Korean Journal of Psychosomatic Medicine (정신신체의학)

Korean Psychosomatic Society (한국정신신체의학회)
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The Relationship between Insomnia and Suicidal Idea Through Resilience

회복탄력성을 통한 주관적 불면의 심각도와 자살사고와의 관계

  • Jung, Saim (Department of Psychiatry, Chungbuk National University Hospital) ;
  • Ju, Gawon (Department of Psychiatry, Chungbuk National University Hospital) ;
  • Lee, Sang Ick (Department of Psychiatry, College of Medicine, Chungbuk National University) ;
  • Shin, Chul-Jin (Department of Psychiatry, College of Medicine, Chungbuk National University) ;
  • Son, Jung-Woo (Department of Psychiatry, College of Medicine, Chungbuk National University) ;
  • Kim, Siekyeong (Department of Psychiatry, College of Medicine, Chungbuk National University)
  • 정사임 (충북대학교병원 정신건강의학과) ;
  • 주가원 (충북대학교병원 정신건강의학과) ;
  • 이상익 (충북대학교 의과대학 정신건강의학교실) ;
  • 신철진 (충북대학교 의과대학 정신건강의학교실) ;
  • 손정우 (충북대학교 의과대학 정신건강의학교실) ;
  • 김시경 (충북대학교 의과대학 정신건강의학교실)
  • Received : 2017.11.01
  • Accepted : 2017.12.15
  • Published : 2017.12.31
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Abstract

Objectives : Insomnia may be one of the risk factor for suicidal ideation, but little is known about the mechanism by which sleep disturbances confer risk for suicide. The aim of this study was to investigate examine whether insomnia severity would be associated with resilience and suicidal ideation, and whether resilience would mediate the relationship between insomnia and suicidal ideation. Methods : A total of 432 community-dwelling adults(227 male, 205 female,) completed the self-report questionnaire that covered basic socio-demographic data. To assess the psychological variables, the following instruments were applied: Insomnia Severity Index(ISI), Korean Version of the Connor-Davidson Resilience Scale(K-CD-RISC), Beck Hopelessness Scale(BHOP) and Scale for Suicidal Ideation(SSI-Beck). People with an ISI score of 8 or higher were defined as insomnia. Results : Greater insomnia symptom severity was significantly associated with higher level of suicidal ideation and lower level of resilience, adjusting for hopelessness, age, sex, presence of family members living together, and household income. Additional analysis revealed that disturbance of sleep initiation and disturbance of sleep maintenance were significantly associated with suicidal ideation. Mediation analyses revealed that resilience significantly accounted for the relationship between insomnia symptom severity and suicidal ideation. Conclusions : These findings suggest that the evaluation and control of insomnia and resilience may be needed to reduce the risk of suicide.

연구목적 불면은 자살사고의 위험요인으로 알려져 있으나 아직 어떻게 자살의 위험에 영향을 미치는지 그 기전은 명확하지 않다. 이에 불면 증상이 회복탄력성과 자살사고와 상관이 있는 지를 살펴보고, 회복탄력성이 불면증상과 자살사고의 매개요소가 될 수 있을지 알아보고자 한다. 방 법 432명의 대학생을 대상으로 자기보고식 설문지를 통하여 일반적 특성 및 관련 검사를 수행하였다. 불면증 심각성 척도, 한국판 코너-데이비드슨 회복탄력성척도, 벡 자살사고 척도 및 벡 무망감 척도를 활용하여 불면증상, 자살사고, 회복탄력성, 무망감에 대해 조사하였으며, 각 요소간의 상관분석 및 경로분석을 수행하였다. 결 과 불면증상이 심할수록 회복탄력성이 낮았고, 자살사고가 증가되는 것을 알 수 있었다. 이는 무망감, 연령, 성별, 동거가족, 가정 내 월수입을 통제하여도 유의하였다. 더불어 입면의 어려움과 유지의 어려움을 겪는 불면증상이 자살사고와 연관됨을 확인하였다. 경로분석을 통하여 불면증상이 자살사고에 직접적, 간접적으로 영향을 미침을 확인할 수 있었으며, 회복탄력성도 유의하게 자살사고에 영향을 주는 것으로 평가되었다. 이에 회복탄력성이 불면과 자살사고와의 관계에 유의미한 중재자가 됨을 확인하였다. 결 론 수면상태와 회복탄력성에 대한 평가 및 개입이 자살사고를 낮추어 자살을 예방하는데 기여할 수 있을 것으로 기대한다.

