Department of Psychiatry, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
Catholic Biomedical Industrial Institute, The Catholic University of Korea, Seoul, Republic of Korea.
J Affect Disord. 2019 Jun 1;252:182-189. doi: 10.1016/j.jad.2019.04.053. Epub 2019 Apr 8.
The purpose of this study was to examine the relationship between sleep problems and suicidal ideation in depressive patients.
Evidence from diverse settings and populations indicates that sleep problems are associated with suicidal ideation. However, relationships between them are not well defined. This study was conducted in order to explore whether poor sleep was associated with suicidal ideation above and beyond depression and whether specific domains of sleep were related to suicidal ideation. We also determined whether the association between sleep problems and suicidal ideation was mediated by depression.
Patients aged 18-65 years from an outpatient clinic at Seoul St. Mary's Hospital were recruited for this study. From September 2010 to November 2017, a total of 909 participants were included in the final sample. The Beck Depression Inventory (BDI) and Pittsburgh Sleep Quality Index (PSQI) were used to assess psychiatric symptoms. Independent samples t-test, chi-square test, Pearson correlation analyses, hierarchical multiple regression analyses, and mediation analyses were performed using SPSS PROCESS macro.
The majority of participants with suicidal ideation also had sleep problems (94.9%). After controlling for age, marital status, and depressive symptoms, total sleep problems estimated by the PSQI global score were also significant associated with suicidal ideation. Among seven sleep components derived from the PSQI, several components including cough or snore loudly, have bad dreams, and use sleep medication were associated with increased suicide risk. Also, the relationship between sleep problems and suicidal ideation was mediated by depressive symptoms indirectly. There was no convincing direct relationship between sleep problems and suicidal ideation.
Investigating the pathways which connect sleep problems and suicidality is fundamental to the development of suicide prevention. While it might be premature to suggest specific interventions, it would be important for clinicians to consider evaluating and managing sleep problems in the context of suicidality.
本研究旨在探讨抑郁患者睡眠问题与自杀意念之间的关系。
来自不同环境和人群的证据表明，睡眠问题与自杀意念有关。然而，它们之间的关系尚未得到很好的定义。本研究旨在探讨睡眠质量差是否与抑郁之外的自杀意念有关，以及睡眠的特定领域是否与自杀意念有关。我们还确定了睡眠问题与自杀意念之间的关联是否通过抑郁来介导。
本研究招募了来自首尔圣玛丽医院门诊的 18-65 岁的患者。2010 年 9 月至 2017 年 11 月，共有 909 名参与者纳入最终样本。采用贝克抑郁量表（BDI）和匹兹堡睡眠质量指数（PSQI）评估精神症状。采用独立样本 t 检验、卡方检验、Pearson 相关分析、层次多重回归分析和 SPSS PROCESS 宏进行中介分析。
大多数有自杀意念的参与者也有睡眠问题（94.9%）。在控制年龄、婚姻状况和抑郁症状后，PSQI 总分估计的总睡眠问题也与自杀意念显著相关。在 PSQI 得出的七个睡眠成分中，包括大声咳嗽或打鼾、做噩梦和使用睡眠药物在内的几个成分与自杀风险增加有关。此外，睡眠问题与自杀意念之间的关系是通过抑郁症状间接介导的。睡眠问题与自杀意念之间没有直接的关系。
研究连接睡眠问题和自杀意念的途径对于预防自杀的发展至关重要。虽然建议具体的干预措施还为时过早，但临床医生在评估和管理自杀意念时考虑评估和管理睡眠问题非常重要。
