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Cited by 248Sleep and related disordersSuicide and Self-Harm StudiesSleep and Work-Related Fatigue

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

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Bernert, Rebecca A., Turvey, Carolyn L., Conwell, Yeates, Joiner, Thomas E.·2014·JAMA Psychiatry
DOI 10.1001/jamapsychiatry.2014.1126PMC PMC4283786
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Abstract

IMPORTANCE: Older adults have high rates of sleep disturbance, die by suicide at disproportionately higher rates compared with other age groups, and tend to visit their physician in the weeks preceding suicide death. To our knowledge, to date, no study has examined disturbed sleep as an independent risk factor for late-life suicide. OBJECTIVE: To examine the relative independent risk for suicide associated with poor subjective sleep quality in a population-based study of older adults during a 10-year observation period. DESIGN, SETTING, AND PARTICIPANTS: A longitudinal case-control cohort study of late-life suicide among a multisite, population-based community sample of older adults participating in the Established Populations for Epidemiologic Studies of the Elderly. Of 14 456 community older adults sampled, 400 control subjects were matched (on age, sex, and study site) to 20 suicide decedents. MAIN OUTCOMES AND MEASURES: Primary measures included the Sleep Quality Index, the Center for Epidemiologic Studies-Depression Scale, and vital statistics. RESULTS: Hierarchical logistic regressions revealed that poor sleep quality at baseline was significantly associated with increased risk for suicide (odds ratio [OR], 1.39; 95% CI, 1.14-1.69; P < .001) by 10 follow-up years. In addition, 2 sleep items were individually associated with elevated risk for suicide at 10-year follow-up: difficulty falling asleep (OR, 2.24; 95% CI, 1.27-3.93; P < .01) and nonrestorative sleep (OR, 2.17; 95% CI, 1.28-3.67; P < .01). Controlling for depressive symptoms, baseline self-reported sleep quality was associated with increased risk for death by suicide (OR, 1.30; 95% CI, 1.04-1.63; P < .05). CONCLUSIONS AND RELEVANCE: Our results indicate that poor subjective sleep quality is associated with increased risk for death by suicide 10 years later, even after adjustment for depressive symptoms. Disturbed sleep appears to confer considerable risk, independent of depressed mood, for the most severe suicidal behaviors and may warrant inclusion in suicide risk assessment frameworks to enhance detection of risk and intervention opportunity in late life.

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  • Depression, physical comorbidity, sleep and pain issues, and cognitive impairment are substantial contributors to suicidal behaviour in older people.

    “Although impulsive-aggressive traits, substance abuse and conduct disorder make proportionally larger contributions to suicide risk in younger people 7,97,109 , depression, physical comorbidity, sleep and pain issues, and cognitive impairment are substantial contributors to suicidal behaviour in older people 110,111 .”

    From Suicide and suicide risk (2019) · cites this paper as [110]

    The Discussion (page unavailable) reports that poor sleep quality was associated with suicide risk in older adults and describes major depression as a strong predictor of suicide. The Results, Post Hoc Analyses (page unavailable), say cognitive and physical impairment did not significantly distinguish suicide decedents from controls. The paper does not establish pain issues or physical comorbidity as substantial contributors, so it does not support the full list. (LLM, conf=0.88)

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  1. [8]Office of the Surgeon General and National Action Alliance for Suicide Prevention 2012 National Strategy for Suicide Prevention: Goals and Objectives for Action: A Report of the U.S. Surgeon General and of the National Action Alliance for Suicide Prevention 2012 US Dept of Health and Human Services Washington, DC 23136686

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Authors
Bernert, R. A., Turvey, C. L., Conwell, Y., & Joiner, T. E.
Affiliations
  • Stanford Medicine (US)
  • University of Iowa (US)
  • University of Rochester Medicine (US)
  • Florida State University (US)
Corresponding author
Bernert, Rebecca A.
ORCID
Venue
JAMA Psychiatry
Publisher
American Medical Association (AMA)
Published
2014-10-01
Volume
71
Issue
10
Pages
1129
ISSN
2168-622X (ISSN-L)
DOI
10.1001/jamapsychiatry.2014.1126
PMC
PMC4283786
OpenAlex
W2118041756
Cited by
248
References
57
Citations by year
2026: 13 · 2025: 19 · 2024: 14 · 2023: 28 · 2022: 19 · 2021: 20 · 2020: 27 · 2019: 18 · 2018: 17 · 2017: 18 · 2016: 27 · 2015: 26 · 2014: 1
FWCI
33.39
Type
journal article
Language
en
Open access
Locations
  • JAMA Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Centers for Disease Control and Prevention (R49CE002093)
  • National Institute of Mental Health (K23MH093490, F31MH080470)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
Keywords
subjective sleep quality, suicide, older adults, sleep disorders, non-restorative sleep, difficulty falling asleep, depressive symptoms, suicide risk factors, suicide risk assessment, sleep quality index
MeSH terms
Aged, Aged, 80 and over, Female, Humans, Male, Prospective Studies, Psychiatric Status Rating Scales, Risk Factors, Sleep Wake Disorders, Suicide, United States, Case-Control Studies

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