Fatigue on Waking, Insomnia, and Workplace Relationship Problems May Help to Detect Suicidal Ideation among New Middle-Aged Primary Care Patients: A 6-Month Prospective Study in Japan
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Subjects
2.2. Information Collection
2.3. Definition of Poor Sleep and Fatigue on Waking
2.4. Case Definition
2.5. Data Analyses
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Subjects with DSI | Subjects without DSI | Crude | Model 1 † | Model 2 ‡ | ||||||
---|---|---|---|---|---|---|---|---|---|---|
(n = 13) | (n = 374) | OR (95% CI) | p Value | OR (95% CI) | p Value | OR (95% CI) | p Value | |||
n (%) | n (%) | |||||||||
Sex | ||||||||||
Male | 6 | (46.2) | 182 | (48.7) | 1.00 | 1.00 | 1.00 | |||
Female | 7 | (53.9) | 192 | (51.3) | 1.11 (0.37–3.35) | 0.859 | 2.43 (0.46–12.9) | 0.296 | 2.64 (0.46–15.1) | 0.277 |
Age (median, range) | 52.0 (40.0–64.3) 48.9 (35.1–64.4) | |||||||||
35–44 (years) | 3 | (23.1) | 145 | (38.8) | 1.00 | 1.00 | 1.00 | |||
45–54 | 8 | (61.5) | 120 | (32.1) | 3.22 (0.84–12.4) | 0.089 | 5.64 (0.96–33.3) | 0.056 | 4.19 (0.70–25.3) | 0.118 |
55–64 | 2 | (15.4) | 109 | (29.1) | 0.89 (0.15–5.40) | 0.896 | 2.52 (0.28–23.0) | 0.414 | 1.20 (0.14–10.3) | 0.867 |
(p for trend 0.933) | (p for trend 0.288) | (p for trend 0.810) | ||||||||
Regular exercise | ||||||||||
Less than once per month | 12 | (92.3) | 244 | (65.2) | 1.00 | 1.00 | 1.00 | |||
Once or more per month | 1 | (7.7) | 130 | (34.8) | 0.16 (0.02–1.22) | 0.076 | 0.17 (0.02–1.76) | 0.136 | 0.19 (0.02–1.82) | 0.148 |
Problems involving care of an ill or elderly family member during the previous 6 months | ||||||||||
No | 10 | (76.9) | 345 | (92.3) | 1.00 | 1.00 | 1.00 | |||
Yes | 3 | (23.1) | 29 | (7.8) | 3.57 (0.93–13.7) | 0.064 | 4.44 (0.76–25.9) | 0.098 | 5.61 (0.88–35.6) | 0.067 |
Death of a family member during the previous 6 months | ||||||||||
No | 11 | (84.6) | 361 | (96.5) | 1.00 | 1.00 | 1.00 | |||
Yes | 2 | (15.4) | 13 | (3.5) | 5.05 (1.01–25.1) | 0.048 | 3.23 (0.38–27.8) | 0.286 | 3.07 (0.35–26.8) | 0.310 |
Relationship problems in the workplace | ||||||||||
No | 7 | (53.9) | 324 | (86.6) | 1.00 | 1.00 | 1.00 | |||
Yes | 6 | (46.2) | 50 | (13.4) | 5.56 (1.79–17.2) | 0.003 | 4.24 (1.00–17.9) | 0.049 | 4.84 (1.14–20.6) | 0.033 |
Cigarette smoking | ||||||||||
Never or former | 6 | (46.2) | 286 | (76.5) | 1.00 | 1.00 | 1.00 | |||
Current | 7 | (53.9) | 88 | (23.5) | 3.79 (1.24–11.6) | 0.019 | 7.48 (1.27–44.2) | 0.027 | 3.42 (0.65–17.9) | 0.146 |
History of psychiatric disorder excluding dementia in parent(s) or child (children) | ||||||||||
None | 10 | (76.9) | 350 | (93.6) | 1.00 | 1.00 | 1.00 | |||
