Citation

Hamilton JL, Buysse DJ. Am. J. Psychiatry 2019; 176(11): 897-899.

Affiliation

Department of Psychiatry (Hamilton, Buysse) and Clinical and Translational Science Institute (Buysse), University of Pittsburgh School of Medicine, Pittsburgh.

Copyright

(Copyright © 2019, American Psychiatric Association)

DOI

10.1176/appi.ajp.2019.19080888

PMID

31672043

Abstract

Suicide is a major public health concern. Rates of suicide have increased in the United States, with most states experiencing a greater than 30% increase in deaths by suicide across the past 20 years (1). Despite decades of research, our efforts at suicide prevention remain limited. One reason is that most identified risk factors for suicide, such as demographic characteristics, psychiatric conditions, or prior suicidal behaviors, are unchangeable or not readily modifiable. By contrast, insomnia offers promise as a risk factor for suicide and suicidality because it is time varying, proximal, and modifiable. Growing evidence suggests that insomnia is associated with suicide and suicidality (i.e., suicidal ideation and behavior) independent of well-established risk factors for suicide, such as depression and hopelessness (2). In light of mounting evidence, sleep disturbances, especially insomnia and nightmares, are now listed as one of the top 10 warning signs by the Substance Abuse and Mental Health Services Administration.

What makes insomnia a particularly auspicious target for suicide prevention is that we have effective interventions. Traditional treatments for depression do not target insomnia, which is the most common residual symptom of depression and which significantly increases risk for relapse (3). On the other hand, insomnia treatments given to patients with major depressive disorder can lead to improvements in insomnia, core symptoms of depression, and even suicidality (4). The scarcity of therapeutic evidence for suicide prevention is in large part due to the limited number of randomized controlled trials of psychopharmacological interventions among patients with active suicidal ideation. More specifically, few randomized controlled trials of insomnia interventions in patients with major depressive disorder have actively selected participants with suicidal ideation. These gaps in research highlight the innovation and impact of the article in this issue by McCall and colleagues, “Reducing Suicidal Ideation Through Insomnia Treatment (REST-IT): A Randomized Clinical Trial” (5). REST-IT takes the important next step of determining whether insomnia treatment can reduce suicidal ideation among patients with major depression and active suicidal ideation ...

Language: en

Keywords

Insomnia; Sleep; Suicide