disturbance. In addition, ER difficulties accounted for significant variance in the relation of sleep disturbance to NSSI frequency (but not suicide risk). Findings highlight the relevance of sleep disturbance to the association between BPD symptoms and both suicidal and nonsuicidal self-injury and suggest the potential utility of interventions aimed at improving sleep quality among individuals with BPD pathology.
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Affiliation(s)
- Kayla M Scamaldo
- Department of Psychology, University of Toledo, Toledo, Ohio, USA
| | - Matthew T Tull
- Department of Psychology, University of Toledo, Toledo, Ohio, USA
| | - Kim L Gratz
- Department of Psychology, University of Toledo, Toledo, Ohio, USA
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12
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Jenkins CA, Thompson KN, Chanen AM, Hartmann JA, Nicol K, Nicholas CL. Subjective and objective sleep in young people with borderline personality disorder features. J Sleep Res 2021; 31:e13463. [PMID: 34409668 DOI: 10.1111/jsr.13463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/21/2021] [Accepted: 07/28/2021] [Indexed: 01/02/2023]
Abstract
Characterising sleep in young people (aged 15-25 years) with borderline personality disorder (BPD) features is crucial given the association between BPD features and sleep disturbance, negative consequences of poor sleep, and normative developmental sleep changes that occur in this age group. The present study aimed to characterise the sleep profile of young people with BPD to determine whether this profile is non-normative and specific to BPD. Participants were 96 young people (40 with BPD features, 38 healthy individuals, and 18 young people seeking help for mental health difficulties without BPD). Sleep was measured subjectively (self-report questionnaires) and objectively (10 days of actigraphy). Young people with BPD features reported poorer subjective sleep quality, greater insomnia symptoms and later chronotype than same-age healthy and clinical comparison groups. Young people with BPD features also displayed irregular sleep timing, later rise times, greater time in bed and longer sleep durations than healthy young people. Those with BPD features had superior sleep quality (greater sleep efficiency, less wake after sleep onset) and longer sleep durations than the clinical comparison group. Sleep profiles were similar across young people with BPD features with and without co-occurring depression. Overall, the findings revealed a subjective-objective sleep discrepancy and suggest that sleep-improvement interventions might be beneficial to improve subjective sleep in young people with BPD features.
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Affiliation(s)
- Claire A Jenkins
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Victoria, Australia.,Orygen, Parkville, Victoria., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Katherine N Thompson
- Orygen, Parkville, Victoria., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Andrew M Chanen
- Orygen, Parkville, Victoria., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Jessica A Hartmann
- Orygen, Parkville, Victoria., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Katie Nicol
- Orygen, Parkville, Victoria., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Christian L Nicholas
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Victoria, Australia.,Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
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13
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Cameron CM, Nieto S, Bosler L, Wong M, Bishop I, Mooney L, Cahill CM. Mechanisms Underlying the Anti-Suicidal Treatment Potential of Buprenorphine. ADVANCES IN DRUG AND ALCOHOL RESEARCH 2021; 1. [PMID: 35265942 PMCID: PMC8903193 DOI: 10.3389/adar.2021.10009] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Death by suicide is a global epidemic with over 800 K suicidal deaths worlwide in 2012. Suicide is the 10th leading cause of death among Americans and more than 44 K people died by suicide in 2019 in the United States. Patients with chronic pain, including, but not limited to, those with substance use disorders, are particularly vulnerable. Chronic pain patients have twice the risk of death by suicide compared to those without pain, and 50% of chronic pain patients report that they have considered suicide at some point due to their pain. The kappa opioid system is implicated in negative mood states including dysphoria, depression, and anxiety, and recent evidence shows that chronic pain increases the function of this system in limbic brain regions important for affect and motivation. Additionally, dynorphin, the endogenous ligand that activates the kappa opioid receptor is increased in the caudate putamen of human suicide victims. A potential treatment for reducing suicidal ideation and suicidal attempts is buprenorphine. Buprenorphine, a partial mu opioid agonist with kappa opioid antagonist properties, reduced suicidal ideation in chronic pain patients with and without an opioid use disorder. This review will highlight the clinical and preclinical evidence to support the use of buprenorphine in mitigating pain-induced negative affective states and suicidal thoughts, where these effects are at least partially mediated via its kappa antagonist properties.
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Affiliation(s)
- Courtney M. Cameron
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
- Shirley and Stefan Hatos Center for Neuropharmacology, University of California, Los Angeles, Los Angeles, CA, United States
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Steven Nieto
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Lucienne Bosler
- Shirley and Stefan Hatos Center for Neuropharmacology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Megan Wong
- Shirley and Stefan Hatos Center for Neuropharmacology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Isabel Bishop
- Shirley and Stefan Hatos Center for Neuropharmacology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Larissa Mooney
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Catherine M. Cahill
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
- Shirley and Stefan Hatos Center for Neuropharmacology, University of California, Los Angeles, Los Angeles, CA, United States
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Correspondence: Catherine M. Cahill,
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14
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Bradford DRR, Biello SM, Russell K. Insomnia symptoms mediate the association between eveningness and suicidal ideation, defeat, entrapment, and psychological distress in students. Chronobiol Int 2021; 38:1397-1408. [PMID: 34100311 DOI: 10.1080/07420528.2021.1931274] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Chronotype describes a person's general preference for mornings, evenings, or neither. It is typically conceptualized as a continuous unidimensional spectrum from morningness to eveningness. Eveningness is associated with poorer outcomes across a myriad of physical and mental health outcomes. This preference for later sleep and wake times is associated with increased risk of depression, anxiety, and suicidal ideation in both clinical and community samples. However, the mechanisms underlying the negative consequences of this preference for evenings are not fully understood. Previous research has found that sleep disturbances may act as a mediator of this relationship. The present study aimed to explore the associations between chronotype and affective outcomes in a sample of students. Additionally, it aimed to investigate the potential role of insomnia as a mediator within these relationships. Participants (n = 190) completed an anonymous self-report survey of validated measures online which assessed chronotype, insomnia symptoms, and a range of affective outcomes (defeat, entrapment, suicide risk, stress, and depressive and anxious symptomology). Eveningness was associated with more severe or frequent experiences of these outcomes, with participants that demonstrated a preference for eveningness more likely to report poorer affective functioning and increased psychological distress. Mediation analysis found the relationship between chronotype and these outcome measures was completely or partially mediated by insomnia symptom severity measured by the validated Sleep Condition Indicator insomnia scale. Taken together, these findings add further evidence for the negative consequences of increased eveningness. Additionally, our results show that chronotype and sleep disturbances should be considered when assessing mental well-being. Implementing appropriate sleep-related behavior change or schedule alterations can offer a tool for mitigation or prevention of psychological distress in students that report a preference for later sleep and wake times.
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15
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Lerman SF, Sylvester S, Hultman CS, Caffrey JA. Suicidality After Burn Injuries: A Systematic Review. J Burn Care Res 2021; 42:357-364. [PMID: 33482003 DOI: 10.1093/jbcr/irab014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Burn survivors may be at increased risk for suicide due to the nature of their injury and psychiatric comorbidities. The purpose of this review is to assess the evidence as to the prevalence of suicidal ideations and behaviors (attempts and completed suicides) in burn survivors as well as evaluate risk and protective factors. PubMed, EMBASE, CINAHL, Cochrane, PsycINFO, and Web Science databases were searched using search terms regarding suicide, suicidality, and burn. Fourteen full-text manuscripts and two published abstracts were included in the review. Overall, burn survivors demonstrate elevated suicidal ideations and a higher lifetime prevalence of suicide attempts compared to the general population. There is mixed evidence as to rates of completed suicide postburn injury, though rates appear to be relatively low. Risk factors include pain at discharge, perceived level of disfigurement, premorbid psychiatric comorbidities, and past suicide attempts. Results of this systematic review shed light on the scarcity of data on rates of suicidality among burn survivors, which is surprising given the multiple risk factors burn survivors possess including chronic pain, sleep disturbances, history of substance abuse, posttraumatic stress disorder, social isolation, and depression which are linked to suicidality in the general population. Suicide risk screening should be included as an integral part of burn survivors' care, and more research is needed to better understand the magnitude of this phenomenon and offer targeted interventions to vulnerable individuals.
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Affiliation(s)
- Sheera F Lerman
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Scott Sylvester
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - C Scott Hultman
- Department of Plastic and Reconstructive Surgery, Division of Burn Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Julie A Caffrey
- Department of Plastic and Reconstructive Surgery, Division of Burn Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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16
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Paulus FW, Ohmann S, Möhler E, Plener P, Popow C. Emotional Dysregulation in Children and Adolescents With Psychiatric Disorders. A Narrative Review. Front Psychiatry 2021; 12:628252. [PMID: 34759846 PMCID: PMC8573252 DOI: 10.3389/fpsyt.2021.628252] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 08/27/2021] [Indexed: 12/14/2022] Open
Abstract
Background: Emotional dysregulation (ED) is a transdiagnostic construct defined as the inability to regulate the intensity and quality of emotions (such as, fear, anger, sadness), in order to generate an appropriate emotional response, to handle excitability, mood instability, and emotional overreactivity, and to come down to an emotional baseline. Because ED has not been defined as a clinical entity, and because ED plays a major role in child and adolescent psychopathology, we decided to summarize current knowledge on this topic based on a narrative review of the current literature. Methods: This narrative review is based on a literature search of peer-reviewed journals. We searched the databases ERIC, PsycARTICLES, PsycINFO and PSYNDEX on June 2, 2020 for peer reviewed articles published between 2000 and 2020 in English language for the preschool, school, and adolescent age (2-17 years) using the following search terms: "emotional dysregulation" OR "affect dysregulation," retrieving 943 articles. Results: The results of the literature search are presented in the following sections: the relationship between ED and psychiatric disorders (ADHD, Mood Disorders, Psychological Trauma, Posttraumatic Stress Disorder, Non-suicidal Self-Injury, Eating Disorders, Oppositional Defiant Disorder, Conduct Disorder, Disruptive Disruptive Mood Dysregulation Disorder, Personality Disorders, Substance Use Disorder, Developmental Disorders, Autism Spectrum Disorder, Psychosis and Schizophrenia, and Gaming Disorder), prevention, and treatment of ED. Conclusion: Basic conditions of ED are genetic disposition, the experience of trauma, especially sexual or physical abuse, emotional neglect in childhood or adolescence, and personal stress. ED is a complex construct and a comprehensive concept, aggravating a number of various mental disorders. Differential treatment is mandatory for individual and social functioning.
