Rebecca Bernert

All Publications

• Cross-cultural relevance of the Interpersonal Theory of suicide across Korean and U.S. undergraduate students. Psychiatry research Suh, S., Ebesutani, C. K., Hagan, C. R., Rogers, M. L., Hom, M. A., Ringer, F. B., Bernert, R. A., Kim, S., Joiner, T. E. 2017; 251: 244-252

  Abstract

  This study investigated the cross-cultural relevance and validity of the Interpersonal Theory of Suicide (ITS) utilizing young adult samples from South Korea (n =554) and the United States (U.S.; n =390). To examine the ITS, all participants completed self-report questionnaires measuring Thwarted Belongingness, Perceived Burdensomeness, and Capability for Suicide. We examined whether each construct significantly predicted the severity of suicidal risk in both samples. We also determined whether the strength of the effects of Thwarted Belongingness and Perceived Burdensomeness on suicidal ideation differed between the two samples due to the greater degree of importance placed on interpersonal relationships in collectivistic cultures such as South Korea. Structural equation modeling was used to examine these hypotheses. Thwarted Belongingness, Perceived Burdensomeness, and Capability for Suicide significantly predicted elevated suicidal risk. However, there were no significant differences in the paths from Thwarted Belongingness or Perceived Burdensomeness to suicide risk between the South Korean and U.S.These findings support the cross-cultural relevance and applicability of the ITS, whereby Thwarted Belongingness and Perceived Burdensomeness serve as indicators of suicide risk in both Western (U.S.) and East Asian (Korean) samples.

  View details for DOI 10.1016/j.psychres.2017.02.005

  View details for PubMedID 28214784

• Sleep architecture parameters as a putative biomarker of suicidal ideation in treatment-resistant depression JOURNAL OF AFFECTIVE DISORDERS Bernert, R. A., Luckenbaugh, D. A., Duncan, W. C., Iwata, N. G., Ballard, E. D., Zarate, C. A. 2017; 208: 309-315

  Abstract

  Disturbed sleep may confer risk for suicidal behaviors. Polysomnographic (PSG) sleep parameters have not been systematically evaluated in association with suicidal ideation (SI) among individuals with treatment-resistant depression (TRD).This secondary data analysis included 54 TRD individuals (N=30 with major depressive disorder (MDD) and N=24 with bipolar depression (BD)). PSG sleep parameters included Sleep Efficiency (SE), Total Sleep Time (TST), Wakefulness After Sleep Onset (WASO), REM percent/latency, and non-REM (NREM) Sleep Stages 1-4. The Hamilton Depression Rating Scale (HAM-D) was used to group participants according to presence or absence of SI. Sleep abnormalities were hypothesized among those with current SI. ANOVA analyses were conducted before (Model 1) and after adjusting for depression (Model 2) and diagnostic variables (Model 3).Significant differences in PSG parameters were observed in Model 1; those with SI had less NREM Stage 4 sleep (p<.05). After adjusting for central covariates, Models 2 and 3 revealed significantly less NREM Stage 4 sleep, lower SE (P<.05), and higher WASO (P<.05) among those with SI. BD participants with SI also had less NREM Stage 4 and more NREM Stage 1 sleep.1) a predominantly white sample; 2) exclusion of imminent suicide risk; 3) concomitant mood stabilizer use among BD patients; and 4) single-item SI assessment.Independent of depression severity, SI was associated with less NREM Stage 4 sleep, and higher nocturnal wakefulness across diagnostic groups. Sleep may warrant further investigation in the pathogenesis of suicide risk, particularly in TRD, where risk may be heightened.

