Association of poor subjective sleep quality with risk for death by suicide during a 10-year period

JAMA Psychiatry. 2014 Oct 1;71(10):1129-37. doi: 10.1001/jamapsychiatry.2014.1126.

Abstract

IMPORTANCE:

Older adults have high rates of sleep disturbance, die by suicide at disproportionately higher rates compared with other age groups, and tend to visit their physician in the weeks preceding suicide death. To our knowledge, to date, no study has examined disturbed sleep as an independent risk factor for late-life suicide.

OBJECTIVE:

To examine the relative independent risk for suicide associated with poor subjective sleep quality in a population-based study of older adults during a 10-year observation period.

DESIGN, SETTING, AND PARTICIPANTS:

A longitudinal case-control cohort study of late-life suicide among a multisite, population-based community sample of older adults participating in the Established Populations for Epidemiologic Studies of the Elderly. Of 14 456 community older adults sampled, 400 control subjects were matched (on age, sex, and study site) to 20 suicide decedents.

MAIN OUTCOMES AND MEASURES:

Primary measures included the Sleep Quality Index, the Center for Epidemiologic Studies-Depression Scale, and vital statistics.

RESULTS:

Hierarchical logistic regressions revealed that poor sleep quality at baseline was significantly associated with increased risk for suicide (odds ratio [OR], 1.39; 95% CI, 1.14-1.69; P < .001) by 10 follow-up years. In addition, 2 sleep items were individually associated with elevated risk for suicide at 10-year follow-up: difficulty falling asleep (OR, 2.24; 95% CI, 1.27-3.93; P < .01) and nonrestorative sleep (OR, 2.17; 95% CI, 1.28-3.67; P < .01). Controlling for depressive symptoms, baseline self-reported sleep quality was associated with increased risk for death by suicide (OR, 1.30; 95% CI, 1.04-1.63; P < .05).

CONCLUSIONS AND RELEVANCE:

Our results indicate that poor subjective sleep quality is associated with increased risk for death by suicide 10 years later, even after adjustment for depressive symptoms. Disturbed sleep appears to confer considerable risk, independent of depressed mood, for the most severe suicidal behaviors and may warrant inclusion in suicide risk assessment frameworks to enhance detection of risk and intervention opportunity in late life.

주요 결과 1

65세 이상 연령에서 Sleep Quality Index로 측정한 수면의 질이 CES-D로 측정한 우울보다 자살 위험을 더 잘 예측했다.

주요 결과 2

특히 SQI 다섯 문항 중 아침에 일어나도 천근만근 몸이 찌뿌듯한 수면(nonrestorative sleep)이 우울을 통제한 후에도 자살 위험을 예측.  

한국에서도 독거 노인 자살율이 점점 높아지는 추세인 것 같다. 구조적인 문제는 임상심리학자가 어떻게 해볼 수 있는 여지가 적지만 수면의 질처럼 임상심리학자가 개입할 수 있는 자살 위험 요소들을 탐색하는 작업이 필요한 것 같다. 

학회에서 보니 심리부검이란 분야가 그런 일을 하는 듯. 현재 김경일 교수님을 주축으로 심리부검 사업이 진행되고 있는데, 얼마나 지속성 있는 사업인지는 잘 모르겠다. 

심리부검 참고 자료: http://radio.ytn.co.kr/program/?f=2&id=29366&s_mcd=0214&s_hcd=01

위 링크에서 김경일 교수님은 빈곤과 사회적 단절을 주요 자살 예측요인으로 언급하고 있다. 

사회적 안전망이 부재하다시피한 사웃스 코리아에서는 자식이 부모 캐어를 안 하면 빈곤과 사회적 단절에 노출되기 십상..

사웃스 코리아가 OECD 국가 중 노인 빈곤율 1위라고 한다(출처 클릭). 

이런 자료만 봐도 독거 노인 자살율은 더 높아질 것이라고 충분히 예측 가능하다.

하지만 박근혜 정부는 앞으로도 관심이 없을 것이 분명하다.