Purpose
Suicide rates in the United States among older adults continue to rise after reaching 48.7/100,000 in 2016 (World Health Organization, 2017). Sleeping problems commonly occur with aging and is one contributing factor to suicidal ideation. According to the Center for Disease Control and Prevention (CDC, 2018), suicides among older adults are rarely associated with a single factor such as a psychiatric diagnosis at the time of death. Data from The National Health and Nutrition Examination Survey (NHANES) conducted in 2015-2016 across the United States was used to examine the relationship between depressive symptoms, sleep duration, daytime sleepiness, and suicidal ideation among adults age 50 and older.
Methods
This was a secondary data analysis of the 2015-2016 CDCs National Health and Nutrition Examination Survey (NHANES). Trained interviewers used the Computer-Assisted Personal Interview (CAPI) system to administer questionnaire items. In this study of adults age 50 and older, demographics included race, gender, marital status, and family income. The original race variable was collapsed into 3 categories: Hispanic origin, Non-Hispanic White, and Non-Hispanic Non-white. Gender was defined as male or female. The original marital status variable was collapsed into Living with partner or Having no partner. Having no partner included those widowed, divorced and separate. Living with partner included those married and living with a partner. Family income was categorized as above or below 25k/year.
The Depression Screening (DPQ) assessed participants’ frequency of depressive symptoms over the past two weeks and contained 9 items on a 4-point Likert scale, with 0 indicating “Not at all” and 3 indicating “Nearly every day.” DPQ items take into account depression criteria from the DSM-IV. The DPQ was identical to the Patient Health Questionnaire (PHQ-9) in which a total score of 10 or greater indicated major depression while a score less than 10 indicated minor depression (Kroenke and Spitzer, 2002; Kroenke et al., 2001). Suicidal ideation was assessed based on answers to one question on the DPQ, “Thoughts that you would be better off dead or of hurting yourself in some way?”.
The Sleep Disorders Questionnaire (SLQ) assessed participants’ sleeping habits, frequency of snoring within the last 12 months, and daytime sleepiness within the last month. Sleep hour was calculated using the difference between time in bed and wake up time. Using this continuous variable, sleep duration was categorized as More than enough if the original variable was larger than or equal to 8 hours/day, Enough if between 5-8, and Not enough if strictly less than 5. Daytime sleepiness was categorized as Never, Occasionally (1-15 times a month), or Almost always (16-30 times a month).
Results
Of 1,860 older adults (weighted 79,233,790), 4.2% (weighted 2,574,042) reported suicidal ideation with males being more likely to wish for suicide than females. Logistic regression was performed to estimate odd ratios and 95% confidence interval controlled for demographic variables. After controlling for gender, race, marital status, and family income, the odds for suicidal ideation increased in those older adults with major depression compared to those with minor depression. Compared to older adults who slept 5-8 hours/day, those sleeping more than 8 hours/day are more likely to have suicidal ideation. Meanwhile, sleeping less than 5 hours/day did not significantly predict one’s wish for suicide. Older adults who reported feeling excessively sleepy during the day, either almost always (t = 3.19, p = .01) or occasionally (t = 2.17, p = .05), are more likely to think they would be better off dead.
Conclusion and Implications
Findings from this study suggest that excessive sleeping, rather than sleep deprivation, may be a better predictor of suicidal ideation or hopes of never waking up. Additional predictors of suicidal ideation such as cognitive impairment (e.g., poor decision-making), chronic illnesses, bereavement, and social isolation should be considered to identify high-risk subgroups among older adults (Bishop et al., 2016; Conejero, Olié, Courtet, & Calati, 2018; Lapierre et al., 2012). Given such predictors can augment depressive symptoms and sleeping problems (O’Rourke et al., 2017), clinicians should develop treatment plans to improve these areas which may in turn decrease suicidal ideation among the aging population.
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