An investigation of the relationship between sleep patterns and suicidal tendencies in patients with schizophrenia and bipolar disorder

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Suicide is a leading cause of death in them. Purpose This study aimed to examine and compare sleep patterns among patients with schizophrenia and bipolar disorder and their relationship to suicidal behaviour. Method The statistical population of the research includes all patients with schizophrenia spectrum disorders and bipolar disorders who were referred to Farabi Hospital in Kermanshah for treatment during the years 2019–2021. Data on 527 schizophrenia and 325 bipolar patients were collected through a census. Descriptive statistics methods of frequency, percentage, mean, and standard deviation were used. Also, a two-sample independent t-test and chi-square test were conducted. All analyses were done with SPSS-24 statistical software at an error level of 5%. Pittsburgh Sleep Quality Inquiry (PSQI) and Suicidal Behavior Questionnaire (SBQ-R) were used in this research. Results In the current study, sleep quality and suicidal risk were correlated by type of psychiatric disorder. However, there was no statistically significant correlation between the two variables. According to these results, 129 patients with schizophrenia and 93 patients with bipolar disorder reported poor sleep quality. Also, the risk of suicidal behaviour was reported at a high level for 316 patients with schizophrenia and 169 patients with bipolar disorder. Conclusion Sleep disorders in people with schizophrenia and bipolar disorder need to be examined further, as early identification and treatment can positively affect a patient's prognosis and quality of life. sleep pattern schizophrenia bipolar disorder suicide Figures Figure 1 Introduction Schizophrenia and bipolar disorder are severe psychiatric disorders that affect approximately 3% of the world's population during their lifetime [1]. Despite the distinction, these two disorders overlap in some aspects, such as symptoms, family patterns, and treatment response [2]. Schizophrenia is a severe psychiatric disorder; its symptoms are usually classified as positive, negative, and cognitive [3]. Positive symptoms include hallucinations and disordered speech, while negative symptoms include social withdrawal [4]. There are also cognitive symptoms, such as executive function and attention deficits [5]. Further, a common complaint among schizophrenia patients is that their sleep patterns have changed [1]. Patients with this condition usually have a longer sleep latency and several awakenings during the night, which decreases the total amount of sleep they get per night [6]. In general, the sleep efficiency of these patients decreases [7]. Approximately 30 to 80 percent of them have different degrees and types of sleep disorders [8]. Sleep complaints in this population are associated with worse psychiatric outcomes, including worsening psychiatric symptoms, poorer quality of life, and increased depressive symptoms [9]. Sleep disorders lead to continuous sympathetic nervous system activation and reduce frontal lobe activity, leading to cognitive impairment and even behavioural control problems in patients [10]. It has also been found that sleep disorders such as poor sleep quality and sleep duration are reliably associated with higher levels of suicide and are commonly present among people with schizophrenia spectrum disorders [11]. The average lifespan of a person diagnosed with schizophrenia, therefore, falls by 14.5 years compared to the general population. This premature mortality can be partially attributed to suicide [12]. Suicide attempts during the lifetime of a person with schizophrenia are estimated to be between 25 and 50% [13]. However, studies have estimated the rate of successful suicide during life in these people as 4.9% [14]. Bipolar disorder is another psychiatric disorder characterized by changes in mood and activity, including depression, hypomania, and mania [15]. Different clinical features and severity are associated with this disorder. While some patients experience psychotic episodes, others do not. Additionally, patients' responses to treatment and drug regimens vary greatly [16]. Symptoms of bipolar disorder are often accompanied by sleep problems [17], which can negatively affect the quality of life, the severity of symptoms, and treatment outcomes [18]. It has been found that the disturbance in sleep, lower sleep time and the increase in feeling sleepy during the day are not only symptoms of bipolar disorder but also contribute to the disorder process and especially to manic or hypomanic behavior [19]. As a result, sleep disorder is the most prevalent initial symptom of mania, with an average prevalence of 77% [20]. Besides, sleep disorders contribute to emotional regulation disorders in bipolar disorder [21], which can lead to decreased emotional control and, as a result, more violent behaviors [10]. Suicide thoughts, attempted suicide, and suicide are all associated with sleep disorders such as insomnia, nightmares, and poor sleep quality [22]. In comparison with other mental disorders, bipolar disorder is the most common cause of suicide and affects daily function [23]. It is known that about 15% of these patients die due to suicide [24]. Therefore, this study is of importance for the following reasons, including that problems in starting and maintaining the sleep process and its timing are common problems among people living with serious mental illness, psychopathology overlaps in schizophrenia and bipolar disorder [25], and timely diagnosis of people who are at risk of suicide is a big challenge for clinicians. Therefore, the present study aimed to compare the sleep pattern in patients with schizophrenia and bipolar disorder and its relationship with suicidal tendencies. Methodology With an analytical approach, the current study examined and compared sleep patterns in schizophrenia and bipolar disorder patients as well as their relationship to suicidal tendencies. The statistical population of the research includes all patients suffering from schizophrenia spectrum disorders and bipolar disorders who were referred to Farabi Hospital in Kermanshah for treatment during 2019–2021 whose demographic information, medical and clinical records, and self-reported records, including sleep patterns and suicidal tendencies has been registered in the psychiatric disorders registration system (Registry of nervous and mental disorders) in Farabi Hospital, Kermanshah. The information of all patients suffering from schizophrenia spectrum disorders and bipolar disorders were analyzed who had been referred to Farabi Psychiatric Hospital in Kermanshah for treatment between 2019 and 2021. Therefore, there was no need to calculate the sample size, and sampling was done as a census. The researcher received the data related to the present study, including demographic information, the clinical records of the patient and their families, and information related to their sleep patterns and suicidal tendencies after obtaining permission and making relevant arrangements with the relevant officials of the Registry and after declaring agreement to preserve the laws and intellectual rights. The complete count was used as the sampling method. In this way, the information of all eligible patients with schizophrenia spectrum disorders and bipolar disorders was included in the study. It should be mentioned that all patients' data and information were collected without mentioning their names and were given to the researcher. The researcher committed that all the patients' information will be used under the confidentiality term. In the end, the recorded information was entered into SPSS-24 software by a statistician and analyzed with the help of relevant statistical methods. Descriptive statistics methods, frequency, and percentage were used to determine the distribution of gender, age group, marital status, employment status, education level, economic status, way of referral, residence status, and place of residence. Also, mean and standard deviation were used to determine the average age and average score of sleep quality (delay in falling asleep, sleep duration, sleep efficiency, sleep disorder, use of sleeping pills, daily functioning disorder, total sleep quality score) and suicidal behaviors. Two-sample independent t-test was used to compare the mean score of sleep quality and suicidal behaviors among the two psychiatric disorders. The chi-square test was used to measure the correlation between the grouped factors. If necessary, Fisher's exact test was used. The information related to 527 patients with schizophrenia and 325 patients with bipolar disorder was entered into the software and analyzed using relevant statistical methods. Also, all analyses were done with the help of SPSS-24 statistical software and at an error level of 5%. It should be noted that this study was implemented with the financial support of Kermanshah University of Medical Sciences after obtaining the code of ethics from the research ethics committee of the said university (IR.KUMS.REC.1400.534). Inclusion and exclusion criteria: Based on a structured interview (DSM-5) by a psychiatrist, patients diagnosed with schizophrenia spectrum disorders and bipolar disorders were included in the study. Patients who had been infected for more than three years were excluded from the study. A detailed flowchart (Fig. 1 ) outlines the complete exclusion criteria for this study. Medications: Drug treatment decisions for patients with schizophrenia and bipolar disorder are made according to a range of factors, including body mass index, age, gender, previous treatment response, prior drug side effects, and known drug sensitivities. Schizophrenia Medications: Elanzapine: 5–15 mg per day, Aripiprazole: 5–30 mg per day, Risperidone: 1–4 mg per day, Clozapine: Rarely used; 30 − 25 mg per day. Bipolar Medications: Lithium: 30-1200 mg per day, Sodium Valproate: 200–1500 mg per day, Lamotrigine: 25–200 mg per day, Carbamazepine: 200–1200 mg per day. While all the mentioned medications can induce drowsiness as a potential side effect, they are not associated with an increased risk of suicide. Bipolar patients are typically hospitalized during the acute phase of their illness. During this time, they often exhibit excitable, elevated or expansive mood states. In contrast, schizophrenic patients often present with irritable or depressed mood during hospitalization. A brief interview is conducted upon a patient's arrival at the emergency room to assess their symptoms. A more comprehensive structured psychiatric interview is conducted upon admission to the ward. For the purposes of this research, only patients hospitalized in psychiatric departments who were in the control phase in terms of symptom severity were included in the study. These patients completed the required questionnaires. Instruments: Pittsburgh Sleep Quality Inquiry (PSQI): The Pittsburgh Sleep Quality Study is a 19-item self-reported questionnaire [9] that evaluates sleep habits in the past month. Each item is scored from 0 to 3, where lower scores indicate better sleep quality [26]. It measures seven components, including sleep duration, sleep disorders, sleep onset delay, daytime dysfunction, normal sleep efficiency, subjective sleep quality, and the use of sleep-inducing drugs. This scale also gives an overall score [9]. A total score higher than 5 indicates a sleep disorder [6]. Suicidal Behavior Questionnaire (SBQ-R): Osman et al. (2001) designed a questionnaire on suicidal behaviors [27]. This scale is a 4-item self-report instrument. In Likert-type questions, people are asked about past and future suicidal thoughts and behaviors. The total score obtained ranges from 3 to 18. It takes approximately 5 minutes to complete this test [28]. Results An evaluation was conducted on 527 patients with schizophrenia and 325 patients with bipolar