Nocturnal wakefulness is associated with next-day suicidal ideation in Major Depression and Bipolar Disorder

FARE Award Winner

Authors

• ED Ballard
• JL Vande Voort
• RA Bernert
• DA Luckenbaugh
• EM Richards
• MJ Niciu
• ML Furey
• WC Duncan
• CA Zarate

Abstract

Objective: Self-reported sleep disturbances may confer elevated risk for suicidal ideation, suicide attempts, and death. However, limited research has evaluated polysomnography (PSG)-determined sleep disturbance as an acute physiological risk factor for suicidal thoughts. This study sought to investigate the relationship between nocturnal wakefulness in association with next-day suicidal ideation using overnight PSG assessment from data collected from 2006-2013. Method: Participants with major depressive disorder (MDD) or bipolar depression (DSM-IV) underwent overnight PSG monitoring in a sleep laboratory. The Hamilton Depression Rating Scale (HAM-D) was administered the morning after PSG 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 AM among participants with suicidal ideation, F(4,136) = 3.65, p = .007. Increased time awake during the 4 AM hour (4:00 to 4:59) was significantly associated with elevated suicidal thoughts the next day (standardized β = .31, p = .008). This relationship persisted after controlling for age, gender, diagnosis, and severity of depressive symptoms. Conclusion: Greater nocturnal wakefulness, particularly in the early morning hours, was significantly associated with next-day suicidal thoughts. PSG-documented sleep disruption at specific times of night may represent an acute warning sign of suicidal ideation that warrants additional research.

Scientific Focus Area: Social and Behavioral Sciences

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