title: Sleep Duration and Insomnia Symptoms as Risk Factors for Suicidal Ideation in a Nationally Representative Sample.
abstract: OBJECTIVE
  Suicidal behavior (suicidal ideation, suicide attempts, and suicide completion) has been increasingly linked with difficulty initiating sleep, maintaining sleep, and early morning awakenings. However, the relationship between suicidal behavior and sleep duration abnormalities is unclear, especially at the population level. The present study used a nationally representative sample to examine the association of suicidal ideation with extreme sleep durations and insomnia symptoms.
  
  
  METHODS
  Cross-sectional data from adult respondents (≥ 18 years of age, N = 6,228) were extracted from the 2007-2008 wave of the National Health and Nutritional Examination Survey. Ordinal logistic regression analyses were used to evaluate the relationship of suicidal ideation with sleep duration, global insomnia, and individual insomnia symptoms in models adjusted for sociodemographic, socioeconomic, and health-related covariates.
  
  
  RESULTS
  Suicidal ideation was associated with abnormalities of sleep duration. This relationship ceased to exist once the model was adjusted for depressive symptoms. As expected, an increased level of suicidal ideation was consistently associated with insomnia. Of the insomnia symptoms, difficulty maintaining sleep was found to be the most predictive of suicidal ideation, followed by difficulty initiating sleep (P< .05).
  
  
  CONCLUSIONS
  Abnormalities of sleep duration and continuity should prompt a clinical assessment for suicide risk.
authors.affiliation: Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia.
authors.forename: Subhajit
authors.initials: S
authors.lastname: Chakravorty
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia.
authors.forename: H Y Katy
authors.initials: HY
authors.lastname: Siu
authors.affiliation: Philadelphia FIGHT Community Health Centers, Philadelphia, Pennsylvania.
authors.forename: Linden
authors.initials: L
authors.lastname: Lalley-Chareczko
authors.affiliation: Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia.
authors.forename: Gregory K
authors.initials: GK
authors.lastname: Brown
authors.affiliation: Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia.
authors.forename: James C
authors.initials: JC
authors.lastname: Findley
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Perlis
authors.affiliation: Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia; University of Arizona College of Medicine, Tuscon.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Grandner