Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, GA.
Department of Psychiatry, University of Pennsylvania, Philadelphia, PA.
Sleep. 2019 Feb 1;42(2). doi: 10.1093/sleep/zsy215.
Insomnia is a common symptom in the clinical course of schizophrenia. There is a robust association between insomnia and suicidality in other psychiatric disorders. Two previous studies found associations between insomnia and suicide attempt or completed suicide in patients with schizophrenia. We hypothesized that greater insomnia would be associated with greater levels of suicidal ideation in patients with schizophrenia and other nonaffective psychoses.
We recruited 108 inpatients and outpatients age 18-65 between July 2010 and July 2016 with DSM-IV nonaffective psychosis (schizophrenia, schizoaffective disorder, or schizophreniform disorder). We investigated relationships between current insomnia (Insomnia Severity Index [ISI]), suicidal ideation over the past week, and lifetime history of suicide attempt (Beck Scale for Suicide Ideation [BSS]) in regression analyses.
After controlling for potential confounders, insomnia was a significant indicator of suicidal ideation (β = 0.27, p = 0.032). Insomnia was also a significant indicator of a high BSS score (≥16; OR = 1.14, 95% CI: 1.01-1.28, p = 0.029). Furthermore, participants with severe insomnia were almost 15 times more likely to have a lifetime history suicide attempt than participants without current insomnia (OR = 14.8, 95% CI: 1.4-157, p = 0.025). Insomnia was also an indicator of greater PANSS total (β = 0.33, p = 0.001), positive subscale (β = 0.32, p = 0.002), and general subscale (β = 0.40, p < 0.001) scores.
Insomnia is associated with suicidal ideation, lifetime suicide attempt, and greater psychopathology in patients with schizophrenia. Our findings suggest that formal assessment of insomnia may be germane to the clinical care of patients with schizophrenia as a marker of suicide risk and symptom severity.
失眠是精神分裂症临床病程中的常见症状。在其他精神疾病中，失眠与自杀意念之间存在着强有力的关联。两项先前的研究发现，失眠与精神分裂症患者自杀未遂或自杀死亡之间存在关联。我们假设，在精神分裂症和其他非情感性精神病患者中，更严重的失眠与更高水平的自杀意念相关。
我们招募了 108 名年龄在 18-65 岁之间的 DSM-IV 非情感性精神病（精神分裂症、分裂情感性障碍或分裂样障碍）的住院和门诊患者，于 2010 年 7 月至 2016 年 7 月期间参与研究。我们在回归分析中研究了当前失眠（失眠严重程度指数 [ISI]）、过去一周的自杀意念以及一生中自杀未遂的历史（贝克自杀意念量表 [BSS]）之间的关系。
在控制了潜在的混杂因素后，失眠是自杀意念的一个显著指标（β=0.27，p=0.032）。失眠也是 BSS 高分（≥16；OR=1.14，95%CI：1.01-1.28，p=0.029）的显著指标。此外，有严重失眠的参与者一生中自杀未遂的可能性几乎是没有当前失眠的参与者的 15 倍（OR=14.8，95%CI：1.4-157，p=0.025）。失眠也是 PANSS 总分（β=0.33，p=0.001）、阳性量表（β=0.32，p=0.002）和一般量表（β=0.40，p<0.001）得分较高的指标。
失眠与精神分裂症患者的自杀意念、一生中自杀未遂以及更严重的精神病症状相关。我们的研究结果表明，对失眠的正式评估可能与精神分裂症患者的临床护理相关，作为自杀风险和症状严重程度的标志物。