  View details for DOI 10.1016/j.jad.2016.08.050

  View details for Web of Science ID 000390732600045

• Objectively Assessed Sleep Variability as an Acute Warning Sign of Suicidal Ideation in a Longitudinal Evaluation of Young Adults at High Suicide Risk. The Journal of clinical psychiatry Bernert, R. A., Hom, M. A., Iwata, N. G., Joiner, T. E. 2017; 78 (6): e678–e687

  Abstract

  Young adults attempt suicide at disproportionately high rates relative to other groups and demonstrate high rates of sleep disturbance. No study has yet prospectively evaluated disturbed sleep as an acute indicator of risk using an objective index of sleep. We investigated objective and subjective parameters of disturbed sleep as a warning sign of suicidal ideation among young adults over an acute period.A longitudinal study across a 21-day observation period and 3 time points. Fifty of 4,847 participants (aged 18-23 years) were prescreened from a university undergraduate research pool (February 2007-June 2008) on the basis of suicide attempt history and recent suicidal ideation. Actigraphic and subjective sleep parameters were evaluated as acute predictors of suicidal ideation (Beck Scale for Suicide Ideation), with adjustment for baseline symptoms. Hierarchical regression analyses were employed to predict residual change scores.Ninety-six percent of participants (n = 48) endorsed a suicide attempt history. Mean actigraphy values revealed objectively disturbed sleep parameters; 78% (n = 39) and 36% (n = 18) endorsed clinically significant insomnia and nightmares, respectively. When results were controlled for baseline suicidal and depressive symptoms, actigraphic and subjective sleep parameters predicted suicidal ideation residual change scores at 7- and 21-day follow-ups (P < .001). Specifically, actigraphy-defined variability in sleep timing, insomnia, and nightmares predicted increases in suicidal ideation (P < .05). In a test of competing risk factors, sleep variability outperformed depressive symptoms in the longitudinal prediction of suicidal ideation across time points (P < .05).Objectively and subjectively measured sleep disturbances predicted acute suicidal ideation increases in this population, independent of depressed mood. Self-reported insomnia and nightmares and actigraphically assessed sleep variability emerged as acute warning signs of suicidal ideation. These findings highlight the potential utility of sleep as a proposed biomarker of suicide risk and a therapeutic target.

  View details for DOI 10.4088/JCP.16m11193

  View details for PubMedID 28682534

• Antisuicidal Response Following Ketamine Infusion Is Associated With Decreased Nighttime Wakefulness in Major Depressive Disorder and Bipolar Disorder. journal of clinical psychiatry Vande Voort, J. L., Ballard, E. D., Luckenbaugh, D. A., Bernert, R. A., Richards, E. M., Niciu, M. J., Park, L. T., Machado-Vieira, R., Duncan, W. C., Zarate, C. A. 2016

  Abstract

  Insomnia and disrupted sleep are associated with increased risk of suicide. The N-methyl-D-aspartate antagonist ketamine has been associated with reduced suicidal thoughts, but the mechanism of action is unknown. This study sought to evaluate differences in nocturnal wakefulness in depressed individuals who did and did not have an antisuicidal response to ketamine.Thirty-four participants with baseline suicidal ideation diagnosed with either DSM-IV major depressive disorder (n = 23) or bipolar depression (n = 11) between 2006 and 2013 completed nighttime electroencephalography (EEG) the night before and the night after a single ketamine infusion (0.5 mg/kg over 40 minutes). Suicidal ideation was assessed at baseline and the morning after ketamine infusion via several measures, including the Hamilton Depression Rating Scale suicide item, the suicide item of the Montgomery-Asberg Depression Rating Scale, and the first 5 items of the Scale for Suicide Ideation. A generalized linear mixed model evaluated differences in nocturnal wakefulness, as verified by EEG, between those who had an antisuicidal response to ketamine and those who did not, controlling for baseline nocturnal wakefulness. Results were also compared to the sleep of healthy controls (n = 22).After analyses adjusted for baseline sleep, participants with an antisuicidal response to ketamine showed significantly reduced nocturnal wakefulness the night after ketamine infusion compared to those without an antisuicidal response (F₁,₂₂ = 5.04, P = .04). Level of nocturnal wakefulness after antisuicidal response to ketamine did not differ significantly from nocturnal wakefulness in the control sample but did differ at a trend level (F₁,₄₀ = 3.15, P = .08).Reductions in wakefulness following ketamine may point to a biological mechanism underlying the effect of ketamine on suicidal ideation.ClinicalTrials.gov identifier: NCT00088699.

