Insomnia, psychiatric disorders and suicidal ideation in a National Representative Sample of active Canadian Forces members

doi:10.1186/s12888-017-1372-5

. 2017 Jun 6;17(1):211.

doi: 10.1186/s12888-017-1372-5.

Insomnia, psychiatric disorders and suicidal ideation in a National Representative Sample of active Canadian Forces members

J D Richardson^{1

2

3

4}, A Thompson⁵, L King⁶, B Corbett^{7

5

8}, P Shnaider^{9

10

11}, K St Cyr⁶, C Nelson^{7

6}, J Sareen^{12

13}, J Elhai¹⁴, M Zamorski⁵

Affiliations

¹ Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada. Don.Richardson@sjhc.london.on.ca.
² McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada. Don.Richardson@sjhc.london.on.ca.
³ Parkwood Operational Stress Injury Clinic-Parkwood Institute-St. Joseph's Health Care London, 550 Wellington Rd, London, ON, N6C 0A7, Canada. Don.Richardson@sjhc.london.on.ca.
⁴ Canadian Forces Health Services Group and Department of Family Medicine, University of Ottawa, 75 Laurier Ave E, Ottawa, ON, K1N 6N5, Canada. Don.Richardson@sjhc.london.on.ca.
⁵ Canadian Forces Health Services Group and Department of Family Medicine, University of Ottawa, 75 Laurier Ave E, Ottawa, ON, K1N 6N5, Canada.
⁶ Parkwood Operational Stress Injury Clinic-Parkwood Institute-St. Joseph's Health Care London, 550 Wellington Rd, London, ON, N6C 0A7, Canada.
⁷ Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada.
⁸ Stamford International University, Prawet, Bangkok, 10250, Thailand.
⁹ McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada.
¹⁰ St. Joseph's Healthcare Hamilton, 2757 King Street East, Hamilton, ON, L8G 5E4, Canada.
¹¹ Ryerson University, 350 Victoria St, Toronto, ON, M5B 2K3, Canada.
¹² University of Manitoba, 66 Chancellors Cir, Winnipeg, MB, R3T 2N2, Canada.
¹³ Deer Lodge Centre Operational Stress Injury Clinic, 2109 Portage Avenue, Winnipeg, MB, R3J 0L3, Canada.
¹⁴ University of Toledo, 2801 W Bancroft St, Toledo, OH, 43606, USA.

PMID: 28583100
PMCID: PMC5460415
DOI: 10.1186/s12888-017-1372-5

Insomnia, psychiatric disorders and suicidal ideation in a National Representative Sample of active Canadian Forces members

J D Richardson et al. BMC Psychiatry. 2017.

. 2017 Jun 6;17(1):211.

doi: 10.1186/s12888-017-1372-5.

