Sleep disorders and suicide attempts following discharge from residential treatment

Introduction: Suicide is a significant public health concern and its prevention remains a top clinical priority of the Veterans Health Administration. Periods of transition in care (e.g., moving from inpatient to outpatient care) represent a period of increased risk. Sleep disorders are prevalent amongst Veterans and are modifiable risk factor for suicide. The present study examined the relationship of sleep disorders to time to suicide attempt amongst Veterans known to have attempted suicide in the 180 days following discharge from a Mental Health Residential Rehabilitation Treatment Program. Method: The present sample was comprised of all Veterans enrolled in services with the Veterans Health Administration known to have attempted suicide following discharge from a Mental Health Residential Rehabilitation Treatment Program during Fiscal Years 13 and 14 (N = 1,489). To create this sample, electronic medical record data were extracted from two VHA data sources: the Corporate Data Warehouse and the Suicide Prevention Application Network. Results: Cox regression models revealed that Veterans with a sleep disturbance (N = 1,211) had a shorter time to suicide attempt than those without a sleep disturbance [Hazard Ratio (HR) = 1.16, CI (1.02–1.32)]. A subsequent Cox regression model including age, insomnia, nightmare disorder, and alcohol dependence revealed that sleep-related breathing disorders [HR = 1.19, CI (1.01–1.38)], alcohol dependence [HR = 1.16, CI (1.02–1.33)], and age group were associated with increased risk. Conclusion: Findings indicate that sleep disturbance, primarily driven by sleep-related breathing disorders, was associated with time to suicide attempt in this sample of high-risk Veterans known to have attempted suicide in the 180 days following their discharge from a Mental Health Residential Rehabilitation Treatment Program. These findings reveal an opportunity to reduce risk through the screening and treatment of sleep disorders in high-risk populations.