Sleep Problems, Suicidal Ideation, and Psychopathology in First-Episode Psychosis

Background and Hypothesis Insomnia occurs frequently in the clinical course of schizophrenia. A growing literature has found associations between insomnia, suicidal ideation and behavior, and psychopathology in schizophrenia. We explored associations between sleep problems, suicidal ideation, and psychopathology in a cohort of patients with first-episode psychosis. Study Design We performed a secondary analysis of data for n = 403 subjects with data from the Recovery After an Initial Schizophrenia Episode study using regression models. Study Results The prevalence of sleep problems and suicidal ideation at baseline was 57% and 15%, respectively. After controlling for potential confounders, in the study baseline sleep problems were associated with increased odds of suicidal ideation with evidence of a dose-dependent relationship (OR = 2.25, 95% CI 1.15-4.41, P = .018). Over 24 months, sleep problems at any time point were associated with an over 3-fold increased odds of concurrent suicidal ideation (OR = 3.21, 95% CI 1.45-7.14, P = .004). Subjects with persistent sleep problems were almost 14 times more likely to endorse suicidal ideation at least once over the study than those without sleep problems (OR = 13.8, 95% CI 6.5-53.4, P < .001). Sleep problems were also a predictor of higher Positive and Negative Syndrome Scale total (beta = 0.13-0.22), positive (beta = 0.14-0.25), and general (beta = 0.16-0.27) subscale scores at baseline and multiple follow-up visits (P < .01 for each). Conclusions Sleep problems are highly prevalent and associated with suicidal ideation and greater psychopathology in first-episode psychosis. Formal assessment and treatment of insomnia appear relevant to the clinical care of patients with psychosis as a predictor of suicidal ideation and symptom severity.

Automated summary

The article "Sleep Problems, Suicidal Ideation, and Psychopathology in First-Episode Psychosis" examines the association between sleep problems, suicidal ideation, and psychopathology in patients with first-episode psychosis. The study found a positive correlation between sleep problems and suicidal ideation, as well as a correlation with higher levels of psychopathology. Therefore, formal assessment and treatment of sleep problems are crucial for the clinical care of patients with psychosis as it predicts suicidal ideation and symptom severity.