title: Sleep disturbance as a proximal predictor of suicidal intent in recently hospitalized attempters.
abstract: Insomnia and short self-reported sleep duration are associated with suicidality, adjusting for concurrent depression. Yet, it is unknown whether they correlate with attempters' suicidal intent and the lethality of suicidal acts. This cross-sectional study in hospitalized suicide attempters aimed to investigate whether temporally proximal self-reported sleep disturbance predicts suicidal intent or exerts mediatory effects.
  
  
  
  Attempters were retrospectively assessed for insomnia severity (Athens Insomnia Scale [AIS]) and average night sleep duration (ANSD) for 2 weeks preceding attempt. The effects of insomnia or ANSD on suicidal intent (Beck's Suicide Intent Scale [BSIS]) were explored in multiple regressions. Mediatory effects were investigated in structural equation models (SEMs).
  
  
  
  A total of 127 adults (59.8% females) were interviewed within two weeks post-suicide attempt. Major psychiatric diagnoses included affective, psychotic, and alcohol-related disorders. Of the participants, 38.6% had current major depression (MDE). A total of 62.2% reported insomnia (AIS ≥ 6); 42.5% reported short ANSD (≤5 hours). BSIS was predicted by AIS (p = 0.034), short ANSD (p = 0.015), or insomnia with short ANSD (p = 0.006). In SEMs, indirect effects of current MDE, affective disorder, and alcohol-related disorder diagnoses on BSIS via AIS tested significant; both AIS and short ANSD partially mediated the effect of age on BSIS.
  
  
  
  Insomnia, short ANSD, and, in particular, insomnia with short ANSD proximally predicted suicidal intent in recent attempters. The effects of current depression and affective and alcohol-related disorder diagnoses on suicidal intent were partially mediated by insomnia; both insomnia and short ANSD partially mediated the effect of age on suicidal intent. Therefore, management of sleep disturbance in at-risk subjects is important, as it may reduce unfavorable outcomes of suicidal acts.
authors.affiliation: Athens University Medical School, 2nd Department of Psychiatry, Attikon General Hospital, Athens, Greece. Electronic address: pferentinos@med.uoa.gr.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Ferentinos
authors.affiliation: Athens University Medical School, 2nd Department of Psychiatry, Attikon General Hospital, Athens, Greece.
authors.forename: Evgenia
authors.initials: E
authors.lastname: Porichi
authors.affiliation: Athens University Medical School, 2nd Department of Psychiatry, Attikon General Hospital, Athens, Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Christodoulou
authors.affiliation: Athens University Medical School, 1st Department of Psychiatry, Eginition Hospital, Athens, Greece.
authors.forename: Dimitris
authors.initials: D
authors.lastname: Dikeos
authors.affiliation: Athens University Medical School, 1st Department of Psychiatry, Eginition Hospital, Athens, Greece.
authors.forename: Charalambos
authors.initials: C
authors.lastname: Papageorgiou
authors.affiliation: Athens University Medical School, 2nd Department of Psychiatry, Attikon General Hospital, Athens, Greece.
authors.forename: Athanassios
authors.initials: A
authors.lastname: Douzenis
mesh_terms: D000328:Adult; D000367:Age Factors; D019973:Alcohol-Related Disorders / Q000523:psychology; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000523:psychology; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D057566:Self Report; D012893:Sleep Wake Disorders / Q000150:complications*; D013406:Suicide, Attempted / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: Age; Alcohol; Depression; Insomnia; Short sleep duration; Suicidal intent