  View details for DOI 10.4088/JCP.15m10440

  View details for PubMedID 27929610

• Sleep architecture parameters as a putative biomarker of suicidal ideation in treatment-resistant depression. Journal of affective disorders Bernert, R. A., Luckenbaugh, D. A., Duncan, W. C., Iwata, N. G., Ballard, E. D., Zarate, C. A. 2016; 208: 309-315

  Abstract

  Disturbed sleep may confer risk for suicidal behaviors. Polysomnographic (PSG) sleep parameters have not been systematically evaluated in association with suicidal ideation (SI) among individuals with treatment-resistant depression (TRD).This secondary data analysis included 54 TRD individuals (N=30 with major depressive disorder (MDD) and N=24 with bipolar depression (BD)). PSG sleep parameters included Sleep Efficiency (SE), Total Sleep Time (TST), Wakefulness After Sleep Onset (WASO), REM percent/latency, and non-REM (NREM) Sleep Stages 1-4. The Hamilton Depression Rating Scale (HAM-D) was used to group participants according to presence or absence of SI. Sleep abnormalities were hypothesized among those with current SI. ANOVA analyses were conducted before (Model 1) and after adjusting for depression (Model 2) and diagnostic variables (Model 3).Significant differences in PSG parameters were observed in Model 1; those with SI had less NREM Stage 4 sleep (p<.05). After adjusting for central covariates, Models 2 and 3 revealed significantly less NREM Stage 4 sleep, lower SE (P<.05), and higher WASO (P<.05) among those with SI. BD participants with SI also had less NREM Stage 4 and more NREM Stage 1 sleep.1) a predominantly white sample; 2) exclusion of imminent suicide risk; 3) concomitant mood stabilizer use among BD patients; and 4) single-item SI assessment.Independent of depression severity, SI was associated with less NREM Stage 4 sleep, and higher nocturnal wakefulness across diagnostic groups. Sleep may warrant further investigation in the pathogenesis of suicide risk, particularly in TRD, where risk may be heightened.

  View details for DOI 10.1016/j.jad.2016.08.050

  View details for PubMedID 27810712

• Suicide and sleep: Is it a bad thing to be awake when reason sleeps? Sleep medicine reviews Perlis, M. L., Grandner, M. A., Chakravorty, S., Bernert, R. A., Brown, G. K., Thase, M. E. 2016; 29: 101-107

  Abstract

  Suicide is the second leading cause of death, worldwide, for those between the ages of 24 and 44 y old. In 2013, more than 41,000 suicides occurred in the United States. These statistics underscore the need to 1) understand why people die by suicide and 2) identify risk factors that are potentially modifiable. While it has been posited that sleep disturbance may represent one such factor, systematic research in this arena did not begin until the 2000s. Since that time, sleep disturbance has been reliably identified as a risk factor for suicidal ideation, suicide attempts, and suicide. While insomnia, nightmares, and other sleep disorders have each been found to contribute to the risk for suicidal ideation and behavior, it is also possible that these factors share some common variance. One possibility is that sleep disturbance results in being awake at night, and being awake at night also confers risk. The hypothesis proffered here is that being awake when one is not biologically prepared to be so results in "hypofrontality" and diminished executive function, and that this represents a common pathway to suicidal ideation and behavior. Such a proposition is highly testable under a variety of possible protocols. The current review summarizes the extant literature on suicide rates by time-of-day, and discusses circadian, psychosocial, and neurocognitive explanations of risk. Such a focus promises to enhance our understanding of how sleep disturbance may confer risk, allows for the identification of future lines of research, and further justifies the need for interventions that promote good sleep continuity among at-risk individuals.

