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SLEEP, SENSE OF COHERENCE AND SUICIDALITY IN SUICIDE ATTEMPTERS Nils Sjöström Institute of Neuroscience and Physiology, Section of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, 2009


Academic year: 2021

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Nils Sjöström

Institute of Neuroscience and Physiology, Section of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, 2009


A suicide attempt is a strong predictor of future suicide. The management of patients who self-harm presents a challenge for psychiatric services. It is therefore important to identify factors that may be related to increased risk of suicidal behaviour in suicide attempters.

The current study aimed to examine the prevalence of specific sleep disturbances in suicide attempters and possible associations between sleep disturbances (including nightmares) and suicidal behaviour. A second focus was to test associations between sense of coherence and suicidality. Further, we tested whether Suicide Assessment Scale (SUAS) predicted repeat attempt.

The study included 165 suicide attempt patients aged 18 – 69 years who were admitted to medical/psychiatric wards at Sahlgrenska University Hospital completed an initial clinical interview including self-report instruments assessing sleep complaints (Uppsala Sleep Inventory), depression/anxiety symptom intensity (CPRS Self-rating Scale for Affective Symptoms) and the individual’s capacity to manage stress and stay well (Sense of Coherence Questionnaire). Ninety-eight patients took part in a 2 month follow-up interview. Data concerning repeat suicide attempts were obtained from hospital case records.

We found that 89 % of the subjects reported some kind of sleep disturbance. The most common complaint was difficulties initiating sleep (73 %) followed by difficulties maintaining sleep (69 %) and early morning awakening (58 %). Sixty-six percent reported nightmares. Persistent frequent nightmares were associated with risk for persistent suicidality and repeat attempt. SOC was associated with suicidality at follow- up, but we could not show an association with repeat attempt. The ability of the SUAS to predict repeat suicidal behaviour in the entire study group was low but the instrument performed better in the subgroup who reported ongoing psychiatric treatment at 2 month follow-up.

Questions regarding sleep disturbances and nightmares could be addressed in the clinical evaluation, care and treatment of suicidal patients. SOC may be a tool to facilitate and deepen the dialogue between the psychiatric nurse and the suicidal patient. Our data provide further support for the use of the SUAS as a complementary tool in the assessment of psychiatric patients after a suicide attempt.

Keywords: Suicidality, repeat suicide attempt, sleep, nightmares, sense of coherence

ISBN 978-91-633-3617-1 Göteborg 2009



Akademisk avhandling

som för avläggande av medicine doktorsexamen vid Sahlgrenska akademin vid Göteborgs universitet kommer att offentligen försvaras i Sahlgrensaulan,

Blå Stråket 5, Sahlgrenska Universitetssjukhuset/Sahlgrenska,

Institutionen för neurovetenskap och fysiologi, Sektionen för psykiatri och neurokemi fredagen den 23 januari 2009 kl 13.00

av Nils Sjöström


Professor Lill Träskman-Bendz Psykiatri, Lund

This thesis is based on the following papers:

I Sjöström N, Waern M, Hetta J. Nightmares and sleep disturbances in relation to suicidality in suicide attempters.

Sleep 2007;30:91-95.

II Sjöström N, Hetta J, Waern M. Persistent nightmares are associated with repeat suicide attempt. A prospective study.

Psychiatry Research 2008, in press.

III Sjöström N, Hetta J, Waern M. Sense of coherence and suicidality in suicide attempters. A prospective study.

Journal of Advanced Nursing, submitted.

IV Waern M, Sjöström N, Marlow T, Hetta J. Does the suicide assessment scale predict risk of repetition? A prospective study of suicide attempters at a hospital emergency department.

In manuscript.

Göteborg 2009


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