Authors

J D Richardson^{1

2

3

4}, A Thompson⁵, L King⁶, B Corbett^{7

5

8}, P Shnaider^{9

10

11}, K St Cyr⁶, C Nelson^{7

6}, J Sareen^{12

13}, J Elhai¹⁴, M Zamorski⁵

Affiliations

¹ Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada. Don.Richardson@sjhc.london.on.ca.
² McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada. Don.Richardson@sjhc.london.on.ca.
³ Parkwood Operational Stress Injury Clinic-Parkwood Institute-St. Joseph's Health Care London, 550 Wellington Rd, London, ON, N6C 0A7, Canada. Don.Richardson@sjhc.london.on.ca.
⁴ Canadian Forces Health Services Group and Department of Family Medicine, University of Ottawa, 75 Laurier Ave E, Ottawa, ON, K1N 6N5, Canada. Don.Richardson@sjhc.london.on.ca.
⁵ Canadian Forces Health Services Group and Department of Family Medicine, University of Ottawa, 75 Laurier Ave E, Ottawa, ON, K1N 6N5, Canada.
⁶ Parkwood Operational Stress Injury Clinic-Parkwood Institute-St. Joseph's Health Care London, 550 Wellington Rd, London, ON, N6C 0A7, Canada.
⁷ Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada.
⁸ Stamford International University, Prawet, Bangkok, 10250, Thailand.
⁹ McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada.
¹⁰ St. Joseph's Healthcare Hamilton, 2757 King Street East, Hamilton, ON, L8G 5E4, Canada.
¹¹ Ryerson University, 350 Victoria St, Toronto, ON, M5B 2K3, Canada.
¹² University of Manitoba, 66 Chancellors Cir, Winnipeg, MB, R3T 2N2, Canada.
¹³ Deer Lodge Centre Operational Stress Injury Clinic, 2109 Portage Avenue, Winnipeg, MB, R3J 0L3, Canada.
¹⁴ University of Toledo, 2801 W Bancroft St, Toledo, OH, 43606, USA.

PMID: 28583100
PMCID: PMC5460415
DOI: 10.1186/s12888-017-1372-5

Abstract

Background: Past research on the association between insomnia and suicidal ideation (SI) has produced mixed findings. The current study explored the relationship between insomnia, SI, and past-year mental health status among a large Canadian Forces (CF) sample.

Method: Data was obtained from the 2013 Canadian Forces Mental Health Survey (CFMHS), and included a large representative sample of Canadian Regular Forces personnel (N = 6700). A series of univariate logistic regressions were conducted to test individual associations between past-year mental health status, insomnia, and potential confounds and SI. Mental health status included three groups: 0, 1, or two or more probable diagnoses of posttraumatic stress disorder (PTSD), major depressive disorder (MDD), generalized anxiety disorder (GAD), panic disorder (PD) and alcohol abuse/dependence. Stepwise multivariate logistic regression was used to assess the relationship between insomnia and SI with mental health status as a moderator.

Results: 40.8% of respondents reported experiencing insomnia. Both insomnia and number of mental health conditions incrementally increased the risk of SI. However, past-year mental health status was a significant moderator of this relationship, such that for CF personnel with either no (AOR = 1.61, 1.37-1.89) or only one past-year mental health condition (AOR = 1.39, 1.12-1.73), an incremental increase in insomnia was associated with an increased likelihood of SI. However, in personnel with two or more past-year mental health disorders, insomnia was no longer significantly associated with SI (AOR = 1.04, 0.81-1.33).

Conclusions: Insomnia significantly increased the odds of SI, but only among individuals with no or one mental health condition. Findings highlight the importance of assessing insomnia among CF members in order to further suicide prevention efforts.

Keywords: Depression; Insomnia; Mental health; Military; Posttraumatic stress disorder; Sleep; Suicidal ideation.

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Figures

**Fig. 1**
Richardson et al. Adjusted predicted probabilities estimating the risk of past-year suicide ideation associated with the effects of the number of past-year MH disorders at different levels of insomnia

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References

1. Harrell MC, Berglass N: Losing the battle: the challenge of military suicide. Policy brief. In. Edited by Security CfaNA. Washington, DC; 2011
1. Nock MK, Deming CA, Fullerton CS, Gilman SE, Goldenberg M, Kessler RC, McCarroll JE, McLaughlin KA, Peterson C, Schoenbaum M, et al. Suicide among soldiers: a review of psychosocial risk and protective factors. Psychiatry. 2013;76(2):97–125. doi: 10.1521/psyc.2013.76.2.97. - DOI - PMC - PubMed
1. Ursano RJ. Suicide: a national health challenge, an army health threat. Psychiatry. 2013;76(2):95–96. doi: 10.1521/psyc.2013.76.2.95. - DOI - PubMed
1. Thompson JM, Zamorski MA, Sweet J, VanTil L, Sareen J, Pietrzak RH, Hopman WH, MacLean MB, Pedlar D. Roles of physical and mental health in suicidal ideation in Canadian Armed Forces regular Force veterans. Can J Public Health. 2014;105(2):e109–e115. doi: 10.17269/cjph.105.4217. - DOI - PMC - PubMed
1. Ursano RJ, Heeringa SG, Stein MB, Jain S, Raman R, Sun X, Chiu WT, Colpe LJ, Fullerton CS, Gilman SE et al: Prevalence and Correlates of Suicidal Behavior among New Soldiers in the U.S. Army: Results from the Army Study to Assess Risk and Resilience in Servicemembers (Army Starrs). Depress Anxiety 2015, 32(1). - PMC - PubMed

