The Intersection of sleep disturbance and suicidal behavior among older Adults: A systematic review

Introduction: As the global population ages, suicide among older adults has become a critical public health concern. Older individuals often exhibit unique suicide risk factors, including chronic health conditions, social isolation, and undiagnosed psychiatric disorders. Sleep disturbances, particularly insomnia, have emerged as a potential but underexplored risk factor for suicidal behavior in this population. This systematic review aims to synthesize existing research on the relationship between sleep disturbances and suicidal behavior among older adults. Methods: A systematic literature search was conducted across PubMed, Web of Science, and Scopus from their inception until June 30, 2024. Studies were included if they were comparative observational studies employing quantitative research designs, examined sleep disturbances in individuals aged 55 and older, and assessed their association with suicidal thoughts or behaviors. Studies that lacked age-stratified results or focused on populations with specific health conditions (e.g., schizophrenia, dementia) were excluded. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist was used to assess study quality. Results: A total of 2630 studies were identified, of which 25 met the inclusion criteria. The majority (21 out of 25) reported a significant association between sleep disturbances and suicidal behavior. Insomnia was the most commonly studied sleep disorder, with six out of eight studies confirming its independent link to suicide risk. Findings on nightmares were mixed, with some studies suggesting a moderate association and others reporting no significant effect. Short sleep duration (<= 5 h) was associated with increased suicidal ideation, whereas inconsistent results were found for general sleep complaints. Variability in study methodologies, sample sizes, and measurement tools limited cross-study comparability. Conclusion: This review underscores sleep disturbances, particularly insomnia, as a modifiable risk factor for suicidal behavior in older adults. Given the lack of stigma surrounding sleep problems, targeted interventions to improve sleep quality could serve as an effective strategy for suicide prevention. Future research should focus on longitudinal studies to clarify causal pathways and explore the impact of sleep interventions on reducing suicide risk.