In a recent publication in Current Opinion in Psychiatry, researchers conducted a systematic review and meta-analysis of studies exploring insomnia, suicide, and psychopathology in schizophrenia.

The authors wrote, “To our knowledge, no previous studies have specifically investigated whether treating insomnia in schizophrenia is associated with reduced suicidal ideation and behavior. Given the potential relevance of insomnia to the clinical care of patients with schizophrenia, we performed a systematic review and meta-analysis of studies of insomnia, suicide, and psychopathology in schizophrenia.”

To obtain data, the researchers analytically examined publications from PubMed, PsycInfo, and Web of Science and the reference lists of studies that met the inclusion/exclusion criteria for the meta-analysis in November 2022. This systematic review was conducted in accordance with the PRISMA statement, and studies involving insomnia, suicide, and psychopathology in patients with schizophrenia were identified.

Random effects meta-analysis computing odds ratios (ORs; for suicide), effect sizes (ES; for psychopathology), and 95% CIs were conducted.

A total of 10 studies met the criteria for inclusion, which involved 3,428 patients with schizophrenia. Of the 10 studies, nine provided data on insomnia and suicide, and eight studies provided data on insomnia and psychopathology.

The researchers discovered that insomnia was correlated with a significant, almost twofold augmented odds of current suicidal ideation (OR 1.84; 95% CI, 1.28-2.65, P <.01) and a nearly sixfold augmented odds of incident suicide attempt or death (OR 5.83; 95% CI, 1.61-2.96, P <.01).

Moreover, insomnia was also correlated with total (ES 0.16; 95% CI, 0.09-0.23, P <.01), positive (ES 0.14; 95% CI, 0.08-0.20, P = .02), and general (ES 0.17; 95% CI, 0.08-0.27, P <.01) psychopathology. In meta-regression analyses, BMI was adversely correlated with suicidal ideation. Otherwise, age, gender, and study year were all unrelated to the correlations.

Based on their findings, the authors indicated that in patients with schizophrenia, insomnia is linked with suicide and psychopathology. The authors also noted that patients with schizophrenia and insomnia should receive psychoeducation on good sleep hygiene, and the findings emphasized the need to expand awareness about identifying and treating insomnia in this patient population. Shared decision-making between the patient and clinician is also recommended to improve clinical outcomes.

The authors concluded, “Our findings provide additional evidence that formal assessment and treatment of insomnia is relevant to the clinical care of patients with schizophrenia as an indicator of suicidal ideation and symptom severity. They also underscore the need for comprehensive suicide risk assessment in these patients.”

Additional large, longitudinal studies in schizophrenia are necessary to examine the correlation between insomnia and incident suicidal ideation and behavior, and the studies should also investigate the influence of the various phases of insomnia, comorbid sleep disorders (e.g., obstructive sleep apnea), and different types of suicidal thoughts were also recommended by the authors.

Lastly, the authors wrote, “There is also a need for studies investigating whether treatment of insomnia reduces suicidal ideation and behavior in schizophrenia.”

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