Sleep disturbances confer an increased risk for suicidal behaviors in older adults, even when depressed mood is accounted for, a study of more than 14,000 people aged 66 to 90 suggests.
Older adults have more trouble sleeping than younger adults. Approximately 57 percent of people aged 65 and older report experiencing clinically significant sleep disruption, Rebecca Bernert, Ph.D., director of the Suicide Prevention Research Laboratory at Stanford University School of Medicine, and colleagues noted in a study published online August 13 in JAMA Psychiatry.
Older adults also die by suicide more frequently than younger people, the researchers said. More than 33,000 Americans died by suicide in 2010, according to the Centers for Disease Control and Prevention. Among Americans of all ages, the rate was 12.4 per 100,000. In those aged 65 to 74, the rate was 13.7. In people aged 85 and older, the rate jumped to 17.6.
To assess the contribution of poor sleep to suicide risk, Bernert and colleagues drew upon data from a longitudinal, multisite study of 14,456 community-dwelling adults aged 65 and older, the Established Populations for Epidemiologic Studies of the Elderly project.
They compared self-reported sleep quality in 20 people who died by suicide over a 10-year observation period with sleep quality reported by 400 other participants randomly selected and matched for age, sex, study site, and duration in the study.
People who reported poor sleep quality at baseline had a 1.4 times higher risk of death by suicide over the 10-year observation period than those who said they slept well, Bernert’s group found. Even after the researchers controlled for effects of depressed mood, they found that poor sleep quality at baseline was associated with a 1.2 times greater risk for suicide death.
While people who died by suicide had higher rates of both sleep disturbances and depressive symptoms than controls did, sleep disturbances outperformed depressive symptoms in predicting risk of death by suicide 10 years later. Two sleep complaints—difficulty falling asleep and nonrestorative sleep, particularly in combination—specifically predicted increased risk for suicide.
Older adults frequently visit their primary care physician in the weeks preceding their death by suicide, the researchers said. Friends and family often know when someone close to them is sleeping poorly. Thus, “Targeting disturbed sleep as a visible warning sign of suicide may constitute a novel opportunity for improved risk detection, particularly among those at elevated risk,” Bernert and colleagues suggested. Poor subjective sleep quality, they said, also may represent a novel therapeutic target for suicide prevention in late life. ■
“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” can be accessed
here.
