title: Sleep problems and suicidality in the National Comorbidity Survey Replication.
abstract: 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.
authors.affiliation: University of Michigan, Department of Psychiatry, 4250 Plymouth Road, Ann Arbor, MI 48109-5763, USA. mwojnar@umich.edu
authors.forename: Marcin
authors.initials: M
authors.lastname: Wojnar
authors.forename: Mark A
authors.initials: MA
authors.lastname: Ilgen
authors.forename: Julita
authors.initials: J
authors.lastname: Wojnar
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: McCammon
authors.forename: Marcia
authors.initials: M
authors.lastname: Valenstein
authors.forename: Kirk J
authors.initials: KJ
authors.lastname: Brower
mesh_terms: 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
references.citation: Gen Hosp Psychiatry. 1997 Jul;19(4):245-50
references.pmid: 9327253
references.citation: J Psychiatr Res. 2005 Mar;39(2):151-9
references.pmid: 15589563
references.citation: Int J Methods Psychiatr Res. 2004;13(2):93-121
references.pmid: 15297906
references.citation: JAMA. 1989 Sep 15;262(11):1479-84
references.pmid: 2769898
references.citation: J Abnorm Psychol. 2006 Aug;115(3):616-23
references.pmid: 16866602
references.citation: J Abnorm Psychol. 2004 Nov;113(4):582-91
references.pmid: 15535790
references.citation: Arch Gen Psychiatry. 1999 Jul;56(7):617-26
references.pmid: 10401507
references.citation: Am J Geriatr Psychiatry. 2002 Jul-Aug;10(4):398-406
references.pmid: 12095899
references.citation: Sleep. 2005 Sep;28(9):1135-41
references.pmid: 16268383
references.citation: J Occup Environ Med. 2003 Dec;45(12):1257-66
references.pmid: 14665811
references.citation: Sleep. 2004 Nov 1;27(7):1351-8
references.pmid: 15586788
references.citation: J Affect Disord. 2007 Mar;98(3):267-70
references.pmid: 16938351
references.citation: Biol Psychiatry. 1996 Mar 15;39(6):411-8
references.pmid: 8679786
references.citation: J Clin Psychiatry. 1997 Jun;58(6):249-51
references.pmid: 9228889
references.citation: Prim Care Companion J Clin Psychiatry. 2007;9(5):338-45
references.pmid: 17998952
references.citation: Int J Methods Psychiatr Res. 2004;13(2):60-8
references.pmid: 15297904
references.citation: Psychosomatics. 1999 Jan-Feb;40(1):18-27
references.pmid: 9989117
references.citation: JAMA. 2005 May 25;293(20):2487-95
references.pmid: 15914749
references.citation: Ann Clin Psychiatry. 2001 Jun;13(2):93-101
references.pmid: 11534931
references.citation: Curr Opin Psychiatry. 2006 May;19(3):288-93
references.pmid: 16612215
references.citation: MMWR Morb Mortal Wkly Rep. 2008 Feb 29;57(8):200-3
references.pmid: 18305450
references.citation: Sleep. 2001 Nov 1;24(7):844-7
references.pmid: 11683487
references.citation: Sleep. 2008 Apr;31(4):473-80
references.pmid: 18457234
references.citation: J Affect Disord. 2007 Jan;97(1-3):203-9
references.pmid: 16854469
references.citation: Am J Drug Alcohol Abuse. 2006;32(1):111-20
references.pmid: 16450646
references.citation: Biol Psychiatry. 2006 Dec 15;60(12):1364-71
references.pmid: 16952333
references.citation: Int J Methods Psychiatr Res. 2004;13(2):69-92
references.pmid: 15297905
references.citation: Sleep. 2007 Feb;30(2):213-8
references.pmid: 17326547
references.citation: Psychiatry Res. 2007 Oct 31;153(2):131-6
references.pmid: 17658614
references.citation: Ann Epidemiol. 2007 Dec;17(12):940-7
references.pmid: 17937993
references.citation: Sleep. 2007 Jul;30(7):873-80
references.pmid: 17682658
references.citation: Sleep Med. 2005 Nov;6(6):549-53
references.pmid: 15994126
references.citation: Alcohol Clin Exp Res. 2006 Dec;30(12):1992-9
references.pmid: 17117964
references.citation: Sleep. 2007 Jan;30(1):91-5
references.pmid: 17310869
references.citation: Am J Psychiatry. 1990 Sep;147(9):1189-94
references.pmid: 2104515
references.citation: Am J Psychiatry. 2001 Mar;158(3):399-404
references.pmid: 11229980
references.citation: J Consult Clin Psychol. 2008 Feb;76(1):84-91
references.pmid: 18229986
references.citation: J Affect Disord. 2008 Nov;111(1):83-93
references.pmid: 18395267
references.citation: Psychol Med. 2006 May;36(5):575-86
references.pmid: 16420727
references.citation: Arch Intern Med. 2000 May 22;160(10):1522-6
references.pmid: 10826468