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[1] Harrell MC, Berglass N: Losing the battle: the challenge of military suicide. Policy brief. In. Edited by Security CfaNA. Washington, DC; 2011

[2] Harrell MC, Berglass N: Losing the battle: the challenge of military suicide. Policy brief. In. Edited by Security CfaNA. Washington, DC; 2011

[3] Nock MK, Deming CA, Fullerton CS, Gilman SE, Goldenberg M, Kessler RC, McCarroll JE, McLaughlin KA, Peterson C, Schoenbaum M, et al. Suicide among soldiers: a review of psychosocial risk and protective factors. Psychiatry. 2013;76(2):97–125. doi: 10.1521/psyc.2013.76.2.97. - DOI - PMC - PubMed

[4] Nock MK, Deming CA, Fullerton CS, Gilman SE, Goldenberg M, Kessler RC, McCarroll JE, McLaughlin KA, Peterson C, Schoenbaum M, et al. Suicide among soldiers: a review of psychosocial risk and protective factors. Psychiatry. 2013;76(2):97–125. doi: 10.1521/psyc.2013.76.2.97. - DOI - PMC - PubMed

[5] Ursano RJ. Suicide: a national health challenge, an army health threat. Psychiatry. 2013;76(2):95–96. doi: 10.1521/psyc.2013.76.2.95. - DOI - PubMed

[6] Ursano RJ. Suicide: a national health challenge, an army health threat. Psychiatry. 2013;76(2):95–96. doi: 10.1521/psyc.2013.76.2.95. - DOI - PubMed

[7] Thompson JM, Zamorski MA, Sweet J, VanTil L, Sareen J, Pietrzak RH, Hopman WH, MacLean MB, Pedlar D. Roles of physical and mental health in suicidal ideation in Canadian Armed Forces regular Force veterans. Can J Public Health. 2014;105(2):e109–e115. doi: 10.17269/cjph.105.4217. - DOI - PMC - PubMed

[8] Thompson JM, Zamorski MA, Sweet J, VanTil L, Sareen J, Pietrzak RH, Hopman WH, MacLean MB, Pedlar D. Roles of physical and mental health in suicidal ideation in Canadian Armed Forces regular Force veterans. Can J Public Health. 2014;105(2):e109–e115. doi: 10.17269/cjph.105.4217. - DOI - PMC - PubMed

[9] Ursano RJ, Heeringa SG, Stein MB, Jain S, Raman R, Sun X, Chiu WT, Colpe LJ, Fullerton CS, Gilman SE et al: Prevalence and Correlates of Suicidal Behavior among New Soldiers in the U.S. Army: Results from the Army Study to Assess Risk and Resilience in Servicemembers (Army Starrs). Depress Anxiety 2015, 32(1). - PMC - PubMed

[10] Ursano RJ, Heeringa SG, Stein MB, Jain S, Raman R, Sun X, Chiu WT, Colpe LJ, Fullerton CS, Gilman SE et al: Prevalence and Correlates of Suicidal Behavior among New Soldiers in the U.S. Army: Results from the Army Study to Assess Risk and Resilience in Servicemembers (Army Starrs). Depress Anxiety 2015, 32(1). - PMC - PubMed

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Insomnia, psychiatric disorders and suicidal ideation in a National Representative Sample of active Canadian Forces members

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Insomnia, psychiatric disorders and suicidal ideation in a National Representative Sample of active Canadian Forces members

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