Insomnia severity is an indicator of suicidal ideation during a depression
clinical trial.
Author(s): McCall WV, Blocker JN, D'Agostino R Jr, Kimball J, Boggs N, Lasater B, Rosenquist
PB.
Affiliation(s): Department of Psychiatry and Behavioral Medicine, Wake Forest University Health
Sciences, Winston-Salem, NC 27157, USA. vmccall@wfubmc.edu
Publication date & source: 2010, Sleep Med. , 11(9):822-7
OBJECTIVE: Insomnia has been linked to suicidal ideas and suicide death in
cross-sectional and longitudinal population-based studies. A link between
insomnia and suicide has not been previously examined in the setting of a
clinical trial. Herein we describe the relationship between insomnia and suicidal
thinking during the course of a clinical trial for depression with insomnia.
METHODS: Sixty patients aged 41.5±12.5 years (2/3 women) with major depressive
episode and symptoms of insomnia received open-label fluoxetine for 9 weeks and
also received blinded, randomized eszopiclone 3mg or placebo at bedtime after the
first week of fluoxetine. Insomnia symptoms were assessed with the Insomnia
Severity Index (ISI), and suicidal ideation was assessed with The Scale for
Suicide Ideation (SSI). Depression symptoms were assessed with the depressed mood
item and the anhedonia item from the Hamilton Rating Scale for Depression-24
(HRSD24), as well as a sum score for all non-sleep and non-suicide items from the
HRSD (HRSD20). Measurements were taken at baseline and weeks 1, 2, 4, 6, and 8.
SSI was examined by generalized linear mixed models for repeated measures as the
outcome of interest for all 60 participants with ISI and various mood symptoms as
independent variables, with adjustment for age, gender, treatment assignment, and
baseline SSI.
RESULTS: Higher levels of insomnia corresponded to significantly greater
intensity of suicidal thinking (p<0.01). The depressed mood item of the HRSD, and
the sum of the HRSD20, both corresponded to greater suicidal thinking (p<0.001).
The anhedonia item did not correspond with suicidal thinking. When both ISI and
the depressed mood item, or ISI and the anhedonia item, were included together in
the same model, the ISI remained an independent predictor of suicidal thinking.
CONCLUSIONS: The results support the concept that insomnia may be a useful
indicator for suicidal ideation and now extend this idea into clinical trials.
Insomnia remains an independent indicator of suicidal ideation, even taking into
account the core symptoms of depression such as depressed mood and anhedonia. The
complaint of insomnia during a depression clinical trial might indicate that more
direct questioning about suicide is warranted.
|