Keywords

References

  1. Organization for Economic Cooperation and Development. OECD Health Statistics 2017. Organization for Economic Cooperation and Development;2017.
  2. Korea National Statistical Office. 2016 annual report on the cause of death statistics. Daejeon: Korea National statistical office;2017.
  3. Currier D, Mann JJ. Stress, genes and the biology of suicidal behavior. Psychiatr Clin North Am 2008;31:247-269. https://doi.org/10.1016/j.psc.2008.01.005
  4. Wojnar M, Ilgen MA, Wojnar J, McCammon RJ, Valenstein M, Brower KJ. Sleep problems and suicidality in the National Comorbidity Survey Replication. J Psychiatr Res 2009;43:526-531. https://doi.org/10.1016/j.jpsychires.2008.07.006
  5. Wong MM, Brower KJ. The prospective relationship between sleep problems and suicidal behavior in the National Longitudinal Study of Adolescent Health. J Psychiatr Res 2012;46: 953-959. https://doi.org/10.1016/j.jpsychires.2012.04.008
  6. Wong MM, Brower KJ, Zucker RA. Sleep problems, suicidal ideation, and self-harm behaviors in adolescence. J Psychiatr Res 2011;45:505-511. https://doi.org/10.1016/j.jpsychires.2010.09.005
  7. Turvey CL, Conwell Y, Jones MP, Phillips C, Simonsick E, Pearson JL, Wallace R. Risk factors for late-life suicide: a prospective, community-based study. Am J Geriatr Psychiatry 2002;10:398-406. https://doi.org/10.1097/00019442-200207000-00006
  8. Bae SM, Lee YJ, Cho IH, Kim SJ, Im JS, Cho SJ. Risk factors for suicidal ideation of the general population. J Korean Med Sci 2013;28:602-607.. https://doi.org/10.3346/jkms.2013.28.4.602
  9. Lapierre S, Boyer R, Desjardins S, Dube M, Lorrain D, Preville M, Brassard J. Daily hassles, physical illness, and sleep problems in older adults with wishes to die. Int Psychogeriatr 2012;24:243-252. https://doi.org/10.1017/S1041610211001591
  10. Kodaka M, Matsumoto T, Katsumata Y, Akazawa M, Tachimori H, Kawakami N, Eguchi N, Shirakawa N, Takeshima T. Suicide risk among individuals with sleep disturbances in Japan: a case-control psychological autopsy study. Sleep Med 2014;15:430-435. https://doi.org/10.1016/j.sleep.2013.11.789
  11. Goldstein TR, Bridge JA, Brent DA. Sleep disturbance preceding completed suicide in adolescents. J Consult Clin Psychol 2008;76:84-91. https://doi.org/10.1037/0022-006X.76.1.84
  12. Ribeiro JD, Pease JL, Gutierrez PM, Silva C, Bernert RA, Rudd MD, Joiner TE. Sleep problems outperform depression and hopelessness as cross-sectional and longitudinal predictors of suicidal ideation and behavior in young adults in the military. J Affect Disord 2012;136:743-750. https://doi.org/10.1016/j.jad.2011.09.049
  13. Bernert RA, Turvey CL, Conwell Y, Joiner TE. 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. JAMA Psychiatry 2014;71:1129-1137. https://doi.org/10.1001/jamapsychiatry.2014.1126
  14. Bernert RA, Joiner TE. Sleep disturbances and suicide risk: A review of the literature. Neuropsychiatr Dis Treat 2007;3:735-743.
  15. Chu C, Hom MA, Rogers ML, Ringer FB, Hames JL, Suh S, Joiner TE. Is Insomnia Lonely? Exploring Thwarted Belongingness as an Explanatory Link between Insomnia and Suicidal Ideation in a Sample of South Korean University Students. J Clin Sleep Med 2016;12:647-652. https://doi.org/10.5664/jcsm.5784
