Sleep disturbance is one of the most common health complaints among late adolescents and young adults. Women report more sleep-related complaints than men (Krishnan and Collop, 2006) and more anxiety or depressive symptoms (Voderholzer et al., 2003). Higher levels of repetitive negative thinking appear to be causally involved in the initiation/maintenance of emotional problems (Ehring and Watkins, 2008).

To analyze the sleep difficulties differences by gender and its associations with stress, cognitive emotion regulation, perseverative thinking and negative affect.

Five hundred and forty-nine students (80.1% females) from two Universities filled in the PSS-10 (Cohen et al., 1983; Amaral et al., 2014), CERQ (Garnefski et al., 2001; Castro et al., 2013), PTQ (Ehring et al., 2011; Chaves et al., 2013) and POMS-58 (McNair et al., 1971; Azevedo et al., 1991; Amaral et al., 2013). Three questions were used to access difficulties of initiating sleep (DIS), maintaining sleep (DMS) and early morning wakening (EMA).

Females reported more sleep difficulties (excluding DIS), stress, perseverative thinking than males. Males reported higher levels in self-blame and blaming-others dimensions. In female sample we found significant correlations between all sleep difficulties and stress, perseverative thinking, emotional regulation (rumination, self-blame, catastrophizing) and negative affect. In male sample only the difficulties of initiating sleep are correlated with stress, perseverative thinking, self-blame and negative affect.

There are no gender differences in frequency and most of correlates of DIS. DMS and EMA were higher in females and were related to perseverative thinking and emotional regulation mechanisms in this sample.

The authors have not supplied their declaration of competing interest.

Nigerian adolescents report various sleep disorders metaphorically based on the local/native description of such disorders. Hence, it is sometimes difficult for clinicians without a good grasp of the nuance in their description to understand their presentation.

To develop a culturally relevant (Nigerian) instrument for assessing sleep disorders.

One thousand two hundred and twenty-seven Nigerian Secondary School adolescents (634 males and 593 females) between 12–19 years with mean age of 15.20 (SD = 1.5) were administered a 44 item instrument developed following the DSM (V), American Association of Sleep Medicine's International Classification of Sleep Disorders (ICSD, 2005) criteria, and case reports of sleep disorders. The data was subjected to a Principal Component Analysis using Varimax rotation.

Ten factors instead of the original eleven factors suggested by the authors emerged in the analysis and on closer examination and in juxtaposition with cultural nuances, it was found the ten factors were in line with what is generally reported by adolescents. Sleep walking disorders and sleep related movement disorders loaded in one factor labelled sleep movement disorders, while items representing non restorative sleep experiences, sleep talking, sleep paralysis, sleep apnea, circadian rhythm sleep disorder, narcolepsy, insomnia, sleep terror disorder and nightmare disorder loaded on their individual factors. The SDINQ showed a Cronbach Alpha of .916 and a good correlation with subscales of the School Sleep Habits Survey (SSHS).

The SDINQ has been found to be a valid and reliable instrument for assessing the presence of sleep disorders among adolescents in Nigeria.

The authors have not supplied their declaration of competing interest.

Restless legs syndrome (RLS) is a sleep disorder affecting a significant part of general population. Clinically RLS is characterized by abnormal sensations of irresistible urge to move legs, becoming worse at night, and frequently causing insomnia. Consequences of RLS include daytime dysfunction, depressed mood, anxiety and decreased quality of life.

Determine prevalence of RLS in professional cyclists.

The aim of this study was to examine the prevalence of RLS in professional cyclists. According to our knowledge this is the first research of RLS in professional cyclists.

A total of 43 professional cyclists were asked to complete 4-item questionnaire based on IRLSSG Diagnostic Criteria for RLS. Data from questionnaire was compared to antropometric measurements, epidemiologic data, age of starting trainings and total years of professional performance.

The results indicated that prevalence of RLS in professional cyclists is 14% and is higher than expected in this age group. We found statistically significant relationship between RLS and age (P < 0,001) and years of experience as a professional cyclist (P < 0,001). Results revealed no significant differences between genders (Table 1).

Table 1

RLS seems to be a common problem in professional cyclists. It can affect sport performance. Future efforts to estimate the influence of RLS on professional sport performance should be considered.

The authors have not supplied their declaration of competing interest.

