Nocturnal wakefulness is associated with next-day suicidal ideation in major depressive disorder and bipolar disorder

Elizabeth D. Ballard, Jennifer L. Vande Voort, Rebecca A. Bernert, David A. Luckenbaugh, Erica Richards, Mark J. Niciu, Maura L. Furey, Wallace C. Duncan, Carlos A. Zarate

Research output: Contribution to journalArticle

Abstract

Objective: Self-reported sleep disturbances may confer elevated risk for suicidal ideation, suicide attempts, and death. However, limited research has evaluated polysomnographically determined sleep disturbance as an acute physiologic risk factor for suicidal thoughts. This study sought to investigate the relationship between nocturnal wakefulness in association with next-day suicidal ideation using overnight polysomnography assessment from data collected between 2006 and 2013. Methods: Sixty-five participants with DSM-IV-diagnosed major depressive disorder or bipolar depression underwent overnight polysomnography monitoring in a sleep laboratory. The Hamilton Depression Rating Scale (HDRS) was administered the morning after polysomnography recording to assess next-day suicidal ideation, severity of depressive symptoms, and subjective sleep disturbances. Results: Using a generalized linear mixed model, a significant time-by-ideation interaction was found indicating greater nocturnal wakefulness at 4:00 am among participants with suicidal ideation (F4,136 = 3.65, P = .007). Increased time awake during the 4:00 am hour (4:00 to 4:59) was significantly associated with elevated suicidal thoughts the next day (standardized β = 0.31, P = .008). This relationship persisted after controlling for age, gender, diagnosis, and severity of depressive symptoms. Conclusions: Greater nocturnal wakefulness, particularly in the early morning hours, was significantly associated with next-day suicidal thoughts. Polysomnographically documented sleep disruption at specific times of night may represent an acute risk factor of suicidal ideation that warrants additional research.

Original languageEnglish (US)
Pages (from-to)825-831
Number of pages7
JournalJournal of Clinical Psychiatry
Volume77
Issue number6
DOIs
Publication statusPublished - Jun 1 2016
Externally publishedYes

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ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Ballard, E. D., Vande Voort, J. L., Bernert, R. A., Luckenbaugh, D. A., Richards, E., Niciu, M. J., ... Zarate, C. A. (2016). Nocturnal wakefulness is associated with next-day suicidal ideation in major depressive disorder and bipolar disorder. Journal of Clinical Psychiatry, 77(6), 825-831. https://doi.org/10.4088/JCP.15m09943