disorder, whose mean ages were (37.70) and (37.85), respectively. In the initial investigations in two groups of schizophrenic and bipolar patients, the proportion of men was reported to be more than twice that of women. Hence, there were 377 (71.5%) patients with schizophrenia and 228 (70.2%) with bipolar disorder. Also, in the two groups, the majority of patients were in the age groups of 26–35 and 36–45, respectively, and the minority of them were in the age group of > 15 years. Moreover, urban residents constituted more than twice the number of rural residents in the two groups. As a result, 116 people in the group of schizophrenic patients (22.1%) and 88 people in the group of bipolar patients (27.2%) were rural residents. The three educational levels of a high-school diploma, a junior high school diploma, and a primary school certificate and being a freelancer, homemaker, and unemployed were reported with the highest frequency in the two groups. More than half of the patients in both groups were forced to visit the hospital by family and friends. A study of the marital status of these patients also revealed that the number of people who reported the death of their spouse in the schizophrenia group 6(1.2%) was four times higher than the number in the bipolar group 1(0.3%). Less than half of the patients in the group of patients with bipolar disorder 134 people (46.0%) were married, and more than half of the patients in the group of patients with schizophrenia, i.e., 275 people (57.2%), were single. On the other hand, the proportion of patients with good economic status in the group of patients with bipolar 6(1.6%) was more than twice that of patients with schizophrenia 3(0.6%). A total of 7 bipolar patients (2.2%) and four schizophrenia patients (0.8%) reported living in institutional homes or camps. However, analysis of demographic data between the two groups showed that the two groups of bipolar patients and schizophrenia patients were not homogeneous, only regarding marital status (P < 0.0001). More results are displayed in the table below (Table 1 ). Table 1 demographic data in bipolar patients and schizophrenic patients Type of psychiatric disorder n (%) Factor Level Schizophrenic spectrum N = 527 Bipolar disorder N = 325 Frequency (%) Chi-square statistic (Significance level) Demographic data Age group 15 36(6/9) 20(6/2) 56(6.7) Sex Female 150(28/5) 97(29/8) 247 (29.0) 0/187 (0/361) Male 377(71/5) 228(70/2) 605(71.0) Area of residence Urban 408(77/9) 235(72/8) 643(75.9) 2/851 (0/055) Rural 116(22/1) 88(27/2) 399(24.1) Education Illiterate 45(8/6) 21(6/5) 66(7.8) (2/254) (0/813) elementary 131(25/6) 77(23/8) 208(24.6) Junior high-school 124(23/7) 74(22/9) 198(23.4) High-school 141(27/0) 98(30/0) 239(28.3) Bachelor's degree 57(10/9) 38(11/8) 95 (11.2) Above bachelor's degree 25(4/8) 15(4/6) 40(4.7) Occupation Student 13(2/5) 11(3/4) 24(2.8) 8/212 (0/314) Freelancer 132(25/2) 91(28/2) 223(26.4) Employee 15(2/9) 16(5/0) 31(3.7) Worker 26(5/0) 21(6/5) 47(5.6) Housewife 136(26/0) 82(25/4) 218(25.6) Unemployed 185(35/4) 90(27/9) 275(32.3) Retired 12(2/3) 9(2/8) 21(2.5) Other 4(0/8) 3(0/9) 7(0.8) Referral Voluntary 221(42/3) 125(38/7) 346(40/9) 1/045 (0/171) Forcible 302(57/7) 198(61/3) 500(59/1) Marital status Single 275(57/2) 119(40/9) 394(51/0) *** 22/80 (0/0001<) Married 150(31/2) 134(46/0) 284(36/8) Divorced 50(10/4) 37(12/7) 87(11/3) death of spouse 6(1/2) 1(0/3) 7(0/9) Economic status Low 231(44/2) 133(41/2) 364(43.0) 3/641 (0/164) Middle 289(55/3) 184(57/0) 473(55.9) High 3(0/6) 6(1/6) 9 (1.1) Residence private house 411(78/6) 235(72/8) 646(76.4) 5/66 (0/059) Rented house 108(20/7) 81(25/1) 189(22.3) Institutional houses or camps 4(0/8) 7(2/2) 11(1.3) * Significant at P < 0.05 ** Significant at P < 0.01 *** Significant at P < 0.001 Additionally, the frequency distribution of disorder diagnosis age showed that the majority of patients in the two groups were between the age categories of 16–25, 26–35, and 36–45. Also, both groups of patients with schizophrenia and bipolar disorder reported a history of mental illness in their family with frequencies of 19(10.9%) and 15 people (12.5%) and a history of chronic physical illness with frequencies of 61(11.6%) and 52 people (16.1%), respectively. In two groups of patients with bipolar and schizophrenia patients, the history of chronic physical illness in the family was statistically significant (P = 0.038) according to correlation analysis. A full list of results can be found in Table 2 . Table 2 demographic data in bipolar patients and schizophrenic patients Factor Levels Type of psychiatric disorder n (%) Frequency (%) Chi-square statistic (Significance level) Schizophrenic disorder N = 527 Bipolar disorder N = 325 Diagnosis age 15 45 16(9/0) 8(6/7) 24(8.1) History of mental illness in the family No 160(89/4) 105(87/5) 265(88.6) 0/253 (0/372) Yes 19(10/9) 15(12/5) 34(11.4) History of physical illness in the family No 465(88/4) 270(83/9) 735(86/7) *** 3/583 (0/038) Yes 61(11/6) 52(16/1) 113(13/3) * Significant at P < 0.05 ** Significant at P < 0.01 *** Significant at P < 0.001 Patients with schizophrenia received a diagnosis with a mean age of 29.85 (10.50) years, while this score was reported as 29.41 (10.65) years in bipolar spectrum disorder patients. Also, the mean score for the current age when conducting the study was 40.03 (9.71) in patients with schizophrenia and 37.71 (10.89) in the bipolar group. Table 3 below displays the results. Table 3 Descriptive statistics of current age and diagnosis age in the studied patients Min-max Mean (SD) Medical and clinical records Diagnosis age Schizophrenia spectrum disorders 18–60 29/85(10/50) Bipolar spectrum disorders 19–70 29/41(10/65) Current age Schizophrenia spectrum disorders 65 − 18 37/71(10/89) Bipolar spectrum disorders 21–72 40/03(9/71) Table 4. The mean score of sleep quality (delay in falling asleep, sleep duration, sleep efficiency, sleep disorder, sleep medication use, daily functioning disorder, total sleep quality score) and suicidal behaviors in the studied patients. Factors Type of psychiatric disorder Mean Std. Deviation Mean Diff Test statistic (p-value) Total score of sleep quality Subjective quality of sleep Schizophrenia 1/06 0/430 -0/026 -0/622 (0/538) Bipolar 1/08 0/463 delay in falling asleep Schizophrenia 1/28 0/665 -0/009 -0/139 (0/891) Bipolar 1/29 0/744 sleep duration Schizophrenia 0/46 0/826 -0/190 - * 2/297 (0/022) Bipolar 0/65 0/958 sleep efficiency Schizophrenia 0/42 0/761 0.053- 0.702- (0/483) Bipolar 0/48 0/864 sleep disorder Schizophrenia 1/02 0/322 0/034 1/029 (0/304) Bipolar 0/99 0/362 sleep medication use Schizophrenia 0/79 0/405 0/058 1/478 (0/140) Bipolar 0/74 0/442 daily functioning disorder Schizophrenia 1/13 0/508 -0/012 -0/227 (0/821) Bipolar 1/14 0/599 total sleep quality score Schizophrenia 6/19 2/70 -0/097 -0/341 (0/739) Bipolar 6/29 3/29 Suicide attempt risk Schizophrenia 4/91 3/18 -0/219 -0/736 (0/462) Bipolar 5/13 3/36 * Significant at P < 0.05 ** Significant at P < 0.01 *** Significant at P < 0.001 The table below shows the mean score of sleep quality and the sub-components of delay in falling asleep, sleep duration, sleep efficiency, sleep disorder, use of sleeping pills, daily functioning disorder, total score of sleep quality, and suicidal behaviors in each group. Based on these results, among the components of sleep quality, the mean score of subjective sleep quality, delay in falling asleep, sleep duration, sleep efficiency, disruption in daily functioning, and total sleep quality was reported to be slightly higher in bipolar patients than in patients with schizophrenia. This difference was reported to be significant only in patients' sleep duration (P = 0.022). The mean score of suicide risk among bipolar and schizophrenia patients also did not have a statistically significant difference (P = 0.462). More results are displayed in the table below (Table 4). The table below shows the frequency distribution of sleep quality and suicide risk among the studied patients. According to these results, 129(52.0%) people with schizophrenia and 93 (47.4%) people with bipolar disorder reported poor sleep quality. Also, for 316 people (60.0%) with schizophrenia and 169 people (52.0%) with bipolar disorder, the risk of suicidal behavior was high. Correlation analysis results also showed a statistically significant difference (P = 0.014) for the risk of suicidal behaviors in two groups of bipolar and schizophrenia groups. More results are displayed in the table below (Table 5 ). Table 5 Sleep quality and suicidal behaviors in bipolar patients and schizophrenic patients Type of psychiatric disorder N (%) Levels Schizophrenia disorder N = 325 Bipolar disorder N = 325 Total Test statistic (p-value) Total sleep quality Good 119(48/0) 103(52/6) 222(50/0) 0/913 (0/195) Poor 129(52/0) 93(47/4) 222(50/0) Suicide attempt risk Low 211(40/0) 156(48/0) 367(43/1) * 5/197 (0/014) High 316(60/0) 169(52/0) 485(56/9) * Significant at P < 0.05 ** Significant at P < 0.01 *** Significant at P < 0.001 In the end, the results of the correlation between sleep quality and suicide risk based on the type of psychiatric disorder showed no statistically significant correlation in any of the studied groups (all p > 0.05). The results of this investigation are shown in the table below (Table 6 ). Table 6 sleep quality and suicidal behaviors based on the type of psychiatric disorder in the studied patients Sleep quality total score n (%) Suicide behavior score Good Poor Total Test statistic (p-value) Bipolar disorder Low 93(78/2) 98(76/0) 191(77/0) 0/167 (0/399) High 26(21/8) 31(24/0) 57(23/0) Schizophrenia disorder Low 74(71/8) 71(76/3) 145(74/0) 0/514 (0/290) High 29(28/2) 22(23/7) 51(26/0) * Significant at P < 0.05 ** Significant at P < 0.01 *** Significant at P < 0.001 Discussion The present study compared the sleep pattern in patients with schizophrenia and bipolar disorder and its relationship with suicidal tendencies. To the best of our knowledge, this is the first study to make this comparison. Our study showed no relationship between the sleep quality of patients with schizophrenia and bipolar disorder and the risk of suicidal behavior in them. Also, our study showed that, among different components of sleep quality, the mean score of subjective sleep quality, delay in falling asleep, sleep duration, sleep efficiency, disruption in daily functioning, and total sleep quality were slightly higher in patients with bipolar disorder than patients with schizophrenia. Also, it was found that this difference was significant only in the component of sleep duration. Studies have shown that many factors may affect sleep quality [29]. Medicines are among the things that should not be ignored. Many antipsychotic drugs, including those prescribed for psychosis or mood disorders, affect sleep quality. In general, antipsychotics are sedative, induce faster sleep onset, increase overall sleep duration, and improve sleep continuity [30]. In his study, Cohrs (2008) stated that most atypical antipsychotics increased total sleep time or sleep efficiency in patients with schizophrenia [31]. Also, there is a change in the circadian rhythm in patients with schizophrenia, reflected in the tendency to be awake at night and sleep during the day. Although its reason is unknown, some believe that the consumption of alcohol and illegal drugs or antipsychotic drugs used to treat patients with schizophrenia may play a role [32]. In addition to drug effects on sleep, comorbidity, such as anxiety, can aggravate sleep disorders in people with bipolar disorder [33]. In addition, the results of our study showed that the difference in the mean score for suicide attempt risk between patients with schizophrenia and bipolar disorder was not statistically significant. However, the risk of suicidal behaviors was different between the two groups. According to the characteristics of the disorder and the stage of the disorder, the risk of suicide is different in bipolar