  View details for DOI 10.1016/j.smrv.2015.10.003

  View details for PubMedID 26706755

• Limitations of a single-item assessment of suicide attempt history: Implications for standardized suicide risk assessment. Psychological assessment Hom, M. A., Joiner, T. E., Bernert, R. A. 2016; 28 (8): 1026-1030

  Abstract

  Although a suicide attempt history is among the single best predictors of risk for eventual death by suicide, little is known about the extent to which reporting of suicide attempts may vary by assessment type. The current study aimed to investigate the correspondence between suicide attempt history information obtained via a single-item self-report survey, multi-item self-report survey, and face-to-face clinical interview. Data were collected among a high-risk sample of undergraduates (N = 100) who endorsed a past attempt on a single-item prescreening survey. Participants subsequently completed a multi-item self-report survey, which was followed by a face-to-face clinical interview, both of which included additional questions regarding the timing and nature of previous attempts. Even though 100% of participants (n = 100) endorsed a suicide attempt history on the single-item prescreening survey, only 67% (n = 67) reported having made a suicide attempt on the multi-item follow-up survey. After incorporating ancillary information from the in-person interview, 60% of participants qualified for a Centers for Disease Control and Prevention (CDC)-defined suicide attempt. Of the 40% who did not qualify for a CDC-defined suicide attempt, 30% instead qualified for no attempt, 7% an aborted attempt, and 3% an interrupted attempt. These findings suggest that single-item assessments of suicide attempt history may result in the misclassification of prior suicidal behaviors. Given that such assessments are commonly used in research and clinical practice, these results emphasize the importance of utilizing follow-up questions and assessments to improve precision in the characterization and assessment of suicide risk. (PsycINFO Database Record

  View details for DOI 10.1037/pas0000241

  View details for PubMedID 26502202

  View details for PubMedCentralID PMC4846594

• Nocturnal Wakefulness Is Associated With Next-Day Suicidal Ideation in Major Depressive Disorder and Bipolar Disorder JOURNAL OF CLINICAL PSYCHIATRY Ballard, E. D., Voort, J. L., Bernert, R. A., Luckenbaugh, D. A., Richards, E. M., Niciu, M. J., Furey, M. L., Duncan, W. C., Zarate, C. A. 2016; 77 (6): 825-831

  Abstract

  Self-reported sleep disturbances may confer elevated risk for suicidal ideation, suicide attempts, and death. However, limited research has evaluated polysomnographically determined sleep disturbance as an acute physiologic risk factor for suicidal thoughts. This study sought to investigate the relationship between nocturnal wakefulness in association with next-day suicidal ideation using overnight polysomnography assessment from data collected between 2006 and 2013.Sixty-five participants with DSM-IV-diagnosed major depressive disorder or bipolar depression underwent overnight polysomnography monitoring in a sleep laboratory. The Hamilton Depression Rating Scale (HDRS) was administered the morning after polysomnography recording to assess next-day suicidal ideation, severity of depressive symptoms, and subjective sleep disturbances.Using a generalized linear mixed model, a significant time-by-ideation interaction was found indicating greater nocturnal wakefulness at 4:00 am among participants with suicidal ideation (F4,136 = 3.65, P = .007). Increased time awake during the 4:00 am hour (4:00 to 4:59) was significantly associated with elevated suicidal thoughts the next day (standardized β = 0.31, P = .008). This relationship persisted after controlling for age, gender, diagnosis, and severity of depressive symptoms.Greater nocturnal wakefulness, particularly in the early morning hours, was significantly associated with next-day suicidal thoughts. Polysomnographically documented sleep disruption at specific times of night may represent an acute risk factor of suicidal ideation that warrants additional research.ClinicalTrials.gov identifier: NCT00024635.

