Background
Methods
Inclusion and exclusion criteria
Data sources and search strategy
Study selection and data extraction
Assessment of study quality and publication bias
Statistical analysis
Results
Description and quality of included studies
Author, year | Study design | Patients ( n) | Female (%) | Age (years) | Psychiatric diagnoses | Suicidal behaviors | Sleep disturbances |
---|---|---|---|---|---|---|---|
Agargun, 1997 [7] | Retrospective | 113 | 74% | Mean: 32.6 range: 18-70 | Major depression | Ideation | Insomnia and hypersomnia assessed by SCID-I |
Li, 2010 [8] | Cross-sectional | 1,231 | 68.20% | Mean: 42.4, range 18-65 | Major depression, Bipolar, Other | Attempt | Self-reported insomnia and recurrent nightmares assessed by a questionnaire |
McGirr, 2007 [12] | Prospective | 156 | 19.20% | Mean: 42.4 | Major depression | Completed suicide | Insomnia and hypersomnia assessed by SCID-I |
Nrugham, 2008 [13] | Prospective | 2,464 | 50.80% | Mean age 13.7 | Depressive symptom and disorder | Ideation, attempt | Insomnia, hypersomnia, non-restorative sleep assessed by K-SADS and MFQ |
Paffenbarger, 1994 [14] | Prospective | 21,582 | 0 | Range: 35-74 | Depressive disorder | Completed suicide | Self-reported insomnia assessed by a questionnaire |
Pompili, 2009 [15] | Retrospective | 40 | 10% | Mean: 40 Range: 23-76 | Schizophrenia | Completed suicide | Insomnia defined as difficulty initiating or maintaining sleep, or non-restorative sleep causing impaired functioning or suffering that was long-lasting or demanded treatment and recorded from patients’ medical records |
Sjostrom, 2009 [16] | Prospective | 165 | 78% | Range: 18-69 | Axis 1 DSM disorders | Attempt | Difficulties initiating sleep, problems maintaining sleep and early morning awakening assessed by USI |
Agargun, 1997 [17] | Prospective | 41 | 76% | Mean: 34.6 SD: 10.8 | Major depression | SADS suicidality score | Subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbance, use of sleeping medications, daytime dysfunction, and global severity measured by PSQI |
Agargun, 1998 [18] | Prospective | 63 | 76% | Mean: 34.1 SD: 10.8 | Major depression | Ideation, attempts | Frequency of nightmares |
Agargun, 1998 [19] | Unclear | 67 | 73.10% | Mean: 31.9 SD: 8.8 | Panic disorder | Ideation | Sleep panic and insomnia ascertained from SADS |
Agargun, 2003 [20] | Prospective | 26 | 61.50% | Unclear | Major depression | HDRS suicide scores | REM latency, REM%, REM periods measured by three nights of polysomnography |
Chellappa, 2007 [21] | Cross-sectional | 70 | 62.90% | Mean:: 40.5 SD: 12.54 | Major depression | Ideation | Insomnia or excessive sleepiness assessed by the SHQ and ICSD |
Krakow, 2000 [22] | Prospective | 153 | 100% | Mean: 36.4 SD: 11.1 | PTSD | Hamilton Depression and suicidality scores | SMD and SDB assessed by AASM 1997 and ASDA 1997 |
Agargun, 2007 [23] | Retrospective | 100 | 52% | Mean: 32.1 SD: 10.7 | Unipolar major depression | Attempt | Nightmares assessed by ICSD-R; insomnia assessed by the HDRS items 6, 7, and 8 |
Yoshimasu, 2006 [24] | Cross-sectional | 231 | 57.10% | Mean: 36.3 SD: 28.5 | Major depression | Ideation | Insomnia assessed by SDS, KMI, and patients’ three most painful complaints |
Bjorngaard 2011 [25] | Prospective | 74,977 | 51% | Mean: 37.9 SD: 16.0 | Anxiety, depression | Completed suicide | Self-reported sleep difficulties assessed by a questionnaire |
Li 2012 [26] | Prospective | 419 | 81.80% | Mean: 44.6 SD: 10.4 | Major depression | Ideation | Insomnia, nightmares, and frequency of sleep disturbances measured by a questionnaire |
Krakow 2011 [27] | Cross-sectional | 1,584 | 55% | Mean: 49.8 SD: 66.4 | Depression | Attempt | Sleep disturbances measured by SMH, ISI DDNSI, FOSQ, and TMB-10 |
Fawcett, 1990 [1] | Prospective | 954 | 58% | Mean: 38.1 Range: 17-79 | Major affective disorder | Completed suicide | Insomnia assessed by SADS |
Suicidal behaviors | OR | 95% CI |
P value | I2
|
---|---|---|---|---|
Ideation | 2.69 | 1.62, 4.48 | <0.001 | 73.5% |
Attempt | 4.36 | 2.28, 8.33 | <0.001 | 0.0% |
Completed suicide | 1.59 | 1.17, 2.17 | <0.01 | 45.0% |
Sleep disturbance type | Studies ( n) | OR | 95% CI |
P value | I2
|
---|---|---|---|---|---|
Insomnia | 11 | 2.66 | 1.74, 4.07 | <0.001 | 75.4% |
Hypersomnia | 3 | 1.91 | 0.60, 6.06 | 0.27 | 85.8% |
Parasomnia | 6 | 4.69 | 2.58, 8.51 | <0.001 | 0.0% |
Sleep-related breathing disorder | 1 | 2.56 | 1.91, 3.43 | <0.001 | n/a |
Other/unclear | 7 | 4.16 | 1.96, 8.81 | <0.001 | 81.7% |