  16. Rutter M. Implications of resilience concepts for scientific understanding. Ann N Y Acad Sci 2006;1094:1-12. https://doi.org/10.1196/annals.1376.002
  17. Masten AS. Resilience in children threatened by extreme adversity: frameworks for research, practice, and translational synergy. Dev Psychopathol 2011;23:493-506. https://doi.org/10.1017/S0954579411000198
  18. Liu DW, Fairweather-Schmidt AK, Roberts RM, Burns R, Anstey KJ. Does resilience predict suicidality? A lifespan analysis. Arch Suicide Res 2014;18:453-464. https://doi.org/10.1080/13811118.2013.833881
  19. Youssef NA, Green KT, Beckham JC, Elbogen EB. A 3-year longitudinal study examining the effect of resilience on suicidality in veterans. Ann Clin Psychiatry 2013;25:59-66.
  20. Min JA, Lee CU, Chae JH. Resilience moderates the risk of depression and anxiety symptoms on suicidal ideation in patients with depression and/or anxiety disorders. Compr Psychiatry 2015;56:103-111. https://doi.org/10.1016/j.comppsych.2014.07.022
  21. Liu DW, Fairweather-Schmidt AK, Burns R, Roberts RM, Anstey KJ. Psychological Resilience Provides No Independent Protection From Suicidal Risk. Crisis 2016;37:130-139. https://doi.org/10.1027/0227-5910/a000364
  22. Bastien CH, Vallieres A, Morin CM. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med 2001;2:297-307. https://doi.org/10.1016/S1389-9457(00)00065-4
  23. Cho YW, Song ML, Morin CM. Validation of a Korean version of the insomnia severity index. J Clin Neurol 2014;10:210-215. https://doi.org/10.3988/jcn.2014.10.3.210
  24. Connor KM, Davidson JR. Development of a new resilience scale: the Connor-Davidson Resilience Scale(CD-RISC). Depress Anxiety 2003;18:76-82. https://doi.org/10.1002/da.10113
  25. Baek HS, Lee KU, Joo EJ, Lee MY, Choi KS. Reliability and validity of the korean version of the connor-davidson resilience scale. Psychiatry Investig 2010;7:109-115. https://doi.org/10.4306/pi.2010.7.2.109
  26. Beck AT, Kovacs M, Weissman A. Assessment of suicidal intention: the Scale for Suicide Ideation. J Consult Clin Psychol 1979;47:343-352. https://doi.org/10.1037/0022-006X.47.2.343
  27. Lee HS, Kwon JH. Validation for the Beck scale for suicide ideation with Korean university students. Korean J Clin Psychol 2009;28:1155-1172. https://doi.org/10.15842/kjcp.2009.28.4.011
  28. Beck AT, Weissman A, Lester D, Trexler L. The measurement of pessimism: the hopelessness scale. J Consult Clin Psychol 1974;42:861-865. https://doi.org/10.1037/h0037562
  29. 신민섭, 박광배, 오경자, 김중술. 고등학생의 자살 성향에 관한 연구 : 우울-절망-자살간의 구조직 관계에 대한 분석. Korean J Clin Psychol 1990;9:1-19.
  30. Hong SH. The criteria for selecting appropriate fit indices in structural euation modeling and their rationales. Korean J Clin Psychol 2000;19:161-177.
  31. Cruess DG, Antoni MH, Gonzalez J, Fletcher MA, Klimas N, Duran R, Ironson G, Schneiderman NL. Sleep disturbance mediates the association between psychological distress and immune status among HIV-positive men and women on combination antiretroviral therapy. J Psychosom Res 2003;54:185-189. https://doi.org/10.1016/S0022-3999(02)00501-9
  32. Chatburn A, Coussens S, Kohler MJ. Resiliency as a mediator of the impact of sleep on child and adolescent behavior. Nat Sci Sleep 2013;6:1-9.
