Diurnal symptoms of sleepiness and dysfunction predict future suicidal ideation in a French cohort of outpatients (FACE-DR) with treatment resistant depression: A 1-year prospective study about sleep markers.
Journal of Affective Disorders. 2023-05-01; 329: 369-378
DOI: 10.1016/j.jad.2023.02.106
Read on PubMed
1. J Affect Disord. 2023 May 15;329:369-378. doi: 10.1016/j.jad.2023.02.106. Epub
2023 Feb 24.
Diurnal symptoms of sleepiness and dysfunction predict future suicidal ideation
in a French cohort of outpatients (FACE-DR) with treatment resistant depression:
A 1-year prospective study about sleep markers.
Maruani J(1), Molière F(2), Godin O(3), Yrondi A(4), Bennabi D(5), Richieri
R(6), El-Hage W(7), Allauze E(8), Anguill L(4), Bouvard A(9), Camus V(7), Dorey
JM(10), Etain B(11), Fond G(12), Genty JB(13), Haffen E(5), Holtzmann J(14),
Horn M(15), Kazour F(7), Nguon AS(14), Petrucci J(13), Rey R(10), Stephan F(16),
Vaiva G(17), Walter M(16); FondaMental Advanced Centers of Expertise in
Resistant Depression (FACE-DR) Collaborators; Lejoyeux M(18), Leboyer M(13),
Llorca PM(8), Courtet P(2), Aouizerate B(9), Geoffroy PA(19).
Author information:
(1)Fondation FondaMental, Creteil, France; Département de psychiatrie et
d’addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat –
Claude Bernard, F-75018 Paris, France; Université de Paris, NeuroDiderot,
Inserm, FHU I2-D2, F-75019 Paris, France. Electronic address:
.
(2)Fondation FondaMental, Creteil, France; Department of Emergency Psychiatry
and Acute Care, CHU Montpellier, INSERM U1061, Montpellier University,
Montpellier, France.
(3)Fondation FondaMental, Creteil, France; INSERM, IMRB, Translational
Neuropsychiatry, Fondation FondaMental, 94000 Créteil, France.
(4)Fondation FondaMental, Creteil, France; Service de Psychiatrie et de
Psychologie Médicale de l’adulte (Department of Psychiatry and Adult Medical
Psychology), Centre Expert Dépression Résistante FondaMental (FondaMental
Advanced Centre of Expertise in Resistant Depression, CHU de Toulouse
(University Hospital Centre), Hôpital Purpan, ToNIC Toulouse NeuroImaging
Centre, Université de Toulouse (Toulouse University), INSERM, UPS, Toulouse,
France.
(5)Fondation FondaMental, Creteil, France; Service de Psychiatrie, Centre Expert
Dépression Résistante FondaMental, CIC-1431 INSERM, CHU de Besançon, Laboratoire
de Recherches Intégratives en Neurosciences et Psychologie Cognitive UR-LINC
481, Neurosciences, Université de Bourgogne Franche Comté, Besançon, France.
(6)Fondation FondaMental, Creteil, France; Aix Marseille Univ, CNRS, Centrale
Marseille, Institut Fresnel, Marseille, France.
(7)Fondation FondaMental, Creteil, France; CHRU de Tours, UMR 1253, iBrain,
Université de Tours, Inserm, Tours, France.
(8)Fondation FondaMental, Creteil, France; Université Clermont Auvergne, CMP-B
CHU, CNRS, Clermont Auvergne INP, Institut Pascal, F-63000 Clermont-Ferrand,
France.
(9)Fondation FondaMental, Creteil, France; Pôle de Psychiatrie Générale et
Universitaire (Department of General and University Academic Psychiatry
Cluster), Centre de référence régional des pathologies anxieuses et de la
dépression (Regional reference center for the management and treatment of
anxiety and depressive disorders), Centre Expert Dépression Résistante
FondaMental (FondaMental Advan-ced Centre of Expertise in Resistant Depression),
CH Charles Perrens, Bordeaux, Laboratoire Nutrition et Neurobiologie intégrée
(Integrated Nutrition and Neurobiology Laboratory) (UMR INRAE 1286), Université
de Bordeaux (Bordeaux University), France.
(10)Fondation FondaMental, Creteil, France; INSERM U1028; CNRS UMR5292;
University Lyon 1; Lyon Neuroscience Research Centre; Psychiatric Disorders:
from Resistance to Response ΨR2 Team; Centre Hospitalier Le Vinatier (Hospital
Centre); F-69678, France.
(11)Fondation FondaMental, Creteil, France; Université Paris Cité et AP-HP.Nord,
GHU Lariboisière-Fernand Widal, Département de Psychiatrie et de Médecine
Addictologique et Fondation Fondamental, Paris, France.