disorder. For example, major depressive episodes are associated with the highest risk of suicide, while manic episodes are associated with the lowest risk of suicide [23]. In their study of older adults with bipolar disorder, ORourke et al. (2017) found that poor sleep quality does not appear to predict suicidal ideation directly. However, their results showed that its indirect effect is significant. For example, both poor sleep quality and cognitive impairments increase depressive symptoms, which in turn increase suicidal ideation [34]. Although suicide is difficult to predict, some factors should be considered red flags in patients with bipolar disorder, including a history of suicide attempts, family history of suicide attempts, and dominant depression polarity [23]. In patients with schizophrenia, it has been found that the more severe the symptoms, the higher the probability of suicidal behavior [35]. In a study conducted by Carruthers et al. on individuals with a spectrum of schizophrenia disorders, both positive symptom severity and depressive thinking were cited as significant risk factors for suicide. Thus, sleep disturbances among individuals with schizophrenia spectrum disorders may exacerbate the severity of positive symptoms and hopelessness, increasing suicidal ideation. Therefore, hopeless thinking is considered one of the important characteristics of the relationship between sleep disorders and suicidal thoughts [11]. It has been shown that sleep disturbances may independently contribute to suicidal risk by impairing cognitive and executive functions and compromising emotional processing, thereby leading to deficits in problem-solving and vulnerability to impulsive behaviors [14]. Also, several studies have shown that insight is associated with suicide. Insight is defined as the awareness of the effects of the disorder on social and cognitive functioning and the fear of worsening the condition [13]. It has been shown that high levels of insight may increase the risk of suicidal behavior [36]. However, more research is needed to examine suicide in people with schizophrenia and bipolar disorder. It is suggested to examine the effects of several variables on the sleep quality of patients with schizophrenia and bipolar disorders and their relationships with suicide ideation, including gender, age at the onset of psychotic symptoms, concurrently suffering from another psychiatric disorder such as anxiety disorders, the severity of depression, the effect of taking antipsychotics, substance abuse, personality disorders, and the severity of positive and negative symptoms and the intensity of hopeless thinking in future research. It is also suggested to consider the routine evaluation of sleep problems in these patients in clinical services, as identifying and treating sleep disorders in the early stages can positively affect the prognosis and quality of life of these patients. Limitations This research has limitations that other researchers can consider: First, self-report tools have been used to collect data, which may leave a possibility of bias. Second, no objective sleep measurement tool was used in this study. Therefore, subjective sleep data may contain inherent limitations of validity and reliability. Third, patients differed in the severity and stage of the disorder and the drugs received. Finally, patients took antipsychotic drugs, which affected the sleep quality of the patients and, as a result, can affect the study results. Declarations Conflicts of Interest All authors declare no conflicts of interest. Patient Consent The objectives and methods of the study, the optionality of participating in the study and guaranteed anonymity were explained to the participants, and then informed consent was obtained from them. Funding This study was funded by the Deputy of Research of Kermanshah University of Medical Sciences. Author Contribution Author contribution: M.S.M and O.D was responsible for the study conception, design, and, writing-original draft, and writing- review and editing. M.M was responsible for supervision, and writing- review and editing. S. H was responsible for results analysis, supervision, writing and revision of the manuscript; F.G and M.A was responsible for the editing and revision of the manuscript; All authors have read and agreed on the published version of the manuscript. Data Availability Data availability: The dataset analysed during this study is available from the corresponding author on reasonable request. References Zanini MA, Castro J, Cunha GR, Asevedo E, Pan PM, Bittencourt L, et al. Abnormalities in sleep patterns in individuals at risk for psychosis and bipolar disorder. Schizophrenia research. 2015;169(1-3):262-7. Yamada Y, Matsumoto M, Iijima K, Sumiyoshi T. Specificity and continuity of schizophrenia and bipolar disorder: relation to biomarkers. Current pharmaceutical design. 2020;26(2):191-200. Kumari V, Ettinger U. Controlled sleep deprivation as an experimental medicine model of schizophrenia: An update. Schizophrenia Research. 2020;221:4-11. Ashton A, Jagannath A. Disrupted sleep and circadian rhythms in schizophrenia and their interaction with dopamine signaling. Frontiers in neuroscience. 2020;14:636. Wu Q, Wang X, Wang Y, Long Y-J, Zhao J-P, Wu R-R. Developments in biological mechanisms and treatments for negative symptoms and cognitive dysfunction of schizophrenia. Neuroscience Bulletin. 2021;37:1609-24. Afonso P, Figueira ML, Paiva T. Sleep–wake patterns in schizophrenia patients compared to healthy controls. The World Journal of Biological Psychiatry. 2014;15(7):517-24. Fröhlich F, Lustenberger C. Neuromodulation of sleep rhythms in schizophrenia: Towards the rational design of non-invasive brain stimulation. Schizophrenia research. 2020;221:71-80. Wang W-L, Zhou Y-Q, Chai N-N, Li G-H. Sleep disturbance and quality of life in clinically stable inpatients with schizophrenia in rural China. Quality of Life Research. 2020;29:2759-68. Chen MH, Korenic SA, Wickwire EM, Wijtenburg SA, Hong LE, Rowland LM. Sex differences in subjective sleep quality patterns in schizophrenia. Behavioral sleep medicine. 2020;18(5):668-79. Chen ZT, Wang HT, Chueh KH, Liu IC, Yang CM. An exploration of the sleep quality and potential violence among patients with schizophrenia in community. Perspectives in psychiatric care. 2021;57(2):648-54. Carruthers SP, Lee SJ, Sankaranarayanan A, Sumner PJ, Toh WL, Tan EJ, et al. Psychosis and hopelessness mediate the relationship between reduced sleep and suicidal ideation in schizophrenia spectrum disorders. Archives of suicide research. 2022;26(4):1862-79. Chong BTW, Wahab S, Muthukrishnan A, Tan KL, Ch’ng ML, Yoong MT. Prevalence and factors associated with suicidal ideation in institutionalized patients with schizophrenia. Psychology research and behavior management. 2020:949-62. Meltzer HY. Treatment of suicidality in schizophrenia. Annals of the New York Academy of Sciences. 2001;932(1):44-60. Li SX, Lam SP, Zhang J, Yu MWM, Chan JWY, Chan CSY, et al. Sleep disturbances and suicide risk in an 8-year longitudinal study of schizophrenia-spectrum disorders. Sleep. 2016;39(6):1275-82. Ching CR, Hibar DP, Gurholt TP, Nunes A, Thomopoulos SI, Abé C, et al. What we learn about bipolar disorder from large‐scale neuroimaging: Findings and future directions from the ENIGMA Bipolar Disorder Working Group. Human brain mapping. 2022;43(1):56-82. Haukvik UK, Gurholt TP, Nerland S, Elvsåshagen T, Akudjedu TN, Alda M, et al. In vivo hippocampal subfield volumes in bipolar disorder—A mega‐analysis from The Enhancing Neuro Imaging Genetics through Meta‐Analysis Bipolar Disorder Working Group. Human brain mapping. 2022;43(1):385-98. Steinan M, Scott J, Lagerberg T, Melle I, Andreassen O, Vaaler A, et al. Sleep problems in bipolar disorders: more than just insomnia. Acta Psychiatrica Scandinavica. 2016;133(5):368-77. Zangani C, Casetta C, Saunders AS, Donati F, Maggioni E, D’Agostino A. Sleep abnormalities across different clinical stages of Bipolar Disorder: A review of EEG studies. Neuroscience & Biobehavioral Reviews. 2020;118:247-57. Hensch T, Wozniak D, Spada J, Sander C, Ulke C, Wittekind DA, et al. Vulnerability to bipolar disorder is linked to sleep and sleepiness. Translational Psychiatry. 2019;9(1):294. Jackson A, Cavanagh J, Scott J. A systematic review of manic and depressive prodromes. Journal of affective disorders. 2003;74(3):209-17. Harvey AG, Kaplan KA, Soehner AM. Interventions for sleep disturbance in bipolar disorder. Sleep medicine clinics. 2015;10(1):101-5. Benard V, Etain B, Vaiva G, Boudebesse C, Yeim S, Benizri C, et al. Sleep and circadian rhythms as possible trait markers of suicide attempt in bipolar disorders: an actigraphy study. Journal of affective disorders. 2019;244:1-8. Miller JN, Black DW. Bipolar disorder and suicide: a review. Current psychiatry reports. 2020;22:1-10. Gordovez FJA, McMahon FJ. The genetics of bipolar disorder. Molecular psychiatry. 2020;25(3):544-59. Meyer N, Faulkner SM, McCutcheon RA, Pillinger T, Dijk D-J, MacCabe JH. Sleep and circadian rhythm disturbance in remitted schizophrenia and bipolar disorder: a systematic review and meta-analysis. Schizophrenia bulletin. 2020;46(5):1126-43. Li M, Lang B. The effects of systematic psychological nursing on the sleep quality of schizophrenic patients with sleep disorders. American journal of translational research. 2021;13(6):7263. Amini-Tehrani M, Nasiri M, Jalali T, Sadeghi R, Ghotbi A, Zamanian H. Validation and psychometric properties of suicide behaviors questionnaire-revised (SBQ-R) in Iran. Asian journal of psychiatry. 2020;47:101856. Rueda-Jaimes G, Castro-Rueda V, Rangel-Martínez-Villalba A, Corzo-Casasadiego J, Moreno-Quijano C, Camacho P. Validity of the Suicide Behaviors Questionnaire-Revised in patients with short-term suicide risk. The European Journal of Psychiatry. 2017;31(4):145-50. Laskemoen JF, Simonsen C, Büchmann C, Barrett EA, Bjella T, Lagerberg TV, et al. Sleep disturbances in schizophrenia spectrum and bipolar disorders–a transdiagnostic perspective. Comprehensive Psychiatry. 2019;91:6-12. Freeman D, Sheaves B, Waite F, Harvey AG, Harrison PJ. Sleep disturbance and psychiatric disorders. The Lancet Psychiatry. 2020;7(7):628-37. Cohrs S. Sleep disturbances in patients with schizophrenia: impact and effect of antipsychotics. CNS drugs. 2008;22:939-62. Krystal AD. Psychiatric disorders and sleep. Neurologic clinics. 2012;30(4):1389-413. Sylvia LG, Dupuy JM, Ostacher MJ, Cowperthwait CM, Hay AC, Sachs GS, et al. Sleep disturbance in euthymic bipolar patients. Journal of psychopharmacology. 2012;26(8):1108-12. O’Rourke N, Heisel MJ, Canham SL, Sixsmith A, Team BS. Predictors of suicide ideation among older adults with bipolar disorder. PLoS One. 2017;12(11):e0187632. De Sousa A, Shah B, Shrivastava A. Suicide and schizophrenia: an interplay of factors. Current psychiatry reports. 2020;22:1-5. Melle I, Ann Barrett E. Insight and suicidal behavior in first-episode schizophrenia. Expert review of neurotherapeutics. 2012;12(3):353-9. Additional Declarations No competing interests reported. 