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 Doctors who treat patients with depression or a history of suicide
attempts should consider sleep problems a further warning sign,
experts say.
“The majority of individuals who die by suicide visit their doctor
in the months preceding, and these are missed opportunities to
enhance detection and intervene,” said lead author Rebecca A.
Bernert of the Stanford Mood Disorders Center at Stanford University
School of Medicine in California.
Sleep can stand alone as a risk factor for death by suicide, even
when depression is accounted for, Bernert told Reuters Health,
though sleep problems are common for many people who should not be
alarmed by this news.
Of the 14,456 people researchers followed over 10 years, 20 died by
suicide.
The study team compared the answers those 20 people gave in a series
of interviews to questions about symptoms of depression, and mental
and physical functioning to the answers of 400 others similar in
age, sex and location.
Those who went on to commit suicide tended to rate their sleep
poorer at the start of the study than the comparison group, which
was true even when researchers took symptoms of clinical depression
into account.
With depression accounted for, poor sleep quality was associated
with a 20 percent higher risk of death by suicide, Bernert
explained. Since only 20 out of nearly 15,000 people in this study
died by suicide, even with a 20 percent increase in risk the
absolute chance of dying by suicide would still be less than two
tenths of one percent.
Globally, suicide accounts for more than half of violent deaths,
according to the World Health Organization. And whereas suicide
attempts and depression are socially stigmatized, patients usually
speak freely about trouble sleeping, since it doesn’t carry that
stigma, Bernert said.
Of all the sleep problems described, difficulty falling asleep and
not feeling like sleep was restorative were both particularly linked
to increased risk of suicide, according to the results in JAMA
Psychiatry.
Some experts believe that sleep problems are due to underlying
depression, which then increases suicide risk, so the fact that
sleep problems were linked in this study to suicide even without
symptoms of depression is important, said Wilfred R. Pigeon, who
directs the VA Center of Excellence for Suicide Prevention Research
and the University of Rochester Sleep Research Lab.
“What is even more interesting is that the risk imparted by poor
sleep is even stronger than that imparted by depression,” he told
Reuters Health by email.
Having both poor sleep and depression conferred the biggest risk,
noted Pigeon, who was not involved in the new study.
In general, not sleeping well causes physical and emotional stress,
and could tip the balance for someone with suicidal thoughts, he
said.
“Poor sleep is associated with difficulties regulating emotion as
well as cognitive deficits, both of which increase the risk of
suicidal behaviors,” said Amy Fiske, who researches depression and
suicidal behavior in late life at West Virginia University in
Morgantown.
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“Thus, it is conceivable that sleep problems could lead to suicide
by reducing a person's ability to cope with stressors and by
impairing their judgment and thinking ability,” said Fiske, who was
not part of the new study.
We cannot say that poor sleep causes suicide based on this study,
since there could have been factors other than depression that could
have caused both disturbed sleep and death by suicide, Fiske told
Reuters Health by email.
“Many of us are prepared to say that some sleep disturbances such as
insomnia have a causative role in the development of new onset
depression, but I don’t think we are there yet with respect to sleep
and suicide,” Pigeon said.
Though many other studies have found a similar link between sleep
and suicide, most clinicians don’t give sleep problems the weight
they deserve, according to Dr. William Vaughn McCall, professor and
Case Distinguished Chairman of the Department of Psychiatry and
Health Behavior at Georgia Regents University in Augusta.
“We need to continue to increase awareness among doctors,” he told
Reuters Health.
Doctors and psychiatrists should recognize that sleep complaints
along with depression indicate elevated suicide risk and require
treatment, he said. Prescription sleep aids work immediately, but
carry risk of dependence and tolerance, and behavioral therapy can
work but takes a few weeks to be effective.
Experts agree: the vast majority of older people who suffer from
sleep problems are not suicidal.
“We don’t want to create needless panic for older people who are
otherwise psychologically healthy and can’t sleep,” McCall said.
“For them it’s not time to ring the alarm.”
“If someone has a mental disorder diagnosis, then the additional
burden of insomnia should be the warning sign,” he said.
The National Suicide Prevention Lifeline toll-free number,
1-800-273-TALK (273-8255), is available 24/7 and can be used
anywhere in the United States.
SOURCE: http://bit.ly/1boZNiZ
JAMA Psychiatry, online August 13, 2014.
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