  33. Pedersen ER, Troxel WM, Shih RA, Pinder E, Lee D, Geyer L. Increasing resilience through promotion of healthy sleep among service members. Mil Med 2015;180:4-6.
  34. Antunez JM, Navarro JF, Adan A. Circadian typology is related to resilience and optimism in healthy adults. Chronobiol Int 2015;32:524-530. https://doi.org/10.3109/07420528.2015.1008700
  35. Kim CK, Kim, SH, Cho MK. The Influences of Self-Control and Resilience on the Experience of Bully of Middle Schoolers Depending on Sleep Duration. J Emot Behav Disord 2016;32:147-163.
  36. Cicchetti D. Resilience under conditions of extreme stress: a multilevel perspective. World Psychiatry 2010;9:145-154. https://doi.org/10.1002/j.2051-5545.2010.tb00297.x
  37. Jan JE, Reiter RJ, Bax MC, Ribary U, Freeman RD, Wasdell MB. Long-term sleep disturbances in children: a cause of neuronal loss. Eur J Paediatr Neurol 2010;14:380-390. https://doi.org/10.1016/j.ejpn.2010.05.001
  38. Tononi G, Cirelli C. Sleep and synaptic homeostasis: a hypothesis. Brain Res Bull 2003;62:143-150. https://doi.org/10.1016/j.brainresbull.2003.09.004
  39. Tononi G, Cirelli C. Sleep and the price of plasticity: from synaptic and cellular homeostasis to memory consolidation and integration. Neuron 2014;81:12-34. doi: 10.1016/j.neuron.2013.1012.1025.
  40. Diekelmann S, Born J. The memory function of sleep. Nat Rev Neurosci 2010;11:114-126. https://doi.org/10.1038/nrn2762
  41. Novati A, Roman V, Cetin T, Hagewoud R, den Boer JA, Luiten PG, Meerlo P. Chronically restricted sleep leads to depression-like changes in neurotransmitter receptor sensitivity and neuroendocrine stress reactivity in rats. Sleep 2008;31:1579-1585. https://doi.org/10.1093/sleep/31.11.1579
  42. Elmenhorst D, Kroll T, Matusch A, Bauer A. Sleep deprivation increases cerebral serotonin 2A receptor binding in humans. Sleep 2012;35:1615-1623. https://doi.org/10.5665/sleep.2230
  43. McCall WV, Black CG. The link between suicide and insomnia: theoretical mechanisms. Curr Psychiatry Rep 2013;15:389. https://doi.org/10.1007/s11920-013-0389-9
  44. Chatzittofis A, Nordstrom P, Hellstrom C, Arver S, Asberg M, Jokinen J. CSF 5-HIAA, cortisol and DHEAS levels in suicide attempters. Eur Neuropsychopharmacol 2013;23:1280-1287. https://doi.org/10.1016/j.euroneuro.2013.02.002
  45. Miller JM, Hesselgrave N, Ogden RT, Sullivan GM, Oquendo MA, Mann JJ, Parsev RV. Positron emission tomography quantification of serotonin transporter in suicide attempters with major depressive disorder. Biol Psychiatry 2013;74:287-295. https://doi.org/10.1016/j.biopsych.2013.01.024
  46. Horn SR, Charney DS, Feder A. Understanding resilience: New approaches for preventing and treating PTSD. Exp Neurol 2016;284:119-132. https://doi.org/10.1016/j.expneurol.2016.07.002
  47. Trockel M, Karlin BE, Taylor CB, Brown GK, Manber R. Effects of cognitive behavioral therapy for insomnia on suicidal ideation in veterans. Sleep 2015;38:259-265. https://doi.org/10.5665/sleep.4410
  48. Kuo WH, Gallo JJ, Eaton WW. Hopelessness, depression, substance disorder, and suicidality--a 13-year communitybased study. Soc Psychiatry Psychiatr Epidemiol 2004;39:497-501.