  View details for DOI 10.4088/JCP.15m09943

  View details for Web of Science ID 000379302500021

  View details for PubMedID 27337418

• The Association between Sleep Disturbances and Depression among Firefighters: Emotion Dysregulation as an Explanatory Factor JOURNAL OF CLINICAL SLEEP MEDICINE Hom, M. A., Stanley, I. H., Rogers, M. L., Tzoneva, M., Bernert, R. A., Joiner, T. E. 2016; 12 (2): 235-245

  View details for DOI 10.5664/jcsm.5492

  View details for Web of Science ID 000374138900012

• Sleep disturbances as an evidence-based suicide risk factor. Current psychiatry reports Bernert, R. A., Kim, J. S., Iwata, N. G., Perlis, M. L. 2015; 17 (3): 554-?

  Abstract

  Increasing research indicates that sleep disturbances may confer increased risk for suicidal behaviors, including suicidal ideation, suicide attempts, and death by suicide. Despite increased investigation, a number of methodological problems present important limitations to the validity and generalizability of findings in this area, which warrant additional focus. To evaluate and delineate sleep disturbances as an evidence-based suicide risk factor, a systematic review of the extant literature was conducted with methodological considerations as a central focus. The following methodologic criteria were required for inclusion: the report (1) evaluated an index of sleep disturbance; (2) examined an outcome measure for suicidal behavior; (3) adjusted for presence of a depression diagnosis or depression severity, as a covariate; and (4) represented an original investigation as opposed to a chart review. Reports meeting inclusion criteria were further classified and reviewed according to: study design and timeframe; sample type and size; sleep disturbance, suicide risk, and depression covariate assessment measure(s); and presence of positive versus negative findings. Based on keyword search, the following search engines were used: PubMed and PsycINFO. Search criteria generated N = 82 articles representing original investigations focused on sleep disturbances and suicide outcomes. Of these, N = 18 met inclusion criteria for review based on systematic analysis. Of the reports identified, N = 18 evaluated insomnia or poor sleep quality symptoms, whereas N = 8 assessed nightmares in association with suicide risk. Despite considerable differences in study designs, samples, and assessment techniques, the comparison of such reports indicates preliminary, converging evidence for sleep disturbances as an empirical risk factor for suicidal behaviors, while highlighting important, future directions for increased investigation.

  View details for DOI 10.1007/s11920-015-0554-4

  View details for PubMedID 25698339

• Sleep Disturbances and Suicide Risk. Sleep medicine clinics Bernert, R. A., Nadorff, M. R. 2015; 10 (1): 35-39

  Abstract

  Suicide occurs in the presence of psychiatric illness, and is associated with biological, psychological, and social risk factors. Insomnia symptoms and nightmares appear to present elevated risk for suicidal ideation, attempts, and death by suicide. Failure to account for the presence of psychopathology and frequent use of single item assessments of sleep and suicidal ideation are common methodological problems in this literature. Preliminary research, addressing these issues, suggests that subjective sleep complaints may confer independent risk for suicidal behaviors.

  View details for DOI 10.1016/j.jsmc.2014.11.004

  View details for PubMedID 26055671

• The Association between Sleep Disturbances and Depression among Firefighters: Emotion Dysregulation as an Explanatory Factor. Journal of clinical sleep medicine Hom, M. A., Stanley, I. H., Rogers, M. L., Tzoneva, M., Bernert, R. A., Joiner, T. E. 2015; 12 (2): 235-245

  Abstract

  To investigate emotion regulation difficulties in association with self-reported insomnia symptoms, nightmares, and depression symptoms in a sample of current and retired firefighters.A total of 880 current and retired United States firefighters completed a web-based survey of firefighter behavioral health. Self-report measures included the Center for Epidemiologic Studies Depression Scale, Insomnia Severity Index, PTSD Checklist, and Difficulties in Emotion Regulation Scale.A notable portion of participants reported clinically significant depression symptoms (39.6%) and insomnia symptoms (52.7%), as well as nightmare problems (19.2%), each of which demonstrated a strong association with emotion regulation difficulties (rs = 0.56-0.80). Bootstrapped mediation analyses revealed that the indirect effects of overall emotion regulation difficulties were significant both for the relationship between insomnia and depression (95% CI: 0.385-0.566) and nightmares and depression (95% CI: 1.445-2.365). Limited access to emotion regulation strategies emerged as the strongest, significant indirect effect for both relationships (insomnia 95% CI: 0.136-0.335; nightmares 95% CI: 0.887-1.931).Findings extend previous affective neuroscience research by providing evidence that insomnia and nightmares may influence depression symptoms specifically through the pathway of explicit emotion regulation difficulties. Sleep disturbances may impair the ability to access and leverage emotion regulation strategies effectively, thus conferring risk for negative affect and depression.