(12)Fondation FondaMental, Creteil, France; Aix-Marseille Univ, School of
medicine – La Timone Medical Campus, EA 3279: Department of Epidemiology and
Health Economics, Clinical Research Unit, Direction de la Recherche en Santé, 27
Boulevard Jean Moulin, 13005 Marseille, France.
(13)Fondation FondaMental, Creteil, France; AP-HP, Hôpital Henri Mondor,
Département Médico-Universitaire de Psychiatrie et d’Addictologie (DMU IMPACT),
Fédération Hospitalo-Universitaire de Médecine de Précision (FHU ADAPT);
Université Paris Est Créteil, INSERM U955, IMRB, Laboratoire Neuro-Psychiatrie
translationnelle, Fondation FondaMental, F-94010 Créteil, France.
(14)Fondation FondaMental, Creteil, France; Service Hospitalo-Universitaire de
Psychiatrie, CHU Grenoble Alpes, Université Grenoble Alpes, Inserm, U1216,
Grenoble Institut Neurosciences (Institute of Neurosciences), 38000 Grenoble,
France.
(15)Fondation FondaMental, Creteil, France; Service de Psychiatrie adulte
(Department of Adult Psychiatry), Centre Expert Dépression Résistante
FondaMental, CHRU de Lille, Hôpital Fontan 1, Lille, France.
(16)Fondation FondaMental, Creteil, France; Service Hospitalo-Universitaire de
Psychiatrie Générale et de Réhabilitation Psycho Sociale 29G01 et 29G02
(University Hospital Department of General Psychiatry and Psychosocial
Rehabilitation), Centre Expert Depression Résistante FondaMental, EA 7479, URCI,
CHRU de Brest, Hôpital de Bohars, Brest, France.
(17)Fondation FondaMental, Creteil, France; Service de Psychiatrie adulte
(Department of Adult Psychiatry), Centre Expert Dépression Résistante
FondaMental, CHRU de Lille, Hôpital Fontan 1, Lille, France; Centre National de
Ressources et Résilience pour les psychotraumatismes (Cn2r Lille Paris), Lille,
France.
(18)Département de psychiatrie et d’addictologie, AP-HP, GHU Paris Nord, DMU
Neurosciences, Hôpital Bichat – Claude Bernard, F-75018 Paris, France;
Université de Paris, NeuroDiderot, Inserm, FHU I2-D2, F-75019 Paris, France; GHU
Paris, Psychiatry & Neurosciences, 1 rue Cabanis, 75014 Paris, France.
(19)Fondation FondaMental, Creteil, France; Département de psychiatrie et
d’addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat –
Claude Bernard, F-75018 Paris, France; Université de Paris, NeuroDiderot,
Inserm, FHU I2-D2, F-75019 Paris, France; CNRS UPR 3212, Institute for Cellular
and Integrative Neurosciences, 5 rue Blaise Pascal, 67000 Strasbourg, France;
GHU Paris, Psychiatry & Neurosciences, 1 rue Cabanis, 75014 Paris, France.
Electronic address: .
BACKGROUND: Patients suffering from treatment-resistant depression (TRD) are at
risk of suicide. Sleep and circadian rhythm alterations are widely recognized as
core symptoms of major depressive disorder and are associated with suicidal
ideation. Thus, sleep and circadian rhythm alterations may be targeted to
prevent suicide.
METHODS: Patients were recruited from a prospective cohort of the French network
of TRD expert centers. Mood, sleep and circadian rhythms were assessed at
baseline; suicidal risk was assessed both at baseline and during a one-year
follow-up with standardized subjective questionnaires.
RESULTS: Excessive daytime sleepiness (adjusted odds ratio aOR = 1.7(1-3.3),
p = 0.04) and daytime dysfunction (aOR = 1.81(1.16-2.81), p = 0.0085) increased
the risk of suicidal thoughts over the one-year follow-up period in patients
with TRD after adjustment on age, gender, depression, trauma, anxiety,
impulsivity, current daily tobacco smoking and body mass index. Hypnotics intake
is associated with a reduced risk of suicidal ideation at one-year follow-up
after the same adjustments (OR = 0.73(0.56-0.95), p = 0.019). Other associations
between sleep quality or circadian rhythms and suicidal ideations at either
baseline or one year did not remain significant in multivariate analyses after
the same adjustments.
LIMITATIONS: Sleep assessments were based on self-reported questionnaires rather
than objective measures.
CONCLUSIONS: Daytime sleepiness and dysfunction are predictors of suicidal
ideations, whereas hypnotics intake is associated with a reduced risk of
suicidal ideations. Diurnal symptoms of sleep disturbances are therefore red
flags to target for preventing suicide in depressed patients, and hypnotics seem
efficient in preventing suicide for patients with TRD.
Copyright © 2023. Published by Elsevier B.V.
DOI: 10.1016/j.jad.2023.02.106
PMID: 36842655 [Indexed for MEDLINE]