Depression and the relationship between sleep disturbances, nightmares, and suicidal ideation in treatment-seeking Canadian Armed Forces members and veterans

doi:10.1186/s12888-018-1782-z

. 2018 Jun 19;18(1):204.

doi: 10.1186/s12888-018-1782-z.

Depression and the relationship between sleep disturbances, nightmares, and suicidal ideation in treatment-seeking Canadian Armed Forces members and veterans

J Don Richardson^{1

2

3}, Lisa King⁴, Kate St Cyr⁴, Philippe Shnaider^{5

6}, Maya L Roth^{4

7}, Felicia Ketcheson⁴, Ken Balderson^{4

8}, Jon D Elhai⁹

Affiliations

¹ Parkwood Institute Operational Stress Injury Clinic, London, ON, Canada. don.richardson@sjhc.london.on.ca.
² Department of Psychiatry, Western University, London, ON, Canada. don.richardson@sjhc.london.on.ca.
³ Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada. don.richardson@sjhc.london.on.ca.
⁴ Parkwood Institute Operational Stress Injury Clinic, London, ON, Canada.
⁵ Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
⁶ Anxiety Treatment and Research Centre, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
⁷ Department of Graduate Studies, Ryerson University, Toronto, ON, Canada.
⁸ Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
⁹ Departments of Psychology and Psychiatry, University of Toledo, Toledo, OH, USA.

PMID: 29921268
PMCID: PMC6011186
DOI: 10.1186/s12888-018-1782-z

Depression and the relationship between sleep disturbances, nightmares, and suicidal ideation in treatment-seeking Canadian Armed Forces members and veterans

J Don Richardson et al. BMC Psychiatry. 2018.

. 2018 Jun 19;18(1):204.

doi: 10.1186/s12888-018-1782-z.

Authors

J Don Richardson^{1

2

3}, Lisa King⁴, Kate St Cyr⁴, Philippe Shnaider^{5

6}, Maya L Roth^{4

7}, Felicia Ketcheson⁴, Ken Balderson^{4

8}, Jon D Elhai⁹

Affiliations

¹ Parkwood Institute Operational Stress Injury Clinic, London, ON, Canada. don.richardson@sjhc.london.on.ca.
² Department of Psychiatry, Western University, London, ON, Canada. don.richardson@sjhc.london.on.ca.
³ Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada. don.richardson@sjhc.london.on.ca.
⁴ Parkwood Institute Operational Stress Injury Clinic, London, ON, Canada.
⁵ Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
⁶ Anxiety Treatment and Research Centre, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
⁷ Department of Graduate Studies, Ryerson University, Toronto, ON, Canada.
⁸ Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
⁹ Departments of Psychology and Psychiatry, University of Toledo, Toledo, OH, USA.

PMID: 29921268
PMCID: PMC6011186
DOI: 10.1186/s12888-018-1782-z

Abstract

Background: Research on the relationship between insomnia and nightmares, and suicidal ideation (SI) has produced variable findings, especially with regard to military samples. This study investigates whether depression mediated the relationship between: 1) sleep disturbances and SI, and 2) trauma-related nightmares and SI, in a sample of treatment-seeking Canadian Armed Forces (CAF) personnel and veterans (N = 663).

Method: Regression analyses were used to investigate associations between sleep disturbances or trauma-related nightmares and SI while controlling for depressive symptom severity, posttraumatic stress disorder (PTSD) symptom severity, anxiety symptom severity, and alcohol use severity. Bootstrapped resampling analyses were used to investigate the mediating effect of depression.

Results: Approximately two-thirds of the sample (68%; N = 400) endorsed sleep disturbances and 88% (N = 516) reported experiencing trauma-related nightmares. Although sleep disturbances and trauma-related nightmares were both significantly associated with SI on their own, these relationships were no longer significant when other psychiatric conditions were included in the models. Instead, depressive symptom severity emerged as the only variable significantly associated with SI in both equations. Bootstrap resampling analyses confirmed a significant mediating role of depression for sleep disturbances.

Conclusions: The findings suggest that sleep disturbances and trauma-related nightmares are associated with SI as a function of depressive symptoms in treatment-seeking CAF personnel and veterans. Treating depression in patients who present with sleep difficulties may subsequently help mitigate suicide risk.

Keywords: Canadian armed forces; Insomnia; Major depressive disorder; Nightmares; Posttraumatic stress disorder; Suicide.

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Conflict of interest statement

Ethics approval and consent to participate

This research was approved by the Health Sciences Research Ethics Board at Western University, as well as the Lawson Health Research Institute. All participants provided written informed consent for their data to be included in the study.