  View details for DOI 10.5664/jcsm.5492

  View details for PubMedID 26350604

  View details for PubMedCentralID PMC4751428

• The prediction of study-emergent suicidal ideation in bipolar disorder: a pilot study using ecological momentary assessment data BIPOLAR DISORDERS Thompson, W. K., Gershon, A., O'Hara, R., Bernert, R. A., Depp, C. A. 2014; 16 (7): 669-677

  View details for DOI 10.1111/bdi.12218

  View details for Web of Science ID 000344373100001

• A Review of Multidisciplinary Clinical Practice Guidelines in Suicide Prevention: Toward an Emerging Standard in Suicide Risk Assessment and Management, Training and Practice ACADEMIC PSYCHIATRY Bernert, R. A., Hom, M. A., Roberts, L. W. 2014; 38 (5): 585-592

  View details for DOI 10.1007/s40596-014-0180-1

  View details for Web of Science ID 000342172000011

• Association of Poor Subjective Sleep Quality With Risk for Death by Suicide During a 10-Year Period A Longitudinal, Population-Based Study of Late Life JAMA PSYCHIATRY Bernert, R. A., Turvey, C. L., Conwell, Y., Joiner, T. E. 2014; 71 (10): 1129-1137

  View details for DOI 10.1001/jamapsychiatry.2014.1126

  View details for Web of Science ID 000342900200007

• Obsessive compulsive symptoms and sleep difficulties: Exploring the unique relationship between insomnia and obsessions. Journal of psychiatric research Timpano, K. R., Carbonella, J. Y., Bernert, R. A., Schmidt, N. B. 2014; 57: 101-107

  Abstract

  Sleep complaints have been linked with Obsessive Compulsive Disorder (OCD), though there is a dearth of research exploring the association between a range of disturbed sleep indicators and obsessive compulsive symptoms (OCS). Two separate studies were conducted to rigorously investigate this relationship in further detail, considering a number of different sleep indices and also the heterogeneous nature of OCS.Study 1 (n = 167) examined the relationship between OCS and the gold standard self-report assessments for delayed bedtime, sleep quality, nightmares, and insomnia symptoms. Study 2 (n = 352) replicated the primary findings from Study 1 in an independent sample and with an alternative measure of OCD, which takes into account the different OCS dimensions.Results revealed a significant, independent link between obsessions and insomnia symptoms, but not between insomnia and compulsions. When examining the different OCS dimensions, insomnia was again found to bear a specific relationship to obsessions, above and beyond that with the other dimensions. Although depression is often highly comorbid with both OCD and sleep disturbances, depressive symptoms did not explain the OCS-sleep relationship in either study, suggesting a unique association between obsessions and insomnia.Findings indicate that high levels of intrusive thoughts exhibit a specific association with insomnia symptoms-one that is not observed with other OCS. Future research may help elucidate the mechanisms and causal nature of this relationship.

  View details for DOI 10.1016/j.jpsychires.2014.06.021

  View details for PubMedID 25038630

• Association of poor subjective sleep quality with risk for death by suicide during a 10-year period: a longitudinal, population-based study of late life. JAMA psychiatry Bernert, R. A., Turvey, C. L., Conwell, Y., Joiner, T. E. 2014; 71 (10): 1129-1137

