Insomnia symptoms contributed indirectly to suicide attempts in a cohort of youth who attended an intensive outpatient suicide prevention program, according to study results published in Psychiatry Research.

Jenny W. Lau, MD, of the Psychiatry Department, Children’s Health Children’s Medical Center, and the University of Texas Southwestern Medical Center, Dallas, and colleagues examined the prospective relationship between insomnia symptoms and suicide attempts in high-risk youth. The investigators acquired data on depressive symptoms, insomnia symptoms, and suicide ideation measures from clinical records for 206 adolescents between the age of 12 and 17 years at both entry and discharge from the prevention program. They also obtained information on suicide attempts within 6 months following discharge.

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The study population was 79.1% female and 89.8% of all patients were diagnosed with depression. Associations between entry insomnia symptoms, suicide attempts within 6 months of discharge, persistent insomnia symptoms, and suicide ideation at discharge were analyzed using multiple regression analyses. 

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When controlling for age, sex, and previous attempts, entry insomnia symptoms were prospectively associated with suicide attempts, but symptoms at discharge were not. Suicide ideation at discharge was also associated with entry insomnia symptoms, as well as attempts within 6 months of discharge. When entry and discharge suicide ideation were controlled, the association between entry insomnia symptoms and attempts lost significance, but the association between discharge ideation and attempts remained significant.

Suicide attempts may have been underestimated as they were reported by parents and not the adolescents. The study did not include aborted or interrupted suicide attempts.

“Our results indicated that there is a chain effect between insomnia symptoms and suicide attempts, as patients with higher insomnia symptom scores at entry had higher suicidal ideation scores at discharge and a subsequent increased likelihood of a suicide attempt 6 months after the program,” the researchers wrote.

“More intensive treatment to reduce suicide ideation in those with insomnia could ultimately reduce the probability of future suicide attempts,” they concluded.

Disclosure: One of the study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Lau JW, Stewart SM, King JD, Kennard BD, Emslie GJ. The association between baseline insomnia symptoms and future suicide attempts within an intensive outpatient treatment program for suicide [published online August 19, 2019]. Psychiatry Res. doi:10.1016/j.psychres.2019.112527