Parent(s) or child (children) with psychiatric illness(es) | 3 | (23.1) | 24 | (6.4) | 4.38 (1.13–17.0) | 0.033 | 4.94 (0.85–28.6) | 0.074 | 3.03 (0.45–20.2) | 0.253 |
Educational background | ||||||||||
Junior high school | 1 | (7.7) | 15 | (4.0) | 1.74 (0.20–15.1) | 0.614 | 1.01 (0.03–31.2) | 0.998 | 1.61 (0.06–42.0) | 0.776 |
High school | 7 | (53.9) | 183 | (48.9) | 1.00 | 1.00 | 1.00 | |||
Technical school, junior college, or higher vocational school | 2 | (15.4) | 88 | (23.5) | 0.59 (0.12–2.92) | 0.522 | 0.34 (0.04–2.59) | 0.296 | 0.24 (0.02–2.32) | 0.216 |
University or graduate school | 3 | (23.1) | 88 | (23.5) | 0.89 (0.23–3.53) | 0.870 | 0.93 (0.15–5.84) | 0.941 | 0.77 (0.12–4.72) | 0.773 |
Mean alcohol consumption per day | ||||||||||
non-drinker | 2 | (15.4) | 147 | (39.3) | 1.00 | 1.00 | 1.00 | |||
≤34 (g) | 10 | (76.9) | 186 | (49.7) | 3.95 (0.85–18.3) | 0.079 | 4.71 (0.77–28.7) | 0.093 | 4.74 (0.71–31.8) | 0.109 |
>34 | 1 | (7.7) | 41 | (11.0) | 1.79 (0.16–20.3) | 0.637 | 3.50 (0.17–70.3) | 0.413 | 3.51 (0.18–67.4) | 0.406 |
(p for trend 0.261) | (p for trend 0.169) | (p for trend 0.209) | ||||||||
Feeling of isolation from other family members (visual analogue scale) | ||||||||||
<10.0 (mm) | 7 | (53.9) | 302 | (80.8) | 1.00 | 1.00 | 1.00 | |||
10.0–19.9 | 2 | (15.4) | 25 | (6.7) | 3.45 (0.68–17.5) | 0.135 | 2.92 (0.33–25.7) | 0.335 | 3.35 (0.42–26.5) | 0.252 |
≥20.0 | 4 | (30.8) | 47 | (12.6) | 3.67 (1.04–13.0) | 0.044 | 1.91 (0.36–10.1) | 0.447 | 2.98 (0.54–16.4) | 0.210 |
(p for trend 0.030) | (p for trend 0.320) | (p for trend 0.145) | ||||||||
Fatigue on waking | ||||||||||
Less than once per month | 3 | (23.1) | 240 | (64.2) | 1.00 | 1.00 | ||||
Once or more per month but less than once per week | 4 | (30.8) | 43 | (11.5) | 7.44 (1.61–34.4) | 0.010 | 7.90 (1.06–58.7) | 0.043 | ||
Once or more per week | 6 | (46.2) | 91 | (24.3) | 5.28 (1.29–21.5) | 0.021 | 6.79 (1.02–45.1) | 0.048 | ||
(p for trend 0.015) | (p for trend 0.051) | |||||||||
Global score on Pittsburgh Sleep Quality Index | ||||||||||
≤5 | 4 | (30.8) | 259 | (69.3) | 1.00 | 1.00 | ||||
6 | 2 | (15.4) | 47 | (12.6) | 2.76 (0.49–15.5) | 0.250 | 2.15 (0.28–16.5) | 0.463 | ||
7–9 | 5 | (38.5) | 58 | (15.5) | 5.58 (1.45–21.4) | 0.012 | 3.22 (0.56–18.7) | 0.193 | ||
≥10 | 2 | (15.4) | 10 | (2.7) | 13.0 (2.12–79.2) | 0.006 | 8.19 (1.05–63.8) | 0.045 | ||
(p for trend 0.001) | (p for trend 0.038) |
Condition | Sensitivity (%) (95% CI) | Specificity (%) (95% CI) | Positive Predictive Value (%) (95% CI) | Negative Predictive Value (%) (95% CI) | Positive Likelihood Ratio (95% CI) | Negative Likelihood Ratio (95% CI) | DSI/Number of Subjects with Condition (s) |