  Abstract

  Older adults have high rates of sleep disturbance, die by suicide at disproportionately higher rates compared with other age groups, and tend to visit their physician in the weeks preceding suicide death. To our knowledge, to date, no study has examined disturbed sleep as an independent risk factor for late-life suicide.To examine the relative independent risk for suicide associated with poor subjective sleep quality in a population-based study of older adults during a 10-year observation period.A longitudinal case-control cohort study of late-life suicide among a multisite, population-based community sample of older adults participating in the Established Populations for Epidemiologic Studies of the Elderly. Of 14 456 community older adults sampled, 400 control subjects were matched (on age, sex, and study site) to 20 suicide decedents.Primary measures included the Sleep Quality Index, the Center for Epidemiologic Studies-Depression Scale, and vital statistics.Hierarchical logistic regressions revealed that poor sleep quality at baseline was significantly associated with increased risk for suicide (odds ratio [OR], 1.39; 95% CI, 1.14-1.69; P < .001) by 10 follow-up years. In addition, 2 sleep items were individually associated with elevated risk for suicide at 10-year follow-up: difficulty falling asleep (OR, 2.24; 95% CI, 1.27-3.93; P < .01) and nonrestorative sleep (OR, 2.17; 95% CI, 1.28-3.67; P < .01). Controlling for depressive symptoms, baseline self-reported sleep quality was associated with increased risk for death by suicide (OR, 1.30; 95% CI, 1.04-1.63; P < .05).Our results indicate that poor subjective sleep quality is associated with increased risk for death by suicide 10 years later, even after adjustment for depressive symptoms. Disturbed sleep appears to confer considerable risk, independent of depressed mood, for the most severe suicidal behaviors and may warrant inclusion in suicide risk assessment frameworks to enhance detection of risk and intervention opportunity in late life.

  View details for DOI 10.1001/jamapsychiatry.2014.1126

  View details for PubMedID 25133759

• Eating disorder and obsessive-compulsive symptoms in a sample of bulimic women: Perfectionism as a mediating factor PERSONALITY AND INDIVIDUAL DIFFERENCES Bernert, R. A., Timpano, K. R., Peterson, C. B., Crow, S. J., Bardone-Cone, A. M., Le Grange, D., Klein, M., Crosby, R. D., Mitchell, J. E., Wonderlich, S. A., Joiner, T. E. 2013; 54 (2): 231-235

  View details for DOI 10.1016/j.paid.2012.08.042

  View details for Web of Science ID 000312926900016

• Clinical significance of night-to-night sleep variability in insomnia SLEEP MEDICINE Suh, S., Nowakowski, S., Bernert, R. A., Ong, J. C., Siebern, A. T., Dowdle, C. L., Manber, R. 2012; 13 (5): 469-475

  Abstract

  To evaluate the clinical relevance of night-to-night variability of sleep schedules and insomnia symptoms.The sample consisted of 455 patients (193 men, mean age=48) seeking treatment for insomnia in a sleep medicine clinic. All participants received group cognitive behavioral therapy for insomnia (CBTI). Variability in sleep parameters was assessed using sleep diary data. Two composite scores were computed, a behavioral schedule composite score (BCS) and insomnia symptom composite score (ICS). The Insomnia Severity Index, the Beck Depression Inventory, and the Morningness-Eveningness Composite Scale were administered at baseline and post-treatment.Results revealed that greater BCS scores were significantly associated with younger age, eveningness chronotype, and greater depression severity (p<0.001). Both depression severity and eveningness chronotype independently predicted variability in sleep schedules (p<0.001). Finally, CBTI resulted in reduced sleep variability for all sleep diary variables except bedtime. Post-treatment symptom reductions in depression severity were greater among those with high versus low baseline BCS scores (p<0.001).Results suggest that variability in sleep schedules predict reduction in insomnia and depressive severity following group CBTI. Schedule variability may be particularly important to assess and address among patients with high depression symptoms and those with the evening chronotype.

