Adequate Sleep Matters for Soldiers at Risk for Suicide

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WASHINGTON — Insomnia symptoms may be an important predictor of suicidal ideation in military troops, a recent study found.1

For the study, researchers evaluated 311 soldiers (255 men and 56 women) who were recruited as part of a treatment study for severe suicidality from two outpatient clinics, an inpatient facility and an emergency department.

Researchers then examined the cross-sectional and longitudinal relationships between insomnia symptoms and suicidal ideation and behavior. They controlled for depressive symptom severity, hopelessness, PTSD diagnosis, anxiety symptoms and drug and alcohol abuse symptoms in the study sample.

The researchers found that self-reported insomnia symptoms were cross-sectionally associated with suicidal ideation, even after accounting for symptoms of depression, hopelessness, PTSD diagnosis, anxiety symptoms and drug and alcohol abuse.

“When a lot of clinicians think about suicide, sleep problems tend to not be on their radar,” Jessica Ribeiro, MS, the lead author of the paper told U.S. Medicine. “On average, it is a vastly overlooked risk factor, but what we are finding consistently is that sleep matters, and it matters a lot.”

The researchers also reported that they found that self-reported insomnia symptoms “predicted suicide attempts prospectively at one-month follow-up at the level of a non-significant trend, when controlling for baseline self-reported insomnia symptoms, depression, hopelessness, PTSD diagnosis and anxiety, drug and alcohol abuse symptoms. Insomnia symptoms were unique predictors of suicide attempt longitudinally when only baseline self-reported insomnia symptoms, depressive symptoms and hopelessness were controlled.”

The researchers wrote that the current study’s findings “converge with a growing

body of research, indicating a relationship between sleep disturbance and suicidality.”

However, they also concluded that the results, “do not diminish the importance of depression and hopelessness as indicators of increased suicide risk as much as they underscore the importance of sleep problems.”

They recommended that clinicians ask patients about sleep.

“Based on the present findings, incorporating sleep problems into suicide risk assessment may be clinically important and potentially enhance detection of at-risk military members as sleep disturbances are often easily detectable (Goldstein et al., 2008), in contrast to many other suicide risk factors (e.g., past suicide attempt history),” they wrote.

Ribeiro added that in fact troops may be more open to talking about insomnia than other mental-health issues.

“One benefit of considering sleep problems is that it is far less stigmatized than things like depression, especially in the military population,” she said. “It may be the case that someone is more open to talking about their sleep than their suicidal thoughts.”

A limitation cited in the study was that the assessment of insomnia symptoms consisted of only three self-reported items. Findings may not generalize outside of populations at severe suicide risk, the researchers wrote.

Ribeiro said that the study results, like any study results, should be replicated in further research. In addition, she pointed out that the study did not look at whether sleep interventions would be helpful.

The study was supported, in part, by grants awarded to the Denver VA Medical Center and to Florida State University by DoD.

  1. Ribeiro JD, Pease JL, Gutierrez PM, Silva C, Bernert RA, Rudd MD, Joiner TE Jr. Sleep problems outperform depression and hopelessness as cross-sectional and longitudinal predictors of suicidal ideation and behavior in young adults in the military. J Affect Disord. 2011 Oct 25. [Epub ahead of print] PubMed PMID: 22032872.

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