---|---|---|---|---|---|---|---|
Relationship problems in the workplace, Pittsburgh Sleep Quality Index score ≥ 10, and fatigue on waking once or more per week (RPW, PS10, and FWW) | 15.4 | 100 | 100 | 97.1 | ∞ | 0.846 | 2/2 |
(1.9–45.5) | (99.0–100) | (15.8–100) | (95.0–98.6) | (0.671–1.067) | |||
Relationship problems in the workplace and Pittsburgh Sleep Quality Index score ≥ 10 (RPW and PS10) | 15.4 | 99.7 | 66.7 | 97.1 | 57.54 | 0.848 | 2/3 |
(1.9–45.5) | (98.5–99.99) | (9.4–99.2) | (94.9–98.6) | (5.565–594.9) | (0.673–1.070) | ||
Relationship problems in the workplace, Pittsburgh Sleep Quality Index score ≥ 6, and fatigue on waking once or more per month (RPW, PS6, and FWM) | 38.5 | 96.8 | 29.4 | 97.8 | 11.99 | 0.636 | 5/17 |
(13.9–68.4) | (94.5–98.3) | (10.3–56.0) | (95.8–99.1) | (4.949–29.04) | (0.414–0.978) | ||
Relationship problems in the workplace and Pittsburgh Sleep Quality Index score ≥ 6 (RPW and PS6) | 46.2 | 94.4 | 22.2 | 98.1 | 8.220 | 0.570 | 6/27 |
(19.2–74.9) | (91.5–96.5) | (8.6–42.3) | (96.0–99.2) | (4.004–16.88) | (0.345–0.944) | ||
Relationship problems in the workplace and fatigue on waking once or more per week (RPW and FWW) | 38.5 | 95.2 | 21.7 | 97.8 | 7.991 | 0.646 | 5/23 |
(13.9–68.4) | (92.5–97.1) | (7.5–43.7) | (95.7–99.1) | (3.512–18.18) | (0.420–0.994) | ||
Pittsburgh Sleep Quality Index score ≥ 10 (PS10) | 15.4 | 97.3 | 16.7 | 97.1 | 5.754 | 0.869 | 2/12 |
(1.9–45.5) | (95.1–98.7) | (2.1–48.4) | (94.8–98.5) | (1.399–23.66) | (0.689–1.097) | ||
Relationship problems in the workplace and fatigue on waking once or more per month (RPW and FWM) | 38.5 | 93.3 | 16.7 | 97.8 | 5.754 | 0.659 | 5/30 |
(13.9–68.4) | (90.3–95.6) | (5.6–34.7) | (95.6–99.0) | (2.624–12.62) | (0.429–1.014) | ||
Relationship problems in the workplace (RPW) | 46.2 | 86.6 | 10.7 | 97.9 | 3.452 | 0.622 | 6/56 |
(19.2–74.9) | (82.8–89.9) | (4.0–21.9) | (95.7–99.2) | (1.818–6.556) | (0.375–1.030) | ||
Relationship problems in the workplace or Pittsburgh Sleep Quality Index score ≥ 10 (RPW or PS10) | 46.2 | 84.2 | 9.2 | 97.8 | 2.926 | 0.639 | 6/65 |
(19.2–74.9) | (80.1–87.8) | (3.5–19.0) | (95.6–99.1) | (1.555–5.505) | (0.386–1.060) | ||
Pittsburgh Sleep Quality Index score ≥ 6 (PS6) | 69.2 | 69.3 | 7.3 | 98.5 | 2.252 | 0.444 | 9/124 |
(38.6–90.9) | (64.3–73.9) | (3.4–13.3) | (96.2–99.6) | (1.520–3.336) | (0.196–1.007) | ||
Fatigue on waking once or more per month (FWM) | 76.9 | 64.2 | 6.9 | 98.8 | 2.147 | 0.360 | 10/144 |
(46.2–95.0) | (59.1–69.0) | (3.4–12.4) | (96.4–99.7) | (1.548–2.978) | (0.133–0.973) | ||
Relationship problems in the workplace or fatigue on waking once or more per month (RPW or FWM) | 84.6 | 57.5 | 6.5 | 99.1 | 1.990 | 0.268 | 11/170 |
