0987 Sleep Characteristics, Suicidal Ideation, and Attempts among Adults Aged 50+ with Depressive Symptoms in Five Middle-Income Countries

Abstract

Introduction: Cross-national studies of sleep disturbance and suicidal ideation and attempts among older adults are essential given the global aging of the population and cross-cultural variation in sleep patterns. As emerging economies with social change and older populations, middle-income countries (MICs) are particularly important to study to stem suicide rates which increase with older age. Methods: We analyzed Wave 1 data (2007-2010) from the WHO Study on Global AGEing and Adult Health (SAGE). Participants were 2,366 adults (median age=64 years [range:50-106]; 59% women) from China (14%), Ghana (17%), India (49%), Russia (13%), and South Africa (7%). Participants who reported past-year depressive symptoms lasting ≥2 weeks were asked whether they had suicidal ideation or had attempted suicide (yes/no for each) when the depressive symptoms were present. Primary predictors were self-reported sleep characteristics: sleep duration averaged across two nights (categorized as ≤6 hours [short], 7-8 hours, ≥9 hours [long]), past-day sleepiness (yes/no), and past-month insomnia symptoms (trouble falling asleep, nighttime awakenings, or early awakenings; dichotomized as “none” [no] or “mild?, “moderate?, “severe?, “extreme” [yes]). Results: Overall, 1,798 (76%) participants reported insomnia symptoms, 874 (37%) sleepiness, 887 (40%) short sleep, and 369 (17%) long sleep. After adjustment for age, sex, country, education, marital status, and past-day self-rated health, in the context of depressive symptoms, past-month insomnia symptoms were associated with higher odds of suicidal ideation (odds ratio [OR]=1.44, 95% confidence interval [CI] 1.14,1.81) and attempt (OR=1.68, 95% CI 1.10,2.56). Past-day sleepiness was associated with higher odds of suicidal ideation (OR=1.37, 95% CI 1.14,1.65), but not attempt (OR=1.17, 95% CI 0.85,1.59). After adjustment, sleep duration was not associated with either outcome. Conclusion: In the context of depressive symptoms, insomnia symptoms and sleepiness were associated with suicidal ideation and attempt among older adults in MICs. Prospective studies would provide evidence about temporal sequence, but sleep disturbance among older adults may be an important signal of suicide risk to consider in prevention strategies.