title: Insomnia is associated with suicide attempt in middle-aged and older adults with depression.
abstract: BACKGROUND
  Insomnia increases in prevalence with age, is strongly associated with depression, and has been identified as a risk factor for suicide in several studies. The aim of this study was to determine whether insomnia severity varies between those who have attempted suicide (n = 72), those who only contemplate suicide (n = 28), and those who are depressed but have no suicidal ideation or attempt history (n = 35).
  
  
  METHODS
  Participants were middle-aged and older adults (age 44-87, M = 66 years) with depression. Insomnia severity was measured as the sum of the early, middle, and late insomnia items from the Hamilton Rating Scale for Depression. General linear models examined relations between group status as the independent variable and insomnia severity as the dependent variable.
  
  
  RESULTS
  The suicide attempt group suffered from more severe insomnia than the suicidal ideation and non-suicidal depressed groups (p < 0.05). Differences remained after adjusting for potential confounders including demographics, cognitive ability, alcohol dependence in the past month, severity of depressed mood, anxiety, and physical health burden. Moreover, greater insomnia severity in the suicide attempt group could not be explained by interpersonal difficulties, executive functioning, benzodiazepine use, or by the presence of post-traumatic stress disorder.
  
  
  CONCLUSIONS
  Our results suggest that insomnia may be more strongly associated with suicidal behavior than with the presence of suicidal thoughts alone. Accordingly, insomnia is a potential treatment target for reducing suicide risk in middle-aged and older adults.
authors.affiliation: Department of Psychiatry,University of Pittsburgh,Pittsburgh,Pennsylvania,15213,USA.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Kay
authors.affiliation: Department of Psychiatry,University of Pittsburgh,Pittsburgh,Pennsylvania,15213,USA.
authors.forename: Alexandre Y
authors.initials: AY
authors.lastname: Dombrovski
authors.affiliation: Department of Psychiatry,University of Pittsburgh,Pittsburgh,Pennsylvania,15213,USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Buysse
authors.affiliation: Department of Psychiatry,University of Pittsburgh,Pittsburgh,Pennsylvania,15213,USA.
authors.forename: Charles F
authors.initials: CF
authors.lastname: Reynolds
authors.affiliation: Department of Psychiatry,University of Pittsburgh,Pittsburgh,Pennsylvania,15213,USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Begley
authors.affiliation: Department of Psychiatry,University of Pittsburgh,Pittsburgh,Pennsylvania,15213,USA.
authors.forename: Katalin
authors.initials: K
authors.lastname: Szanto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D012720:Severity of Illness Index; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications / Q000453:epidemiology / Q000523:psychology*; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000523:psychology* / Q000706:statistics & numerical data
keywords: depression; insomnia symptoms; suicidal ideation; suicide attempt