(54.6–98.1) | (52.3–62.6) | (3.3–11.3) | (96.7–99.9) | (1.535–2.581) | (0.075–0.960) | ||
Fatigue on waking once or more per week (FWW) | 46.2 | 75.7 | 6.2 | 97.6 | 1.897 | 0.712 | 6/97 |
(19.2–74.9) | (71.0–79.9) | (2.3–13.0) | (95.1–99.0) | (1.027–3.504) | (0.429–1.181) | ||
Relationship problems in the workplace or Pittsburgh Sleep Quality Index score ≥ 6 (RPW or PQ6) | 69.2 | 61.5 | 5.9 | 98.3 | 1.798 | 0.500 | 9/153 |
(38.6–90.9) | (56.4–66.5) | (2.7–10.9) | (95.7–99.5) | (1.224–2.641) | (0.221–1.135) | ||
Relationship problems in the workplace, Pittsburgh Sleep Quality Index score ≥ 6, or fatigue on waking once or more per month (RPW, PS6, or FWM) | 92.3 | 44.9 | 5.5 | 99.4 | 1.676 | 0.171 | 12/218 |
(64.0–99.8) | (39.8–50.1) | (2.9–9.4) | (96.8–99.99) | (1.397–2.010) | (0.026–1.130) | ||
Relationship problems in the workplace or fatigue on waking once or more per week (RPW or FWW) | 53.9 | 67.1 | 5.4 | 97.7 | 1.637 | 0.688 | 7/130 |
(25.1–80.8) | (62.1–71.9) | (2.2–10.8) | (95.0–99.1) | (0.970–2.764) | (0.381–1.242) | ||
Relationship problems in the workplace, Pittsburgh Sleep Quality Index score ≥ 10, or fatigue on waking once or more per week (RPW, PQ10, or FWW) | 53.9 | 65.0 | 5.1 | 97.6 | 1.537 | 0.710 | 7/138 |
(25.1–80.8) | (59.9–69.8) | (2.1–10.2) | (94.8–99.1) | (0.912–2.591) | (0.393–1.284) |
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Fujieda, M.; Uchida, K.; Ikebe, S.; Kimura, A.; Kimura, M.; Watanabe, T.; Sakamoto, H.; Matsumoto, T.; Uchimura, N. Fatigue on Waking, Insomnia, and Workplace Relationship Problems May Help to Detect Suicidal Ideation among New Middle-Aged Primary Care Patients: A 6-Month Prospective Study in Japan. Int. J. Environ. Res. Public Health 2023, 20, 5547. https://doi.org/10.3390/ijerph20085547
Fujieda M, Uchida K, Ikebe S, Kimura A, Kimura M, Watanabe T, Sakamoto H, Matsumoto T, Uchimura N. Fatigue on Waking, Insomnia, and Workplace Relationship Problems May Help to Detect Suicidal Ideation among New Middle-Aged Primary Care Patients: A 6-Month Prospective Study in Japan. International Journal of Environmental Research and Public Health. 2023; 20(8):5547. https://doi.org/10.3390/ijerph20085547
Chicago/Turabian StyleFujieda, Megumi, Katsuhisa Uchida, Shinichiro Ikebe, Akihiro Kimura, Masashi Kimura, Toshiaki Watanabe, Hisako Sakamoto, Teruaki Matsumoto, and Naohisa Uchimura. 2023. "Fatigue on Waking, Insomnia, and Workplace Relationship Problems May Help to Detect Suicidal Ideation among New Middle-Aged Primary Care Patients: A 6-Month Prospective Study in Japan" International Journal of Environmental Research and Public Health 20, no. 8: 5547. https://doi.org/10.3390/ijerph20085547