Insomnia Symptoms, Nightmares, and Suicidal Ideation in Older Adults

If suicide is a problem in the United States, then suicide among older adults is a crisis. In 2008, the suicide rate for adults aged 65 and older was more than 30% higher than the suicide rate for those below age 65 (Centers for Disease Control and Prevention, 2012). In addition, suicidal behavior among older adults is more likely to be fatal than suicidal behavior at younger ages. The older adult attempt/death ratio of 4:1 reflects much greater lethality than either the overall attempt/death ratio of 25:1 or the 100–200:1 ratio found in those who are young (Chan, Draper, & Banerjee, 2007). Older adult suicidal behavior also differs in several other important ways from suicidal behavior earlier in the lifespan (e.g., gender ratio; Chan et al., 2007), suggesting that research using younger age groups may not generalize to older adults. Thus, more research investigating suicidal behaviors specifically among older adults is urgently needed. Suicide is a difficult topic to study due to the statistical rarity of the event. Thus, research often focuses on suicidal behavior and suicidal ideation, as both are risk factors for death by suicide. Studying suicidal ideation is important because it is not only a risk factor for suicidal behavior, but a vital component, as suicidal behavior is not suicidal without suicidal ideation and intent (Silverman, Berman, Sanddal, O’Carroll, & Joiner, 2007). Thus, suicidal ideation is an important part of suicidal behavior and risk. A potential risk factor for suicidal ideation and behavior that warrants investigation among older adults is sleep disturbance. Sleep difficulties have been shown to be related to suicidal ideation and behavior in young adults and mixed age samples (Cukrowicz et al., 2006; Nadorff, Nazem, & Fiske, 2011; Sjostrom, Waern, & Hetta, 2007), but this relation has not yet been examined specifically in older adults. It would be particularly important to know if there is a relation between sleep disturbance and suicidality in this age group, as it has been estimated that up to 50% of older adults complain of sleep difficulties (Vitiello, Larsen, & Moe, 2004). To date, two types of sleep disturbance have been examined in relation to suicidal ideation and behavior—insomnia symptoms and nightmares.