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Review
. 2025 Oct 24;68(1):e154.
doi: 10.1192/j.eurpsy.2025.10102.

Boulevard of broken rhythms: A systematic review and meta-analysis on the relationship between sleep disturbances and suicidal behavior in bipolar disorder

Marta Bort  1   2   3   4 , Chiara Possidente  5 , Vincenzo Oliva  1   2   3   4 , Michele De Prisco  1   2   3   4 , Constanza Sommerhoff  1   2   3   4 , Giovanna Fico  1   2   3   4 , Tábatha Fernández-Plaza  1   2   3   4 , Amadeu Obach  1 , Laura Montejo  1   2   3   4 , Anabel Martinez-Aran  1   2   3   4 , Eduard Vieta  1   2   3   4 , Andrea Murru  1   2   3   4
Affiliations
Review

Boulevard of broken rhythms: A systematic review and meta-analysis on the relationship between sleep disturbances and suicidal behavior in bipolar disorder

Marta Bort et al. Eur Psychiatry. .

Abstract

Background: Among the clinical features of bipolar disorder (BD), sleep disturbances are highly prevalent and persist across all phases of the illness, from onset to acute and inter-episodic periods. Substantial evidence suggests that sleep disturbances may function as proximal triggers for suicidal behavior, independent of other underlying psychiatric conditions. Although suicide is a major clinical concern in BD, the interplay between sleep disturbances and suicidality remains incompletely understood.

Methods: We conducted a systematic review and meta-analysis (SRMA) following the PRISMA guidelines. We performed a comprehensive search across PubMed, PsycINFO, and SCOPUS, including all studies reporting an association between sleep disturbances and suicidal behavior in BD. A total of 16 reports, comprising 14 cross-sectional studies and two longitudinal studies, were included in this SRMA.

Results: Among individuals with BD, sleep disturbances were associated with increased odds of lifetime suicidal behaviors (OR = 1.51, 95% CI = 1.23, 1.86), and a history of suicide attempts was associated with significantly elevated odds of experiencing sleep disturbances (OR = 1.37, 95% CI = 1.21, 1.55). In addition, poor sleep quality as measured by the Pittsburgh Sleep Quality Index positively correlated with suicidality (r = 0.24, 95% CI = 0.10, 0.36).

Conclusions: These results highlight the link between sleep disturbances and suicidal tendencies in individuals with BD. Prompt recognition and treatment of sleep disturbances could be crucial for averting or reducing suicidal behaviors in this population.

Keywords: bipolar disorder; insomnia; sleep disturbances; suicidal attempts; suicidal ideation.

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Conflict of interest statement

GF has received CME-related honoraria or consulting fees from Angelini, Janssen-Cilag, and Lundbeck.

AM has received grants and served as a consultant, advisor, or CME speaker for the following entities: Angelini, Idorsia, Lundbeck, Pfizer, Takeda, outside of the submitted work.

EV has received grants and served as a consultant, advisor, or CME speaker for the following entities: AB-Biotics, AbbVie, Angelini, Biogen, Biohaven, Boehringer-Ingelheim, Celon Pharma, Compass, Dainippon Sumitomo Pharma, Ethypharm, Ferrer, Gedeon Richter, GH Research, Glaxo-Smith Kline, Idorsia, Janssen, Lundbeck, Medincell, Neuraxpharm, Newron, Novartis, Orion Corporation, Organon, Otsuka, Rovi, Sage, Sanofi-Aventis, Sunovion, Takeda, Teva, and Viatris, outside the submitted work.

All the other authors have no conflicts to declare.

Figures

Figure 1.
Figure 1.
PRISMA flowchart, 2020 edition, adapted.
Figure 2.
Figure 2.
Jungle plots summarizing the main effect sizes: (A) Odds ratios (OR), (B) Standardized mean differences (SMD), (C) Correlation coefficients. Black-filled dots represent statistically significant comparisons, while white-filled dots indicate non-significant comparisons. Dot size corresponds to the sample size of each comparison.
See this image and copyright information in PMC

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MeSH terms