To our knowledge there are no research about the influence of self-criticism and self-compassion in the occurrence of insomnia.

To study the association between self-criticism, self-compassion and insomnia on university students; to explore differences in these associations on two moments of student's lives–examination and no examination period.

We anticipate that the stress and pressure of the examination period have an impact on student's sleep and there are, also, differences by age and gender.

Self-Criticism and Self-Reassurance Scale, Self-Compassion Scale, Pre-Activation Sleep Scale, Insomnia Assessment Scale and Anxiety and Depression and Stress Scales were answered by 160 college students (M = 26.45, SD = 7.98; range = 19–54 years) during an examination period and by 108 college students during a no examination period (M = 26.34; SD = 0.43; range = 19–54 years).

In both periods (examination and no examination period) older students (30–54 years) tended to be more self-compassionate and tolerant, such as less self-critical and punitive. During the examination period, younger students (19–29 years) showed higher levels of self-criticism, cognitive, and somatic activation before falling asleep. There was also a higher proportion of younger students in the insomniac and insomnia symptomatic groups. Moreover, significant correlations were found between cognitive and somatic activation and depression, anxiety, and stress in both moments.

In the examination period, the youngest students are more critical and less compassionate, what might lead to greater cognitive and somatic activation before sleep and, consequently, to insomnia symptoms and insomnia itself.

The authors have not supplied their declaration of competing interest.

Mindfulness based programs during pregnancy (some including self-compassion components) increase self-compassion, mindfulness and maternal self-efficacy, and reduce anxiety, stress and psychological distress in pregnant women. According to our knowledge, there are no studies about the association between self-compassion and sleep outcomes in pregnancy.

To explore differences in self-compassion, between three sleep groups, in a sample of Portuguese pregnant women.

Four hundred and nineteen pregnant women (mean age: 32.51 ± 4.759; weeks of gestation: 17.32 ± 4.803) completed the Self-Compassion Scale (SCS, Bento et al., 2015), presenting six dimensions (self-kindness, self-judgment, common humanity, isolation, mindfulness and over-identification) and the Insomnia Assessment Scale (Marques et al., 2015). Three sleep groups were formed: good sleepers (no insomnia symptoms; no associated daily impairment); insomnia symptoms groups (one/more insomnia symptoms; no associated daily impairment); insomniacs (one/more insomnia symptoms; daily associated impairment).

There were significant differences in the total SCS, self-judgment, isolation and over-identification scores, between sleep groups [respectively, F (2,396) = 7,926, P ≤ 0,001; F (2,409) = 19,155, P ≤ 0,001; F (2,410) = 13,016, P ≤ 0,001; F (2,412) = 11,258, P ≤ 0,001]. Self-judgement, isolation and over-identification scores of good sleepers and insomnia symptoms group were higher than of insomniacs. Total SCS score of good sleepers was higher than of insomniacs and the same score of symptoms of insomnia group was also higher than of insomniacs.

Results seem to show the importance of developing self-compassion to improve sleep in pregnancy or reduce the impact of insomnia symptoms (common at pregnancy).

The authors have not supplied their declaration of competing interest.

Sleep symptoms, depression and anxiety often coexist and tertiary students are a population group that are increasingly recognised to be at risk. However the rates of these conditions in the tunisian population are poorly understood.

The aim of this study was to evaluate sleep quality among medicine students during exam periods and identify correlations with anxiety and depression.

This is a descriptive and analytical cross-sectional study. It involved students of medicine University of Sfax during the period of exams. Each student filled out demographic questionnaire, the Pittsburgh Sleep Quality Index (PSQI) to assess the quality of sleep and Hospital Anxiety and Depression scale (HAD) to screen for anxiety and depressive disorders.

The average age was 22.27 years. The sex ratio M/F was 0.66. The students were single in 96.7% of cases. The average score of PSQI was 6.67 ± 3.23. According to the PSQI, 53.3% of students had poor sleep quality. The anxiety score ranged from 0 to 7 with an average of 8.37. The depression score ranged from 0 to 16 with an average of 7.47. Anxiety and depressive symptoms were present in 26.7% of students. The PSQI score was significantly correlated with anxiety (p <0.01) and depression scores (P = 0.019).