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Affiliation(s)
- Frank W Paulus
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Saarland University Medical Center, Homburg, Germany
| | - Susanne Ohmann
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria.,Austrian Society of Cognitive Behavioral Therapy (OeGVT), Vienna, Austria
| | - Eva Möhler
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Saarland University Medical Center, Homburg, Germany
| | - Paul Plener
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Christian Popow
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria.,Austrian Society of Cognitive Behavioral Therapy (OeGVT), Vienna, Austria.,Department of Child and Adolescent Psychiatry and Psychotherapy, Regional Psychiatric Hospital, Mauer, Austria
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17
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Vanek J, Prasko J, Ociskova M, Hodny F, Holubova M, Minarikova K, Slepecky M, Nesnidal V. Insomnia in Patients with Borderline Personality Disorder. Nat Sci Sleep 2021; 13:239-250. [PMID: 33654445 PMCID: PMC7910080 DOI: 10.2147/nss.s295030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/20/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Both sleep disorders and BPD are prevalent in the population, and one is often a comorbidity of the other. This narrative review aims to assess contemporary literature and scientific databases to provide the current state of knowledge about sleep disorders in patients with borderline personality disorder (BPD) and clinical suggestions for managing sleep disorders in BPD patients and future research direction. METHODS Articles were acquired via PubMed and Web of Science, and papers published between January 1980 and October 2020 were extracted. Authors made a series of literature searches using the keywords: Sleep problems, Insomnia, Nightmares, Obstructive sleep apnea, Borderline personality disorder. The inclusion criteria were: published in peer-reviewed journals; studies in humans; or reviews on the related topic; English language. The exclusion criteria were: abstracts from conferences; commentaries; subjects younger than 18 years. After an inspection of the full texts, 42 papers from 101 were selected. Secondary documents from the reference lists of the primary designated papers were searched, assessed for suitability, and included. In total, 71 papers were included in the review process. RESULTS Sleep disturbance is common among patients with BPD. Nevertheless, the number of investigations is limited, and the prevalence differs between 5-45%. Studies assessing objective changes in sleep architecture in BPD show inconsistent results. Some of them identify REM sleep changes and a decrease in slow-wave sleep, while other studies found no objective sleep architecture changes. There is also a higher prevalence of nightmares in patients with BPD. Untreated insomnia can worsen BPD symptoms via interference with emotional regulation. BPD itself seems to influence the subjective quality of sleep significantly. Proper diagnosis and treatment of sleep disorders in patients with BPD could lead to better results in therapy. Psychotherapeutic approaches can improve both sleep disorders and BPD symptoms. CONCLUSION Recognising and managing sleep disorders in patients with BPD may help alleviate the disorder's symptoms. Treatment of people with BPD may be more effective if the treatment plan explicitly addresses sleep problems. Further research is needed to reach reliable conclusions.
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Affiliation(s)
- Jakub Vanek
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, University Hospital, Olomouc, 77520, The Czech Republic
| | - Jan Prasko
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, University Hospital, Olomouc, 77520, The Czech Republic.,Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, The Slovak Republic.,Institute for Postgraduate Education in Health Care, Prague, The Czech Republic
| | - Marie Ociskova
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, University Hospital, Olomouc, 77520, The Czech Republic
| | - Frantisek Hodny
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, University Hospital, Olomouc, 77520, The Czech Republic
| | - Michaela Holubova
- Department of Psychiatry, Hospital Liberec, Liberec, The Czech Republic
| | - Kamila Minarikova
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, University Hospital, Olomouc, 77520, The Czech Republic
| | - Milos Slepecky
- Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, The Slovak Republic
| | - Vlastimil Nesnidal
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, University Hospital, Olomouc, 77520, The Czech Republic
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18
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Abstract
Sleep disturbances, particularly insomnia, nightmares, and excessive daytime sleepiness (EDS), are significant, proximal, and modifiable risk factors for suicidal ideation and behaviors (SIB) and could be targeted for preventative interventions. In this chapter, we review the evidence supporting the association of insomnia, nightmares, and EDS with SIB. We also describe these sleep disturbances in the general population, as well as their association with psychiatric disorders. A PubMed search was conducted to identify the relevant literature. Insomnia is very frequent across mental disorders, but SIB patients are particularly exposed. Specific interventions focused on insomnia are useful in contending suicidal ideation. Nightmares seem to constitute an independent risk factor for SIB, beyond insomnia, particularly in young people and when experienced frequently. The evidence regarding the association of EDS and SIB is less clear and probably explained by the reduction of health-related quality of life and comorbid depression. The mechanisms underlying the relationship between sleep disturbances and SIB as well as the role of potential confounders and future perspectives in this field are also discussed.
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Affiliation(s)
- Jorge Lopez-Castroman
- PSNREC, University of Montpellier, INSERM, Montpellier, France. .,Nimes University Hospital, Nimes, France. .,CIBERSAM, Madrid, Spain.
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19
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Association between different contexts of physical activity and anxiety-induced sleep disturbance among 100,648 Brazilian adolescents: Brazilian school-based health survey. Psychiatry Res 2020; 293:113367. [PMID: 32777618 DOI: 10.1016/j.psychres.2020.113367] [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: 02/18/2020] [Revised: 07/28/2020] [Accepted: 08/02/2020] [Indexed: 11/24/2022]
Abstract
Physical activity (PA) practice can be a protective factor for anxiety-induced sleep disturbance (AISD), however the association between different contexts of PA and anxiety-induced sleep disturbance is not clear. We aimed to analyze the association between different contexts of PA and AISD. Data from the Brazilian School-based Health Survey [n=100,648; age: 14.3y (range:11-18 years)], conducted in 2015, were used. Higher PA during transport was associated with higher AISD. PA during physical education classes presented lower odds for AISD. PA practiced outside school was associated with reduced AISD among boys. The association between PA and AISD seems to be context-dependent.
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20
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Rufino KA, Ward-Ciesielski EF, Webb CA, Nadorff MR. Emotion regulation difficulties are associated with nightmares and suicide attempts in an adult psychiatric inpatient sample. Psychiatry Res 2020; 293:113437. [PMID: 32916439 DOI: 10.1016/j.psychres.2020.113437] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/26/2020] [Accepted: 08/29/2020] [Indexed: 11/26/2022]
Abstract
Although many studies have examined potential moderators of the relation between nightmares and suicide, few have examined emotion regulation, particularly utilizing severe populations such as psychiatric inpatients. The present study sought to investigate whether emotion regulation difficulties are associated with nightmares and suicide attempts in an inpatient sample. We included 2,683 psychiatric inpatients ranging from 18 to 81 years (M = 34.35, SD = 14.70). Nightmare frequency, emotion regulation difficulties, and their interaction predicted previous suicide attempts. Limitations include the homogeneity and cross-sectional nature of the sample. Suggestions for future study are discussed.
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Affiliation(s)
- Katrina A Rufino
- University of Houston Downtown, Department of Social Sciences, Houston, Texas, USA; The Menninger Clinic, Houston, Texas, USA.
| | - Erin F Ward-Ciesielski
- Boston University, Center for Anxiety and Related Disoders, Department of Psychological and Brain Sciences, Boston, Massachusetts, USA
| | | | - Michael R Nadorff
- Mississippi State University, Department of Psychology, Missippi State, Mississippi, USA
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21
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Gauchat A, Zadra A, El-Hourani M, Parent S, Tremblay RE, Séguin JR. Disturbing Dreams and Psychosocial Maladjustment in Children: A Prospective Study of the Moderating Role of Early Negative Emotionality. Front Neurol 2020; 11:762. [PMID: 32849218 PMCID: PMC7427048 DOI: 10.3389/fneur.2020.00762] [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: 12/11/2019] [Accepted: 06/19/2020] [Indexed: 12/26/2022] Open
Abstract
Although frequent disturbing dreams, including bad dreams and nightmares, have been repeatedly associated with poor psychological well-being in adults, considerably less information exists on their psychosocial correlates in children. Recent empirical and theoretical contributions suggest that the association between disturbing dream frequency and psychosocial adaptation in children may differ as a function of children's negative emotionality. The current study assessed the moderating effect of very early negative emotionality (17 months of age) in the relation between disturbing dream frequency and psychosocial maladjustment (i.e., externalizing + internalizing behaviors) in a sample of 173 11-year-old children. Mixed-model analyses revealed that disturbing dream frequency was associated with some internalizing behaviors but that the association between disturbing dream frequency and most externalizing behaviors was moderated by early negative emotionality. The latter result indicates that the relation between disturbing dream frequency and externalizing behaviors was significant in 11-year-old children showing moderate negative emotionality early in life, but particularly strong in those children with high early negative emotionality. Whereas, a moderating effect of early negative emotionality was not found between disturbing dream frequency and internalizing behaviors, the findings highlight the more specific role of early emotional negativity as a developmental moderator for the link between disturbing dreams and externalizing behaviors in children. The results are discussed in light of recent models of disturbed dreaming production.
