Winsper Catherine, Tang Nicole K Y
Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick , Coventry , UK.
Int Rev Psychiatry. 2014 Apr;26(2):189-204. doi: 10.3109/09540261.2014.881330.
Insomnia can be lethal, increasing the risk of suicide and accidental death by overdose. In this review we present a synthesis of the literature investigating the insomnia-suicide link and the psychological mechanisms underpinning the association. Specifically, we review the findings of prospective epidemiological studies demonstrating the insomnia-suicide link in adult and adolescent community populations. Robust associations between insomnia and suicide are observed in clinically depressed and anxious populations, and there are indications across a number of cross-sectional and longitudinal studies that these linkages are attributable to a disrupted sleep pattern, dysfunctional beliefs about sleep and nightmares, independent of depression and anxiety symptoms. Borderline personality disorder (BPD) and chronic pain (CP) are highlighted as high-risk subgroups given the elevated rates of insomnia and suicidality in both conditions. Aside from the influence of comorbid depression and anxiety symptoms, emerging evidence has identified impulsivity and emotional dysregulation as possible mechanisms driving the insomnia-suicide link in BPD, and catastrophizing and the sense of defeat/entrapment as potential cognitive pathways through which insomnia aggravates suicidality in CP. Screening for, and interventions that tackle, insomnia and these associated psychological mechanisms, offer a novel avenue for reducing suicidality across a range of clinical and non-clinical populations.
失眠可能是致命的，会增加自杀风险以及因用药过量导致意外死亡的风险。在本综述中，我们对有关失眠与自杀关联以及支撑该关联的心理机制的文献进行了综合阐述。具体而言，我们回顾了前瞻性流行病学研究的结果，这些研究证实了成年和青少年社区人群中存在失眠与自杀的关联。在临床抑郁和焦虑人群中观察到失眠与自杀之间存在密切关联，并且多项横断面和纵向研究表明，这些联系可归因于睡眠模式紊乱、对睡眠和噩梦的功能失调信念，而与抑郁和焦虑症状无关。鉴于边缘性人格障碍（BPD）和慢性疼痛（CP）患者中失眠和自杀倾向的发生率较高，这两个群体被视为高危亚组。除了共病抑郁和焦虑症状的影响外，新出现的证据表明，冲动性和情绪失调可能是导致BPD患者失眠与自杀关联的机制，而灾难化思维以及挫败感/被困感是失眠加剧CP患者自杀倾向的潜在认知途径。针对失眠以及这些相关心理机制进行筛查和干预，为降低一系列临床和非临床人群的自杀倾向提供了一条新途径。
