Sleep disturbances linked with suicidal behavior in the mentally ill

Suicide is a global crisis. Over one million people die each year by taking their own lives. In the United States, suicide ranks among the top ten causes of death. Failed attempts are more prevalent than the act itself (10 to 25 occurrences for each death) and come with their own grave consequences in the form of disability and/or negative social responses.

People with mental illnesses have a high risk of suicidal ideation and attempts in comparison to the general public. A symptom of many psychological conditions is disordered sleeping (insomnia, parasomnia, etc.), which is known to be linked with suicide in healthy people. A recent study shows that suicidal behaviors are also associated with sleep disturbances in people with mental illnesses, presenting a potential target for diagnosis and/or treatment.

Published in a 2016 issue of the Journal of Psychiatric Research, this investigation utilized a subset of data obtained from the National Comorbidity Survey Replication (NCSR), which itself was part of a larger survey designed to collect information about the prevalence and characteristics of mental disorders in the public. Responses from a total of 5701 participants were included in the analysis.

Those with mental illnesses were categorized into one of six groups: bipolar disorders (BD), depression, anxiety, substance related disorders (SRD), early life disorders (ELD) and eating disorders (ED). Suicidal behaviors were identified and coded as being thoughts only (ideation), plans or attempts. A variety of sleep related issues (problems getting to sleep, staying asleep, waking, etc.) were counted as disturbances.

Without accounting for mental illness, regression analysis showed that people who experienced disruptions in sleep had significantly higher odds of developing suicidal thoughts. People with mental illnesses were more likely to have suicidal ideations, plans and attempts at any time. As predicted, suicidal thoughts were significantly higher in mentally ill people who had disturbed sleep. All categorized types of illness displayed this association, ranging from an odds ratio of 2.2 for depression to 8.9 for bipolar disorders. Finally, suicidal plans and attempts were associated with sleep disturbances for people with any of the identified mental illnesses, but not for those without.

The results of this study, which was performed by a research team led by Brendon Stubbs, support the role of sleep disturbances as a risk factor for suicidal behaviors in people with any of a wide range of mental illnesses. Monitoring sleep may be an effective way to identify increasing risk and ideally prevent impending suicidal behaviors. The treatment of sleep disruptions could be a valid means for improving mental health in the psychologically ill in other ways as well, but more research will be required to better clarify the relationship.