  View details for DOI 10.1016/j.sleep.2011.10.034

  View details for Web of Science ID 000303346800004

  View details for PubMedID 22357064

• Sleep problems outperform depression and hopelessness as cross-sectional and longitudinal predictors of suicidal ideation and behavior in young adults in the military JOURNAL OF AFFECTIVE DISORDERS Ribeiro, J. D., Pease, J. L., Gutierrez, P. M., Silva, C., Bernert, R. A., Rudd, M. D., Joiner, T. E. 2012; 136 (3): 743-750

  Abstract

  Sleep problems appear to represent an underappreciated and important warning sign and risk factor for suicidal behaviors. Given past research indicating that disturbed sleep may confer such risk independent of depressed mood, in the present report we compared self-reported insomnia symptoms to several more traditional, well-established suicide risk factors: depression severity, hopelessness, PTSD diagnosis, as well as anxiety, drug abuse, and alcohol abuse symptoms.Using multiple regression, we examined the cross-sectional and longitudinal relationships between insomnia symptoms and suicidal ideation and behavior, controlling for depressive symptom severity, hopelessness, PTSD diagnosis, anxiety symptoms, and drug and alcohol abuse symptoms in a sample of military personnel (N=311).In support of a priori hypotheses, self-reported insomnia symptoms were cross-sectionally associated with suicidal ideation, even after accounting for symptoms of depression, hopelessness, PTSD diagnosis, anxiety symptoms and drug and alcohol abuse. Self-reported insomnia symptoms also predicted suicide attempts prospectively at one-month follow up at the level of a non-significant trend, when controlling for baseline self-reported insomnia symptoms, depression, hopelessness, PTSD diagnosis and anxiety, drug and alcohol abuse symptoms. Insomnia symptoms were unique predictors of suicide attempt longitudinally when only baseline self-reported insomnia symptoms, depressive symptoms and hopelessness were controlled.The assessment of insomnia symptoms consisted of only three self-report items. Findings may not generalize outside of populations at severe suicide risk.These findings suggest that insomnia symptoms may be an important target for suicide risk assessment and the treatment development of interventions to prevent suicide.

  View details for DOI 10.1016/j.jad.2011.09.049

  View details for Web of Science ID 000301996000071

  View details for PubMedID 22032872

• CBT for Insomnia in Patients with High and Low Depressive Symptom Severity: Adherence and Clinical Outcomes JOURNAL OF CLINICAL SLEEP MEDICINE Manber, R., Bernert, R. A., Suh, S., Nowakowski, S., Siebern, A. T., Ong, J. C. 2011; 7 (6): 645-652

  Abstract

  To evaluate whether depressive symptom severity leads to poorer response and perceived adherence to cognitive behavioral therapy for insomnia (CBTI) and to examine the impact of CBTI on well-being, depressive symptom severity, and suicidal ideation.Pre- to posttreatment case replication series comparing low depression (LowDep) and high depression (HiDep) groups (based on a cutoff of 14 on the Beck Depression Inventory [BDI]).127 men and 174 women referred for the treatment of insomnia.Seven sessions of group CBTI.Improvement in the insomnia severity, perceived energy, productivity, self-esteem, other aspects of wellbeing, and overall treatment satisfaction did not differ between the HiDep and LowDep groups (p > 0.14). HiDep patients reported lower adherence to a fixed rise time, restricting time in bed, and changing expectations about sleep (p < 0.05). HiDep participants experienced significant reductions in BDI, after removing the sleep item. Levels of suicidal ideation dropped significantly among patients with pretreatment elevations (p < 0.0001).Results suggest that pre- to post CBTI improvements in insomnia symptoms, perceived energy, productivity, self-esteem, and other aspects of well-being were similar among patients with and without elevation in depressive symptom severity. Thus, the benefits of CBTI extend beyond insomnia and include improvements in non-sleep outcomes, such as overall well-being and depressive symptom severity, including suicidal ideation, among patients with baseline elevations. Results identify aspects of CBTI that may merit additional attention to further improve outcomes among patients with insomnia and elevated depressive symptom severity.

  View details for DOI 10.5664/jcsm.1472

  View details for Web of Science ID 000300161900012

  View details for PubMedID 22171204