Prescription medications for insomnia are associated with suicidal thoughts and behaviors in two nationally representative samples

Andrew S. Tubbs, Fabian Xosé Fernandez, Sadia B. Ghani, Jordan F. Karp, Salma I. Patel, Sairam Parthasarathy, Michael A. Grandner

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Study Objectives: Z-drugs (eszopiclone, zolpidem, and zaleplon) are commonly used for insomnia but are also associated with suicide risk. However, it is unclear if this association is unique to Z-drugs. Therefore, the present study estimated the associations between multiple prescription insomnia medications and suicidal thoughts and behaviors. Methods: Data were acquired from the National Survey on Drug Use and Health for 2015-2018 and the National Health and Nutrition Examination Survey for 2005-2018. Samples were balanced on sociodemographic and mental health covariates using inverse probability of treatment weighting. Associations of Z-drugs, trazodone, and sedative benzodiazepines (temazepam, triazolam, flurazepam) with suicidal ideation, planning, and attempts were estimated using binomial logistic regression. Results: In the National Survey on Drug Use and Health, Z-drugs were associated with suicidal ideation (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.14-1.54]), suicide planning (OR, 1.44; 95%CI, 1.19-1.75), and suicide attempts (OR, 1.45; 95%CI, 1.13-1.86) after adjusting for age, sex, race/ethnicity, income, depression, illicit substance use, and the 6-item Kessler Psychological Distress Scale and World Health Organization Disability Assessment Schedule II scores. When analyses accounted for the same factors, sedative benzodiazepines were associated with suicide attempts (OR, 1.76; 95%CI, 1.06-2.87) but not suicidal ideation (OR, 1.37; 95% CI, 0.99-1.88) or suicide planning (OR, 1.39; 95% CI, 0.97-2.00). In the National Health and Nutrition Examination Survey, Z-drugs were associated with suicidal ideation (OR, 2.44; 95% CI, 1.41-4.22), as was trazodone (OR, 2.33; 95% CI, 1.45-3.75), after analyses adjusted for age, sex, race/ethnicity, and exposure to various psychotropic medications. Conclusions: Multiple classes of prescription insomnia medications are associated with suicidal thinking and behaviors, even after analyses adjusted for measures of mental health.

Original languageEnglish (US)
Pages (from-to)1025-1030
Number of pages6
JournalJournal of Clinical Sleep Medicine
Volume17
Issue number5
DOIs
StatePublished - May 1 2021

Keywords

  • Insomnia
  • NHANES
  • NSDUH
  • Sedative hypnotics
  • Sleep
  • Suicide

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Neurology
  • Clinical Neurology

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