Meta-analysis of insomnia, suicide, and psychopathology in schizophrenia

PURPOSE OF REVIEW: Insomnia is common in schizophrenia. Insomnia has been associated with suicidal ideation and behavior, as well as greater severity of psychopathology, in schizophrenia. This review performs a meta-analysis of associations between insomnia, suicide, and psychopathology in patients with schizophrenia.

RECENT FINDINGS: We searched major electronic databases from inception until November 2022 for studies of insomnia, suicide, and psychopathology in patients with schizophrenia. Random effects meta-analysis calculating odds ratios (ORs, for suicide) and effect sizes (ESs, for psychopathology) and 95% confidence intervals (CIs) were performed. Ten studies met the inclusion criteria, comprising 3428 patients with schizophrenia. Insomnia was associated with a significant increased odds of suicidal ideation (OR = 1.84, 95% CI 1.28-2.65, P < 0.01) and suicide attempt or death (OR = 5.83, 95% CI 1.61-2.96, P < 0.01). Insomnia was also associated with total (ES = 0.16, 95% CI 0.09-0.23, P < 0.01), positive (ES = 0.14, 95% CI 0.08-0.20, P = 0.02), and general (ES = 0.17, 95% CI 0.08-0.27, P < 0.01) psychopathology. In meta-regression analyses, BMI was negatively associated with suicidal ideation. Otherwise, age, sex, and study year were all unrelated to the associations.

SUMMARY: Insomnia is associated with suicide and psychopathology in schizophrenia. Formal assessment and treatment of insomnia appears relevant to the clinical care of schizophrenia.