Anxiety and depressive symptoms are common among students during exam periods. They are associated with poor quality sleep. The establishment of a helpline for students during exam time, with psychologists and psychiatrists, would help them better manage this difficult period.

The authors have not supplied their declaration of competing interest.

Pregnancy is characterized by important changes in sleep and some of them (as insomnia) predict negative outcomes, like depression, through all the perinatal period. There are few Portuguese adapted and validated instruments assessing insomnia in pregnancy.

To validate the Insomnia Assessment Scale in a sample of Portuguese pregnant women.

419 pregnant women (mean age: 32.51 ± 4.759; weeks of gestation: 17.32 ± 4.803) answered the Insomnia Assessment Scale (IAS), constructed according to the DSM-V and the ICSD-3 criteria and presenting fourteen items: three evaluating insomnia symptoms (1 to 3); one assessing if sleep difficulties were present although there were adequate conditions to sleep (item 4); one assessing if sleep difficulties occurred three times/week (item 5); one evaluating if sleep was not restorative (item 6); three assessing daily impairment associated to insomnia symptoms (7 to 9); two assessing the use of prescribed and/or homemade medication (10 and 11); three excluding that sleep difficulties were not due to another sleep disorder, substance use, a physical condition or a mental disorder) (12 to 14).

The IAS Kuder-Richardson alpha was very good (α=0.85) and none of the items increased the alpha if removed. A principal component analysis revealed a three factors solution, explaining a variance/EV of 63,74%: F1/Insomnia symptoms (items 1 to 6) (EV 36.02%; α=0.81); F2/Daily impairment associated to insomnia symptoms (items 7 to 9) (EV 18.67%; α=0.79); F3/Differential diagnosis (items 12 to 14) (EV 8.38%; α=0.81).

The IAS adapted for Portuguese pregnant women presented good reliability and validity.

The authors have not supplied their declaration of competing interest.

The impact of mindfulness in improving insomnia symptoms is documented in different samples (e.g. anxiety disorders; insomnia samples) and mindfulness based programs for pregnancy refer the association between mindfulness development and the reduction of insomnia symptoms/improvement of sleep.

To explore differences in the Facets Mindfulness Questionnaire-10 (FMQ-10; Azevedo et at. 2015), between sleep groups, in Portuguese pregnant women.

Four hundred and nineteen pregnant women (mean age: 32.51 ± 4.759; weeks of gestation: 17.32 ± 4.803) answered the Facets Mindfulness Questionnaire-10 and the Insomnia Assessment Scale (IAS, Marques et al., 2015). Three sleep groups were created considering all the IAS items: good sleepers (no insomnia symptoms; no associated daily impairment); insomnia symptoms groups (one/more insomnia symptoms; no associated daily impairment; exclusion of other conditions/disorders explaining the symptoms); insomniacs (one/more insomnia symptoms; one/more daily associated impairment; exclusion of other conditions/disorders explaining the symptoms).

There were significant differences in the total FMQ-10 score, the F1/Nonjudging of inner experience and the F2/acting with awareness, between sleep groups [respectively, F (2.402) = 6,933; P = 0.001; F (2.406) = 10.243; P = 0.001; F (2.406) = 37.431; P = 0.002]. Tukey tests indicated that the mean total FMQ-10 and F1/Nonjudging of inner experience scores of good sleepers and insomnia symptoms group were significantly higher than of the insomniacs. The mean value of F2/acting with awareness in the good sleepers was significantly higher than of the insomniacs.

It seems important to develop mindfulness to improve sleep in pregnancy or reduce the impact of insomnia symptoms (common at pregnancy).

The authors have not supplied their declaration of competing interest.

To investigate the causes that postpartum women most mention for changes in sleep pattern and its associations with obstetric and sleep variables and depressive symptoms.

At three months postpartum 192 women fill in a booklet containing obstetric and sleep variables and the Postpartum Depression Screening Scale (PDSS; Pereira et al., 2010). If they experienced changes in their sleep pattern, they were asked about the perceived cause(s) (multiple choice). Chi-squared and Student t tests were applied as appropriate.

