title: DEPRESSION MEDIATES THE RELATION OF INSOMNIA SEVERITY WITH SUICIDE RISK IN THREE CLINICAL SAMPLES OF U.S. MILITARY PERSONNEL.
abstract: BACKGROUND
  A growing body of empirical research suggests insomnia severity is directly related to suicide ideation, attempts, and death in nonmilitary samples, even when controlling for depression and other suicide risk factors. Few studies have explored this relationship in U.S. military personnel.
  
  
  METHODS
  The present study entailed secondary data analyses examining the associations of insomnia severity with suicide ideation and attempts in three clinical samples: Air Force psychiatric outpatients (n = 158), recently discharged Army psychiatric inpatients (n = 168), and Army psychiatric outpatients (n = 54). Participants completed the Beck Scale for Suicide Ideation, the Beck Depression Inventory-II or Patient Health Questionnaire-9, the Insomnia Severity Index, and the Posttraumatic Stress Disorder Checklist at baseline; two samples also completed these measures during follow-up.
  
  
  RESULTS
  Sleep disturbance was associated with concurrent (β's > 0.21; P's < 0.059) and prospective (β's > 0.39; P's < 0.001) suicide ideation in all three samples. When adjusting for age, gender, depression, and posttraumatic stress, insomnia severity was no longer directly associated with suicide ideation either concurrently (β's < 0.19; P's > 0.200) or prospectively (β's < 0.26; P's > 0.063), but depression was (β's > 0.22; P's < 0.012). Results of a latent difference score mediation model indicated that depression mediated the relation of insomnia severity with suicide ideation.
  
  
  CONCLUSIONS
  Across three clinical samples of military personnel, depression explained the relationship between insomnia severity and suicide risk.
authors.affiliation: National Center for Veterans Studies, The University of Utah, Salt Lake City, Utah.|The University of Utah, Salt Lake City, Utah.
authors.forename: Craig J
authors.initials: CJ
authors.lastname: Bryan
authors.affiliation: National Center for Veterans Studies, The University of Utah, Salt Lake City, Utah.|The University of Utah, Salt Lake City, Utah.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Gonzales
authors.affiliation: National Center for Veterans Studies, The University of Utah, Salt Lake City, Utah.|The University of Memphis, Memphis, Tennessee.
authors.forename: M David
authors.initials: MD
authors.lastname: Rudd
authors.affiliation: National Center for Veterans Studies, The University of Utah, Salt Lake City, Utah.|The University of Utah, Salt Lake City, Utah.
authors.forename: AnnaBelle O
authors.initials: AO
authors.lastname: Bryan
authors.affiliation: National Center for Veterans Studies, The University of Utah, Salt Lake City, Utah.|The University of Utah, Salt Lake City, Utah.
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Clemans
authors.affiliation: National Center for Veterans Studies, The University of Utah, Salt Lake City, Utah.|The University of Utah, Salt Lake City, Utah.
authors.forename: Bobbie
authors.initials: B
authors.lastname: Ray-Sannerud
authors.affiliation: Fort Carson, Colorado Springs, Colorado.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Wertenberger
authors.affiliation: Fort Carson, Colorado Springs, Colorado.
authors.forename: Bruce
authors.initials: B
authors.lastname: Leeson
authors.affiliation: Lackland Air Force Base, San Antonio, Texas.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Heron
authors.affiliation: Hurlburt Field, Mary Esther, Florida.
authors.forename: Chad E
authors.initials: CE
authors.lastname: Morrow
authors.affiliation: Maxwell AFB, Montgomery, Alabama.
authors.forename: Neysa
authors.initials: N
authors.lastname: Etienne
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D003863:Depression / Q000453:epidemiology / Q000523:psychology*; D003866:Depressive Disorder / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008889:Military Personnel / Q000523:psychology* / Q000706:statistics & numerical data; D010045:Outpatients; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D012494:Sampling Studies; D016728:Self-Injurious Behavior / Q000523:psychology; D012720:Severity of Illness Index; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000523:psychology; D059020:Suicidal Ideation; D013405:Suicide / Q000523:psychology; D014481:United States / Q000453:epidemiology
keywords: agitation; insomnia; military; sleep; suicide; veterans