Bernert Rebecca A, Kim Joanne S, Iwata Naomi G, Perlis Michael L
Suicide Prevention Research Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA, USA,
Curr Psychiatry Rep. 2015 Mar;17(3):554. doi: 10.1007/s11920-015-0554-4.
Increasing research indicates that sleep disturbances may confer increased risk for suicidal behaviors, including suicidal ideation, suicide attempts, and death by suicide. Despite increased investigation, a number of methodological problems present important limitations to the validity and generalizability of findings in this area, which warrant additional focus. To evaluate and delineate sleep disturbances as an evidence-based suicide risk factor, a systematic review of the extant literature was conducted with methodological considerations as a central focus. The following methodologic criteria were required for inclusion: the report (1) evaluated an index of sleep disturbance; (2) examined an outcome measure for suicidal behavior; (3) adjusted for presence of a depression diagnosis or depression severity, as a covariate; and (4) represented an original investigation as opposed to a chart review. Reports meeting inclusion criteria were further classified and reviewed according to: study design and timeframe; sample type and size; sleep disturbance, suicide risk, and depression covariate assessment measure(s); and presence of positive versus negative findings. Based on keyword search, the following search engines were used: PubMed and PsycINFO. Search criteria generated N = 82 articles representing original investigations focused on sleep disturbances and suicide outcomes. Of these, N = 18 met inclusion criteria for review based on systematic analysis. Of the reports identified, N = 18 evaluated insomnia or poor sleep quality symptoms, whereas N = 8 assessed nightmares in association with suicide risk. Despite considerable differences in study designs, samples, and assessment techniques, the comparison of such reports indicates preliminary, converging evidence for sleep disturbances as an empirical risk factor for suicidal behaviors, while highlighting important, future directions for increased investigation.
越来越多的研究表明，睡眠障碍可能会增加自杀行为的风险，包括自杀意念、自杀未遂和自杀死亡。尽管研究有所增加，但一些方法学问题对该领域研究结果的有效性和普遍性构成了重要限制，值得进一步关注。为了评估和界定睡眠障碍作为基于证据的自杀风险因素，我们以方法学考量为核心重点，对现有文献进行了系统综述。纳入研究需满足以下方法学标准：报告（1）评估了睡眠障碍指标；（2）考察了自杀行为的结果指标；（3）将抑郁症诊断或抑郁严重程度作为协变量进行了调整；（4）代表原创性研究而非病历回顾。符合纳入标准的报告进一步根据以下方面进行分类和综述：研究设计和时间框架；样本类型和规模；睡眠障碍、自杀风险和抑郁协变量评估指标；以及阳性和阴性结果的存在情况。基于关键词搜索，使用了以下搜索引擎：PubMed和PsycINFO。搜索标准共产生了N = 82篇代表关注睡眠障碍和自杀结果的原创性研究的文章。其中，N = 18篇基于系统分析符合纳入综述的标准。在已识别的报告中，N = 18篇评估了失眠或睡眠质量差的症状，而N = 8篇评估了与自杀风险相关的噩梦。尽管研究设计、样本和评估技术存在很大差异，但这些报告的比较表明，有初步的、趋同的证据支持睡眠障碍是自杀行为的一个实证风险因素，同时突出了未来进一步研究的重要方向。
