Association of sleep problems with suicidal behaviors and healthcare utilization in adults with chronic diseases: the role of mental illness

Objectives: This study aimed to examine the association between sleep problems and suicidal behaviors and healthcare utilization in Canadian adults with chronic diseases, and the mediating role of mental illness. Methods: Data were drawn from the Canadian Community Health Survey, 2015-16, from Ontario, Manitoba, and Saskatchewan– the provinces that selected the survey module on sleep. A total of 22,700 participants aged ≥18 years () and diagnosed with chronic diseases were enrolled in the study. Sleep problems referred to extreme sleep durations (either <5 or ≥10 hours) and insomnia. Mental illness was defined as a self-reported mood or anxiety disorder. Results: Of the 6,318,400 participants, higher prevalence of all suicidal behaviors and healthcare utilization outcomes were found in participants with extreme sleep durations (compared with 7 to <8 hours), and in participants with insomnia (compared with no insomnia). After multivariate adjustment, extreme sleep durations and insomnia were still independently associated with increased odds of suicidal behaviors and healthcare utilization. Mediation analyzes showed that mental illness partly mediated the associations of extreme sleep durations and insomnia with suicidal behaviors and healthcare utilization. Conclusions: In conclusion, both extreme sleep durations and insomnia were associated with increased odds of suicidal behaviors and healthcare utilization outcomes in adults with chronic diseases, whereas mental illness partially mediated the association.