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

Wulf Rössler (1, 2, 3) , Jules Angst (1) , Vladeta Ajdacic-Gross (1) , Helene Haker (1) , Sofian Berrouiguet (4, 5, 6, 7) , Mariam Ujeyl (2) , Nicholas Glozier (8) , Michael O. Hengartner (9)

1 UZH - Universität Zürich [Zürich] = University of Zurich
2 Charité - UniversitätsMedizin = Charité - University Hospital [Berlin]
3 USP - Universidade de São Paulo = University of São Paulo
4 Lab-STICC_IMTA_CID_DECIDE
5 IMT Atlantique - LUSSI - Département Logique des Usages, Sciences sociales et Sciences de l'Information
6 CHU - BREST - Hopital de Bohars - CHRU Brest
7 EA7479 SPURBO - Soins Primaires, Santé Publique, Registre des cancers de Bretagne Occidentale
8 The University of Sydney
9 ZHAW - Zürcher Hochschule für Angewandte Wissenschaften = Zurich University of Applied Sciences

Study objectives: Associations between sleep problems and suicidality are increasingly acknowledged, but prospective data from well-controlled long-term community studies are lacking. Methods: We analyzed data from a longitudinal cohort study with n = 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). Results: Concurrently, and fully adjusted for several covariates, including mental disorders, relative to no sleep problems there was an odds ratio (OR) of OR = 1.9 (95% confidence interval 1.4–2.5), OR = 3.3 (2.5–4.4), and OR = 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 OR = 1.5; 1.1–1.9). Disturbed sleep initiation, a proxy for insomnia, significantly predicted subsequent suicidality (OR = 1.5; 1.1–1.9), whereas mild suicidality, but not severe suicidality, significantly predicted subsequent insomnia (OR = 1.5; 1.1–2.0). Conclusions: 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.

Mots clés: suicidality; sleep; insomnia; depression; epidemiology

Domaines: Ordinateur et société [cs.CY]; Psychiatrie et santé mentale

Wulf Rössler, Jules Angst, Vladeta Ajdacic-Gross, Helene Haker, Sofian Berrouiguet, et al.. Sleep Disturbances and Suicidality–A Longitudinal Analysis From a Representative Community Study Over 30 Years. Frontiers in Psychiatry, 2018, 9, ⟨10.3389/fpsyt.2018.00320⟩. ⟨hal-01983113⟩