Sleep disturbances as an evidence-based suicide risk factor.
Sleep disturbances as an evidence-based suicide risk factor.
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DOI：
10.1007/s11920-015-0554-4
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发表时间：
2015-03
影响因子：
6.7
通讯作者：
Perlis ML
中科院分区：
文献类型：
--
作者：
Bernert RA;Kim JS;Iwata NG;Perlis ML
越来越多的研究表明，睡眠障碍可能会增加自杀行为的风险，包括自杀意念、自杀企图和自杀死亡。尽管增加了调查，但一些方法上的问题对这一领域的调查结果的有效性和普遍性造成了重大限制，值得进一步关注。为了评估和描述睡眠障碍作为一个基于证据的自杀风险因素，对现有文献进行了系统的回顾，并以方法学考虑为中心焦点。纳入研究需要以下方法学标准：报告(1)评估睡眠障碍指数；(2)检验自杀行为的结果测量；(3)调整抑郁诊断或抑郁严重程度作为协变量；(4)代表原始调查，而不是图表审查。符合纳入标准的报告进一步分类，并根据研究设计和时间框架进行审查；样品类型和尺寸；睡眠障碍、自杀风险和抑郁协变量评估方法；积极和消极结果的对比。基于关键词搜索，使用了PubMed和PsycINFO搜索引擎。搜索条件产生了N=82篇文章，代表了关注睡眠障碍和自杀结果的原始调查。其中，N=18符合纳入标准，通过系统分析进行评价。在已确定的报告中，N=18评估了失眠或睡眠质量差的症状，而N=8评估了与自杀风险相关的噩梦。尽管在研究设计、样本和评估技术上存在相当大的差异，但这些报告的比较表明，睡眠障碍是自杀行为的一个经验风险因素，这是初步的、趋同的证据，同时强调了重要的、未来的研究方向。
Increasing research indicates that sleep disturbances may confer increased risk for suicidal behaviors, including suicidal ideation, suicide attempts, and death by suicide. Despite increased investigation, a number of methodological problems present important limitations to the validity and generalizability of findings in this area, which warrant additional focus. To evaluate and delineate sleep disturbances as an evidence-based suicide risk factor, a systematic review of the extant literature was conducted with methodological considerations as a central focus. The following methodologic criteria were required for inclusion: the report (1) evaluated an index of sleep disturbance; (2) examined an outcome measure for suicidal behavior; (3) adjusted for presence of a depression diagnosis or depression severity, as a covariate; and (4) represented an original investigation as opposed to a chart review. Reports meeting inclusion criteria were further classified and reviewed according to study design and timeframe; sample type and size; sleep disturbance, suicide risk, and depression covariate assessment measure(s); and presence of positive versus negative findings. Based on keyword search, the following search engines were used: PubMed and PsycINFO. Search criteria generated N=82 articles representing original investigations focused on sleep disturbances and suicide outcomes. Of these, N=18 met inclusion criteria for review based on systematic analysis. Of the reports identified, N=18 evaluated insomnia or poor sleep quality symptoms, whereas N=8 assessed nightmares in association with suicide risk. Despite considerable differences in study designs, samples, and assessment techniques, the comparison of such reports indicates preliminary, converging evidence for sleep disturbances as an empirical risk factor for suicidal behaviors, while highlighting important, future directions for increased investigation.
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