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Despite the distinction, these two disorders overlap in some aspects, such as symptoms, family patterns, and treatment response [2]. Schizophrenia is a severe psychiatric disorder; its symptoms are usually classified as positive, negative, and cognitive [3]. Positive symptoms include hallucinations and disordered speech, while negative symptoms include social withdrawal [4]. There are also cognitive symptoms, such as executive function and attention deficits [5]. Further, a common complaint among schizophrenia patients is that their sleep patterns have changed [1]. Patients with this condition usually have a longer sleep latency and several awakenings during the night, which decreases the total amount of sleep they get per night [6]. In general, the sleep efficiency of these patients decreases [7]. Approximately 30 to 80 percent of them have different degrees and types of sleep disorders [8]. Sleep complaints in this population are associated with worse psychiatric outcomes, including worsening psychiatric symptoms, poorer quality of life, and increased depressive symptoms [9]. Sleep disorders lead to continuous sympathetic nervous system activation and reduce frontal lobe activity, leading to cognitive impairment and even behavioural control problems in patients [10]. It has also been found that sleep disorders such as poor sleep quality and sleep duration are reliably associated with higher levels of suicide and are commonly present among people with schizophrenia spectrum disorders [11]. The average lifespan of a person diagnosed with schizophrenia, therefore, falls by 14.5 years compared to the general population. This premature mortality can be partially attributed to suicide [12]. Suicide attempts during the lifetime of a person with schizophrenia are estimated to be between 25 and 50% [13]. However, studies have estimated the rate of successful suicide during life in these people as 4.9% [14]. Bipolar disorder is another psychiatric disorder characterized by changes in mood and activity, including depression, hypomania, and mania [15]. Different clinical features and severity are associated with this disorder. While some patients experience psychotic episodes, others do not. Additionally, patients' responses to treatment and drug regimens vary greatly [16]. Symptoms of bipolar disorder are often accompanied by sleep problems [17], which can negatively affect the quality of life, the severity of symptoms, and treatment outcomes [18]. It has been found that the disturbance in sleep, lower sleep time and the increase in feeling sleepy during the day are not only symptoms of bipolar disorder but also contribute to the disorder process and especially to manic or hypomanic behavior [19]. As a result, sleep disorder is the most prevalent initial symptom of mania, with an average prevalence of 77% [20]. Besides, sleep disorders contribute to emotional regulation disorders in bipolar disorder [21], which can lead to decreased emotional control and, as a result, more violent behaviors [10]. Suicide thoughts, attempted suicide, and suicide are all associated with sleep disorders such as insomnia, nightmares, and poor sleep quality [22]. In comparison with other mental disorders, bipolar disorder is the most common cause of suicide and affects daily function [23]. It is known that about 15% of these patients die due to suicide [24]. Therefore, this study is of importance for the following reasons, including that problems in starting and maintaining the sleep process and its timing are common problems among people living with serious mental illness, psychopathology overlaps in schizophrenia and bipolar disorder [25], and timely diagnosis of people who are at risk of suicide is a big challenge for clinicians. Therefore, the present study aimed to compare the sleep pattern in patients with schizophrenia and bipolar disorder and its relationship with suicidal tendencies.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003eWith an analytical approach, the current study examined and compared sleep patterns in schizophrenia and bipolar disorder patients as well as their relationship to suicidal tendencies. The statistical population of the research includes all patients suffering from schizophrenia spectrum disorders and bipolar disorders who were referred to Farabi Hospital in Kermanshah for treatment during 2019\u0026ndash;2021 whose demographic information, medical and clinical records, and self-reported records, including sleep patterns and suicidal tendencies has been registered in the psychiatric disorders registration system (Registry of nervous and mental disorders) in Farabi Hospital, Kermanshah. The information of all patients suffering from schizophrenia spectrum disorders and bipolar disorders were analyzed who had been referred to Farabi Psychiatric Hospital in Kermanshah for treatment between 2019 and 2021. Therefore, there was no need to calculate the sample size, and sampling was done as a census. The researcher received the data related to the present study, including demographic information, the clinical records of the patient and their families, and information related to their sleep patterns and suicidal tendencies after obtaining permission and making relevant arrangements with the relevant officials of the Registry and after declaring agreement to preserve the laws and intellectual rights. The complete count was used as the sampling method. In this way, the information of all eligible patients with schizophrenia spectrum disorders and bipolar disorders was included in the study. It should be mentioned that all patients' data and information were collected without mentioning their names and were given to the researcher. The researcher committed that all the patients' information will be used under the confidentiality term. In the end, the recorded information was entered into SPSS-24 software by a statistician and analyzed with the help of relevant statistical methods.\u003c/p\u003e \u003cp\u003eDescriptive statistics methods, frequency, and percentage were used to determine the distribution of gender, age group, marital status, employment status, education level, economic status, way of referral, residence status, and place of residence. Also, mean and standard deviation were used to determine the average age and average score of sleep quality (delay in falling asleep, sleep duration, sleep efficiency, sleep disorder, use of sleeping pills, daily functioning disorder, total sleep quality score) and suicidal behaviors. Two-sample independent t-test was used to compare the mean score of sleep quality and suicidal behaviors among the two psychiatric disorders. The chi-square test was used to measure the correlation between the grouped factors. If necessary, Fisher's exact test was used. The information related to 527 patients with schizophrenia and 325 patients with bipolar disorder was entered into the software and analyzed using relevant statistical methods. Also, all analyses were done with the help of SPSS-24 statistical software and at an error level of 5%. It should be noted that this study was implemented with the financial support of Kermanshah University of Medical Sciences after obtaining the code of ethics from the research ethics committee of the said university (IR.KUMS.REC.1400.534).\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eInclusion and exclusion criteria:\u003c/h2\u003e \u003cp\u003eBased on a structured interview (DSM-5) by a psychiatrist, patients diagnosed with schizophrenia spectrum disorders and bipolar disorders were included in the study. Patients who had been infected for more than three years were excluded from the study. A detailed flowchart (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) outlines the complete exclusion criteria for this study.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMedications:\u003c/h3\u003e\n\u003cp\u003eDrug treatment decisions for patients with schizophrenia and bipolar disorder are made according to a range of factors, including body mass index, age, gender, previous treatment response, prior drug side effects, and known drug sensitivities.\u003c/p\u003e \u003cp\u003eSchizophrenia Medications:\u003c/p\u003e \u003cp\u003eElanzapine: 5\u0026ndash;15 mg per day, Aripiprazole: 5\u0026ndash;30 mg per day, Risperidone: 1\u0026ndash;4 mg per day, Clozapine: Rarely used; 30\u0026thinsp;\u0026minus;\u0026thinsp;25 mg per day.\u003c/p\u003e \u003cp\u003eBipolar Medications:\u003c/p\u003e \u003cp\u003eLithium: 30-1200 mg per day, Sodium Valproate: 200\u0026ndash;1500 mg per day, Lamotrigine: 25\u0026ndash;200 mg per day, Carbamazepine: 200\u0026ndash;1200 mg per day.\u003c/p\u003e \u003cp\u003eWhile all the mentioned medications can induce drowsiness as a potential side effect, they are not associated with an increased risk of suicide. Bipolar patients are typically hospitalized during the acute phase of their illness. During this time, they often exhibit excitable, elevated or expansive mood states. In contrast, schizophrenic patients often present with irritable or depressed mood during hospitalization. A brief interview is conducted upon a patient's arrival at the emergency room to assess their symptoms. A more comprehensive structured psychiatric interview is conducted upon admission to the ward. For the purposes of this research, only patients hospitalized in psychiatric departments who were in the control phase in terms of symptom severity were included in the study. These patients completed the required questionnaires.\u003c/p\u003e\n\u003ch3\u003eInstruments:\u003c/h3\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003ePittsburgh Sleep Quality Inquiry (PSQI):\u003c/h2\u003e \u003cp\u003eThe Pittsburgh Sleep Quality Study is a 19-item self-reported questionnaire [9] that evaluates sleep habits in the past month. Each item is scored from 0 to 3, where lower scores indicate better sleep quality [26]. It measures seven components, including sleep duration, sleep disorders, sleep onset delay, daytime dysfunction, normal sleep efficiency, subjective sleep quality, and the use of sleep-inducing drugs. This scale also gives an overall score [9]. A total score higher than 5 indicates a sleep disorder [6].\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSuicidal Behavior Questionnaire (SBQ-R):\u003c/h3\u003e\n\u003cp\u003eOsman et al. (2001) designed a questionnaire on suicidal behaviors [27]. This scale is a 4-item self-report instrument. In Likert-type questions, people are asked about past and future suicidal thoughts and behaviors. The total score obtained ranges from 3 to 18. It takes approximately 5 minutes to complete this test [28].\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAn evaluation was conducted on 527 patients with schizophrenia and 325 patients with bipolar disorder, whose mean ages were (37.70) and (37.85), respectively. In the initial investigations in two groups of schizophrenic and bipolar patients, the proportion of men was reported to be more than twice that of women. Hence, there were 377 (71.5%) patients with schizophrenia and 228 (70.2%) with bipolar disorder. Also, in the two groups, the majority of patients were in the age groups of 26\u0026ndash;35 and 36\u0026ndash;45, respectively, and the minority of them were in the age group of \u0026gt;\u0026thinsp;15 years. Moreover, urban residents constituted more than twice the number of rural residents in the two groups. As a result, 116 people in the group of schizophrenic patients (22.1%) and 88 people in the group of bipolar patients (27.2%) were rural residents. The three educational levels of a high-school diploma, a junior high school diploma, and a primary school certificate and being a freelancer, homemaker, and unemployed were reported with the highest frequency in the two groups. More than half of the patients in both groups were forced to visit the hospital by family and friends. A study of the marital status of these patients also revealed that the number of people who reported the death of their spouse in the schizophrenia group 6(1.2%) was four times higher than the number in the bipolar group 1(0.3%). Less than half of the patients in the group of patients with bipolar disorder 134 people (46.0%) were married, and more than half of the patients in the group of patients with schizophrenia, i.e., 275 people (57.2%), were single. On the other hand, the proportion of patients with good economic status in the group of patients with bipolar 6(1.6%) was more than twice that of patients with schizophrenia 3(0.6%). A total of 7 bipolar patients (2.2%) and four schizophrenia patients (0.8%) reported living in institutional homes or camps. However, analysis of demographic data between the two groups showed that the two groups of bipolar patients and schizophrenia patients were not homogeneous, only regarding marital status (P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). More results are displayed in the table below (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003edemographic data in bipolar patients and schizophrenic patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eType of psychiatric disorder n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLevel\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSchizophrenic spectrum\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;527\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBipolar disorder\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFrequency (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eChi-square statistic\u003c/p\u003e \u003cp\u003e(Significance level)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"35\" rowspan=\"36\"\u003e \u003cp\u003eDemographic data\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eAge group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u0026lt;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (0/6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2(0/6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5(0/6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e1/853\u003c/p\u003e \u003cp\u003e(0/896)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16\u0026ndash;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60 (11/6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42(13/0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e102(12.