Consent for publication

N/A

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

**Fig. 1**
Association (a) and Mediation model for sleep disturbances and suicidal ideation (b)

**Fig. 2**
Association (a) and Mediation model for nightmares and suicidal ideation (b)

See this image and copyright information in PMC

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References

1. Troxel WM, Shih RA, Pedersen E, Geyer L, Fisher MP, Griffin BA, et al. Sleep in the Military: Promoting Healthy Sleep Among U.S. Servicemembers. Santa Monica, CA: RAND Corporation; 2015. - PMC - PubMed
1. Tanielian T, Karney BR, Chandra A, Meadows SO. The deployment life study: methodological overview and baseline sample description. Santa Monica, CA: RAND Corporation; 2014.
1. Plumb TR, Peachey JT, Zelman DC. Sleep disturbance is common among servicemembers and veterans of operations enduring freedom and Iraqi freedom. Psychol Serv. 2014;11(2):209–219. doi: 10.1037/a0034958. - DOI - PubMed
1. Richardson JD, St Cyr K, Nelson C, Elhai JD, Sareen J. Sleep disturbances and suicidal ideation in a sample of treatment-seeking Canadian forces members and veterans. Psychiatry Res. 2014;218(1–2):118–123. doi: 10.1016/j.psychres.2014.04.008. - DOI - PubMed
1. Maher MJ, Rego SA, Asnis GM. Sleep disturbances in patients with post-traumatic stress disorder: epidemiology, impact and approaches to management. CNS Drugs. 2006;20(7):567–590. doi: 10.2165/00023210-200620070-00003. - DOI - PubMed

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[1] Troxel WM, Shih RA, Pedersen E, Geyer L, Fisher MP, Griffin BA, et al. Sleep in the Military: Promoting Healthy Sleep Among U.S. Servicemembers. Santa Monica, CA: RAND Corporation; 2015. - PMC - PubMed

[2] Troxel WM, Shih RA, Pedersen E, Geyer L, Fisher MP, Griffin BA, et al. Sleep in the Military: Promoting Healthy Sleep Among U.S. Servicemembers. Santa Monica, CA: RAND Corporation; 2015. - PMC - PubMed

[3] Tanielian T, Karney BR, Chandra A, Meadows SO. The deployment life study: methodological overview and baseline sample description. Santa Monica, CA: RAND Corporation; 2014.

[4] Tanielian T, Karney BR, Chandra A, Meadows SO. The deployment life study: methodological overview and baseline sample description. Santa Monica, CA: RAND Corporation; 2014.

[5] Plumb TR, Peachey JT, Zelman DC. Sleep disturbance is common among servicemembers and veterans of operations enduring freedom and Iraqi freedom. Psychol Serv. 2014;11(2):209–219. doi: 10.1037/a0034958. - DOI - PubMed

[6] Plumb TR, Peachey JT, Zelman DC. Sleep disturbance is common among servicemembers and veterans of operations enduring freedom and Iraqi freedom. Psychol Serv. 2014;11(2):209–219. doi: 10.1037/a0034958. - DOI - PubMed

[7] Richardson JD, St Cyr K, Nelson C, Elhai JD, Sareen J. Sleep disturbances and suicidal ideation in a sample of treatment-seeking Canadian forces members and veterans. Psychiatry Res. 2014;218(1–2):118–123. doi: 10.1016/j.psychres.2014.04.008. - DOI - PubMed

[8] Richardson JD, St Cyr K, Nelson C, Elhai JD, Sareen J. Sleep disturbances and suicidal ideation in a sample of treatment-seeking Canadian forces members and veterans. Psychiatry Res. 2014;218(1–2):118–123. doi: 10.1016/j.psychres.2014.04.008. - DOI - PubMed

[9] Maher MJ, Rego SA, Asnis GM. Sleep disturbances in patients with post-traumatic stress disorder: epidemiology, impact and approaches to management. CNS Drugs. 2006;20(7):567–590. doi: 10.2165/00023210-200620070-00003. - DOI - PubMed

[10] Maher MJ, Rego SA, Asnis GM. Sleep disturbances in patients with post-traumatic stress disorder: epidemiology, impact and approaches to management. CNS Drugs. 2006;20(7):567–590. doi: 10.2165/00023210-200620070-00003. - DOI - PubMed

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Depression and the relationship between sleep disturbances, nightmares, and suicidal ideation in treatment-seeking Canadian Armed Forces members and veterans

Affiliations

Depression and the relationship between sleep disturbances, nightmares, and suicidal ideation in treatment-seeking Canadian Armed Forces members and veterans

Authors

Affiliations

Abstract

Conflict of interest statement

Ethics approval and consent to participate

Consent for publication

Competing interests

Publisher’s Note

Figures

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Cited by

References

MeSH terms

LinkOut - more resources

Full Text Sources

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Medical

Abstract

Conflict of interest statement

Ethics approval and consent to participate

Consent for publication

Competing interests

Publisher’s Note

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Cited by

References

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