title: Sleep problems and suicide associated with mood instability in the Adult Psychiatric Morbidity Survey, 2007.
abstract: OBJECTIVE
  Mood instability is common in the general population. Mood instability is a precursor to mental illness and associated with a range of negative health outcomes. Sleep disturbance appears to be closely linked with mood instability. This study assesses the association between mood instability and sleep disturbance and the link with suicidal ideation and behaviour in a general population sample in England.
  
  
  METHODS
  The Adult Psychiatric Morbidity Survey, 2007 collected detailed information about mental health symptoms and correlates in a representative sample of adult household residents living in England ( n = 7303). Mood instability was assessed using the Structured Clinical Interview for DSM-IV Axis-II. Sleep problems were defined as sleeping more than usual or less than usual during the past month. Other dependent variables included medication use and suicidal ideation and behaviour (response rate 57%). Generalized linear modelling was used to estimate the prevalence of mood instability and sleep problems. Logistic regression was used to estimate odds ratios. All estimates were weighted.
  
  
  RESULTS
  The prevalence of mood instability was 14.7% (95% confidence interval [13.6%, 15.7%]). Sleep problems occurred in 69.8% (95% confidence interval: [66.6%, 73.1%]) of those with mood instability versus 37.6% (95% confidence interval: [36.2%, 39.1%]) of those without mood instability. The use of sedating and non-sedating medications did not influence the association. Sleep problems were significantly associated with suicidal ideation and behaviour even after adjusting for mood instability.
  
  
  CONCLUSIONS
  Sleep problems are highly prevalent in the general population, particularly among those with mood instability. Sleep problems are strongly associated with suicidal ideation and behaviour. Treatments that target risk and maintenance factors that transcend diagnostic boundaries, such as therapies that target sleep disturbance, may be particularly valuable for preventing and addressing complications related to mood instability such as suicide.
authors.affiliation: 1 Department of Psychiatry, University of Oxford, Oxford, UK.
authors.forename: Keltie C
authors.initials: KC
authors.lastname: McDonald
authors.affiliation: 1 Department of Psychiatry, University of Oxford, Oxford, UK.|2 Oxford Health NHS Foundation Trust, Oxford, UK.
authors.forename: Kate Ea
authors.initials: KE
authors.lastname: Saunders
authors.affiliation: 1 Department of Psychiatry, University of Oxford, Oxford, UK.|2 Oxford Health NHS Foundation Trust, Oxford, UK.
authors.forename: John R
authors.initials: JR
authors.lastname: Geddes
mesh_terms: D000328:Adult; D000339:Affect / Q000502:physiology*; D000368:Aged; D000369:Aged, 80 and over; D004739:England / Q000453:epidemiology; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D012893:Sleep Wake Disorders / Q000453:epidemiology / Q000503:physiopathology*; D013405:Suicide / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Mood instability; cross-sectional studies; psychiatric illness; sleep problems; suicidality