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26\u0026ndash;35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e169(32/6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e94(29/1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e263 (31.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36\u0026ndash;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e169(32/6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e107(33/1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e276(32.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46\u0026ndash;55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e82 (15/8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e58(18/0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e140(16.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55\u0026gt;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36(6/9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20(6/2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e56(6.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e150(28/5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e97(29/8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e247 (29.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0/187\u003c/p\u003e \u003cp\u003e(0/361)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e377(71/5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e228(70/2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e605(71.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eArea of residence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e408(77/9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e235(72/8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e643(75.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e2/851\u003c/p\u003e \u003cp\u003e(0/055)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e116(22/1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e88(27/2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e399(24.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIlliterate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45(8/6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21(6/5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e66(7.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e(2/254)\u003c/p\u003e \u003cp\u003e(0/813)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eelementary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e131(25/6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e77(23/8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e208(24.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eJunior high-school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e124(23/7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e74(22/9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e198(23.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHigh-school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e141(27/0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e98(30/0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e239(28.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBachelor's degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57(10/9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e38(11/8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95 (11.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAbove bachelor's degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25(4/8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15(4/6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e40(4.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003eOccupation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStudent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13(2/5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11(3/4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e24(2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003e8/212\u003c/p\u003e \u003cp\u003e(0/314)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFreelancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e132(25/2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e91(28/2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e223(26.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEmployee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15(2/9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16(5/0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e31(3.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWorker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26(5/0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21(6/5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e47(5.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHousewife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e136(26/0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e82(25/4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e218(25.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e185(35/4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e90(27/9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e275(32.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12(2/3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9(2/8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e21(2.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4(0/8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3(0/9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7(0.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eReferral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVoluntary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e221(42/3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e125(38/7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e346(40/9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1/045\u003c/p\u003e \u003cp\u003e(0/171)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eForcible\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e302(57/7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e198(61/3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e500(59/1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e275(57/2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e119(40/9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e394(51/0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003csup\u003e***\u003c/sup\u003e22/80\u003c/p\u003e \u003cp\u003e(0/0001\u0026lt;)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e150(31/2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e134(46/0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e284(36/8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50(10/4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37(12/7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e87(11/3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003edeath of spouse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6(1/2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1(0/3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7(0/9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eEconomic status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e231(44/2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e133(41/2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e364(43.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e3/641\u003c/p\u003e \u003cp\u003e(0/164)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMiddle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e289(55/3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e184(57/0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e473(55.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3(0/6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6(1/6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9 (1.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eResidence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eprivate house\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e411(78/6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e235(72/8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e646(76.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e5/66\u003c/p\u003e \u003cp\u003e(0/059)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRented house\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e108(20/7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e81(25/1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e189(22.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInstitutional houses or camps\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4(0/8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7(2/2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11(1.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e* Significant at \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 ** Significant at \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01 *** Significant at \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAdditionally, the frequency distribution of disorder diagnosis age showed that the majority of patients in the two groups were between the age categories of 16\u0026ndash;25, 26\u0026ndash;35, and 36\u0026ndash;45. Also, both groups of patients with schizophrenia and bipolar disorder reported a history of mental illness in their family with frequencies of 19(10.9%) and 15 people (12.5%) and a history of chronic physical illness with frequencies of 61(11.6%) and 52 people (16.1%), respectively. In two groups of patients with bipolar and schizophrenia patients, the history of chronic physical illness in the family was statistically significant (P\u0026thinsp;=\u0026thinsp;0.038) according to correlation analysis. A full list of results can be found in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003edemographic data in bipolar patients and schizophrenic patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLevels\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eType of psychiatric disorder n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFrequency (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eChi-square statistic\u003c/p\u003e \u003cp\u003e(Significance level)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSchizophrenic disorder\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;527\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBipolar disorder\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;325\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eDiagnosis age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u0026lt;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(3/9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7(5/8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14(4.