Insomnia and suicide risk: a multi-study replication and extension among military and high-risk college student samples

Raymond P Tucker,Robert J Cramer,Jennifer Langhinrichsen-Rohling,Ricky Rodriguez-Cue,Susan Rasmussen,Nicolas Oakey-Frost,Capt Michael Franks,Capt Craig A Cunningham

doi:10.1016/j.sleep.2021.06.032

Abstract

Objective/backgroundA clear link between insomnia concerns and suicidal ideation has been shown in a variety of populations. These investigations failed to use a theoretical lens in understanding this relationship. Research within the veteran population has demonstrated that feelings of thwarted belongingness (TB), but not perceived burdensomeness (PB), mediate the insomnia and suicidal ideation relationship. Using two high risk samples, the present investigation replicated and extended this line of inquiry to include interpersonal hopelessness about TB, a key component of the Interpersonal Psychological Theory of Suicide. Methods/results/conclusionsUsing medical record review and survey data, study 1 replicated the finding that TB is a stronger explanatory factor of the insomnia to suicidal ideation/suicide risk relationship in a sample of N = 200 treatment-seeking active-duty personnel. Study 2 found that insomnia symptoms had an indirect effect on suicidal ideation through TB and PB but not interpersonal hopelessness in a sample of N = 151 college students with a history of suicidal thoughts and/or behaviors. TB was the only mediator of the insomnia-suicide attempt likelihood link and insomnia to clinically significant suicide risk screening status. Limitations include cross-sectional design of both studies and the lack of formal diagnoses of insomnia. Implications and future research directions are discussed.

Highlights

Insomnia is globally recognized as a major public health concern (Chattu et al, 2019)
An indirect effect for insomnia symptoms on suicidal ideation (SI) was observed through thwarted belongingness (TB) (ß=.04, 95% CI[.02,.06]) and perceived burdensomeness (PB) (ß=.01, 95% CI[.01,.21]) A pairwise comparison of the indirect effects demonstrated no a stronger effect for TB compared to PB (β=.11, 95% CI[.01, .22])
An indirect effect for insomnia symptoms on SI was observed through TB (ß=.03, 95% CI[.01,.06]) and PB (ß=.03, 95% CI[.01,.07]) but not interpersonal hopelessness (β=.01, 95% CI[-.02,.03])

Summary

Introduction

Insomnia is globally recognized as a major public health concern (Chattu et al, 2019). The relationship between insomnia and STBs has been demonstrated in the general population (Park et al, 2019), civilian medical patients receiving services at a sleep clinic (Krakow, Ribeiro, Ulibarri, Krakow, & Joiner, 2011), active-duty military (Ribeiro et al, 2012), and military veterans (Bishop, Crean, Hoff, & Pigeon, 2019; Britton, et al, 2019). Recent empirical work has shed more light on the mechanisms that explain the link between insomnia and STBs. For example, in a survey of over 12,000 female adolescents, insufficient sleep maintained a direct association with suicidal ideation (SI), even after controlling for co-occurring symptoms of depression (Park et al, 2019). While there is growing consensus about the link between insomnia and suicide, the understanding of the mechanisms underlying this link is rudimentary

Methods

Results

Discussion

Conclusion