Nightmares and sleep disturbances in relation to suicidality in suicide attempters

STUDY OBJECTIVES: To study the prevalence of specific sleep disturbances in suicide attempters and to examine the association between specific sleep disturbances and suicidality. DESIGN AND SETTING: A cross-sectional study in suicide attempters during the period October 1, 2001, to June 30, 2004. PARTICIPANTS: One hundred sixty-five patients aged 18 to 68 years who were admitted to medical units or psychiatric wards at Sahlgrenska University Hospital after a suicide attempt. INTERVENTIONS: N/A. MEASUREMENTS: The face-to-face interview included Structured Clinical Interview for DSM-IV-IV and the Suicide Assessment Scale. Two self-report instruments were employed, the Uppsala Sleep Inventory and Comprehensive Psychopathological Self-rating Scale for Affective Syndromes. The latter assessed symptom burden. Using multiple logistic regression analyses, we examined associations between sleep complaints and suicidality. RESULTS: Eighty-nine percent of subjects reported some kind of sleep disturbance. The most common complaint was difficulties initiating sleep (73%). Other complaints included difficulties maintaining sleep (69%), nightmares (66%) and early morning awakening (58%). Nightmares were associated with a 5-fold increase in risk for high suicidality. This relationship remained after adjustment for psychiatric diagnosis and psychiatric symptom intensity. CONCLUSIONS: Sleep disturbances are common among suicide attempters. Nightmares are associated with suicidality. Our findings suggest that questions concerning sleep disturbance and nightmares should be addressed in the clinical assessment of suicidal patients.