SynthesisEuropean psychiatry : the journal of the Association of European Psychiatrists2025
Boulevard of broken rhythms: A systematic review and meta-analysis on the relationship between sleep disturbances and suicidal behavior in bipolar disorder.
Synthesis in European psychiatry : the journal of the Association of European Psychiatrists, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundAmong 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.
methodsWe 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.
resultsAmong 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).
conclusionsThese 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.
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