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Affiliation(s)
- Aline Gauchat
- Clinique de Consultation Conjugale et Familiale Poitras-Wright, Côté, Longueuil, QC, Canada.,Department of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Antonio Zadra
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Mira El-Hourani
- Department of Psychology, Université de Montréal, Montreal, QC, Canada.,CHU Ste-Justine Research Center, Montreal, QC, Canada
| | - Sophie Parent
- School of Psychoeducation, Université de Montréal, Montreal, QC, Canada
| | - Richard E Tremblay
- Department of Psychology, Université de Montréal, Montreal, QC, Canada.,CHU Ste-Justine Research Center, Montreal, QC, Canada.,Department of Pediatrics, Université de Montréal, Montreal, QC, Canada.,School of Public Health, University College Dublin, Dublin, Ireland
| | - Jean R Séguin
- CHU Ste-Justine Research Center, Montreal, QC, Canada.,Department of Psychiatry and Addictology, Université de Montréal, Montreal, QC, Canada
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22
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Abstract
The concept of sleep health provides a positive holistic framing of multiple sleep characteristics, including sleep duration, continuity, timing, alertness, and satisfaction. Sleep health promotion is an underrecognized public health opportunity with implications for a wide range of critical health outcomes, including cardiovascular disease, obesity, mental health, and neurodegenerative disease. Using a socioecological framework, we describe interacting domains of individual, social, and contextual influences on sleep health. To the extent that these determinants of sleep health are modifiable, sleep and public health researchers may benefit from taking a multilevel approach for addressing disparities in sleep health. For example, in addition to providing individual-level sleep behavioral recommendations, health promotion interventions need to occur at multiple contextual levels (e.g., family, schools, workplaces, media, and policy). Because sleep health, a key indicator of overall health, is unevenly distributed across the population, we consider improving sleep health a necessary step toward achieving health equity.
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Affiliation(s)
- Lauren Hale
- Program in Public Health; and Department of Family, Population, and Preventive Medicine; Renaissance School of Medicine, Stony Brook University, Stony Brook, New York 11794-8338, USA;
| | - Wendy Troxel
- Division of Behavior and Policy Sciences, RAND Corporation, Pittsburgh, Pennsylvania 15213, USA;
| | - Daniel J Buysse
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA;
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23
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Provencher T, Lemyre A, Vallières A, Bastien CH. Insomnia in personality disorders and substance use disorders. Curr Opin Psychol 2019; 34:72-76. [PMID: 31778972 DOI: 10.1016/j.copsyc.2019.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 10/05/2019] [Accepted: 10/21/2019] [Indexed: 11/30/2022]
Abstract
The relationship between certain personality disorders (PDs) and insomnia has been the object of few studies in recent years. Even though it is not indicated to use polysomnography to diagnose insomnia, objective measures have shown sleep abnormalities in individuals with a personality disorder and insomnia. Interestingly, there is increasing evidence that emotion dysregulation is involved in a mutually aggravating relationship between Borderline Personality Disorder (BPD) and insomnia. While BPD traits are highly associated with suicide ideation and attempts, these behaviors could be potentiated or enhanced in individuals presenting sleep disturbances. Because BPD and other mental disorders are often linked with the use of medication or other substances, it is also important to review the association between substance use disorders (SUD) and insomnia. SUD can disrupt sleep and foster insomnia, which in turn might increase motivation to use substances. Insomnia has also been shown to precede (i.e., predict) SUD, and can be present during withdrawal as well. These results highlight the need to assess and treat insomnia when working with patients who present a PD or SUD.
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Affiliation(s)
| | | | - Annie Vallières
- School of Psychology, Université Laval, Québec, QC, Canada; CERVO Brain Research Center, Québec, QC, Canada; Psycho- Socio- Cultural Sleep Laboratory, School of Psychology, Université Laval, Québec, QC, Canada; CHU Research Center - Université Laval, Québec, QC, Canada
| | - Célyne H Bastien
- School of Psychology, Université Laval, Québec, QC, Canada; CERVO Brain Research Center, Québec, QC, Canada; Psycho- Socio- Cultural Sleep Laboratory, School of Psychology, Université Laval, Québec, QC, Canada; CHU Research Center - Université Laval, Québec, QC, Canada; Research Laboratory on Human Neurophysiology and Sleep, School of psychology, Université Laval, Québec, QC, Canada.
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24
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Kalmbach DA, Cheng P, Ong JC, Ciesla JA, Kingsberg SA, Sangha R, Swanson LM, O'Brien LM, Roth T, Drake CL. Depression and suicidal ideation in pregnancy: exploring relationships with insomnia, short sleep, and nocturnal rumination. Sleep Med 2019; 65:62-73. [PMID: 31710876 DOI: 10.1016/j.sleep.2019.07.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/03/2019] [Accepted: 07/09/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Sleep problems and depression are highly prevalent in pregnancy. Nocturnal rumination has been linked to insomnia and depression in non-pregnant samples, but remains poorly characterized in pregnancy. This study explored relationships of depression and suicidal ideation with insomnia, short sleep, and nocturnal rumination in mid-to-late pregnancy. METHODS In this study, 267 pregnant women were recruited from obstetric clinics and completed online surveys on sleep, depression, and nocturnal rumination. RESULTS Over half (58.4%) of the sample reported clinical insomnia on the Insomnia Severity Index, 16.1% screened positive for major depression on the Edinburgh Postnatal Depression Scale (EPDS), and 10.1% endorsed suicidal ideation. Nocturnal rumination was more robustly associated with sleep onset difficulties than with sleep maintenance issues. Depressed women were at greater odds of sleep onset insomnia (OR = 2.80), sleep maintenance insomnia (OR = 6.50), high nocturnal rumination (OR = 6.50), and negative perinatal-focused rumination (OR = 2.70). Suicidal ideation was associated with depression (OR = 3.64) and negative perinatal-focused rumination (OR = 3.50). A four-group comparison based on insomnia status and high/low rumination revealed that pregnant women with insomnia and high rumination endorsed higher rates of depression (35.6%) and suicidal ideation (17.3%) than good-sleeping women with low rumination (1.2% depressed, 4.9% suicidal). Women with insomnia alone (depression: 3.9%, suicidal: 5.9%) or high rumination alone (depression: 10.7%, suicidal: 7.1%) did not differ from good-sleeping women with low rumination. CONCLUSIONS High rumination and insomnia are highly common in mid-to-late pregnancy and both are associated with depression and suicidal ideation. Depression and suicidal ideation are most prevalent in pregnant women with both insomnia and high rumination. CLINICALTRIALS. GOV IDENTIFIER NCT03596879.
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Affiliation(s)
- David A Kalmbach
- Thomas Roth Sleep Disorders & Research Center, Division of Sleep Medicine, Henry Ford Health System, Detroit, MI, 48202, USA.
| | - Philip Cheng
- Thomas Roth Sleep Disorders & Research Center, Division of Sleep Medicine, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Jason C Ong
- Departments of Neurology and Psychiatry & Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Jeffrey A Ciesla
- Department of Psychological Sciences, Kent State University, Kent, OH, 44240, USA
| | - Sheryl A Kingsberg
- Departments of Reproductive Biology and Psychiatry, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Roopina Sangha
- Department of Obstetrics & Gynecology, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Leslie M Swanson
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Louise M O'Brien
- Departments of Obstetrics & Gynecology and Neurology, Ann Arbor, MI, 48105, USA
| | - Thomas Roth
- Thomas Roth Sleep Disorders & Research Center, Division of Sleep Medicine, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Christopher L Drake
- Thomas Roth Sleep Disorders & Research Center, Division of Sleep Medicine, Henry Ford Health System, Detroit, MI, 48202, USA
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Brupbacher G, Straus D, Porschke H, Zander-Schellenberg T, Gerber M, von Känel R, Schmidt-Trucksäss A. The acute effects of aerobic exercise on sleep in patients with depression: study protocol for a randomized controlled trial. Trials 2019; 20:352. [PMID: 31196147 PMCID: PMC6567535 DOI: 10.1186/s13063-019-3415-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 05/08/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Unipolar depression is one of the most important mental disorders. Insomnia is a symptom of cardinal importance in depression. It increases the risk to develop depression, negatively affects disease trajectory, is the most common symptom after remission, increases the risk of relapse, and is associated with higher suicide rates. Existing therapies for insomnia in depression have limitations. Further adjuvant therapies are therefore needed. Acute aerobic exercise has been shown to have beneficial effects on sleep in healthy individuals and patients with insomnia. We therefore hypothesize that a single session of aerobic exercise has a positive impact on sleep in patients with unipolar depression. This trial aims to investigate the effects of a single bout of aerobic exercise on the subsequent night's sleep in patients with depression. METHODS/DESIGN This is a two-arm parallel group, randomized, outcome assessor blinded, controlled, superiority trial. Patients between 18 and 65 years of age with a primary diagnosis of unipolar depression (without a psychotic episode) are included. Exclusion criteria are regular use of hypnotic agents, opioids, and certain beta-blockers, as well as the presence of factors precluding exercise, history of epilepsy, restless legs syndrome, moderate obstructive sleep apnea, and a BMI > 40. The intervention is a single bout of aerobic exercise, performed for 30 min on a bicycle ergometer at 80% individual anaerobic threshold. The control group sits and reads for 30 min. The primary outcome is sleep efficiency measured by polysomnography. Secondary outcomes include further polysomnographic variables, subjective pre-sleep arousal, nocturnal cardiovascular autonomic modulation, subjective sleep quality, daytime sleepiness, and adverse events. According to the sample size calculation, a total of 92 patients will be randomized using minimization. DISCUSSION This trial will add new information to the body of knowledge concerning the treatment of insomnia in patients with depression. Thereby, the results will inform decision makers on the utility of acute aerobic exercise. TRIAL REGISTRATION Clinicaltrials.gov, NCT03673397 . Protocol version 1 registered on 17 September 2018.