A total of 64.6% women referred to some cause(s); the most mentioned were feeding/baby care and older children care (32.3%) and worries (baby and life problems related) (29.5%). Women who mentioned feeding/baby and older children care as a cause did not significantly differ in relation to type of delivery, feeding method proportions and in PDSS mean scores. Women who identified worries as a cause vs. women who did not – presented significant differences in proportions of vaginal (20.0%) vs. assisted delivery (52.2%) (OR 4.444), caesarean-section (22.2%) vs. assisted delivery (52.6%) (OR 3.827), in breast-feeding (36.0%) vs. bottle-feeding (12.9%) (OR .263) and in “having trouble sleeping even when the baby is asleep” (28.0% vs. 2.9%) (OR 12.833) (all P<.05). PDSS mean scores were also significantly higher in women who mentioned worries as a cause (50.20 ± 20.622 vs. 58.640 ± 15.766, P < 0.05).

It is important to distinguish the causes for changes in sleep pattern in postpartum women. Worries as a perceived cause have a higher impact and clinical significance than causes related to baby care demands.

The authors have not supplied their declaration of competing interest.

The author has not supplied his/her declaration of competing interest.

Dialectical behavior therapy (DBT) is a comprehensive psycho-social treatment developed by Marsha Linehan and originally designed for persons meeting criteria for borderline personality disorder (BPD). DBT is considered as a standard evidence based treatment for suicidal BPD patients in most international guidelines. Although its effectiveness has been proved in multiple studies across different patient populations but almost all the research was conducted in North American or European countries. The current study was the first trial to apply DBT in Egypt with a different language and culture than where the treatment was originally developed.

Assessment of incidence of suicidal attempts and non-suicidal self-injury (NSSI) among a sample of Egyptian BPD patients enrolled in an outpatient DBT program.

The aim of the current study was to estimate impact of comprehensive DBT on suicidal attempts and NSSI when applied to Egyptian BPD patients.

Twenty-five BPD patients, 4 males and 21 females, were included in a comprehensive outpatient DBT program for one year and incidence of suicidal attempts and NSSI were calculated.

Five patients only attempted suicide again with an incidence of 20% and a mean of one attempt/patient. Seven patients attempted NSSI with an incidence of 28%, an overall 22 incidents and a mean of 3 incidents/patient.

Although this was the first time to apply DBT in an Egyptian population, DBT proved to be an effective psycho-therapeutic intervention for suicidal BPD patients across regardless of different language or culture.

The authors have not supplied their declaration of competing interest.

The aim of the present study was to investigate various risk factors of suicidal behaviors, including the mixed features specifier, in Korean patients with bipolar disorder.

We retrospectively reviewed medical charts from 2005 to 2014. A total of 334 patients diagnosed with bipolar disorder using the DSM-IV TR were enrolled. Subjects were categorized into two groups according to their history of suicidal behavior and the demographic and clinical characteristics of the groups were compared, including the mixed features specifier. We re-evaluated the index episode using DSM-5 criteria and classified subjects into an index episode with mixed features group and an index episode without mixed features group. Logistic regression was performed to evaluate significant risk factors associated with suicidal behavior.

Suicidal behavior had an independent relationship with mixed features at the index episode using DSM-5 criteria (OR = 3.39; 95% CI: 1.57–7.34) and number of previous depressive episodes (OR = 1.62; 95% CI: 1.34–1.95) in Korean bipolar patients. The mixed feature specifier was the strongest risk factor for suicidal behavior in the present study. Limitations: this was a retrospective study and structured psychiatric interviews were not conducted.

This study may help clinicians understand potential risk factors and manage bipolar disorders with suicidal behaviors. Clinicians should carefully monitor patients with bipolar disorder who exhibit numerous depressive episodes or mixed features for suicidal behavior.

The authors have not supplied their declaration of competing interest.

Most suicide attempters are referred to community health professionals (CHP) after discharge from emergency department (ED). Thereafter, outpatient treatment engagement (OTE) is often poor. Strengthening it seems likely to reduce the risk of repeat suicidal behaviour.

To identify the predictive factors of OTE.

Multicentre prospective study in true life conducted in adult patients (≥18) in 4 EDs of the Southern Paris region. Patients were referred to CHP. OTE was assessed by telephone calls at 1 and 3 months. OTE at 1 month was defined as having booked 1 appointment; OTE at 3 months as having attended 2 appointments and booked another one.

