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Cited by 178Suicide and Self-Harm StudiesSleep and related disordersTreatment of Major Depression

The DOI matches its Crossref record; 68 of the 68 references it cites were found in a registry or an index.

Systematic review and meta-analysis of the relationship between sleep disorders and suicidal behaviour in patients with depression

Open access
Wang, Xiaofen, Cheng, Sixiang, Xu, Huilan·2019·BMC Psychiatry
DOI 10.1186/s12888-019-2302-5PMC PMC6798511
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Abstract

Background: The potential link between sleep disorders and suicidal behaviour has been the subject of several reviews. We performed this meta-analysis to estimate the overall association between sleep disorders and suicidal behaviour and to identify a more specific relationship in patients with depression. Methods: A systematic search strategy was developed across the electronic databases PubMed, EMBASE and the Cochrane Library from inception to January 1, 2019 for studies that reported a relationship between sleep disorders and suicidal behaviour in depressed patients. The odds ratio (OR) and corresponding 95% confidence interval (CI) were used to measure the outcomes. Heterogeneity was evaluated by Cochran’s Q test and the I 2 statistic. The Newcastle-Ottawa Scale (NOS) was adopted to evaluate the methodological quality of each of the included studies, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the quality of the evidence. We calculated the overall association between sleep disorders and suicidal behaviour and estimated more specific categories, including insomnia, nightmares, hypersomnia, suicidal ideation, suicide attempt, and completed suicide. Results: A total of 18 studies were included in this study. Overall, sleep disorders were closely related to suicidal behaviour in patients with depression (OR = 2.45 95% CI: 1.33 4.52). The relatively increased risks of sleep disorders with suicidal ideation, suicide attempt and completed suicide ranged from 1.24 (95% CI: 1.00 1.53) to 2.41 (95% CI: 1.45 4.02). Nightmares were found to be highly correlated with the risk of suicidal behaviour (OR = 4.47 95% CI: 2.00 9.97), followed by insomnia (OR = 2.29 95% CI: 1.69 3.10). The certainty of the evidence was rated as very low for the overall outcome and the major depression subgroup and was rated as low for the depression subgroup. Conclusions: This meta-analysis supports the finding that sleep disorders, particularly nightmares and insomnia, increase the risk of suicidal behaviour in depressed patients. Considering that all included studies were observational, the quality of the evidence is rated as very low. More well-designed studies are needed to confirm our findings and to better explain the mechanisms by which sleep disorders aggravate suicidal behaviour in depressed patients.

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Figures

Fig. 1 Flow diagram of included/excluded studies. A total of 1634 documents were found in the initial search. After removing duplicates, reading titles, abstracts and full texts, and evaluating the quality of the articles, 18 eligible studies were included and analysed
Fig. 1 Flow diagram of included/excluded studies. A total of 1634 documents were found in the initial search. After removing duplicates, reading titles, abstracts and full texts, and evaluating the quality of the articles, 18 eligible studies were included and analysedCC BY · PubMed Central
Fig. 2 Assessment of the risk of bias. a Risk of bias graph and b Risk of bias summary; a represents the percentage of each bias level for five items, and b indicates the level of specific items in each study. Different colours (green, red, yellow) and symbols (“+”, “ - “, “?”) indicate “low risk of bias”, “high risk of bias” and “unclear risk of bias”. A study with three or more green “+” can be considered to have a low risk of bias
Fig. 2 Assessment of the risk of bias. a Risk of bias graph and b Risk of bias summary; a represents the percentage of each bias level for five items, and b indicates the level of specific items in each study. Different colours (green, red, yellow) and symbols (“+”, “ - “, “?”) indicate “low risk of bias”, “high risk of bias” and “unclear risk of bias”. A study with three or more green “+” can be considered to have a low risk of biasCC BY · PubMed Central
Fig. 3 Forest plot of the relationship between sleep disorders and suicidal behaviour in depressed patients, N = 198,893. The data are expressed as odds ratios and the corresponding 95% confidence intervals. Pooled effect evaluation, represented by a diamond, was obtained with a random effects model. The heterogeneity between studies was explored by Cochran’s Q test and the I2 statistic, where I2 > 50% was considered evidence of substantial heterogeneity
Fig. 3 Forest plot of the relationship between sleep disorders and suicidal behaviour in depressed patients, N = 198,893. The data are expressed as odds ratios and the corresponding 95% confidence intervals. Pooled effect evaluation, represented by a diamond, was obtained with a random effects model. The heterogeneity between studies was explored by Cochran’s Q test and the I2 statistic, where I2 > 50% was considered evidence of substantial heterogeneityCC BY · PubMed Central

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Research works printed but not linked: 1

  1. Bernert R, Reeve J, Perlis MIL, Joiner TE. Insomnia and nightmares as predictors of elevated suicide risk among patients seeking admission to emergency mental health facility. Sleep. 2009;32:A365–6.

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Metadata

Authors
Wang, X., Cheng, S., & Xu, H.
Affiliations
Central South University (CN)
Corresponding author
Xu, Huilan
ORCID
Venue
BMC Psychiatry
Publisher
Springer Science and Business Media LLC
Published
2019-10-17
Volume
19
Issue
1
Pages
303-303
ISSN
1471-244X (ISSN-L)
DOI
10.1186/s12888-019-2302-5
PMC
PMC6798511
OpenAlex
W2980774592
Cited by
178
References
68
Citations by year
2026: 12 · 2025: 29 · 2024: 38 · 2023: 32 · 2022: 30 · 2021: 23 · 2020: 13
FWCI
2.60
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Psychiatry (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
Keywords
sleep disorders, suicidal behavior, depression, insomnia, nightmares, hypersomnia, suicidal ideation, suicide attempts, suicide mortality, suicide risk
MeSH terms
Adult, Depression, Major Depressive Disorder, Female, Humans, Male, Sleep Wake Disorders, Suicide, Attempted, Odds Ratio, Suicidal Ideation

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