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Affiliation(s)
- Gavin Brupbacher
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052, Basel, Switzerland.
- OBERWAID AG, Rorschacher Strasse 311, 9016, St. Gallen, Switzerland.
| | - Doris Straus
- OBERWAID AG, Rorschacher Strasse 311, 9016, St. Gallen, Switzerland
| | | | - Thea Zander-Schellenberg
- Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland
| | - Markus Gerber
- Division of Sport and Psychosocial Health, Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052, Basel, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Culmannstrasse 8, 8091, Zurich, Switzerland
| | - Arno Schmidt-Trucksäss
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052, Basel, Switzerland
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Tae H, Jeong BR, Chae JH. Sleep problems as a risk factor for suicide: Are certain specific sleep domains associated with increased suicide risk? J Affect Disord 2019; 252:182-189. [PMID: 30986733 DOI: 10.1016/j.jad.2019.04.053] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 04/02/2019] [Accepted: 04/08/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The purpose of this study was to examine the relationship between sleep problems and suicidal ideation in depressive patients. BACKGROUND AND AIMS Evidence from diverse settings and populations indicates that sleep problems are associated with suicidal ideation. However, relationships between them are not well defined. This study was conducted in order to explore whether poor sleep was associated with suicidal ideation above and beyond depression and whether specific domains of sleep were related to suicidal ideation. We also determined whether the association between sleep problems and suicidal ideation was mediated by depression. MATERIALS AND METHODS Patients aged 18-65 years from an outpatient clinic at Seoul St. Mary's Hospital were recruited for this study. From September 2010 to November 2017, a total of 909 participants were included in the final sample. The Beck Depression Inventory (BDI) and Pittsburgh Sleep Quality Index (PSQI) were used to assess psychiatric symptoms. Independent samples t-test, chi-square test, Pearson correlation analyses, hierarchical multiple regression analyses, and mediation analyses were performed using SPSS PROCESS macro. RESULTS The majority of participants with suicidal ideation also had sleep problems (94.9%). After controlling for age, marital status, and depressive symptoms, total sleep problems estimated by the PSQI global score were also significant associated with suicidal ideation. Among seven sleep components derived from the PSQI, several components including cough or snore loudly, have bad dreams, and use sleep medication were associated with increased suicide risk. Also, the relationship between sleep problems and suicidal ideation was mediated by depressive symptoms indirectly. There was no convincing direct relationship between sleep problems and suicidal ideation. CONCLUSIONS Investigating the pathways which connect sleep problems and suicidality is fundamental to the development of suicide prevention. While it might be premature to suggest specific interventions, it would be important for clinicians to consider evaluating and managing sleep problems in the context of suicidality.
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Affiliation(s)
- Hyejin Tae
- Department of Psychiatry, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Bo Ram Jeong
- Catholic Biomedical Industrial Institute, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jeong-Ho Chae
- Department of Psychiatry, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
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Brupbacher G, Gerger H, Wechsler M, Zander-Schellenberg T, Straus D, Porschke H, Gerber M, von Känel R, Schmidt-Trucksäss A. The effects of aerobic, resistance, and meditative movement exercise on sleep in individuals with depression: protocol for a systematic review and network meta-analysis. Syst Rev 2019; 8:105. [PMID: 31027509 PMCID: PMC6486698 DOI: 10.1186/s13643-019-1018-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 04/05/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The main objective of this review is to assess the effects of aerobic, resistance, and meditative movement exercise on sleep quality in patients with unipolar depression. A secondary goal is to ascertain the effects on sleep duration, sleepiness, daytime functioning, use of hypnotics, and adverse events. METHODS A systematic computerized search will be performed in the following online databases: PubMed, EMBASE (on Ovid), Cochrane Library, PsycINFO (on Ovid), SPORTDiscus (on EBSCOhost), CINHAL (on EBSCOhost), Clinicaltrials.gov , WHO International Clinical Trials Registry, OpenGrey, and ProQuest Dissertations and Theses. Bibliographies of all included studies as well as any other relevant reviews identified via the search will be screened. Randomized trials using aerobic, resistance, or meditative movement exercise interventions which target sleep as a primary or secondary outcome will be included. The primary outcome will be differences in sleep quality at post-intervention. Secondary outcomes will be adverse events, differences in sleep duration, daytime sleepiness and functioning, and the use of hypnotics at post-intervention. Two authors will independently screen the identified records. Disagreement will be resolved by consensus or if no consensus can be reached by adjudication of a designated third reviewer. Data extraction will be done independently by two authors using a standardized and piloted data extraction sheet. Bias in individual studies will be assessed using the revised Cochrane risk of bias tool. The certainty of evidence across all outcomes will be evaluated using the CINeMA (Confidence in Network Meta-Analysis) framework. A frequentist network meta-analysis will be conducted. The systematic review and network meta-analysis will be presented according to the PRISMA for Network Meta-Analyses (PRISMA-NMA) guideline. DISCUSSION This systematic review and network meta-analysis will provide a synthesis of the currently available evidence concerning the effects of aerobic, resistance, and meditative movement exercises on sleep in patients with unipolar depression. Thereby, we hope to accelerate the consolidation of evidence and inform decision-makers on potential benefits and harms. SYSTEMATIC REVIEW REGISTRATION The protocol has been registered at the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD42019115705).
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Affiliation(s)
- Gavin Brupbacher
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052, Basel, Switzerland.
- Oberwaid AG, Rorschacher Strasse 311, 9016, St. Gallen, Switzerland.
| | - Heike Gerger
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Missionsstrasse 62a, 4055, Basel, Switzerland
| | - Monika Wechsler
- University Medical Library Basel, Spiegelgasse 5, 4051, Basel, Switzerland
| | - Thea Zander-Schellenberg
- Division of Clinical Psychology and Epidemiology, Faculty of Psychology, University of Basel, Missionsstrasse 62a, 4055, Basel, Switzerland
| | - Doris Straus
- Oberwaid AG, Rorschacher Strasse 311, 9016, St. Gallen, Switzerland
| | | | - Markus Gerber
- Division of Sport and Psychosocial Health, Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052, Basel, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zürich, University of Zurich, Culmannstrasse 8, 8091, Zurich, Switzerland
| | - Arno Schmidt-Trucksäss
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052, Basel, Switzerland
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28
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Schennach R, Feige B, Riemann D, Heuser J, Voderholzer U. Pre- to post-inpatient treatment of subjective sleep quality in 5,481 patients with mental disorders: A longitudinal analysis. J Sleep Res 2019; 28:e12842. [PMID: 30907038 DOI: 10.1111/jsr.12842] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 09/20/2018] [Accepted: 02/12/2019] [Indexed: 01/26/2023]
Abstract
There is only limited evidence of the course of sleep quality and sleep disturbances during acute inpatient treatment and the prediction of/association with treatment outcome in mental disorders. Within this naturalistic study, 5,481 consecutively admitted inpatients completed the Pittsburgh Sleep Quality Index (PSQI) and the Beck Depression Inventory (BDI-II) at admission and at discharge. Treatment included both individual and group psychotherapy (but no specific interventions for sleep disturbances) and pharmacotherapy based on current national treatment guidelines. Correlation analyses, analyses of variance and linear models were calculated to analyse the datasets. The PSQI improved significantly (p < 0.001) from admission (mean score 9.51 [±4.11]) to discharge (mean score 8.08 [±4.20]) in all diagnostic subgroups. Despite this improvement, 47% of the patients still showed elevated PSQI scores (>5) at discharge. Patients with post-traumatic stress disorder showed the largest sleep disturbances at both time-points; patients with obsessive-compulsive disorder were the least impaired. An improvement of the PSQI was found to be significantly correlated (p < 0.001) to the change of BDI-II values (without the sleep item) during treatment. The likelihood of achieving remission of depressive symptoms (BDI-II total score <14) was significantly associated with less sleep disturbances at admission. The results suggest that almost half of inpatients with mental disorders treated successfully with state-of-the art specific psychotherapy and pharmacotherapy do not have remission of their sleep problems. Therefore, specific treatment programmes for insomnia should be evaluated and implemented in daily clinical routines.
