title: Association of poor subjective sleep quality with risk for death by suicide during a 10-year period: a longitudinal, population-based study of late life.
abstract: OBJECTIVE
  Older adults have high rates of sleep disturbance, die by suicide at disproportionately higher rates compared with other age groups, and tend to visit their physician in the weeks preceding suicide death. To our knowledge, to date, no study has examined disturbed sleep as an independent risk factor for late-life suicide.
  
  
  OBJECTIVE
  To examine the relative independent risk for suicide associated with poor subjective sleep quality in a population-based study of older adults during a 10-year observation period.
  
  
  METHODS
  A longitudinal case-control cohort study of late-life suicide among a multisite, population-based community sample of older adults participating in the Established Populations for Epidemiologic Studies of the Elderly. Of 14 456 community older adults sampled, 400 control subjects were matched (on age, sex, and study site) to 20 suicide decedents.
  
  
  METHODS
  Primary measures included the Sleep Quality Index, the Center for Epidemiologic Studies-Depression Scale, and vital statistics.
  
  
  RESULTS
  Hierarchical logistic regressions revealed that poor sleep quality at baseline was significantly associated with increased risk for suicide (odds ratio [OR], 1.39; 95% CI, 1.14-1.69; P < .001) by 10 follow-up years. In addition, 2 sleep items were individually associated with elevated risk for suicide at 10-year follow-up: difficulty falling asleep (OR, 2.24; 95% CI, 1.27-3.93; P < .01) and nonrestorative sleep (OR, 2.17; 95% CI, 1.28-3.67; P < .01). Controlling for depressive symptoms, baseline self-reported sleep quality was associated with increased risk for death by suicide (OR, 1.30; 95% CI, 1.04-1.63; P < .05).
  
  
  CONCLUSIONS
  Our results indicate that poor subjective sleep quality is associated with increased risk for death by suicide 10 years later, even after adjustment for depressive symptoms. Disturbed sleep appears to confer considerable risk, independent of depressed mood, for the most severe suicidal behaviors and may warrant inclusion in suicide risk assessment frameworks to enhance detection of risk and intervention opportunity in late life.
authors.affiliation: Stanford Mood Disorders Center, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Bernert
authors.affiliation: Department of Psychiatry, University of Iowa, Iowa City.
authors.forename: Carolyn L
authors.initials: CL
authors.lastname: Turvey
authors.affiliation: Office for Aging Research and Health Services, University of Rochester Medical Center, Rochester, New York4Center for the Study and Prevention of Suicide, Department of Psychiatry, University of Rochester, Rochester, New York.
authors.forename: Yeates
authors.initials: Y
authors.lastname: Conwell
authors.affiliation: Department of Psychology, Florida State University, Tallahassee.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Joiner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D012893:Sleep Wake Disorders / Q000150:complications* / Q000523:psychology; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology