Sleep and circadian rhythms as possible trait markers of suicide attempt in bipolar disorders: An actigraphy study

Oct 6, 2018Journal of affective disorders

Sleep and daily body clock patterns as possible lasting signs of suicide attempts in bipolar disorder

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Abstract

A sample of 236 participants revealed that woman gender, vigorous circadian type, insomnia, and an earlier daily activity are associated with suicide attempts in patients with bipolar disorder.

Suicide attempts were more common in women and those with a familial history of suicide attempts.
Patients with a history of suicide attempts showed a significant preference for morning activity phases.
Increased vigor on the circadian type inventory was linked to a history of suicide attempts.
Insomnia was reported more frequently among those with a history of suicide attempts (45% vs. 25%).
An earlier onset of daily activity was observed in patients with a history of suicide attempts.

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BACKGROUND: The poor prognostic of Bipolar disorders (BD) is closely linked to deaths by suicide. Sleep and circadian abnormalities are observed during all phases of BD and are also associated with suicide attempt (SA). In this context, this study sought to identify specific sleep and circadian rhythms markers associated with suicidal attempt in euthymic patients with BD.

METHODS: The sample (N = 236) comprised 3 groups: 147 patients with BD including 57 with a history of SA and 90 without (NoSA), and 89 healthy controls (HC). All participants were recorded during 21 days with actigraphy.

RESULTS: SA was associated with women gender (p = 0.03), familial history of SA (p = 0.03), mixed episodes (p = 0.001), and benzodiazepines (p = 0.019). SA, compared to noSA, had a morning phase preference (p = 0.04), and were more vigorous on the circadian type inventory (p = 0.04), and tended to suffer more from insomnia (45% versus 25% respectively, p = 0.10). SA was also associated with an earlier onset of daily activity assessed with actigraphy (M10 onset: p = 0.01). Backward stepwise linear regression indicated that a combination of four variables (Gender, vigour, insomnia, M10onset) significantly differentiated patients with SA from NoSA (p = 0.03).

LIMITATIONS: Cross-sectional design, and no examination of suicidal behaviors' subgroups such as first attempters or repeaters, or violent suicide attempt.

CONCLUSIONS: Woman gender, vigorous circadian type, insomnia and an earlier daily activity appeared independently associated with SA in BD. If these biomarkers are confirmed in prospective studies, they should be screened and used to prevent suicide, with the development of personal and targeted chronobiological treatments.

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Sleep and circadian rhythms as possible trait markers of suicide attempt in bipolar disorders: An actigraphy study

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