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Affiliation(s)
- Rebecca Schennach
- Schoen Clinic Roseneck, Prien am Chiemsee, Germany.,Department of Psychiatry, LMU Munich, Munich, Germany
| | - Bernd Feige
- Department of Psychiatry and Psychotherapy, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dieter Riemann
- Department of Psychiatry and Psychotherapy, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jörg Heuser
- Schoen Clinic Roseneck, Prien am Chiemsee, Germany
| | - Ulrich Voderholzer
- Schoen Clinic Roseneck, Prien am Chiemsee, Germany.,Department of Psychiatry and Psychotherapy, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Vancampfort D, Van Damme T, Stubbs B, Smith L, Firth J, Hallgren M, Mugisha J, Koyanagi A. Sedentary behavior and anxiety-induced sleep disturbance among 181,093 adolescents from 67 countries: a global perspective. Sleep Med 2019; 58:19-26. [PMID: 31048258 DOI: 10.1016/j.sleep.2019.01.048] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 01/26/2019] [Accepted: 01/31/2019] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Sleep problems are burdensome in adolescents. Understanding modifiable environmental risk factors is essential. There is evidence that physical activity is protective against sleep problems in adolescents. However, the association between sedentary behavior (SB) and anxiety-induced sleep disturbance has not been investigated. METHODS Using cross-sectional data from the Global school-based Student Health Survey, we explored the association between SB and anxiety-induced sleep disturbance in 181,093 adolescents [mean (standard deviation, SD) age 13.7 (1.0) years; 48.4% girls] from 67 countries, controlling for confounders (including physical activity). Adolescents reported anxiety-induced sleep disturbance during the past 12 months, and SB, which was a composite variable assessing time spent sitting and watching television, playing computer games, talking with friends during a typical day excluding the hours spent sitting at school and doing homework. Multivariable logistic regression analysis was conducted and a countrywide meta-analysis undertaken. RESULTS Overall, 7.8% of adolescents had anxiety-induced sleep disturbance. The prevalence of SB was: <1 h/day 39.9%; 1-2 h/day 33.8%; 3-4 h/day 15.4%; 5-8 h/day 7.4%; and >8 h/day 3.6%. Compared to <1 h/day of SB, >8 h/day was associated with a 2.27 [95% confidence interval (CI) = 1.98-2.62] times higher odds for anxiety-induced sleep disturbance. The association was similar among both sexes. The pooled odds ratio for anxiety-induced sleep disturbance when being sedentary ≥3 h/day was 1.42 (95% CI = 1.36-1.48) with only a small degree of between-country heterogeneity (I2 = 41.4%). CONCLUSIONS Future longitudinal data are required to confirm/refute the findings to inform public interventions which aim to reduce anxiety and sleep disturbance in adolescents.
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Affiliation(s)
- Davy Vancampfort
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium; KU Leuven, University Psychiatric Center KU Leuven, Kortenberg, Belgium.
| | - Tine Van Damme
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Joseph Firth
- NICM Health Research Institute, University of Western Sydney, Sydney, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia; Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Mats Hallgren
- Department of Public Health Sciences, Karolinska Institutet, Solna, Sweden
| | - James Mugisha
- Kyambogo University, Kampala, Uganda; Butabika National Referral and Mental Health Hospital, Kampala, Uganda
| | - Ai Koyanagi
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr. Antoni Pujadas, Barcelona, Spain
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30
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Hochard KD, Ashcroft S, Carroll J, Heym N, Townsend E. Exploring Thematic Nightmare Content and Associated Self-Harm Risk. Suicide Life Threat Behav 2019; 49:64-75. [PMID: 28960406 DOI: 10.1111/sltb.12402] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 07/25/2017] [Indexed: 01/17/2023]
Abstract
Nightmares have been shown to be robust predictors of self-harm risk, beyond depressive symptoms and hopelessness at times. However, few studies have investigated associations between nightmare content and increased self-harm risk. This study explored associations of thematic nightmare content with history of self-harm, and risk of self-harm phenomena the morning following a nightmare. A mixed-method diary study was performed. Prospective nightmare reports were obtained from 72 participants. A total of 47 nightmare reports met inclusion criteria and were analyzed for themes using inductive thematic analysis. Chi-square and bootstrap Pearson's correlation tests were performed to assess the associations between nightmare themes and self-harm history, and risk of self-harm phenomena following a nightmare. "Powerlessness to Change Behavior" was associated with a history of self-harm engagement, whereas "Financial Hardship" indicated reduced risk. Themes were not significantly associated with increased risk of self-harm phenomena following a nightmare. Content may be of use in detecting lifetime history of self-harm engagement, particularly in populations where disclosure is seen as taboo. However, nightmare symptom severity remains a better indicator of risk. Evidence for the utility of nightmare content in assessing immediate self-harm risk is presently lacking. Replication with increased power is recommended.
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Affiliation(s)
- Kevin D Hochard
- Department of Psychology, University of Chester, Chester, UK
| | - Sam Ashcroft
- Department of Psychology, University of Chester, Chester, UK
| | - Janine Carroll
- Department of Psychology, University of Chester, Chester, UK
| | - Nadja Heym
- Division of Psychology, Nottingham Trent University, Nottingham, UK
| | - Ellen Townsend
- School of Psychology, University of Nottingham, University Park, Nottingham, UK
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31
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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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32
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Sleep problem, suicide and self-harm in university students: A systematic review. Sleep Med Rev 2019; 44:58-69. [PMID: 30721844 DOI: 10.1016/j.smrv.2018.12.008] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 12/10/2018] [Accepted: 12/31/2018] [Indexed: 12/21/2022]
Abstract
Suicide and self-harm behaviours represent public health concerns, and university students are a particularly high risk group. Identifying modifiable risk factors for the development and maintenance of suicidal thoughts and behaviours is a research priority, as prevention is crucial. Research examining the relationship between poor sleep and self-harm/suicidality within university students is, for the first time, systematically evaluated, critically appraised, and synthesised. This literature consistently demonstrates that insomnia and nightmares are associated with elevated suicide risk of suicidal thoughts and behaviours within this subpopulation of young adults. However, as findings are predominantly derived from cross-sectional investigations, the directionality of this relationship is not yet clear. While research investigating the psychological processes driving these relationships is in its infancy, preliminary findings suggest that thwarted belongingness, socio-cognitive factors and emotional dysregulation could be partly responsible. Methodological limitations are highlighted and a research agenda suggesting the key directions for future research is proposed. Continued research in this area - employing longitudinal designs, and testing novel theoretically derived hypotheses - will be crucial to the development of suicide prevention and intervention efforts.
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33
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Owen-Smith AA, Ahmedani BK, Peterson E, Simon GE, Rossom RC, Lynch FL, Lu CY, Waitzfelder BE, Beck A, DeBar LL, Sanon V, Maaz Y, Khan S, Miller-Matero LR, Prabhakar D, Frank C, Drake CL, Braciszewski JM. The Mediating Effect of Sleep Disturbance on the Relationship Between Nonmalignant Chronic Pain and Suicide Death. Pain Pract 2019; 19:382-389. [PMID: 30462885 DOI: 10.1111/papr.12750] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/08/2018] [Accepted: 11/14/2018] [Indexed: 11/30/2022]
Abstract
IMPORTANCE Few studies have examined the relationship between nonmalignant chronic pain (NMCP) and suicide death, and even fewer have specifically explored what role sleep disturbance might play in the association between NMCP and suicide death. OBJECTIVE To assess whether sleep disturbance mediates the relationship between NMCP and suicide death. DESIGN This case-control study included 2,674 individuals who died by suicide between 2000 and 2013 (cases) and 267,400 matched individuals (controls). SETTING Eight Mental Health Research Network (MHRN)-affiliated healthcare systems. PARTICIPANTS All cases and matched controls were health plan members for at least 10 months during the year prior to the index date. MAIN OUTCOMES AND MEASURES Sociodemographic data and diagnosis codes for NMCP and sleep disorders were extracted from the MHRN's Virtual Data Warehouse. Suicide mortality was identified using International Statistical Classification of Diseases and Related Health Problems (ICD)-10 codes from official government mortality records matched to health system records. RESULTS After accounting for covariates, there was a significant relationship between NMCP and sleep disturbance; those who were diagnosed with NMCP were more likely to develop subsequent sleep disturbance. Similarly, sleep disturbance was significantly associated with suicide death. Finally, a significant indirect effect of NMCP on suicide death, through sleep disturbance, and a nonsignificant direct effect of NMCP on suicide death provide support for a fully mediated model. CONCLUSIONS AND RELEVANCE There is a need for clinicians to screen for both sleep disturbance and suicidal ideation in NMCP patients and for health systems to implement more widespread behavioral treatments that address comorbid sleep problems and NMCP.
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Affiliation(s)
- Ashli A Owen-Smith
- School of Public Health, Georgia State University, Atlanta, Georgia, U.S.A.,Kaiser Permanente Georgia, Center for Research and Evaluation, Atlanta, Georgia
| | - Brian K Ahmedani
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan, U.S.A.,Behavioral Health Services, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Ed Peterson
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Gregory E Simon
- Kaiser Permanente Washington, Health Research Institute, Seattle, Washington, U.S.A
| | | | - Frances L Lynch
- Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon, U.S.A
| | - Christine Y Lu
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts, U.S.A
| | - Beth E Waitzfelder
- Kaiser Permanente Hawaii, Center for Health Research, Honolulu, Hawaii, U.S.A
| | - Arne Beck
- Kaiser Permanente Colorado, Institute for Health Research, Aurora, Colorado, U.S.A
| | - Lynn L DeBar
- Kaiser Permanente Washington, Health Research Institute, Seattle, Washington, U.S.A
| | - Victoria Sanon
- School of Public Health, Georgia State University, Atlanta, Georgia, U.S.A
| | - Yousef Maaz
- Behavioral Health Services, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Shehryar Khan
- Behavioral Health Services, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Lisa R Miller-Matero
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan, U.S.A.,Behavioral Health Services, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Deepak Prabhakar
- Behavioral Health Services, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Cathy Frank
- Behavioral Health Services, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Christopher L Drake
- Sleep Disorders and Research Center, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Jordan M Braciszewski
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan, U.S.A
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Racine M. Chronic pain and suicide risk: A comprehensive review. Prog Neuropsychopharmacol Biol Psychiatry 2018; 87:269-280. [PMID: 28847525 DOI: 10.1016/j.pnpbp.2017.08.020] [Citation(s) in RCA: 176] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 08/07/2017] [Accepted: 08/23/2017] [Indexed: 12/24/2022]
Abstract
Death by suicide is one of the leading causes of mortality worldwide. Because individuals with chronic pain are at least twice as likely to report suicidal behaviors or to complete suicide, it is of utmost importance to target which risk factors contribute the most to increasing suicidality. This comprehensive review aims to provide an update on research advancements relating to the identification of potential risk factors for suicidality in individuals with chronic pain. Supporting the results of prior reviews, we found robust evidence that chronic pain itself, regardless of type, was an important independent risk factor for suicidality. The only sociodemographic factor found to be associated with suicidality in individuals with chronic pain was being unemployed/disabled. Depressive symptoms, anger problems, harmful habits (e.g. smoking, alcohol misuse, illicit drugs), childhood or adulthood adversities, and family history of depression/suicide were all also identified as general risk factors. Regarding pain-related factors, sleep problems, poorer perceived mental health, concurrent chronic pain conditions, and more frequent episodes of intermittent pain, were all found to be predictors of suicidality. Unexpectedly, pain characteristics (e.g. type, duration, and intensity/severity) and physical status (e.g. pain interference or disability) were not related to suicide risk. We also identified promising new psychosocial factors (e.g. mental defeat, pain catastrophizing, hopelessness, perceived burdensomeness and thwarted belongingness) associated with suicidality outcomes. A large number of these factors are amenable to change through targeted intervention, highlighting the importance of comprehensively assessing chronic pain patients at risk for suicide, while also incorporating a suicide prevention component into chronic pain management programs.