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e2/72\u003c/p\u003e \u003cp\u003e(0/606)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u0026ndash;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67(37/6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44(36/7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e111(37.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26\u0026ndash;35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54(30/3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31(25/8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e85(28.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36\u0026ndash;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34(19/1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30(25/0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e64(19.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16(9/0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8(6/7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24(8.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHistory of mental illness in the family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e160(89/4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e105(87/5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e265(88.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0/253\u003c/p\u003e \u003cp\u003e(0/372)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19(10/9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15(12/5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34(11.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHistory of physical illness in the family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e465(88/4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e270(83/9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e735(86/7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003csup\u003e***\u003c/sup\u003e3/583\u003c/p\u003e \u003cp\u003e(0/038)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61(11/6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52(16/1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e113(13/3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e* Significant at \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 ** Significant at \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01 *** Significant at \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ePatients with schizophrenia received a diagnosis with a mean age of 29.85 (10.50) years, while this score was reported as 29.41 (10.65) years in bipolar spectrum disorder patients. Also, the mean score for the current age when conducting the study was 40.03 (9.71) in patients with schizophrenia and 37.71 (10.89) in the bipolar group. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e below displays the results.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescriptive statistics of current age and diagnosis age in the studied patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMin-max\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eMedical\u003c/p\u003e \u003cp\u003eand clinical records\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDiagnosis age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSchizophrenia spectrum disorders\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18\u0026ndash;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29/85(10/50)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBipolar spectrum disorders\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19\u0026ndash;70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29/41(10/65)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCurrent age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSchizophrenia spectrum disorders\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65\u0026thinsp;\u0026minus;\u0026thinsp;18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37/71(10/89)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBipolar spectrum disorders\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21\u0026ndash;72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40/03(9/71)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"12\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"10\" nameend=\"c10\" namest=\"c1\"\u003e \u003cp\u003eTable\u0026nbsp;4. The mean score of sleep quality (delay in falling asleep, sleep duration, sleep efficiency, sleep disorder, sleep medication use, daily functioning disorder, total sleep quality score) and suicidal behaviors in the studied patients.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFactors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eType of psychiatric disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eStd. Deviation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003eMean Diff\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003eTest statistic\u003c/p\u003e \u003cp\u003e(p-value)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c12\" namest=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"15\" rowspan=\"16\"\u003e \u003cp\u003eTotal score of sleep quality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSubjective quality of sleep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSchizophrenia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1/06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0/430\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" morerows=\"1\" nameend=\"c9\" namest=\"c7\" rowspan=\"2\"\u003e \u003cp\u003e-0/026\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c11\" namest=\"c10\" rowspan=\"2\"\u003e \u003cp\u003e-0/622\u003c/p\u003e \u003cp\u003e(0/538)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c12\" namest=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBipolar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1/08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0/463\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c12\" namest=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003edelay in falling asleep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSchizophrenia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1/28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0/665\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" morerows=\"1\" nameend=\"c9\" namest=\"c7\" rowspan=\"2\"\u003e \u003cp\u003e-0/009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c11\" namest=\"c10\" rowspan=\"2\"\u003e \u003cp\u003e-0/139\u003c/p\u003e \u003cp\u003e(0/891)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c12\" namest=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBipolar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1/29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0/744\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c12\" namest=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003esleep duration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSchizophrenia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0/46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0/826\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" morerows=\"1\" nameend=\"c9\" namest=\"c7\" rowspan=\"2\"\u003e \u003cp\u003e-0/190\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c11\" namest=\"c10\" rowspan=\"2\"\u003e \u003cp\u003e-\u003csup\u003e*\u003c/sup\u003e2/297\u003c/p\u003e \u003cp\u003e(0/022)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c12\" namest=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBipolar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0/65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0/958\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c12\" namest=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003esleep efficiency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSchizophrenia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0/42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0/761\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" morerows=\"1\" nameend=\"c9\" namest=\"c7\" rowspan=\"2\"\u003e \u003cp\u003e0.053-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c11\" namest=\"c10\" rowspan=\"2\"\u003e \u003cp\u003e0.702-\u003c/p\u003e \u003cp\u003e(0/483)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c12\" namest=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBipolar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0/48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0/864\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c12\" namest=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003esleep disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSchizophrenia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1/02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0/322\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" morerows=\"1\" nameend=\"c9\" namest=\"c7\" rowspan=\"2\"\u003e \u003cp\u003e0/034\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c11\" namest=\"c10\" rowspan=\"2\"\u003e \u003cp\u003e1/029\u003c/p\u003e \u003cp\u003e(0/304)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c12\" namest=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBipolar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0/99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0/362\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c12\" namest=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003esleep medication use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSchizophrenia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0/79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0/405\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" morerows=\"1\" nameend=\"c9\" namest=\"c7\" rowspan=\"2\"\u003e \u003cp\u003e0/058\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c11\" namest=\"c10\" rowspan=\"2\"\u003e \u003cp\u003e1/478\u003c/p\u003e \u003cp\u003e(0/140)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c12\" namest=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBipolar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0/74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0/442\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c12\" namest=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003edaily functioning disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSchizophrenia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1/13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0/508\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" morerows=\"1\" nameend=\"c9\" namest=\"c7\" rowspan=\"2\"\u003e \u003cp\u003e-0/012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c11\" namest=\"c10\" rowspan=\"2\"\u003e \u003cp\u003e-0/227\u003c/p\u003e \u003cp\u003e(0/821)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c12\" namest=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBipolar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1/14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0/599\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c12\" namest=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003etotal sleep quality score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSchizophrenia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6/19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e2/70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c8\" namest=\"c7\" rowspan=\"2\"\u003e \u003cp\u003e-0/097\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" morerows=\"1\" nameend=\"c12\" namest=\"c9\" rowspan=\"2\"\u003e \u003cp\u003e-0/341\u003c/p\u003e \u003cp\u003e(0/739)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBipolar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6/29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e3/29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSuicide