Which statement about insomnia is accurate in relation to suicide risk?

• A. Insomnia lowers suicide risk
• B. Insomnia has no relation to suicide risk
• C. Insomnia is only relevant when depression is present
• D. Insomnia has long been known to increase suicide risk and is an independent risk factor

Answer: (D)

Insomnia itself can elevate suicide risk even when other mental health conditions are not considered or controlled for. Sleep problems have been shown to increase the likelihood of suicidal thoughts, planning, and attempts, and this association persists after accounting for depression and other conditions, making insomnia an independent risk factor. The reasons involve both biology and cognition: ongoing sleep loss creates hyperarousal and cognitive strain that can heighten hopelessness, impair judgment, and reduce problem-solving ability, while increasing impulsivity and emotional dysregulation. Neurobiological changes linked to sleep deprivation—such as stress system activation and neurotransmitter imbalances—may also contribute to this heightened risk. Clinically, this means assessing sleep health is crucial in suicide risk assessments, and treating insomnia—such as with cognitive-behavioral therapy for insomnia—can be an important part of reducing suicidality, beyond addressing mood disorders alone.