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Affiliation(s)
- Mélanie Racine
- Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.
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Rössler W, Angst J, Ajdacic-Gross V, Haker H, Berrouiguet S, Ujeyl M, Glozier N, Hengartner MP. Sleep Disturbances and Suicidality-A Longitudinal Analysis From a Representative Community Study Over 30 Years. Front Psychiatry 2018; 9:320. [PMID: 30061849 PMCID: PMC6054984 DOI: 10.3389/fpsyt.2018.00320] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 06/26/2018] [Indexed: 11/16/2022] Open
Abstract
Study objectives: Associations between sleep problems and suicidality are increasingly acknowledged, but prospective data from well-controlled long-term community studies are lacking. Methods: We analyzed data from a longitudinal cohort study with n = 591 young adults from Zurich, Switzerland, prospectively followed from 1979 (age 20/21 years) to 2008 (age 49/50 years). Twelve-month prevalence of various mental disorders, socio-environmental confounders and sleep problems were carefully assessed with semi-structured interviews at 7 assessment waves spanning overall a 30-year observation period. Interviews were conducted with the "Structured Psychopathological Interview and Rating of the Social Consequences of Psychological Disturbances for Epidemiology" (SPIKE). The 12-month prevalence of sleep problems was graded according to frequency and associated distress of reported symptoms. 12-month prevalence of suicidality was classified as either mild (transient suicidal ideation) or severe (self-harm, suicide attempts). Results: Concurrently, and fully adjusted for several covariates, including mental disorders, relative to no sleep problems there was an odds ratio (OR) of OR = 1.9 (95% confidence interval 1.4-2.5), OR = 3.3 (2.5-4.4), and OR = 1.9 (1.3-2.8) for mild, moderate and severe sleep problems in association with suicidality. There was no evidence for a prospective effect of broad sleep problems on subsequent suicidality. Mild suicidality, but not severe suicidality, prospectively predicted subsequent broad sleep problems in the fully adjusted multivariate model (adjusted OR = 1.5; 1.1-1.9). Disturbed sleep initiation, a proxy for insomnia, significantly predicted subsequent suicidality (OR = 1.5; 1.1-1.9), whereas mild suicidality, but not severe suicidality, significantly predicted subsequent insomnia (OR = 1.5; 1.1-2.0). Conclusions: Sleep problems and suicidality are longitudinally inter-related, which has important implications for clinical practice. Most importantly, the causal pathways appear to be bi-directional and independent of socio-demographics and concomitant mental disorders. More research is needed to examine the possible biopsychosocial etiological mechanisms linking suicidality to sleep problems.
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Affiliation(s)
- Wulf Rössler
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Universität Zurich, Zurich, Switzerland.,Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin, Berlin, Germany.,Laboratory of Neuroscience, Institute of Psychiatry, Universidade de São Paulo, São Paulo, Brazil
| | - Jules Angst
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Universität Zurich, Zurich, Switzerland
| | - Vladeta Ajdacic-Gross
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Universität Zurich, Zurich, Switzerland
| | - Helene Haker
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Universität Zurich, Zurich, Switzerland
| | - Sofian Berrouiguet
- 5IMT Atlantique, Lab-STICC, UBL, EA 7479 SPURBO, Université de Bretagne Occidentale, Brest, France
| | - Mariam Ujeyl
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin, Berlin, Germany
| | - Nicholas Glozier
- Brain and Mind Centre, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Michael P Hengartner
- Department of Applied Psychology, Zurich University of Applied Sciences, Winterthur, Switzerland
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The aetiology of borderline personality disorder (BPD): contemporary theories and putative mechanisms. Curr Opin Psychol 2017; 21:105-110. [PMID: 29182951 DOI: 10.1016/j.copsyc.2017.10.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 10/27/2017] [Accepted: 10/31/2017] [Indexed: 12/11/2022]
Abstract
This article presents an overview of current knowledge regarding the aetiology of Borderline Personality Disorder (BPD). It begins with a brief synopsis of early research and theory, and discusses how changing conceptualisations of BPD have impacted on our aetiological knowledge. Contemporary theories are described and presented within a developmental psychopathology framework. Deficient co-regulation and social communication in infancy are purported to underpin emotional dysregulation and social cognition deficits across development. These mechanisms are further potentiated by maladaptive social experiences in a series of positive feedback loops. Prospective research provides preliminary evidence for the reciprocal (or mediating) effects of maladaptive experiences and childhood dysregulation. Moving forward, cohort studies may incorporate neurobiological assessments to examine the biological systems underpinning phenotypic (e.g., impulsivity, disturbed relatedness) covariation.
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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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Dixon-Gordon KL, Conkey LC, Whalen DJ. Recent advances in understanding physical health problems in personality disorders. Curr Opin Psychol 2017; 21:1-5. [PMID: 28915400 DOI: 10.1016/j.copsyc.2017.08.036] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 08/28/2017] [Accepted: 08/29/2017] [Indexed: 11/16/2022]
Abstract
Personality disorders are associated with a range of adverse health outcomes, contributing to the high healthcare utilization seen in patients with these disorders. A growing literature supports a robust association of personality disorders and health problems. The primary aim of this article is to summarize the most recent research documenting the associations between personality disorders and health conditions. Extending past reviews, we discuss the association of personality disorders with chronic physical illnesses, sleep disturbances, pain conditions, and obesity. We provide recommendations for future research in this area.
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Affiliation(s)
- Katherine L Dixon-Gordon
- University of Massachusetts Amherst, Department of Psychological and Brain Sciences, 135 Hicks Way, Amherst, MA 01003, USA.
| | - Lindsey C Conkey
- University of Massachusetts Amherst, Department of Psychological and Brain Sciences, 135 Hicks Way, Amherst, MA 01003, USA
| | - Diana J Whalen
- Washington University School of Medicine, Department of Psychiatry, Box 8511, St. Louis, MO 63110, USA
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Sleep Problems in Childhood and Borderline Personality Disorder Symptoms in Early Adolescence. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2017; 45:193-206. [PMID: 27108717 PMCID: PMC5219009 DOI: 10.1007/s10802-016-0158-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Sleep disorders, such as insomnia and nightmares, are commonly associated with Borderline Personality Disorder (BPD) in adulthood. Whether nightmares and sleep-onset and maintenance problems predate BPD symptoms earlier in development is unknown. We addressed this gap in the literature using data from the Avon Longitudinal Study of Parents and Children (ALSPAC). Participants included 6050 adolescents (51.4 % female) who completed the UK Childhood Interview for DSM-IV BPD at 11 to 12 years of age. Nightmares and sleep onset and maintenance problems were prospectively assessed via mother report when children were 2.5, 3.5, 4.8 and 6.8 years of age. Psychopathological (i.e., emotional temperament; psychiatric diagnoses; and emotional and behavioural problems) and psychosocial (i.e., abuse, maladaptive parenting, and family adversity) confounders were assessed via mother report. In logistic regressions, persistent nightmares (i.e., regular nightmares at 3 or more time-points) were significantly associated with BPD symptoms following adjustment for sleep onset and maintenance problems and all confounders (Adjusted Odds Ratio = 1.62; 95 % Confidence Interval = 1.12 to 2.32). Persistent sleep onset and maintenance problems were not significantly associated with BPD symptoms. In path analysis controlling for all associations between confounders, persistent nightmares independently predicted BPD symptoms (Probit co-efficient [β] = 0.08, p = 0.013). Emotional and behavioural problems significantly mediated the association between nightmares and BPD (β =0.016, p < 0.001), while nightmares significantly mediated associations between emotional temperament (β = 0.001, p = 0.018), abuse (β = 0.015, p = 0.018), maladaptive parenting (β = 0.002, p = 0.021) and subsequent BPD. These findings tentatively support that childhood nightmares may potentially increase the risk of BPD symptoms in early adolescence via a number of aetiological pathways. If replicated, the current findings could have important implications for early intervention, and assist clinicians in the identification of children at risk of developing BPD.
