Association of Poor Subjective Sleep Quality With Risk for Death by Suicide During a 10-Year Period
Published Date:Oct 2014
Source:JAMA Psychiatry. 2014; 71(10):1129-1137.
Pubmed Central ID:PMC4283786
Funding:F31MH080470-01/MH/NIMH NIH HHS/United States
K23 MH093490/MH/NIMH NIH HHS/United States
K23MH093490/MH/NIMH NIH HHS/United States
R49 CE002093/CE/NCIPC CDC HHS/United States
Older adults have high rates of sleep disturbance, die by suicide at disproportionately higher rates compared with other age groups, and tend to visit their physician in the weeks preceding suicide death. To our knowledge, to date, no study has examined disturbed sleep as an independent risk factor for late-life suicide.
To examine the relative independent risk for suicide associated with poor subjective sleep quality in a population-based study of older adults during a 10-year observation period.
DESIGN, SETTING, AND PARTICIPANTS
A longitudinal case-control cohort study of late-life suicide among a multisite, population-based community sample of older adults participating in the Established Populations for Epidemiologic Studies of the Elderly. Of 14 456 community older adults sampled, 400 control subjects were matched (on age, sex, and study site) to 20 suicide decedents.
MAIN OUTCOMES AND MEASURES
Primary measures included the Sleep Quality Index, the Center for Epidemiologic Studies–Depression Scale, and vital statistics.
Hierarchical logistic regressions revealed that poor sleep quality at baseline was significantly associated with increased risk for suicide (odds ratio [OR], 1.39; 95% CI, 1.14-1.69; P &lt; .001) by 10 follow-up years. In addition, 2 sleep items were individually associated with elevated risk for suicide at 10-year follow-up: difficulty falling asleep (OR, 2.24; 95% CI, 1.27-3.93; P &lt; .01) and nonrestorative sleep (OR, 2.17; 95% CI, 1.28-3.67; P &lt; .01). Controlling for depressive symptoms, baseline self-reported sleep quality was associated with increased risk for death by suicide (OR, 1.30; 95% CI, 1.04-1.63; P &lt; .05).
CONCLUSIONS AND RELEVANCE
Our results indicate that poor subjective sleep quality is associated with increased risk for death by suicide 10 years later, even after adjustment for depressive symptoms. Disturbed sleep appears to confer considerable risk, independent of depressed mood, for the most severe suicidal behaviors and may warrant inclusion in suicide risk assessment frameworks to enhance detection of risk and intervention opportunity in late life.
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