The Menninger Clinic, Houston TX USA 77035; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston TX USA 77030.
The Menninger Clinic, Houston TX USA 77035; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston TX USA 77030; The University of Houston Downtown, Houston TX USA 77002.
J Affect Disord. 2019 May 15;251:248-255. doi: 10.1016/j.jad.2019.03.069. Epub 2019 Mar 22.
As there has been a demonstrated link between sleep disturbance and suicide, the present study investigated the relationship between self-reported sleep disturbance during inpatient psychiatric treatment and clinical outcomes at discharge and six months post-discharge.
Participants were 2,970 adults receiving care in a long-term inpatient psychiatric hospital. Greater than 90% of inpatients reported at least mild sleep disturbance throughout treatment. Group-based trajectory modeling was used to determine patterns of sleep disturbance changes over time.
Participants fit into distinct categories based on their trajectories of sleep problems across treatment: No Sleep Problems (10.3% of participants, no sleep problems endorsed over the course of inpatient psychiatric treatment), Resolvers (sleep problems completely resolved over the course of inpatient psychiatric treatment; 10.6%), Non-Responders (did not respond to inpatient psychiatric treatment; 35.7%) and Responders (sleep problems decreased but did not fully resolve over the course of inpatient psychiatric treatment; 43.4%). Individuals with comorbid major depressive disorder and generalized anxiety disorder were significantly more likely to demonstrate higher rates of sleep disturbance throughout inpatient psychiatric treatment and their sleep problems did not respond to treatment as usual (Non-Responders). Further, patients in the Non-Responder group had significantly more suicidal ideation and worse clinical outcomes (higher anxiety, more disability, and lower well-being) at discharge and six months post-discharge, as well as were on more medication including hypnotics throughout treatment.
Findings indicate the urgent need to design and implement inpatient psychiatry sleep protocols to not only improve sleep and clinical outcomes, but also reduce the risk for suicide post-discharge.
由于睡眠障碍与自杀之间存在明显关联，本研究调查了住院精神病治疗期间自我报告的睡眠障碍与出院时和出院后六个月的临床结局之间的关系。
参与者为 2970 名在长期住院精神病院接受治疗的成年人。超过 90%的住院患者在整个治疗过程中报告至少有轻度睡眠障碍。基于组的轨迹建模用于确定随时间变化的睡眠障碍变化模式。
根据他们在治疗过程中睡眠问题的轨迹，参与者分为不同的类别：无睡眠问题（10.3%的参与者，在住院精神病治疗过程中没有报告睡眠问题）、解决者（睡眠问题在住院精神病治疗过程中完全解决；10.6%）、非应答者（对住院精神病治疗没有反应；35.7%）和应答者（睡眠问题减少但未完全解决住院精神病治疗过程中；43.4%）。同时患有重度抑郁症和广泛性焦虑症的个体在整个住院精神病治疗过程中表现出更高的睡眠障碍发生率，并且他们的睡眠问题对常规治疗没有反应（非应答者）。此外，非应答者组的患者在出院和出院后六个月时的自杀意念明显更多，临床结局更差（焦虑程度更高、残疾程度更高、幸福感更低），并且在整个治疗过程中使用的药物包括催眠药更多。
研究结果表明，迫切需要设计和实施住院精神病学睡眠方案，不仅要改善睡眠和临床结局，还要降低出院后自杀的风险。
