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Sleep complaints are associated with increased suicide risk independently of psychiatric disorders: results from a national 3-year prospective study

Abstract

Prior research suggests that sleep disturbances are associated with increased risk of suicide. However, sleep disturbances are associated with a wide range of psychiatric disorders, and it is unknown whether this association is independent of psychopathology. In a large nationally representative prospective survey, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), we used structural equation modeling to examine the shared and specific effects of three sleep complaints (i.e., trouble falling asleep, early morning awakening, and hypersomnia) on the 3-year occurrence of attempting suicide. Because psychiatric disorders increase the risk of suicide attempt almost exclusively through a general psychopathology factor representing their shared effect, covariates included that factor, prior history of suicide attempt, and a wide range of sociodemographic and clinical characteristics. The 3-year prevalence rate of suicide attempt was 0.6% (n = 241). Compared with participants who did not attempt suicide between the two waves, those who did reported significantly more frequently having trouble falling asleep (44.6% vs. 16.6%), early morning awakening (38.9% vs. 12.7%), and hypersomnia (35.0% vs. 10.7%). Following adjustments, effects of sleep complaints on this risk were significant and exerted almost exclusively through a general sleep complaints factor representing the shared effect across all sleep complaints. There were no residual associations of any individual sleep complaint with attempting suicide above that association. Sleep complaints are associated with an increased risk of attempting suicide independently of psychopathology, and should be included in suicide risk assessments as these symptoms may provide targets for reducing the risks of suicidal behaviors.

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Fig. 1: Shared and specific effects of sleep complaints (i.e., trouble falling asleep, early morning awakening, and hypersomnia) assessed at Wave 1 on suicide attempt occurrence between the two waves among participants from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) (N = 34,653).
Fig. 2: Shared and specific effects of sleep complaints (i.e., trouble falling asleep, early morning awakening, and hypersomnia) on suicide attempt occurrence between the two waves among participants with a lifetime history of 2-week period of low mood or anhedonia in Wave 1 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) (N = 11,417).

Data availability

The original data set for the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) is available from the National Institute on Alcohol Abuse and Alcoholism (http://www.niaaa.nih.gov).

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MAO receives royalties for the commercial use of the C-SSRS, owns shares in Mantra Inc., and her family owns stock in Bristol Myers Squibb. FL has received speaker and consulting fees from AstraZeneca, Janssen, Lundbeck, Otsuka Pharmaceuticals, Roche and Servier outside the submitted work. Other authors report no conflicts of interest.

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Geoffroy, P.A., Oquendo, M.A., Courtet, P. et al. Sleep complaints are associated with increased suicide risk independently of psychiatric disorders: results from a national 3-year prospective study. Mol Psychiatry 26, 2126–2136 (2021). https://doi.org/10.1038/s41380-020-0735-3

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