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Sleep and suicide: an analysis of a cohort of 394,000 Taiwanese adults

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Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

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Abstract

Background

Sleep problems may lead to, or be symptomatic of, depression and other mental illnesses yet few studies have investigated their association with suicide risk.

Design

Prospective cohort study.

Setting

Taiwan.

Participants

393,983 men and women aged 20 or above participating in the MJ health check-up programme.

Results

There were 335 suicides over a mean of 7.4 years follow-up. There was a reverse J-shaped association between sleep duration and suicide risk. When compared with those sleeping 6–8 h per night the adjusted hazard ratios (95 % confidence intervals) for suicide associated with 0–4, 4–6 and >8 h sleep were 3.5 (2.0–6.1), 1.5 (1.1–1.9) and 1.5 (1.1–2.0), respectively. People requiring sleeping pills to get to sleep (1.2 % participants) were at over 11-fold increased risk; difficulty falling asleep (11.5 % participants), frequent dreaming (16.7 %) and being easily awoken (30.6 %) were associated with a 2.0-, 1.6- and 1.3-fold increased risk of suicide, respectively.

Conclusions

Less than 6 h sleep duration, sleep disturbances and reported use of sleep medicines are markers of suicide risk. Sleep problems should be assessed when evaluating suicide risk.

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Acknowledgments

This study is supported in part by Taiwan Department of Health Clinical Trial and Research Center of Excellence (DOH102-TD-B-111-004). Professor David Gunnell is a UK National Institute for Health Research Senior Investigator. Dr. Shu-Sen Chang’s fellowship at the University of Bristol was funded by the National Science Council, Taiwan (NSC-98-2917-I-564-162). Dr. Shu-Sen Chang was supported by the Hong Kong Research Grants Council (RCG) General Research Fund (HKU784210M and HKU784012M). We thank the institutional support from the National Health Research Institutes, Taiwan. The views in this manuscript are those of the authors and not necessarily any funding bodies or of the MJ Health Management Institution.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. School of Social and Community Medicine, University of Bristol, Bristol, UK

    David Gunnell & Shu-Sen Chang

  2. The HKJC Centre for Suicide Research and Prevention, The University of Hong Kong, Pokfulam, Hong Kong SAR, China

    Shu-Sen Chang

  3. Ju Shan Hospital, Taoyuan, Taiwan

    Shu-Sen Chang

  4. China Medical University Hospital, Taichung, Taiwan

    Min Kuang Tsai & Chi Pang Wen

  5. The Institute of Population Health Science, National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli County, 350, Taiwan

    Min Kuang Tsai & Chi Pang Wen

  6. MJ Health Management Institution, Taipei, Taiwan

    Chwen Keng Tsao

Authors
  1. David Gunnell
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  2. Shu-Sen Chang
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  3. Min Kuang Tsai
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  4. Chwen Keng Tsao
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  5. Chi Pang Wen
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Corresponding author

Correspondence to Chi Pang Wen.

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Gunnell, D., Chang, SS., Tsai, M.K. et al. Sleep and suicide: an analysis of a cohort of 394,000 Taiwanese adults. Soc Psychiatry Psychiatr Epidemiol 48, 1457–1465 (2013). https://doi.org/10.1007/s00127-013-0675-1

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  • DOI: https://doi.org/10.1007/s00127-013-0675-1

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