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Sleep. 2015 Feb 1;38(2):259-65. doi: 10.5665/sleep.4410.

Effects of cognitive behavioral therapy for insomnia on suicidal ideation in veterans.

Author information

1
Sierra-Pacific Mental Illness Research, Education, and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA.
2
Stanford University School of Medicine, Palo Alto, CA.
3
Mental Health Services, U.S. Department of Veterans Affairs Central Office, Washington, DC.
4
Education Development Center, Inc., New York, NY.
5
Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.
6
Mental Illness Research, Education, and Clinical Center, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA.
7
Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA.

Abstract

OBJECTIVE:

To examine the effects of cognitive behavioral therapy for insomnia (CBT-I) on suicidal ideation among Veterans with insomnia.

DESIGN:

Longitudinal data collected in the course of an uncontrolled evaluation of a large-scale CBT-I training program.

SETTING:

Outpatient and residential treatment facilities.

PARTICIPANTS:

Four hundred five Veterans presenting for treatment of insomnia.

INTERVENTIONS:

Cognitive behavioral therapy for insomnia (CBT-I).

MEASUREMENT AND RESULTS:

At baseline, 32% of patients, compared with 21% at final assessment, endorsed some level of suicidal ideation [χ(2)(df = 1) = 125; P < 0.001]. After adjusting for demographic variables and baseline insomnia severity, each 7-point decrease in Insomnia Severity Index (ISI) score achieved during CBT-I treatment was associated with a 65% (OR = 0.35; 95% CI = 0.24 to 0.52) reduction in odds of suicidal ideation. The effect of change in insomnia severity on change in depression severity was also significant. After controlling for change in depression severity and other variables in the model, the effect of change in insomnia severity on change in suicidal ideation remained significant.

CONCLUSION:

This evaluation of the largest dissemination of CBT-I in the United States found a clinically meaningful reduction in suicidal ideation among Veterans receiving CBT-I. The mechanisms by which effective treatment of insomnia with CBT-I reduces suicide risk are unknown and warrant investigation. The current results may have significant public health implications for preventing suicide among Veterans.

KEYWORDS:

Veterans; cognitive behavioral therapy; dissemination; insomnia, suicidal ideation

PMID:
25515115
PMCID:
PMC4288607
DOI:
10.5665/sleep.4410
[Indexed for MEDLINE]
Free PMC Article

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