Study Identifies Psychological Processes Underlying Sleep-Suicide Link

insomnia hyperarousal_TS_497207581
insomnia hyperarousal_TS_497207581
Suicide prevention strategies should include the provision of nighttime services.

An estimated 50-70 million US adults suffer from sleep or wakefulness disorders, prompting the Centers for Disease Control and Prevention to frame inadequate sleep as a public health epidemic. A recent survey found that nearly 30% of adults slept 6 hours or less each night, and only 31% of high school students averaged at least 8 hours nightly.1 That bodes poorly for the nation’s health, as researchers have linked poor sleep with a variety of mental and physical health problems ranging from diabetes and cancer to anxiety and depression.1,2

A new study published in BMJ Open examined the link between sleep and another serious outcome: suicide.3 Previous research reported an increased risk of suicidal thoughts and behaviors in individuals who have impaired sleep, and a large longitudinal cohort study revealed that poor sleep quality predicted increased suicide risk over a 10-year period.4 In addition, despite the connections that have observed between depression and suicide, and depression and sleep, a meta-analysis found an association between poor sleep and suicidal thoughts and behaviors independent of depression status.4

Citing the need to identify psychological processes underlying the relationship between sleep and suicide risk, which prior studies were not able to capture due to their design, researchers at the University of Manchester and the University of Oxford in the UK conducted the first qualitative study on the topic. The sample included 18 adults who had experienced an episode of major depressive disorder (MDD) as defined by DSM-IV criteria, and reported having had suicidal thoughts or behaviors within the past year. Face-to-face, semi-structured interviews were conducted with participants, and data was analyzed using an inductive and latent thematic analysis.

The findings show that participants acknowledged the importance of sleep and its role in their mental functioning, and 3 interrelated pathways emerged by which beliefs about sleep influenced suicidal ideation and behavior:

  • First, being awake at night increased the risk of suicide attempts because participants perceived it as an opportune time, given the lower likelihood that someone would be nearby to intervene. This decreased support at nighttime further added to the risk.
  • Second, participants perceived lack of good sleep as making life harder by influencing depression through increased negative thinking, attention problems, and inactivity.
  • Third, participants indicated that sleep was an alternative to suicide in that it offers escape from one’s problems. However, the associated daytime sleeping may further contribute to impaired sleeping patterns.

The authors conclude that suicide prevention strategies should include the provision of nighttime services, and clinicians should help connect patients with support resources that are available at night. Additionally, sleep problems should be addressed as part of recovery, and techniques to reduce rumination should be emphasized.

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1. Centers for Disease Control and Prevention. Insufficient Sleep Is a Public Health Epidemic. Retrieved October 6, 2016 from

2. National Alliance on Mental Illness. Mental Illnesses: Insomnia. Retrieved October 6, 2016 from

3. Littlewood DL, Gooding P, Kyle SD, Pratt D, Peters S. Understanding the role of sleep in suicide risk: qualitative interview study. BMJ Open. 2016; 6:e012113 doi:10.1136/bmjopen-2016-012113

4. Bernert RA, Turvey CL, Conwell Y, et al. Association of poor subjective sleep quality with risk for death by suicide during a 10-year period: a longitudinal, population-based study of late life. JAMA Psychiatry. 2014; 71:1129–37.

5. Pigeon WR, Pinquart M, Conner K. Meta-analysis of sleep disturbance and suicidal thoughts and behaviors. J Clin Psychiatry. 2012; 73:e1160–7.