Sleep problems and suicide associated with mood instability in the Adult Psychiatric Morbidity Survey, 2007

Objective: Mood instability (MI) is common in the general population. Mood instability is a precursor to mental illness and associated with a range of negative health outcomes. Sleep disturbance appears to be closely linked with MI. This study assesses the association between MI and sleep disturbance and the link with suicidal ideation and behaviour in a general population sample in England. Method: The Adult Psychiatric Morbidity Survey 2007 collected detailed information about mental health symptoms and correlates in a representative sample of adult household residents living in England (n=7303). Mood instability was assessed using the Structured Clinical Interview for DSM IV Axis II. Sleep problems were defined as sleeping more than usual or less than usual during the past month. Other dependent variables included medication use and suicidal ideation and behaviour (response rate 57%). Generalized linear modelling was used to estimate the prevalence of MI and sleep problems. Logistic regression was used to estimate odds ratios. All estimates were weighted. Results: The prevalence of MI was 14.7% (95% CI 13.6%-15.7%). Sleep problems occurred in 69.8% (95% CI 66.6%-73.1%) of those with MI versus 37.6% (95% CI 36.2%-39.1%) of those without MI. The use of sedating and non-sedating medications did not influence the association. Sleep problems were significantly associated with suicidal ideation and behaviour even after adjusting for MI. Conclusion: Sleep problems are highly prevalent in the general population, particularly among those with MI. Sleep problems are strongly associated with suicidal ideation and behaviour. Treatments that target risk and maintenance factors that transcend diagnostic boundaries, such as therapies that target sleep disturbance, may be particularly valuable for preventing and addressing complications related to MI such as suicide