Nighttime Sleep Quality and Daytime Sleepiness Predicts Suicide Risk in Adults Admitted to an Inpatient Psychiatric Hospital

ABSTRACT

As sleep problems have been identified as an important, yet understudied, predictor of suicide risk, the present study analyzed the relationship between daytime sleepiness and nighttime sleep disturbance in a high-risk population of adults admitted to an inpatient psychiatric hospital. Objectives were to (1) examine the time course of subjective daytime sleepiness, nighttime sleep disturbance, and suicide risk throughout inpatient psychiatric treatment, (2) examine pre- to post-treatment changes in sleep disturbance with treatment as usual in an inpatient psychiatric setting, and (3) investigate whether daytime sleepiness and nighttime sleep disturbance predicted suicide risk above and beyond anxiety and depression. Participants were 500 consecutively admitted adults admitted to an intermediate length of stay (4–6 weeks) inpatient psychiatric hospital (47% female; 18–87 years of age). Measures of sleep, suicide risk, depression, and anxiety were completed at admission, weeks 1 through 4, and at discharge. Latent growth curve modeling (LGM) and hierarchal linear modeling (HLM) were conducted. The LGM analysis demonstrated that daytime sleepiness, nighttime sleep disturbance, and suicide risk all improved throughout inpatient treatment. Further, HLM showed that daytime sleepiness predicted suicide risk above and beyond symptoms of anxiety, depression, major sleep medications, and prior suicidal ideation and attempts, while nighttime sleep disturbance predicted suicide risk above and beyond symptoms of anxiety, major sleep medications, and prior suicidal ideation and attempts. Findings indicate the need to reevaluate safety protocols that may impact sleep, particularly that may increase daytime sleepiness, and to develop evidence-based sleep interventions for individuals admitted to inpatient psychiatric hospitals.

Acknowledgments

We would like to recognize the members of the research team at the Menninger Clinic for their contributions to research and data collection. This includes: Tina Holmes, Steve Herrera, Anika Wiltgen, Cameron Johnson, Christopher Frazier, Danna Ramirez, Dr. Hyuntaek Oh, Led Camille Soriano, Megan Rech, and Ryan Smith.

Disclosure statement

J. M. O. is the Editor of the Journal of Psychiatric Practice, the Editor of the Journal of Personality Disorders, the Joint Editor-in-Chief of Borderline Personality Disorder and Emotion Dysregulation, and an author, co-author, Editor, and Co-Editor with American Psychiatric Association Publishing. He is also an Officer with NPSP25, LLC and on the Silver Hill Academic Advisory Board.

S. J. M. is supported through the use of resources and facilities at the Michael E. Debakey VA Medical Center, Houston, Texas and receives support from The Menninger Clinic, Houston, Texas. S. J. M. has served as a consultant to Allergan, Alkermes, Axsome Therapeutics, BioXcel Therapeutics, Clexio Biosciences, Eleusis, EMA Wellness, Engrail Therapeutics, Greenwich Biosciences, Intra-Cellular Therapies, Janssen, Levo Therapeutics, Perception Neurosciences, Praxis Precision Medicines, Neurocrine, Relmada Therapeutics, Sage Therapeutics, Seelos Therapeutics, and Signant Health. 

Additional information

Funding

These data included herein were collected through the use of facilities and resources at The Menninger Clinic, Houston, Texas USA. All authors are supported through funding from The Menninger Clinic and The Menninger Clinic Foundation. None of these funding sources had a role in the study design, collection, analysis, or interpretation of the data, writing the article, or in the decision to submit the article for publication.