attempt risk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSchizophrenia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e4/91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3/18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e-0/219\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" morerows=\"1\" nameend=\"c10\" namest=\"c8\" rowspan=\"2\"\u003e \u003cp\u003e-0/736\u003c/p\u003e \u003cp\u003e(0/462)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBipolar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e5/13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3/36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"12\"\u003e* Significant at \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 ** Significant at \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01 *** Significant at \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe table below shows the mean score of sleep quality and the sub-components of delay in falling asleep, sleep duration, sleep efficiency, sleep disorder, use of sleeping pills, daily functioning disorder, total score of sleep quality, and suicidal behaviors in each group. Based on these results, among the components of sleep quality, the mean score of subjective sleep quality, delay in falling asleep, sleep duration, sleep efficiency, disruption in daily functioning, and total sleep quality was reported to be slightly higher in bipolar patients than in patients with schizophrenia. This difference was reported to be significant only in patients' sleep duration (P\u0026thinsp;=\u0026thinsp;0.022). The mean score of suicide risk among bipolar and schizophrenia patients also did not have a statistically significant difference (P\u0026thinsp;=\u0026thinsp;0.462). More results are displayed in the table below (Table\u0026nbsp;4).\u003c/p\u003e \u003cp\u003eThe table below shows the frequency distribution of sleep quality and suicide risk among the studied patients. According to these results, 129(52.0%) people with schizophrenia and 93 (47.4%) people with bipolar disorder reported poor sleep quality. Also, for 316 people (60.0%) with schizophrenia and 169 people (52.0%) with bipolar disorder, the risk of suicidal behavior was high. Correlation analysis results also showed a statistically significant difference (P\u0026thinsp;=\u0026thinsp;0.014) for the risk of suicidal behaviors in two groups of bipolar and schizophrenia groups. More results are displayed in the table below (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSleep quality and suicidal behaviors in bipolar patients and schizophrenic patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eType of psychiatric disorder N (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLevels\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSchizophrenia disorder\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBipolar disorder\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTest statistic\u003c/p\u003e \u003cp\u003e(p-value)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal sleep quality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e119(48/0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e103(52/6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e222(50/0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0/913\u003c/p\u003e \u003cp\u003e(0/195)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e129(52/0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e93(47/4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e222(50/0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSuicide attempt risk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e211(40/0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e156(48/0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e367(43/1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e5/197\u003c/p\u003e \u003cp\u003e(0/014)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e316(60/0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e169(52/0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e485(56/9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e* Significant at \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 ** Significant at \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01 *** Significant at \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn the end, the results of the correlation between sleep quality and suicide risk based on the type of psychiatric disorder showed no statistically significant correlation in any of the studied groups (all p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The results of this investigation are shown in the table below (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003esleep quality and suicidal behaviors based on the type of psychiatric disorder in the studied patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eSleep quality total score n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSuicide behavior score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eTest statistic\u003c/p\u003e \u003cp\u003e(p-value)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBipolar disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e93(78/2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e98(76/0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e191(77/0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0/167\u003c/p\u003e \u003cp\u003e(0/399)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26(21/8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31(24/0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e57(23/0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSchizophrenia disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e74(71/8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e71(76/3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e145(74/0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0/514\u003c/p\u003e \u003cp\u003e(0/290)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29(28/2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22(23/7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e51(26/0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e* Significant at \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 ** Significant at \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01 *** Significant at \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":" \u003cp\u003eThe present study compared the sleep pattern in patients with schizophrenia and bipolar disorder and its relationship with suicidal tendencies. To the best of our knowledge, this is the first study to make this comparison. Our study showed no relationship between the sleep quality of patients with schizophrenia and bipolar disorder and the risk of suicidal behavior in them. Also, our study showed that, among different components of sleep quality, the mean score of subjective sleep quality, delay in falling asleep, sleep duration, sleep efficiency, disruption in daily functioning, and total sleep quality were slightly higher in patients with bipolar disorder than patients with schizophrenia. Also, it was found that this difference was significant only in the component of sleep duration. Studies have shown that many factors may affect sleep quality [29]. Medicines are among the things that should not be ignored. Many antipsychotic drugs, including those prescribed for psychosis or mood disorders, affect sleep quality. In general, antipsychotics are sedative, induce faster sleep onset, increase overall sleep duration, and improve sleep continuity [30]. In his study, Cohrs (2008) stated that most atypical antipsychotics increased total sleep time or sleep efficiency in patients with schizophrenia [31]. Also, there is a change in the circadian rhythm in patients with schizophrenia, reflected in the tendency to be awake at night and sleep during the day. Although its reason is unknown, some believe that the consumption of alcohol and illegal drugs or antipsychotic drugs used to treat patients with schizophrenia may play a role [32]. In addition to drug effects on sleep, comorbidity, such as anxiety, can aggravate sleep disorders in people with bipolar disorder [33]. In addition, the results of our study showed that the difference in the mean score for suicide attempt risk between patients with schizophrenia and bipolar disorder was not statistically significant. However, the risk of suicidal behaviors was different between the two groups. According to the characteristics of the disorder and the stage of the disorder, the risk of suicide is different in bipolar disorder. For example, major depressive episodes are associated with the highest risk of suicide, while manic episodes are associated with the lowest risk of suicide [23]. In their study of older adults with bipolar disorder, ORourke et al. (2017) found that poor sleep quality does not appear to predict suicidal ideation directly. However, their results showed that its indirect effect is significant. For example, both poor sleep quality and cognitive impairments increase depressive symptoms, which in turn increase suicidal ideation [34]. Although suicide is difficult to predict, some factors should be considered red flags in patients with bipolar disorder, including a history of suicide attempts, family history of suicide attempts, and dominant depression polarity [23]. In patients with schizophrenia, it has been found that the more severe the symptoms, the higher the probability of suicidal behavior [35]. In a study conducted by Carruthers et al. on individuals with a spectrum of schizophrenia disorders, both positive symptom severity and depressive thinking were cited as significant risk factors for suicide. Thus, sleep disturbances among individuals with schizophrenia spectrum disorders may exacerbate the severity of positive symptoms and hopelessness, increasing suicidal ideation. Therefore, hopeless thinking is considered one of the important characteristics of the relationship between sleep disorders and suicidal thoughts [11]. It has been shown that sleep disturbances may independently contribute to suicidal risk by impairing cognitive and executive functions and compromising emotional processing, thereby leading to deficits in problem-solving and vulnerability to impulsive behaviors [14]. Also, several studies have shown that insight is associated with suicide. Insight is defined as the awareness of the effects of the disorder on social and cognitive functioning and the fear of worsening the condition [13]. It has been shown that high levels of insight may increase the risk of suicidal behavior [36]. However, more research is needed to examine suicide in people with schizophrenia and bipolar disorder. It is suggested to examine the effects of several variables on the sleep quality of patients with schizophrenia and bipolar disorders and their relationships with suicide ideation, including gender, age at the onset of psychotic symptoms, concurrently suffering from another psychiatric disorder such as anxiety disorders, the severity of depression, the effect of taking antipsychotics, substance abuse, personality disorders, and the severity of positive and negative symptoms and the intensity of hopeless thinking in future research. It is also suggested to consider the routine evaluation of sleep problems in these patients in clinical services, as identifying and treating sleep disorders in the early stages can positively affect the prognosis and quality of life of these patients.\u003c/p\u003e"},{"header":"Limitations","content":"\u003cp\u003eThis research has limitations that other researchers can consider: First, self-report tools have been used to collect data, which may leave a possibility of bias. Second, no objective sleep measurement tool was used in this study. Therefore, subjective sleep data may contain inherent limitations of validity and reliability. Third, patients differed in the severity and stage of the disorder and the drugs received. Finally, patients took antipsychotic drugs, which affected the sleep quality of the patients and, as a result, can affect the study results.