Sleep problems and suicidality in the National Comorbidity Survey Replication.
OBJECTIVE
Links between sleep problems and suicidality have been frequently described in clinical samples; however, this issue has not been well-studied in the general population. Using data from a nationally representative survey, we examined the association between self-reported sleep difficulties and suicidality in the United States.


METHODS
The WHO Composite International Diagnostic Interview was used to assess sleep problems and suicidality in the National Comorbidity Survey Replication (NCS-R). Relationships between three measures of sleep (difficulty initiating sleep, maintaining sleep, early morning awaking), and suicidal thoughts, plans, and attempts were assessed in logistic regression analyses, while controlling for demographic characteristics, 12-month diagnoses of mood, anxiety and substance use disorders, and chronic health conditions.


RESULTS
In multivariate models, the presence of any of these sleep problems was significantly related to each measure of suicidality, including suicidal ideation (OR=2.1), planning (OR=2.6), and suicide attempt (OR=2.5). Early morning awakening was associated with suicidal ideation (OR=2.0), suicide planning (OR=2.1), and suicide attempt (OR=2.7). Difficulty initiating sleep was a significant predictor of suicidal ideation and planning (ORs: 1.9 for ideation; 2.2 for planning), while difficulty maintaining sleep during the night was a significant predictor of suicidal ideation and suicide attempts (ORs: 2.0 for ideation; 3.0 for attempt).


CONCLUSIONS
Among community residents, chronic sleep problems are consistently associated with greater risk for suicidality. Efforts to develop comprehensive models of suicidality should consider sleep problems as potentially independent indicators of risk.
Wojnar
Marcin
M
University of Michigan, Department of Psychiatry, 4250 Plymouth Road, Ann Arbor, MI 48109-5763, USA. mwojnar@umich.edu
Ilgen
Mark A
MA
Wojnar
Julita
J
McCammon
Ryan J
RJ
Valenstein
Marcia
M
Brower
Kirk J
KJ
D000293:Adolescent; D000328:Adult; D015897:Comorbidity; D005260:Female; D006306:Health Surveys; D006801:Humans; D007406:Interview, Psychological / Q000379:methods; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D012650:Self Disclosure; D012893:Sleep Wake Disorders / Q000453:epidemiology* / Q000523:psychology; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
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