title: A population study of the association between sleep disturbance and suicidal behaviour in people with mental illness.
abstract: Limited representative research has considered the relationship between sleep disturbance and suicidal behaviour among people with mental illness. We investigated the relationship between sleep disturbance and suicidal behaviour across Part II interview of the National Comorbidity Survey Replication (NCSR). The associations between sleep disturbance and suicidal behaviour (thoughts, plans and attempts) were investigated using logistic and multinomial logistic regressions and stratified across six mental disorder groups (depression, anxiety, substance use disorders (SUD), eating disorders (ED), bipolar disorders (BD) and early life disorders). From 5701 participants (mean age 43.4 years 58% women), people with any mental disorder experiencing sleep disturbance were at increased odds of suicidal thoughts (odds ratio (OR): 2.5; 95% CI: 1.7, 3.6) and suicidal plans and attempts (OR: 5.7; 95% CI: 2.7, 11.9) adjusting for age, sex and income. People with BD (OR: 8.9; 95 CI: 2.1, 38.1), early life disorders (OR 6.98, 95% ci 2.48, 19.67), depression (OR 1.88, 95% CI 1.14, 3.11), anxiety (OR 1.90, 95% CI 1.28, 2.85) and SUD (2.60, 95% CI 1.23, 5.49) but not ED, were at increased odds of suicidal thoughts in the presence of sleep disturbance. Adjusting for anti-depressant intake attenuated the effect sizes by up to 20% but the associations remained significant. In conclusion, sleep disturbance is a potential risk factor for suicidal behaviours in people with mental illness. Monitoring and management of sleep disturbance in clinical practice might be an important strategy to mitigate suicidal behaviours in people with mental illness.
authors: Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK; Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, SE5 8AZ, UK. Electronic address: brendon.stubbs@kcl.ac.uk.
authors: Brendon
authors: B
authors: Stubbs
authors: REACH: The Centre for Research in Aging and Cognitive Health, College of Life and Environmental Sciences - Psychology, University of Exeter, Exeter, EX4 4QG, UK.
authors: Yu-Tzu
authors: YT
authors: Wu
authors: King's College London, Institute of Psychiatry, Psychology & Neuroscience, Health Service and Population Research Department, Centre for Global Mental Health, De Crespigny Park, London, SE5 8AF, UK.
authors: A Matthew
authors: AM
authors: Prina
authors: Department of Psychiatry, University of California, San Francisco, 4150 Clement Street, 94121, CA, USA.
authors: Yue
authors: Y
authors: Leng
authors: MRC Unit for Lifelong Health and Ageing at UCL, 33 Bedford Place, London, WC1B 5JU, UK.
authors: Theodore D
authors: TD
authors: Cosco
mesh_terms: D000328:Adult; D018672:Community Health Planning; D015897:Comorbidity; D005260:Female; D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000145:classification / Q000453:epidemiology* / Q000523:psychology*; D008875:Middle Aged; D016017:Odds Ratio; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D012893:Sleep Wake Disorders / Q000453:epidemiology*; D013405:Suicide / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Bipolar disorder; Mental disorders; Mental illness; Schizophrenia; Sleep; Sleep disturbance; Suicidal; Suicide