One hundred and fifty-five patients were assessed at 1 month and 144 at 3 months. OTE at 1 and 3 months was observed in 58% and 51% respectively. A multivariate analysis showed factors significantly predictive of OTE at 1 month: a psychiatric follow-up before the suicide attempt (SA), ≥2 psychiatric interviews during the stay at ED, appointment with CHP booked before discharge from the ED; and at 3 months: college or university education, absence of alcohol intake during the SA, psychiatric follow-up before the SA, appointment with CHP booked before discharge from the ED.

This multicentre prospective study highlights the benefit of booking outpatient appointment before discharge from ED; of allowing patient to benefit from at least two psychiatric interviews; of being particularly cautious with patients who took alcohol concomitantly to their SA, patients with low level of academic achievement and patients without psychiatric follow-up.

The authors have not supplied their declaration of competing interest.

Suicide is a global public health problem. More than 800,000 people die due to suicide every year according to the WHOM. In Spain, about 9 people die due to suicide every day, and the rates increase every year. The presence of previous suicide attempts is one of the strongest risk factors for suicide consumption. Nevertheless, patients sometimes do not receive a correct assistance after a suicide attempt.

To study the follow-up of patients, without previous psychiatrichistory, who commit a first suicide attempt in the area of Huelva (Spain).

Retrospective review of the electronic clinical histories of patients attended in the Emergency service of Juan Ramón Jiménez Hospital after a first suicide attempt during the first six months of 2015.

From January to June of 2015 we collected a total of 159 patients who committed a firs suicide attempt in our area. A total of 69.18% were women and 30.82 were men. In both sex the mean age was 39 years. Out of the 159 attended after a first suicide attempt, only 54% were referred to the Psychiatry service to be followed up. Out of those referred, only 62% actually attended and only half of them really staying treatment.

An adequate psychiatric follow up after a suicide attempt is needed to reduce the risk of more suicide attempts or consumption. A minority (30.8%) of the patients attended in our area after a first suicide attempt received an adequate attention.

The authors have not supplied their declaration of competing interest.

It has been suggested that there is a relationship between BMI and suicide. Thus, BMI of subjects who commit suicide would be lower than the BMI of other unnatural deaths (Flaig 2013).

Explore the possible relationship between BMI and suicide.

A total of 1197 suicides and 473 unnatural deaths (not by suicide) were collected systematically for 60 months at the Institute of Legal Medicine of Seville. Age, sex, weight, height and cause of death were recorded. Statistical analysis was performed using SPSS v19.0.

(Figure 1)

In our study we found that suicide (of all age groups and both sexes) have a lower BMI than controls. However, the relationship between these two variables is complex and not all studies support it. Moreover, the relationships between depression, suicide and overweight point in different directions. More and more studies indicate the existence of a relationship between depression and overweight, suggesting that perhaps the “epidemic” of depression and overweight that we see in Western societies has some connection. In addition, depression is a risk factor for suicide well established. Our results indicate that suicide group tends to have lower BMI (less weight in relation to its size) than the controls.

The authors have not supplied their declaration of competing interest.

Psychological autopsy studies have constantly indicated a clear relation between mental disorders and suicide. This relation has been found in studies across the world, although the percentage of cases with at least one mental disorder diagnosed may vary between studies and specially, between countries and geographical regions.

Review of psychological autopsy studies of suicide completers which contained information on diagnostic distribution. Only studies carried out in Europe and North America were included.

A total of 14 studies, including 1519 suicides, were analyzed (Table 1).

Suicide risk is a multifactor phenomenon, however, it is strongly related to mental disorders. Mental health strategies should be directed to target clinical groups at high risk of suicide.

The authors have not supplied their declaration of competing interest.

Suicide is a major public health problem and one of the common causes of maternal mortality. Rates of suicide and self-harm are higher in British South Asian women compared to the majority white population. Suicidal Ideation (SI) is a significant risk factor associated with self-harm and suicide.

To explore the prevalence and risk factors of SI in British Pakistani women.

To identify risk factors associated with SI, in order to inform future preventive strategies.

This is a secondary analysis of a larger study which looked at depression during pregnancy and infant outcomes. Participants who consented (women aged 18 or over, in their third pregnancy trimester) were initially assessed for maternal depression using the Edinburgh Post-Natal Depression Scale (EPDS), with one of the questions on the EPDS being on SI. Participants who met the study criteria, were further assessed regarding socio-demographic factors, perceived social support, social adversity and isolation.

