Longitudinal study of insomnia, suicidal ideation, and psychopathology in schizophrenia

Evan Ketcham; Nina R Schooler; Joanne B Severe; Peter F Buckley; Brian J Miller

doi:10.1016/j.schres.2024.03.030

Longitudinal study of insomnia, suicidal ideation, and psychopathology in schizophrenia

Schizophr Res. 2024 Mar 21:267:34-38. doi: 10.1016/j.schres.2024.03.030. Online ahead of print.

Authors

Evan Ketcham¹, Nina R Schooler², Joanne B Severe³, Peter F Buckley⁴, Brian J Miller⁵

Affiliations

¹ Medical College of Georgia, Augusta University, Augusta, GA, United States.
² SUNY Downstate Health Sciences Center, Brooklyn, NY, United States.
³ Research Consultant, Rockville, MD, United States.
⁴ Chancellor's Office, University of Tennessee Health Sciences Center, Memphis, TN, United States.
⁵ Medical College of Georgia, Augusta University, Augusta, GA, United States; Department of Psychiatry and Health Behavior, Augusta University, Augusta, GA, United States. Electronic address: brmiller@augusta.edu.

PMID: 38518475
DOI: 10.1016/j.schres.2024.03.030

Abstract

Objective: Insomnia is a common comorbidity in schizophrenia. Increasing cross-sectional evidence suggests an association between insomnia and suicidal ideation (SI) and symptom severity in schizophrenia. We investigated longitudinal associations over 3 months between insomnia, suicidal ideation, and symptom severity in a group of patients with chronic schizophrenia.

Method: We performed a secondary analysis of data from n = 305 participants from the Preventing Relapse Oral Antipsychotics Compared to Injectables Evaluating Efficacy (PROACTIVE) schizophrenia trial using regression models.

Results: The prevalence of moderate-to-severe insomnia was 17.7 % at baseline and 13.6 % at 3 months, respectively. The prevalence of SI was 22 % at baseline and 22.5 % at 3 months. After controlling for potential confounders, improved SI from baseline to 3 months was associated with both baseline moderate-to-severe insomnia (OR = 3.81, 95 % CI 1.11-13.12, p = 0.034) and improvement in insomnia (OR = 3.50, 95 % CI 1.23-9.92, p = 0.013). Worsening SI from baseline to 3 months was associated with worsening insomnia (OR = 3.50, 95 % CI 1.23-9.92, p = 0.013), but not baseline insomnia. Improvement in BPRS total score from baseline to 3 months was associated with improvement in insomnia (β = 0.17, p = 0.029), but not baseline insomnia.

Conclusion: Insomnia is common in patients with chronic schizophrenia and insomnia showed significant associations with SI and psychopathology. Clinicians should consider insomnia when assessing suicide risk in patients with schizophrenia.

Keywords: Insomnia; Psychopathology; Schizophrenia; Suicidal ideation; Suicide.