AUTHOR=Rössler Wulf , Angst Jules , Ajdacic-Gross Vladeta , Haker Helene , Berrouiguet Sofian , Ujeyl Mariam , Glozier Nicholas , Hengartner Michael P. 

TITLE=Sleep Disturbances and Suicidality–A Longitudinal Analysis From a Representative Community Study Over 30 Years

JOURNAL=Frontiers in Psychiatry

VOLUME=9

YEAR=2018

URL=https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2018.00320

DOI=10.3389/fpsyt.2018.00320

ISSN=1664-0640

ABSTRACT=<p><bold>Study objectives:</bold> Associations between sleep problems and suicidality are increasingly acknowledged, but prospective data from well-controlled long-term community studies are lacking.</p><p><bold>Methods:</bold> We analyzed data from a longitudinal cohort study with <italic>n</italic> = 591 young adults from Zurich, Switzerland, prospectively followed from 1979 (age 20/21 years) to 2008 (age 49/50 years). Twelve-month prevalence of various mental disorders, socio-environmental confounders and sleep problems were carefully assessed with semi-structured interviews at 7 assessment waves spanning overall a 30-year observation period. Interviews were conducted with the “Structured Psychopathological Interview and Rating of the Social Consequences of Psychological Disturbances for Epidemiology” (SPIKE). The 12-month prevalence of sleep problems was graded according to frequency and associated distress of reported symptoms. 12-month prevalence of suicidality was classified as either mild (transient suicidal ideation) or severe (self-harm, suicide attempts).</p><p><bold>Results:</bold> Concurrently, and fully adjusted for several covariates, including mental disorders, relative to no sleep problems there was an odds ratio (OR) of <italic>OR</italic> = 1.9 (95% confidence interval 1.4–2.5), <italic>OR</italic> = 3.3 (2.5–4.4), and <italic>OR</italic> = 1.9 (1.3–2.8) for mild, moderate and severe sleep problems in association with suicidality. There was no evidence for a prospective effect of broad sleep problems on subsequent suicidality. Mild suicidality, but not severe suicidality, prospectively predicted subsequent broad sleep problems in the fully adjusted multivariate model (adjusted <italic>OR</italic> = 1.5; 1.1–1.9). Disturbed sleep initiation, a proxy for insomnia, significantly predicted subsequent suicidality (<italic>OR</italic> = 1.5; 1.1–1.9), whereas mild suicidality, but not severe suicidality, significantly predicted subsequent insomnia (<italic>OR</italic> = 1.5; 1.1–2.0).</p><p><bold>Conclusions:</bold> Sleep problems and suicidality are longitudinally inter-related, which has important implications for clinical practice. Most importantly, the causal pathways appear to be bi-directional and independent of socio-demographics and concomitant mental disorders. More research is needed to examine the possible biopsychosocial etiological mechanisms linking suicidality to sleep problems.</p>