Ehlers Cindy L, Karriker-Jaffe Katherine J, Bernert Rebecca
Neurosciences Department, The Scripps Research Institute, La Jolla, CA, USA.
Community Health Research Division, RTI International, Berkeley, CA, USA.
Sleep Adv. 2023 May 19;4(1):zpad024. doi: 10.1093/sleepadvances/zpad024. eCollection 2023.
Although American Indian/Alaska Native (AI/AN) have high suicide rates few studies have systematically investigated sleep quality and its association with suicidal behaviors in AI/AN. This study is a cross-sectional investigation of self-reported sleep quality and suicidal behaviors in an adult AI population.
A semi-structured interview was used to collect data on suicidal ideation, suicidal plans, and suicidal attempts and the Pittsburgh Sleep Quality Index (PSQI) was collected to assess sleep quality in American Indian adults.
In this sample ( = 477), 91 (19%) of the participants endorsed suicidal ideation (thoughts and plans), and 66 (14%) reported suicidal attempts, including four who subsequently died by suicide. More women reported suicidal thoughts or acts than men. Those endorsing suicidal thoughts slept fewer hours during the night, reported more nocturnal awakenings, and showed poorer subjective sleep quality according to PSQI total scores compared to those with no suicidal thoughts or acts. Participants with suicidal acts ( = 66) reported more bad dreams and higher PSQI total scores compared to those with no suicidal thoughts or acts. When those with any suicidal thoughts or acts ( = 157, 33%) were compared to those without, they were more likely to endorse nocturnal awakenings and bad dreams and demonstrated significantly higher PSQI total scores.
Although additional research is needed to evaluate sleep disturbances as a proximal, causal risk factor for suicidal behaviors in AI, findings highlight need for further study of sleep as a warning sign and intervention tool for suicide prevention among American Indian adults.
尽管美国印第安人/阿拉斯加原住民（AI/AN）的自杀率很高，但很少有研究系统地调查该群体的睡眠质量及其与自杀行为的关联。本研究是一项针对成年AI人群自我报告的睡眠质量和自杀行为的横断面调查。
采用半结构化访谈收集自杀意念、自杀计划和自杀未遂的数据，并收集匹兹堡睡眠质量指数（PSQI）以评估美国印第安成年人的睡眠质量。
在这个样本（n = 477）中，91名（19%）参与者认可有自杀意念（想法和计划），66名（14%）报告有自杀未遂情况，其中4人随后自杀身亡。报告有自杀想法或行为的女性多于男性。与没有自杀想法或行为的人相比，认可有自杀想法的人夜间睡眠时间更少，夜间觉醒次数更多，且根据PSQI总分显示主观睡眠质量更差。与没有自杀想法或行为的人相比，有自杀行为的参与者（n = 66）报告有更多噩梦且PSQI总分更高。将有任何自杀想法或行为的人（n = 157，33%）与没有的人进行比较时，他们更有可能认可夜间觉醒和噩梦，且PSQI总分显著更高。
尽管需要进一步研究以评估睡眠障碍作为AI人群自杀行为的直接因果风险因素，但研究结果凸显了有必要进一步研究睡眠作为美国印第安成年人自杀预防的警示信号和干预工具。
