Sleep, sense of coherence and suicidality in suicide attempters

Abstract

A suicide attempt is a strong predictor of future suicide. The management of patients who self-harm presents a challenge for psychiatric services. It is therefore important to identify factors that may be related to increased risk of suicidal behaviour in suicide attempters. The current study aimed to examine the prevalence of specific sleep disturbances in suicide attempters and possible associations between sleep disturbances (including nightmares) and suicidal behaviour. A second focus was to test associations between sense of coherence and suicidality. Further, we tested whether Suicide Assessment Scale (SUAS) predicted repeat attempt. The study included 165 suicide attempt patients aged 18 – 69 years who were admitted to medical/psychiatric wards at Sahlgrenska University Hospital completed an initial clinical interview including self-report instruments assessing sleep complaints (Uppsala Sleep Inventory), depression/anxiety symptom intensity (CPRS Self-rating Scale for Affective Symptoms) and the individual’s capacity to manage stress and stay well (Sense of Coherence Questionnaire). Ninety-eight patients took part in a 2 month follow-up interview. Data concerning repeat suicide attempts were obtained from hospital case records. We found that 89 % of the subjects reported some kind of sleep disturbance. The most common complaint was difficulties initiating sleep (73 %) followed by difficulties maintaining sleep (69 %) and early morning awakening (58 %). Sixty-six percent reported nightmares. Persistent frequent nightmares were associated with risk for persistent suicidality and repeat attempt. SOC was associated with suicidality at followup, but we could not show an association with repeat attempt. The ability of the SUAS to predict repeat suicidal behaviour in the entire study group was low but the instrument performed better in the subgroup who reported ongoing psychiatric treatment at 2 month follow-up. Questions regarding sleep disturbances and nightmares could be addressed in the clinical evaluation, care and treatment of suicidal patients. SOC may be a tool to facilitate and deepen the dialogue between the psychiatric nurse and the suicidal patient. Our data provide further support for the use of the SUAS as a complementary tool in the assessment of psychiatric patients after a suicide attempt.