Insomnia severity is an indicator of suicidal ideation during a depression clinical trial
Insomnia severity is an indicator of suicidal ideation during a depression clinical trial
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DOI：
10.1016/j.sleep.2010.04.004
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发表时间：
2010-10-01
期刊：
影响因子：
4.8
通讯作者：
Rosenquist, Peter B.
中科院分区：
文献类型：
--
作者：
McCall, W. Vaughn;Blocker, Jill N.;Rosenquist, Peter B.
目的：在基于人群的横断面和纵向研究中，失眠与自杀意念和自杀死亡有关。此前尚未在临床试验中研究过失眠与自杀之间的联系。在此，我们描述了抑郁症伴失眠临床试验过程中失眠与自杀念头之间的关系。 方法：60 名年龄为 41.5 +/- 12.5 岁、患有严重抑郁发作和失眠症状的患者（2/3 女性）接受开放标签氟西汀治疗 9 周，并在氟西汀治疗第一周后在睡前接受盲法随机右佐匹克隆 3 mg 或安慰剂。失眠症状通过失眠严重指数（ISI）进行评估，自杀意念通过自杀意念量表（SSI）进行评估。抑郁症状通过汉密尔顿抑郁量表 24 (HRSD24) 中的抑郁情绪项目和快感缺失项目以及 HRSD (HRSD20) 中所有非睡眠和非自杀项目的总分进行评估。在基线以及第 1、2、4、6 和 8 周进行测量。通过广义线性混合模型重复测量来检查 SSI，作为所有 60 名以 ISI 和各种情绪症状为自变量的参与者的兴趣结果，并根据年龄、性别、治疗分配和基线 SSI 进行调整。结果：失眠程度越高，自杀念头的强度就越强（p < 0.01）。 HRSD 的抑郁情绪项目以及 HRSD20 的总和均对应于更大的自杀想法 (p < 0.001)。快感缺失项目与自杀想法不相符。当 ISI 和抑郁情绪项目，或者 ISI 和快感缺乏项目一起包含在同一模型中时，ISI 仍然是自杀想法的独立预测因子。结论：结果支持失眠可能是自杀意念的有用指标这一概念，现在将这一想法扩展到临床试验中。即使考虑到抑郁症的核心症状，如情绪低落和快感缺乏，失眠仍然是自杀意念的一个独立指标。抑郁症临床试验期间的失眠投诉可能表明有必要对自杀进行更直接的询问。 (C) 2010 Elsevier B.V. 保留所有权利。
Objective: Insomnia has been linked to suicidal ideas and suicide death in cross-sectional and longitudinal population-based studies. A link between insomnia and suicide has not been previously examined in the setting of a clinical trial. Herein we describe the relationship between insomnia and suicidal thinking during the course of a clinical trial for depression with insomnia.Methods: Sixty patients aged 41.5 +/- 12.5 years (2/3 women) with major depressive episode and symptoms of insomnia received open-label fluoxetine for 9 weeks and also received blinded, randomized eszopiclone 3 mg or placebo at bedtime after the first week of fluoxetine. Insomnia symptoms were assessed with the Insomnia Severity Index (ISI), and suicidal ideation was assessed with The Scale for Suicide Ideation (SSI). Depression symptoms were assessed with the depressed mood item and the anhedonia item from the Hamilton Rating Scale for Depression-24 (HRSD24), as well as a sum score for all non-sleep and non-suicide items from the HRSD (HRSD20). Measurements were taken at baseline and weeks 1, 2, 4, 6, and 8. SSI was examined by generalized linear mixed models for repeated measures as the outcome of interest for all 60 participants with ISI and various mood symptoms as independent variables, with adjustment for age, gender, treatment assignment, and baseline SSI.Results: Higher levels of insomnia corresponded to significantly greater intensity of suicidal thinking (p < 0.01). The depressed mood item of the HRSD, and the sum of the HRSD20, both corresponded to greater suicidal thinking (p < 0.001). The anhedonia item did not correspond with suicidal thinking. When both ISI and the depressed mood item, or ISI and the anhedonia item, were included together in the same model, the ISI remained an independent predictor of suicidal thinking.Conclusions: The results support the concept that insomnia may be a useful indicator for suicidal ideation and now extend this idea into clinical trials. Insomnia remains an independent indicator of suicidal ideation, even taking into account the core symptoms of depression such as depressed mood and anhedonia. The complaint of insomnia during a depression clinical trial might indicate that more direct questioning about suicide is warranted. (C) 2010 Elsevier B.V. All rights reserved.