What Difficulties Are Linked With Suicidality in Psychiatric Inpatients?

woman sitting on hospital bed
woman sitting on hospital bed
The aims of this study were to model suicide trajectory groups across length of stay among inpatients at a psychiatric hospital and to determine whether emotional regulation problems and sleep issues differ between groups.

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Persistent suicidality among psychiatric inpatients was associated with greater difficulties with emotion regulation and sleep, according to study data presented at the American Psychiatry Association Annual Meeting, held online May 1 to 3, 2021.

Adult inpatients at a psychiatric hospital in Houston, Texas, were enrolled in a study that assessed suicidality, emotion regulation, and sleep. Patients completed the Columbia-Suicide Severity Risk Scale (C-SSRS) at baseline, discharge, and every 2 weeks between.

At baseline and discharge, emotion regulation problems and sleep difficulties were captured using the Difficulties in Emotion Regulation Scale Short Form (DERS-SF) and the sleep-related item of the Patient Health Questionnaire-9 (PHQ-9), respectively. Group-based modeling of suicidal ideation trajectories was performed using C-SSRS scores from baseline and weeks 2, 4, and 6. Between-group differences in emotion regulation and sleep problems were assessed.

The study cohort comprised 3406 adult patients, among whom 1637 were women and 1769 were men. Their mean age was 35.24 years and 88.9% were White. The average length of inpatient stay was 42.16±20.90 days. Four distinct trajectories were identified for C-SSRS scores over time: (1) nonresponders, with persistently elevated suicidality; (2) early remitters, with elevated scores at admission that declined rapidly; (3) late remitters, with elevated scores at baseline that declined slowly; and (4) the “no suicide” group, with persistently low scores.

A one-way analysis of variance indicated substantial between-group differences in both emotional difficulties and sleep problems at admission (both P <.001). Nonresponders had the greatest mean baseline DERS-SF score (116.89±23.78) compared with the late remitters group (111.91±24.84; P =.038), early remitters group (106.35±24.55; P <.001), and no suicide group (89.20±26.04; P <.001). The nonresponder group also had a greater mean baseline score on the PHQ-9 sleep difficulties item (2.33±0.94) compared with the early remitters group (2.09±1.04; P <.001) and the no suicide group (1.68±1.13; P <.001), though not compared to the late remitters group (2.25±0.95; P =.741).

These results emphasize the close correlation between emotion dysregulation, sleep difficulties, and risk for suicide. Compared with other groups, patients with persistent and nonremitting suicidality experienced greater sleep difficulties and emotion regulation problems. Further studies are necessary to better explore the relationship between these factors and identify modifiable treatment targets. In particular, treatments targeting sleep patterns may serve as an entry point to addressing suicidality among adult inpatients.

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Rech ME, Rufino K, Patriquin MA. Trajectories of suicidal thoughts and behaviors and their relationship with sleep and emotion regulation among adult psychiatric inpatients. Presented at: American Psychiatry Association annual meeting May 1-3, 2021. Abstract/Poster: 4932