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Bainter SA. Bayesian Estimation for Item Factor Analysis Models with Sparse Categorical Indicators. MULTIVARIATE BEHAVIORAL RESEARCH 2017; 52:593-615. [PMID: 28715231 PMCID: PMC6062000 DOI: 10.1080/00273171.2017.1342203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Psychometric models for item-level data are broadly useful in psychology. A recurring issue for estimating item factor analysis (IFA) models is low-item endorsement (item sparseness), due to limited sample sizes or extreme items such as rare symptoms or behaviors. In this paper, I demonstrate that under conditions characterized by sparseness, currently available estimation methods, including maximum likelihood (ML), are likely to fail to converge or lead to extreme estimates and low empirical power. Bayesian estimation incorporating prior information is a promising alternative to ML estimation for IFA models with item sparseness. In this article, I use a simulation study to demonstrate that Bayesian estimation incorporating general prior information improves parameter estimate stability, overall variability in estimates, and power for IFA models with sparse, categorical indicators. Importantly, the priors proposed here can be generally applied to many research contexts in psychology, and they do not impact results compared to ML when indicators are not sparse. I then apply this method to examine the relationship between suicide ideation and insomnia in a sample of first-year college students. This provides an important alternative for researchers who may need to model items with sparse endorsement.
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Affiliation(s)
- Sierra A Bainter
- a University of Miami
- b University of North Carolina at Chapel Hill
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41
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Lichstein KL. Insomnia identity. Behav Res Ther 2017; 97:230-241. [PMID: 28858698 DOI: 10.1016/j.brat.2017.08.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 06/29/2017] [Accepted: 08/07/2017] [Indexed: 01/31/2023]
Abstract
Insomnia identity refers to the conviction that one has insomnia, and this sleep complaint can be measured independently of sleep. Conventional wisdom predicts that sleep complaints are synchronous with poor sleep, but crossing the presence or absence of poor sleep with the presence or absence of insomnia identity reveals incongruity with expected patterns. This review of existing research on insomnia identity processes and influence finds that about one-fourth of the population are uncoupled sleepers, meaning there is an uncoupling of sleep and sleep appraisal, and daytime impairment accrues more strongly to those who endorse an insomnia identity. Research supports the conclusion that there is a cost to pathologizing sleep. Individuals claiming an insomnia identity, regardless of sleep status, are at greater risk for a range of sequelae including self-stigma, depression, suicidal ideation, anxiety, hypertension, and fatigue. A broad research agenda is proposed with hypotheses about the sources, clinical mechanisms, and clinical management of insomnia identity.
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Abstract
PURPOSE We aimed to systematically review recent publications (01/2014-03/2017) with longitudinal designs allowing for the assessment of the prospective risk of insomnia on new onset mental illness in key conditions: anxiety, depression, bipolar disorder, posttraumatic stress disorder, substance use disorders, and suicide. RECENT FINDINGS A literature yielded 1859 unique articles meeting search criteria were identified; 16 articles met all selection criteria and reviewed with some studies reporting on more than one mental health outcome. Overall, the review supports the hypothesis that insomnia is a predictor of subsequent mental illness. The evidence is strongest for an insomnia-depression relationship. The new studies identified and reviewed add to a modest number of publications supporting a prospective role of insomnia in new onset mental illness in three areas: anxiety disorders, bipolar disorder, and suicide. The few selected new studies focused on SUD were mixed, and no studies focused on PTSD were identified that met the selection criteria. Treatment of insomnia may also be a preventive mental health strategy.
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Mirsu-Paun A, Jaussent I, Komar G, Courtet P, Lopez-Castroman J. Sleep complaints associated with wish to die after a suicide crisis-an exploratory study. J Sleep Res 2017; 26:726-731. [DOI: 10.1111/jsr.12537] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 03/12/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Anca Mirsu-Paun
- ‘Francisc Rainer’ Institute for Anthropology of the Romanian Academy; Bucharest Romania
| | - Isabelle Jaussent
- Inserm u1061; Montpellier France
- Universitéde Montpellier; Montpellier France
| | | | - Philippe Courtet
- Universitéde Montpellier; Montpellier France
- FondaMental Foundation; Créteil France
- Department of Psychiatric Emergency and Post-Acute Care; Lapeyronie Hospital; Montpellier France
| | - Jorge Lopez-Castroman
- Inserm u1061; Montpellier France
- Universitéde Montpellier; Montpellier France
- Department of Adult Psychiatry; Nimes University Hospital France
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Examining the role of psychological factors in the relationship between sleep problems and suicide. Clin Psychol Rev 2017; 54:1-16. [PMID: 28371648 PMCID: PMC5434037 DOI: 10.1016/j.cpr.2017.03.009] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 11/29/2016] [Accepted: 03/27/2017] [Indexed: 01/08/2023]
Abstract
We sought to conduct the first systematic review of empirical evidence investigating the role of psychological factors in the relationship between sleep problems and suicidal thoughts and behaviours. Twelve studies were identified which examined psychological factors grouped into four categories of cognitive appraisals, psychosocial factors, emotion regulation strategies, and risk behaviours. Although there was substantial heterogeneity across studies with respect to measurement, sampling, and analysis, preliminary evidence indicated that negative cognitive appraisals, perceived social isolation, and unhelpful emotion regulation strategies may contribute to the association between sleep problems and suicidal thoughts and behaviours. Given that findings in this area are currently restricted to studies with cross-sectional designs, the directionality of the interrelationships between these psychological factors, sleep problems and suicidality, remains unclear. We integrate the findings of our review with contemporary psychological models of suicidal behaviour to develop a clear research agenda. Identified pathways should now be tested with longitudinal and experimental designs. In addition, a more thorough investigation of the complexities of sleep, psychological factors, and suicidal thoughts and behaviours is crucial for the development of targeted psychological interventions. Systematic review of the role of psychological factors in sleep/suicide relationships Review findings integrated with suicide theory to define a clear research agenda. Reliance on cross-sectional designs limits interpretation of directionality of pathways. Identified pathways should be investigated with longitudinal and experimental designs.
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45
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The sleep phenotype of Borderline Personality Disorder: A systematic review and meta-analysis. Neurosci Biobehav Rev 2017; 73:48-67. [DOI: 10.1016/j.neubiorev.2016.12.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 11/22/2016] [Accepted: 12/09/2016] [Indexed: 12/30/2022]
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Aubert E, Jaussent I, Olié E, Ducasse D, Azorin JM, Bellivier F, Belzeaux R, Bougerol T, Etain B, Gard S, Henry C, Kahn JP, Leboyer M, Loftus J, Passerieux C, Lopez-Castroman J, Courtet P. Effect of early trauma on the sleep quality of euthymic bipolar patients. J Affect Disord 2016; 206:261-267. [PMID: 27517134 DOI: 10.1016/j.jad.2016.07.045] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 06/20/2016] [Accepted: 07/09/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Poor quality of sleep is frequent in euthymic bipolar patients and conveys worse clinical outcomes. We investigated the features of euthymic bipolar patients associated with poor sleep quality, with a focus on the effect of childhood trauma. METHOD 493 euthymic patients with DSM-IV-defined bipolar disorders were recruited in FondaMental Advanced Centers of Expertize for Bipolar Disorders (FACE-BD) between 2009 and 2014. Clinical variables were recorded. Subjective sleep quality and history of childhood trauma were respectively measured by the Pittsburgh Sleep Quality Index (PSQI) and the Childhood Trauma Questionnaire (CTQ). RESULTS Poor sleepers were older, less professionally active, had significantly higher anxiety levels, took more anxiolytic drugs and did endorse more suicide attempts and suicidal ideas than good sleepers after adjusting for anxiety levels and age. Emotional abuse was associated with poor sleep quality after adjustment for BMI, age, professional activity, and bipolar disorders (BD) type (OR=1.83; 95% CI [1.30; 3.10]; p=0.02). However, this association was lost after adjustment for anxiety levels, anxiolytic treatment and suicide ideation/attempts. LIMITATIONS The main limitation was the type of sleep assessment, which only measured the subjective part of sleep complaints. CONCLUSION A history of emotional abuse might underlie sleep problems in many bipolar patients but anxiety seems to act as a confounding factor in this relationship. New studies are needed to elucidate the role of childhood maltreatment on poor sleep among bipolar patients.