The rate of SI in this group of women was 8.1%, with baseline interview results suggesting that women with SI being significantly more likely to be aged 20 or less, have experience of severe life events and being less likely to have social support.

This area of research is key to understanding SI in British Pakistani women, to better develop culturally sensitive interventions for use within this group.

The authors have not supplied their declaration of competing interest.

The aim of this study was to analyze the clinical characteristics of individuals who used alcohol at the time of attempting suicide.

We divided 143 individuals who attempted suicide by consuming drugs into two groups on the basis of their blood alcohol concentration level: drinker group (n = 79) and non-drinker group (n = 64). We compared epidemiological characteristics and suicidal behavior between the groups by using the Suicidal Intent Scale (SIS) and the Risk Rescue Rating Scale (RRRS). In addition, we administered the Glasgow Coma Scale (GCS) and the Acute Physiology and Chronic Health Evaluation–II (APACHE–II) to evaluate the medical lethality of the individuals who attempted suicide. We used Student's t-test, Pearson's correlation analysis, and multiple linear regression to analyze the data.

The drinker group scored lower on the SIS's planning subscale than the non-drinker group did (P = 0.022). The drinker group's blood alcohol concentration levels were negatively correlated with the rescue potential of their suicidal attempt (P = 0.031) and the APACHE-II score (P = 0.003). Higher blood alcohol concentration levels predicted poorer medical outcomes measured by the APACHE-II (P = 0.004).

Our findings support the notion that alcohol use increases suicidal impulsivity, decreases rescue potential, and worsens medical outcomes. Therefore, suicide prevention programs need to include education and counselling about the risks associated with alcohol use.

The authors have not supplied their declaration of competing interest.

Suicide is a major public-health problem in Canada. Data from ‘Statistics Canada’ suggests that there was a 10% increase in suicide rate between the years 1997 and 1999. Studies have found substantial differences in suicide rates (and patterns) amongst ethnic immigrants compared to Canadian-born individuals.

The aim of the study was to investigate whether ethnic-immigrant patients differed from Canadian-born patients in their social, demographic, psychiatric and historical associations.

All registered patients (n = 276) known to have completed suicide from 1966–1997 constituted the study sample. Data were extracted from the written case audits, autopsy and toxicology reports, and medical records.

Of the 276 known cases of suicide, 11 were Afro-Caribbean, 24 were Eastern European, 14 were Asian and 215 were Canadian-born patients. The ethnic-immigrant groups were broadly comparable to the Canadian-born group in terms of the social, demographic, psychiatric and background historical factors (except that the latter had a higher prevalence of alcohol and substance misuse). There were no significant differences between different ethnic immigrant groups themselves.

The most salient implication of the findings are that social, psychiatric and historical associations of mentally ill patients who complete suicide are common across different ethnic immigrant groups, and as such a universal approach to mental health promotion, early identification and treatment would be similarly applicable to patients belonging to all groups.

The authors have not supplied their declaration of competing interest.

Acute suicidality or a condition after attempted suicide frequently leads patients to both voluntary or involuntary inpatient admission. Emergency room psychiatrists decide whether such patients can be treated on an outpatient basis.

To identify if immigration status is associated with the decision whether a patient needs a hospital admission.

To detect social determinants of hospital-based health resource uses.

A cross-sectional study including data from 323 patients treated in a general hospital's emergency room after a suicidal attempt during year 2014.

Seventy-six patients were admitted to the hospital (23.5%). Hospitalization frequencies for immigrant and non-immigrant individuals were 6.3% and 26.5% (P = 0.002). No significant association was found between psychiatric admission and history of a diagnosed psychiatric disorder, previous suicidal attempts, previous emergency room care use, family support or current drug use. A subgroup of patients (n = 37; 9%) answered Beck's suicidal intent scale (SIS), a measure of risk in suicidal attempters. Mean SIS was found to be higher among hospitalized than discharged patients (8.5 vs. 16.5; P = 0.01). No significant difference was found in mean SIS between immigrant and non-immigrant patients (9.3 vs. 9.1; P = 0.3).

These preliminary results call for consideration. The highly significant lower rate of psychiatric admission among immigrant patients, without significant differences in mean SIS score in regard to non-immigrants, needs further study.

The authors have not supplied their declaration of competing interest.