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eConflicts of Interest\u003c/h2\u003e \u003cp\u003eAll authors declare no conflicts of interest.\u003c/p\u003e \u003ch2\u003ePatient Consent\u003c/h2\u003e \u003cp\u003e The objectives and methods of the study, the optionality of participating in the study and guaranteed anonymity were explained to the participants, and then informed consent was obtained from them.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis study was funded by the Deputy of Research of Kermanshah University of Medical Sciences.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAuthor contribution: M.S.M and O.D was responsible for the study conception, design, and, writing-original draft, and writing- review and editing. M.M was responsible for supervision, and writing- review and editing. S. H was responsible for results analysis, supervision, writing and revision of the manuscript; F.G and M.A was responsible for the editing and revision of the manuscript; All authors have read and agreed on the published version of the manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData availability: The dataset analysed during this study is available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eZanini MA, Castro J, Cunha GR, Asevedo E, Pan PM, Bittencourt L, et al. Abnormalities in sleep patterns in individuals at risk for psychosis and bipolar disorder. Schizophrenia research. 2015;169(1-3):262-7.\u003c/li\u003e\n\u003cli\u003eYamada Y, Matsumoto M, Iijima K, Sumiyoshi T. Specificity and continuity of schizophrenia and bipolar disorder: relation to biomarkers. Current pharmaceutical design. 2020;26(2):191-200.\u003c/li\u003e\n\u003cli\u003eKumari V, Ettinger U. Controlled sleep deprivation as an experimental medicine model of schizophrenia: An update. Schizophrenia Research. 2020;221:4-11.\u003c/li\u003e\n\u003cli\u003eAshton A, Jagannath A. Disrupted sleep and circadian rhythms in schizophrenia and their interaction with dopamine signaling. Frontiers in neuroscience. 2020;14:636.\u003c/li\u003e\n\u003cli\u003eWu Q, Wang X, Wang Y, Long Y-J, Zhao J-P, Wu R-R. Developments in biological mechanisms and treatments for negative symptoms and cognitive dysfunction of schizophrenia. Neuroscience Bulletin. 2021;37:1609-24.\u003c/li\u003e\n\u003cli\u003eAfonso P, Figueira ML, Paiva T. Sleep\u0026ndash;wake patterns in schizophrenia patients compared to healthy controls. The World Journal of Biological Psychiatry. 2014;15(7):517-24.\u003c/li\u003e\n\u003cli\u003eFr\u0026ouml;hlich F, Lustenberger C. Neuromodulation of sleep rhythms in schizophrenia: Towards the rational design of non-invasive brain stimulation. Schizophrenia research. 2020;221:71-80.\u003c/li\u003e\n\u003cli\u003eWang W-L, Zhou Y-Q, Chai N-N, Li G-H. Sleep disturbance and quality of life in clinically stable inpatients with schizophrenia in rural China. Quality of Life Research. 2020;29:2759-68.\u003c/li\u003e\n\u003cli\u003eChen MH, Korenic SA, Wickwire EM, Wijtenburg SA, Hong LE, Rowland LM. Sex differences in subjective sleep quality patterns in schizophrenia. Behavioral sleep medicine. 2020;18(5):668-79.\u003c/li\u003e\n\u003cli\u003eChen ZT, Wang HT, Chueh KH, Liu IC, Yang CM. An exploration of the sleep quality and potential violence among patients with schizophrenia in community. Perspectives in psychiatric care. 2021;57(2):648-54.\u003c/li\u003e\n\u003cli\u003eCarruthers SP, Lee SJ, Sankaranarayanan A, Sumner PJ, Toh WL, Tan EJ, et al. Psychosis and hopelessness mediate the relationship between reduced sleep and suicidal ideation in schizophrenia spectrum disorders. Archives of suicide research. 2022;26(4):1862-79.\u003c/li\u003e\n\u003cli\u003eChong BTW, Wahab S, Muthukrishnan A, Tan KL, Ch\u0026rsquo;ng ML, Yoong MT. Prevalence and factors associated with suicidal ideation in institutionalized patients with schizophrenia. Psychology research and behavior management. 2020:949-62.\u003c/li\u003e\n\u003cli\u003eMeltzer HY. Treatment of suicidality in schizophrenia. Annals of the New York Academy of Sciences. 2001;932(1):44-60.\u003c/li\u003e\n\u003cli\u003eLi SX, Lam SP, Zhang J, Yu MWM, Chan JWY, Chan CSY, et al. Sleep disturbances and suicide risk in an 8-year longitudinal study of schizophrenia-spectrum disorders. Sleep. 2016;39(6):1275-82.\u003c/li\u003e\n\u003cli\u003eChing CR, Hibar DP, Gurholt TP, Nunes A, Thomopoulos SI, Ab\u0026eacute; C, et al. What we learn about bipolar disorder from large‐scale neuroimaging: Findings and future directions from the ENIGMA Bipolar Disorder Working Group. Human brain mapping. 2022;43(1):56-82.\u003c/li\u003e\n\u003cli\u003eHaukvik UK, Gurholt TP, Nerland S, Elvs\u0026aring;shagen T, Akudjedu TN, Alda M, et al. In vivo hippocampal subfield volumes in bipolar disorder\u0026mdash;A mega‐analysis from The Enhancing Neuro Imaging Genetics through Meta‐Analysis Bipolar Disorder Working Group. Human brain mapping. 2022;43(1):385-98.\u003c/li\u003e\n\u003cli\u003eSteinan M, Scott J, Lagerberg T, Melle I, Andreassen O, Vaaler A, et al. Sleep problems in bipolar disorders: more than just insomnia. Acta Psychiatrica Scandinavica. 2016;133(5):368-77.\u003c/li\u003e\n\u003cli\u003eZangani C, Casetta C, Saunders AS, Donati F, Maggioni E, D\u0026rsquo;Agostino A. Sleep abnormalities across different clinical stages of Bipolar Disorder: A review of EEG studies. Neuroscience \u0026amp; Biobehavioral Reviews. 2020;118:247-57.\u003c/li\u003e\n\u003cli\u003eHensch T, Wozniak D, Spada J, Sander C, Ulke C, Wittekind DA, et al. Vulnerability to bipolar disorder is linked to sleep and sleepiness. Translational Psychiatry. 2019;9(1):294.\u003c/li\u003e\n\u003cli\u003eJackson A, Cavanagh J, Scott J. A systematic review of manic and depressive prodromes. Journal of affective disorders. 2003;74(3):209-17.\u003c/li\u003e\n\u003cli\u003eHarvey AG, Kaplan KA, Soehner AM. Interventions for sleep disturbance in bipolar disorder. Sleep medicine clinics. 2015;10(1):101-5.\u003c/li\u003e\n\u003cli\u003eBenard V, Etain B, Vaiva G, Boudebesse C, Yeim S, Benizri C, et al. Sleep and circadian rhythms as possible trait markers of suicide attempt in bipolar disorders: an actigraphy study. Journal of affective disorders. 2019;244:1-8.\u003c/li\u003e\n\u003cli\u003eMiller JN, Black DW. Bipolar disorder and suicide: a review. Current psychiatry reports. 2020;22:1-10.\u003c/li\u003e\n\u003cli\u003eGordovez FJA, McMahon FJ. The genetics of bipolar disorder. Molecular psychiatry. 2020;25(3):544-59.\u003c/li\u003e\n\u003cli\u003eMeyer N, Faulkner SM, McCutcheon RA, Pillinger T, Dijk D-J, MacCabe JH. Sleep and circadian rhythm disturbance in remitted schizophrenia and bipolar disorder: a systematic review and meta-analysis. Schizophrenia bulletin. 2020;46(5):1126-43.\u003c/li\u003e\n\u003cli\u003eLi M, Lang B. The effects of systematic psychological nursing on the sleep quality of schizophrenic patients with sleep disorders. American journal of translational research. 2021;13(6):7263.\u003c/li\u003e\n\u003cli\u003eAmini-Tehrani M, Nasiri M, Jalali T, Sadeghi R, Ghotbi A, Zamanian H. Validation and psychometric properties of suicide behaviors questionnaire-revised (SBQ-R) in Iran. Asian journal of psychiatry. 2020;47:101856.\u003c/li\u003e\n\u003cli\u003eRueda-Jaimes G, Castro-Rueda V, Rangel-Mart\u0026iacute;nez-Villalba A, Corzo-Casasadiego J, Moreno-Quijano C, Camacho P. Validity of the Suicide Behaviors Questionnaire-Revised in patients with short-term suicide risk. The European Journal of Psychiatry. 2017;31(4):145-50.\u003c/li\u003e\n\u003cli\u003eLaskemoen JF, Simonsen C, B\u0026uuml;chmann C, Barrett EA, Bjella T, Lagerberg TV, et al. Sleep disturbances in schizophrenia spectrum and bipolar disorders\u0026ndash;a transdiagnostic perspective. Comprehensive Psychiatry. 2019;91:6-12.\u003c/li\u003e\n\u003cli\u003eFreeman D, Sheaves B, Waite F, Harvey AG, Harrison PJ. Sleep disturbance and psychiatric disorders. The Lancet Psychiatry. 2020;7(7):628-37.\u003c/li\u003e\n\u003cli\u003eCohrs S. Sleep disturbances in patients with schizophrenia: impact and effect of antipsychotics. CNS drugs. 2008;22:939-62.\u003c/li\u003e\n\u003cli\u003eKrystal AD. Psychiatric disorders and sleep. Neurologic clinics. 2012;30(4):1389-413.\u003c/li\u003e\n\u003cli\u003eSylvia LG, Dupuy JM, Ostacher MJ, Cowperthwait CM, Hay AC, Sachs GS, et al. Sleep disturbance in euthymic bipolar patients. Journal of psychopharmacology. 2012;26(8):1108-12.\u003c/li\u003e\n\u003cli\u003eO\u0026rsquo;Rourke N, Heisel MJ, Canham SL, Sixsmith A, Team BS. Predictors of suicide ideation among older adults with bipolar disorder. PLoS One. 2017;12(11):e0187632.\u003c/li\u003e\n\u003cli\u003eDe Sousa A, Shah B, Shrivastava A. Suicide and schizophrenia: an interplay of factors. Current psychiatry reports. 2020;22:1-5.\u003c/li\u003e\n\u003cli\u003eMelle I, Ann Barrett E. Insight and suicidal behavior in first-episode schizophrenia. Expert review of neurotherapeutics. 2012;12(3):353-9.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"sleep pattern, schizophrenia, bipolar disorder, suicide","lastPublishedDoi":"10.21203/rs.3.rs-6016322/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6016322/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eDespite significant advances in medical science, bipolar disorder and schizophrenia remain among the most important psychiatric disorders of the current century. Suicide is a leading cause of death in them.\u003c/p\u003e\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eThis study aimed to examine and compare sleep patterns among patients with schizophrenia and bipolar disorder and their relationship to suicidal behaviour.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eThe statistical population of the research includes all patients with schizophrenia spectrum disorders and bipolar disorders who were referred to Farabi Hospital in Kermanshah for treatment during the years 2019\u0026ndash;2021. Data on 527 schizophrenia and 325 bipolar patients were collected through a census. Descriptive statistics methods of frequency, percentage, mean, and standard deviation were used. Also, a two-sample independent t-test and chi-square test were conducted. All analyses were done with SPSS-24 statistical software at an error level of 5%. Pittsburgh Sleep Quality Inquiry (PSQI) and Suicidal Behavior Questionnaire (SBQ-R) were used in this research.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eIn the current study, sleep quality and suicidal risk were correlated by type of psychiatric disorder. However, there was no statistically significant correlation between the two variables. According to these results, 129 patients with schizophrenia and 93 patients with bipolar disorder reported poor sleep quality. Also, the risk of suicidal behaviour was reported at a high level for 316 patients with schizophrenia and 169 patients with bipolar disorder.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eSleep disorders in people with schizophrenia and bipolar disorder need to be examined further, as early identification and treatment can positively affect a patient's prognosis and quality of life.\u003c/p\u003e","manuscriptTitle":"An investigation of the relationship between sleep patterns and suicidal tendencies in patients with schizophrenia and bipolar disorder","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-27 04:45:13","doi":"10.21203/rs.3.rs-6016322/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"764bcb28-4489-46b6-b84f-03e9b75d376d","owner":[],"postedDate":"February 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-03-25T07:08:10+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-27 04:45:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6016322","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6016322","identity":"rs-6016322","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}