Sleep disturbance and suicidality in patients with bipolar disorders - the mediating role of rumination and impulsivity
Refereed conference paper presented and published in conference proceedings

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摘要Introduction: Individuals with bipolar disorders (BAD) often complain of having insomnia and nightmares. Such sleep disturbance has been shown to be associated with an increased risk for suicidality. Some psychological factors observed in BAD patients, namely rumination and impulsivity, are thought to be exacerbated by sleep disturbance. The present study aimed to examine whether rumination and impulsivity mediated the association between sleep disturbance and suicidal ideation in a sample of BAD patients.

Materials and methods: One hundred and seven BAD patients (Mean age = 46.6 years, SD = 11.6, female = 73%) were recruited from local psychiatric outpatient clinics and completed a battery of self-report questionnaires. The diagnosis was ascertained by the Mini-International Neuropsychiatric Interview (MINI). Sleep disturbance was assessed by Insomnia Severity Index (ISI) for insomnia and Nightmare Distress Questionnaire (NDQ) for nightmares. Rumination and trait impulsivity were assessed by Ruminative Response Scale (RRS) and Barratt Impulsiveness Scale (BIS-11), respectively. Suicidal ideation was assessed by Beck's Scale for Suicidal Ideation (BSSI). A series of mediation models were tested with regression analysis with the significance of indirect effect tested by bootstrapping 5000 samples.

Results: Within our sample, 32.7% reported having clinical insomnia (defined as >= 15 on ISI) and 18.8% reported experiencing frequent nightmares (at least once per week) in the past three months. Suicidal ideation was significantly correlated with insomnia (r = .487, p < .001) and nightmares ( r = .384, p < .001). A positive correlation between rumination and impulsiveness was found (r = .496, p < .001). There was a significant mediation effect of insomnia on suicidal ideation through rumination (ab = .270, 95% CI [.157, .405], PM = .627) and through impulsivity (ab = .100, 95% CI [.016, .206], PM = .233). A significant mediation effect of nightmares on suicidal ideation was also found through rumination (ab = .368, 95% CI [.191, .574], PM = .693) and impulsivity (ab = 124, 95% CI [.008, .267], PM = .235).

Conclusions: Both insomnia and nightmares are associated with an increase in suicidal ideation in BAD patients. Our data suggest that these associations are mediated by both rumination and impulsivity, where rumination overall have greater mediating effects. Our findings suggest targeting rumination as a possible pathway in treatment strategies and support the need for sleep-focused intervention in suicide risk prevention and intervention in bipolar patients.

Acknowledgements: This work was supported by Health and Medical Research Fund (03140636).
著者T.W.F.Cheung, H.Feng, L.Y.Ho, B.Lei, N.Y.Chan, J.W.Y.Chan, S.W.H.Chau, J.Zhang, Y.K.Wing, S.X.Li
會議名稱The 15th World Sleep Congress
會議開始日20.09.2019
會議完結日25.09.2019
會議地點Vancouver
會議國家/地區加拿大
會議論文集題名Sleep Medicine
出版年份2019
月份12
卷號64
期次Suppl 1
出版社Elsevier
頁次S70 - S70
語言美式英語

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