Suicide Attempts, Sleep Disturbance Associated With Internet Addiction

Suicide attempts and sleep in adults are associated with Internet addiction.

Adults with severe Internet addiction (IA) suffer from more sleep disturbances and a higher risk for lifetime suicide attempts than adults without IA, according to a new study conducted by a team of researchers in Seoul, Korea.

To investigate the association between suicide attempts and sleep in adults with IA, Kiwon Kim, MD, from the Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea, and colleagues conducted a cross-sectional, population-based study of 3212 randomly selected adults (aged 18-64 years).

IA was defined as a score of ≥50 on the Korean version of Young’s Internet Addiction Test. Sleep disturbances were defined according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, and assessed 5 domains: difficulty initiating sleep (DIS), difficulty maintaining sleep, early morning awakening, nonrestorative sleep, and daytime functional impairment resulting from poor sleep quality. Participants were also asked about sleep duration during weekdays and during weekends and holidays. They were asked about suicidal ideation, plans, and attempts. All questions were conducted on a face-to-face basis.

Of the total sample, 204 (6.35%) subjects were assessed to have IA. They were found to be younger, more frequently male, unmarried, and unemployed, and had poorer sleep quality than adults without IA (32.8% versus 19.8%). Participants with IA demonstrated a more frequent history of suicidal ideation and plan, but there were no significant differences found in monthly income, absolute sleep duration, and previous suicide attempt history between the 2 groups.

Subjects with IA showed poorer sleep quality than those without IA (adjusted odds ratio [AOR], 1.73; P <.0001) and a significantly higher tendency to have DIS (AOR, 1.66; P =.028), with a significantly longer duration shown (DIS for >6 months; AOR, 1.73; P =.032]) than participants without IA.

Participants with more sleep problems showed more severe IA, which was a tendency found to be stronger in the group with a previous suicide attempt, as well as more frequent suicidal plan and suicidal attempts than participants with sleep problems but without IA (AOR, 3.83 [P =.005] and AOR, 3.34 [P =.007], respectively); these participants showed a significant association with IA in the group with poor sleep quality.

After adjusting for age, sex, education years, and marital status, adults with both IA and sleep problems had significantly more frequent overall psychiatric disorders and overall anxiety disorders (AOR, 2.730 [P =.001] and AOR, 10.088 [P <.0001], respectively) than adults with IA but without sleep problems.

The specific sleep disturbances associated with IA were problems in sleep initiation and maintenance, resulting in nonrestorative sleep and difficult in daytime functioning, the authors note.

They highlight the difference in suicidal patterns between the IA subjects with sleep disturbances and those without. “[T]he current study showed that the IA with sleep problem group had more tendency for suicide plan and attempt, while the IA without sleep problem group had more tendency for suicide ideation and plan.” They suggest that the “[l]ack of the protective factor of storage sleep in suicide, along with impulsivity seen in IA, could have caused this difference.”

In light of the “importance of adequate sleep in the protective effect on mental health and high risk of suicidal plan and attempt observed in the IA with sleep problem group,” the researchers advise health professionals to “be aware of coexistence of sleep problems and IA, not only in the adolescent group but also in the adult group.”

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Kim K, Lee H, Hong JP, et al. Poor sleep quality and suicide attempt among adults with internet addiction: A nationwide community sample of Korea [published online April 6, 2017]. PLoS One. doi: 10.1371/journal.pone.0174619