Poor Self-reported Sleep Quality Associated with Suicide Risk in a Community Sample of American Indian Adults

Overview

Journal Sleep Adv

Date 2023 Jun 9

PMID 37293513

Authors

Cindy L Ehlers

Katherine J Karriker-Jaffe

Rebecca Bernert

Affiliations

Soon will be listed here.

Abstract

Study Objectives: Although American Indian/Alaska Native (AI/AN) have high suicide rates few studies have systematically investigated sleep quality and its association with suicidal behaviors in AI/AN. This study is a cross-sectional investigation of self-reported sleep quality and suicidal behaviors in an adult AI population.

Methods: A semi-structured interview was used to collect data on suicidal ideation, suicidal plans, and suicidal attempts and the Pittsburgh Sleep Quality Index (PSQI) was collected to assess sleep quality in American Indian adults.

Results: In this sample ( = 477), 91 (19%) of the participants endorsed suicidal ideation (thoughts and plans), and 66 (14%) reported suicidal attempts, including four who subsequently died by suicide. More women reported suicidal thoughts or acts than men. Those endorsing suicidal thoughts slept fewer hours during the night, reported more nocturnal awakenings, and showed poorer subjective sleep quality according to PSQI total scores compared to those with no suicidal thoughts or acts. Participants with suicidal acts ( = 66) reported more bad dreams and higher PSQI total scores compared to those with no suicidal thoughts or acts. When those with any suicidal thoughts or acts ( = 157, 33%) were compared to those without, they were more likely to endorse nocturnal awakenings and bad dreams and demonstrated significantly higher PSQI total scores.

Conclusions: Although additional research is needed to evaluate sleep disturbances as a proximal, causal risk factor for suicidal behaviors in AI, findings highlight need for further study of sleep as a warning sign and intervention tool for suicide prevention among American Indian adults.

Citing Articles

Restless nights, cold hearts: Poor sleep causally blunts empathy.

Gordon-Hecker T, Choshen-Hillel S, Ben-Simon E, Walker M, Perry A, Gileles-Hillel A Int J Clin Health Psychol. 2025; 25(1):100548.

PMID: 39995510 PMC: 11848082. DOI: 10.1016/j.ijchp.2025.100548.

Comorbidity of anxiety/affective, conduct/antisocial, attention deficit, and alcohol use disorders with suicidal behaviors in an American Indian community sample of adults and adolescents.

Ehlers C, Gilder D, Karriker-Jaffe K, Bernert R J Psychiatr Res. 2023; 167:63-70.

PMID: 37837862 PMC: 10997741. DOI: 10.1016/j.jpsychires.2023.10.005.

References

Liu Y, Njai R, Greenlund K, Chapman D, Croft J . Relationships between housing and food insecurity, frequent mental distress, and insufficient sleep among adults in 12 US States, 2009. Prev Chronic Dis. 2014; 11:E37. PMC: 3958143. DOI: 10.5888/pcd11.130334. View

Venner K, Wall T, Lau P, Ehlers C . Testing of an orthogonal measure of cultural identification with adult mission Indians. Cultur Divers Ethnic Minor Psychol. 2006; 12(4):632-43. DOI: 10.1037/1099-9809.12.4.632. View

Taylor D, Pruiksma K, Hale W, Kelly K, Maurer D, Peterson A . Prevalence, Correlates, and Predictors of Insomnia in the US Army prior to Deployment. Sleep. 2016; 39(10):1795-1806. PMC: 5020361. DOI: 10.5665/sleep.6156. View

Shore J, Orton H, Manson S . Trauma-related nightmares among American Indian veterans: views from the dream catcher. Am Indian Alsk Native Ment Health Res. 2009; 16(1):25-38. DOI: 10.5820/aian.1601.2009.25. View

