Psychosis and Hopelessness Mediate the Relationship Between Reduced Sleep and Suicidal Ideation in Schizophrenia Spectrum Disorders

Abstract

Objective

Suicide is a major cause of death amongst individuals with schizophrenia spectrum disorders (SSD). Despite numerous risk factors being identified, accurate prediction of suicidality and provision of tailored and effective treatment is difficult. One factor that may warrant particular attention as a contributor to increased psychopathology and suicidality in SSD is disturbed sleep. Sleep disturbances have been reliably linked to greater levels of suicidal ideation and are highly prevalent amongst individuals with SSD. This study aimed to examine if reduced sleep duration and psychopathology are associated with increased suicidal ideation.

Method

One-hundred and eighteen adults with chronic SSD living within the community participated in this cross-sectional study. Psychosis symptoms were assessed using the Positive and Negative Syndrome Scale. Items 4 and 10 from the Montgomery-Asperg Depression Rating Scale and Item 2 from the Calgary Depression Scale for Schizophrenia were used to assess reduced sleep duration, current suicidal ideation, and hopelessness, respectively. All measures were rated concurrently.

Results

A hierarchical logistic regression revealed that greater acute sleep disturbances were associated with increased suicidal ideation and this relationship was found to be uniquely mediated by both positive symptom severity and hopelessness.

Conclusion

These results suggest that individuals with SSD who exhibited disrupted or disordered sleep, positive symptoms and/or hopelessness should be routinely screened for suicidal thinking. Furthermore, interventions that effectively target sleep disruptions may provide much-needed action against suicidal ideation.

HIGHLIGHTS

• Reduced sleep found to be associated with increased suicidal ideation

• This was uniquely mediated by both hopelessness and positive symptoms

• More regular screening of sleep problems in schizophrenia is needed

Keywords:

• Hallucinations
• insomnia
• schizoaffective disorder
• self-harm
• suicidality
• suicide

ACKNOWLEDGEMENTS

The authors wish to acknowledge the contributions of study participants, staff at recruitment services, staff at the Centre for Mental Health, and staff at the Monash Alfred Psychiatry Research Centre (MAPrc), including Professor Jayashri Kulkarni.

DISCLOSURE STATEMENT

No potential conflict of interest was reported by the author(s).

Additional information

Funding

Participants for this study were sourced, in part, through the Cognitive and Genetic Explanations of Mental Illness (CAGEMIS) bio-databank, which is supported by the Australian National Health and Medical Research Council (NHMRC; Project grant to Rossell, S. [GNT1060664] and Toh, W. L. [GNT1161609], Early Career Fellowships to Gurvich, C. [GNT546262], Lee, S. [GNT1111428], Tan, E. [GNT1142424] and Van Rheenen, T. [GNT1088785], and a Senior Research Fellowship to Rossell, S. [GNT154651]). This research was also supported by a Barbara Dicker Brain Sciences Foundation grant awarded to Dr Carruthers and Prof Rossell. None of the funding sources played any role in the study design; collection, analysis or interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.

Notes on contributors

Sean P. Carruthers

Sean P. Carruthers and Stuart J. Lee, Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia.

Stuart J. Lee

Sean P. Carruthers and Stuart J. Lee, Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia.

Anoop Sankaranarayanan

Anoop Sankaranarayanan, Blacktown Mental Health Services, Western Sydney Mental Health Service, Sydney, NSW, Australia; School of Medicine and Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, Australia.

Philip J. Sumner

Philip J. Sumner and Wei Lin Toh, Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia.

Wei Lin Toh

Philip J. Sumner and Wei Lin Toh, Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia.

Eric J. Tan

Eric J. Tan, Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia; Department of Psychiatry, St Vincent’s Hospital, Melbourne, VIC, Australia.

Erica Neill

Erica Neill, Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia; Department of Psychiatry, St Vincent’s Hospital, Melbourne, VIC, Australia; Department of Psychiatry, University of Melbourne, VIC, Australia.

Tamsyn E. Van Rheenen

Tamsyn E. Van Rheenen, Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia; Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Victoria, Australia.

Caroline Gurvich

Caroline Gurvich, Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia; Monash Alfred Psychiatry Research Centre (MAPrc), Monash University Central Clinical School and The Alfred Hospital, Melbourne, Australia.

Susan L. Rossell

Susan L. Rossell, Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia; Department of Psychiatry, St Vincent’s Hospital, Melbourne, VIC, Australia.