In the context of other mental disorders which has long been known to increase suicide risk, and is also an independent risk factor?

• A. Depression
• B. Anxiety
• C. Substance use
• D. Insomnia

Answer: (D)

Sleep disturbance, especially insomnia, has long been known to raise suicide risk and stands as an independent risk factor across mental health conditions. This means that even when you control for other disorders like depression, anxiety, or substance use, insomnia itself still predicts higher levels of suicidal thoughts and behaviors. The reasons are multifaceted: poor sleep impairs emotion regulation and cognitive control, increases irritability and distress, heightens rumination, and can amplify fatigue and hopelessness. Physiologically, sleep loss can dysregulate stress systems and neurochemical pathways involved in mood and impulse control, creating a stronger link to suicidality beyond the presence of another disorder. Because insomnia can persist as a separate risk factor, addressing sleep problems directly—through approaches like cognitive-behavioral therapy for insomnia or other sleep-focused treatments—can reduce suicidality and improve overall functioning, making sleep health a crucial, modifiable target in risk assessment and intervention.