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Affiliation(s)
- E Aubert
- CHU Montpellier, Hôpital Lapeyronie, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France; Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France.
| | - I Jaussent
- Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France
| | - E Olié
- CHU Montpellier, Hôpital Lapeyronie, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France; Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France; FondaMental Foundation, Créteil, France
| | - D Ducasse
- CHU Montpellier, Hôpital Lapeyronie, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France; Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France; FondaMental Foundation, Créteil, France
| | - J M Azorin
- FondaMental Foundation, Créteil, France; AP HM, Psychiatric Pole, Sainte Marguerite, Marseille, France
| | - F Bellivier
- FondaMental Foundation, Créteil, France; Hospital Saint-Louis - Lariboisière - Fernand Widal, AP-HP, Paris, France
| | - R Belzeaux
- FondaMental Foundation, Créteil, France; AP HM, Psychiatric Pole, Sainte Marguerite, Marseille, France
| | - T Bougerol
- FondaMental Foundation, Créteil, France; Academic Hospital of Grenoble, Grenoble, France
| | - B Etain
- FondaMental Foundation, Créteil, France; Université Paris-Est, Hopital Chenevier and AP-HP, Créteil, France
| | - S Gard
- FondaMental Foundation, Créteil, France; Charles Perrens Hospital, Bordeaux, France
| | - C Henry
- FondaMental Foundation, Créteil, France; Université Paris-Est, Hopital Chenevier and AP-HP, Créteil, France
| | - J P Kahn
- FondaMental Foundation, Créteil, France; Brabois Hospital, Academic Hospital of Nancy, Vandoeuvre Les Nancy, France
| | - M Leboyer
- FondaMental Foundation, Créteil, France; Université Paris-Est, Hopital Chenevier and AP-HP, Créteil, France
| | - J Loftus
- FondaMental Foundation, Créteil, France; Department of Psychiatry, Princesse-Grace Hospital, Monaco
| | - C Passerieux
- FondaMental Foundation, Créteil, France; Academic Hospital of Versailles, Le Chesnay, France
| | - J Lopez-Castroman
- CHU Montpellier, Hôpital Lapeyronie, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France; Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France
| | - Ph Courtet
- CHU Montpellier, Hôpital Lapeyronie, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France; Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France; FondaMental Foundation, Créteil, France
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Abstract
OBJECTIVE Sleep problems are associated with increased risk of suicide, independent of depression. This analysis explores narrative accounts of the role of sleep in relation to suicidal thoughts and behaviours. DESIGN Qualitative study, based on in-depth semistructured interviews which were analysed with an inductive, latent thematic analysis. PARTICIPANTS A maximum variation sample of 18 people with experience of a major depressive episode, and suicidal thoughts and behaviours. SETTING Primary care, North West England. RESULTS Respondents emphasised the importance of sleep for recovery and management of their mental well-being. Moreover, three inter-related pathways were identified, whereby beliefs about sleep contributed to suicidal thoughts and behaviours. First, being awake during the biological night heightened risk of suicidal behaviours, as this was perceived to be an opportune time for a suicide attempt due to the decreased chances that a friend of family member would intervene during a suicide attempt. Additionally, the reduction in available support at night added to suicide risk. Second, failure to achieve good sleep was perceived to make life harder through contributing to core features of depression, such as negative thinking, attention difficulties and inactivity. Third, sleep acted as an alternative to suicide, by providing an escape from problems, including mental health problems, in waking life. However, this desire to sleep to escape was associated with excessive daytime sleeping, which subsequently may reinforce disturbed sleeping patterns. CONCLUSIONS Sleep problems should be an important treatment target when working with suicidal clients. More broadly, night-time service provision should be considered when developing suicide prevention initiatives.
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Affiliation(s)
| | - Patricia Gooding
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Simon D Kyle
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Daniel Pratt
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Sarah Peters
- School of Health Sciences, University of Manchester, Manchester, UK
- Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
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Huỳnh C, Guilé JM, Breton JJ, Godbout R. Sleep-Wake Patterns of Adolescents with Borderline Personality Disorder and Bipolar Disorder. Child Psychiatry Hum Dev 2016; 47:202-14. [PMID: 26003420 DOI: 10.1007/s10578-015-0557-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Sleep-wake patterns are rarely examined in adolescents with borderline personality disorder (BPD) or bipolar disorder (BD). Within a developmental perspective, this study explores the sleep-wake cycle of adolescents aged 12-17 years with BPD or BD and healthy controls (HC) during periods with and without entrainment by school/work schedules. Eighteen euthymic BPD, six euthymic BD, and 20 HC adolescents wore wrist actigraphy during nine consecutive days to assess sleep-wake patterns. During school/work days, BPD adolescents spent more time awake when they were in bed compared to HC and BD adolescents (p = 0.039). On schedule-free days, BPD and BD youths spent more time in bed compared to HC adolescents (p = 0.015). BPD adolescents woke up over 1 h later compared to HC (p = 0.003). Total sleep time was more variable between nights in BPD adolescents compared to the HC group (p = 0.031). Future research should explore if sleep-wake pattern disruptions are a cause or a consequence of BPD symptomatology in adolescents. Addressing sleep-wake pattern during clinical assessment and treatment of BPD adolescents may potentially reduce their symptoms; this therapeutic effect still needs to be evaluated.
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Affiliation(s)
- Christophe Huỳnh
- Sleep Laboratory and Clinic, Rivière-des-Prairies Hospital, 7070 Boul. Perras, Montréal, QC, H1E 1A4, Canada
- Mood Disorders Clinic and Research Branch, Rivière-des-Prairies Hospital, Montréal, QC, Canada
- Department of Psychiatry, Université de Montréal, Montréal, QC, Canada
- Research Centre, Rivière-des-Prairies Hospital and Institut Universitaire en Santé Mentale de Montréal, Montréal, QC, Canada
| | - Jean-Marc Guilé
- Mood Disorders Clinic and Research Branch, Rivière-des-Prairies Hospital, Montréal, QC, Canada
- Department of Psychiatry, Université de Montréal, Montréal, QC, Canada
| | - Jean-Jacques Breton
- Mood Disorders Clinic and Research Branch, Rivière-des-Prairies Hospital, Montréal, QC, Canada
- Department of Psychiatry, Université de Montréal, Montréal, QC, Canada
- Research Centre, Rivière-des-Prairies Hospital and Institut Universitaire en Santé Mentale de Montréal, Montréal, QC, Canada
| | - Roger Godbout
- Sleep Laboratory and Clinic, Rivière-des-Prairies Hospital, 7070 Boul. Perras, Montréal, QC, H1E 1A4, Canada.
- Department of Psychiatry, Université de Montréal, Montréal, QC, Canada.
- Research Centre, Rivière-des-Prairies Hospital and Institut Universitaire en Santé Mentale de Montréal, Montréal, QC, Canada.
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Koyanagi A, Stickley A. The Association between Sleep Problems and Psychotic Symptoms in the General Population: A Global Perspective. Sleep 2015; 38:1875-85. [PMID: 26085291 PMCID: PMC4667394 DOI: 10.5665/sleep.5232] [Citation(s) in RCA: 130] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 04/24/2015] [Indexed: 12/18/2022] Open
Abstract
STUDY OBJECTIVES To assess the prevalence of sleep problems and their association with psychotic symptoms using a global database. DESIGN Community-based cross-sectional study. SETTING Data were analyzed from the World Health Organization's World Health Survey (WHS), a population-based survey conducted in 70 countries between 2002 and 2004. PATIENTS OR PARTICIPANTS 261,547 individuals aged ≥ 18 years from 56 countries. INTERVENTIONS N/A. MEASUREMENTS AND RESULTS The presence of psychotic symptoms in the past 12 months was established using 4 questions pertaining to positive symptoms from the psychosis screening module of the Composite International Diagnostic Interview. Sleep problems referred to severe or extreme sleep problems in the past 30 days. Multivariable logistic regression was used to estimate the associations. The overall prevalence of sleep problems was 7.6% and ranged from 1.6% (China) to 18.6% (Morocco). Sleep problems were associated with significantly higher odds for at least one psychotic symptom in the vast majority of countries. In the pooled sample, after adjusting for demographic factors, alcohol consumption, smoking, and chronic medical conditions, having sleep problems resulted in an odds ratio (OR) for at least one psychotic symptom of 2.41 (95% confidence interval [CI] 2.18-2.65). This OR was 1.59 (1.40-1.81) when further adjusted for anxiety and depression. CONCLUSIONS A strong association between sleep problems and psychotic symptoms was observed globally. These results have clinical implications and serve as a basis for future studies to elucidate the causal association between psychotic symptoms and sleep problems.
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Affiliation(s)
- Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
- The Stockholm Centre for Health and Social Change (SCOHOST), Södertörn University, Huddinge, Sweden
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Andrew Stickley
- The Stockholm Centre for Health and Social Change (SCOHOST), Södertörn University, Huddinge, Sweden
- Department of Human Ecology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Child and Adolescent Mental Health, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
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Abstract
OBJECTIVES To examine the hypothesis that respondents with any of three specific sleep patterns would have a higher likelihood of suicidality than those without reports of these patterns in Korean adolescents. SETTING Data from the 2011-2013 Korea Youth Risk Behavior Web-based Survey were used. PARTICIPANTS 191,642 subjects were included. The survey's target population was students in grades 7 through 12 in South Korea. INDEPENDENT VARIABLE Sleep time. PRIMARY AND SECONDARY OUTCOME MEASURES Suicidal thoughts, plans and attempts. RESULTS The odds of suicidal thoughts in subjects with very short or long time in bed were 1.487-fold higher (95% CI 1.219 to 1.815) or 0.611-fold lower (95% CI 0.460 to 0.811), respectively, than for subjects with 7 h/day in bed; the odds were similar for suicidal plans. The odds of suicidal thoughts in subjects with early or late awakening times were 1.231-fold higher (95% CI 1.050 to 1.442) or 1.528-fold lower (95% CI 1.000 to 2.334), respectively, than for subjects with 7 h/day in bed; these odds were lower for suicidal plans and attempts. The odds of suicidal thoughts in subjects with early bedtime were 1.748-fold higher (95% CI 1.302 to 2.346), the odds of suicidal plans in people with an early bedtime were 2.494-fold higher (95% CI 1.671 to 3.722) and the odds of suicide attempts in subjects with late bedtime were 1.313-fold higher (95% CI 1.005 to 1.716) than for subjects with a bedtime of 23:00. CONCLUSIONS The sleep-related time is associated with suicide-related behaviours in Korean adolescents. Multilateral approaches are needed to identify the greatest risk factors for suicidal behaviours.
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Affiliation(s)
- Jae-Hyun Kim
- Department of Public Health, Graduate School, Yonsei University, Seoul, Korea
- Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Gyu Lee
- Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Korea
- Department of Hospital Management, Graduate School of Public Health, Yonsei University, Seoul, Korea
| | - Ki-Bong Yoo
- Department of Healthcare Management, Eulji University, Sungnam, Korea
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