Allen J, Wexler L, Rasmus S . Protective Factors as a Unifying Framework for Strength-Based Intervention and Culturally Responsive American Indian and Alaska Native Suicide Prevention. Prev Sci. 2021; 23(1):59-72. DOI: 10.1007/s11121-021-01265-0. View

Wexler L, Chandler M, Gone J, Cwik M, Kirmayer L, LaFromboise T . Advancing suicide prevention research with rural American Indian and Alaska Native populations. Am J Public Health. 2015; 105(5):891-9. PMC: 4386511. DOI: 10.2105/AJPH.2014.302517. View

Ribeiro J, Pease J, Gutierrez P, Silva C, Bernert R, Rudd M . 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. 2011; 136(3):743-50. DOI: 10.1016/j.jad.2011.09.049. View

Devi S . Native American health left out in the cold. Lancet. 2011; 377(9776):1481-2. DOI: 10.1016/s0140-6736(11)60586-2. View

Novins D, Beals J, Roberts R, Manson S . Factors associated with suicide ideation among American Indian adolescents: does culture matter?. Suicide Life Threat Behav. 2000; 29(4):332-46. View

10.

Sabanayagam C, Shankar A, Buchwald D, Goins R . Insomnia symptoms and cardiovascular disease among older American Indians: the Native Elder Care Study. J Environ Public Health. 2012; 2011:964617. PMC: 3246795. DOI: 10.1155/2011/964617. View

11.

Carpenter J, Andrykowski M . Psychometric evaluation of the Pittsburgh Sleep Quality Index. J Psychosom Res. 1998; 45(1):5-13. DOI: 10.1016/s0022-3999(97)00298-5. View

12.

Bernert R, Kim J, Iwata N, Perlis M . Sleep disturbances as an evidence-based suicide risk factor. Curr Psychiatry Rep. 2015; 17(3):554. PMC: 6613558. DOI: 10.1007/s11920-015-0554-4. View

13.

Ehlers C, Wall T, Betancourt M, Gilder D . The clinical course of alcoholism in 243 Mission Indians. Am J Psychiatry. 2004; 161(7):1204-10. DOI: 10.1176/appi.ajp.161.7.1204. View

14.

Buysse D, Reynolds 3rd C, Monk T, BERMAN S, Kupfer D . The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989; 28(2):193-213. DOI: 10.1016/0165-1781(89)90047-4. View

15.

Liu Y, Wheaton A, Chapman D, Cunningham T, Lu H, Croft J . Prevalence of Healthy Sleep Duration among Adults--United States, 2014. MMWR Morb Mortal Wkly Rep. 2016; 65(6):137-41. DOI: 10.15585/mmwr.mm6506a1. View

16.

Chapman D, Croft J, Liu Y, Perry G, Presley-Cantrell L, Ford E . Excess frequent insufficient sleep in American Indians/Alaska natives. J Environ Public Health. 2013; 2013:259645. PMC: 3595691. DOI: 10.1155/2013/259645. View

17.

Arnold E, McCall V, Anderson A, Bryant A, Bell R . Sleep Problems, Suicidality and Depression among American Indian Youth. J Sleep Disord Treat Care. 2014; 2(3):119. PMC: 4191909. DOI: 10.4172/2325-9639.1000119. View

18.

Muhib F, Lin L, Stueve A, Miller R, Ford W, Johnson W . A venue-based method for sampling hard-to-reach populations. Public Health Rep. 2002; 116 Suppl 1:216-22. PMC: 1913675. DOI: 10.1093/phr/116.S1.216. View

19.

Bernert R, Turvey C, Conwell Y, Joiner Jr T . 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(10):1129-37. PMC: 4283786. DOI: 10.1001/jamapsychiatry.2014.1126. View

20.

Livingston R, Daily R, Guerrero A, Walkup J, Novins D . No Indians to Spare: Depression and Suicide in Indigenous American Children and Youth. Child Adolesc Psychiatr Clin N Am. 2019; 28(3):497-507. DOI: 10.1016/j.chc.2019.02.015. View