EFFECTS OF CBT FOR INSOMNIA ON SUICIDAL IDEATION IN VETERANS
Effects of Cognitive Behavioral Therapy for Insomnia on Suicidal Ideation in Veterans
Mickey Trockel, MD, PhD1,2; Bradley E. Karlin, PhD, ABPP3,4,5; C. Barr Taylor, MD2; Gregory K. Brown, PhD6,7; Rachel Manber, PhD1,2
1Sierra-Pacific Mental Illness Research, Education, and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; 2Stanford University School of Medicine, Palo Alto, CA; 3Mental Health Services, U.S. Department of Veterans Affairs Central Office, Washington, DC; 4Education Development Center, Inc., New York, NY; 5Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; 6Mental Illness Research, Education, and Clinical Center, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA; 7Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
To examine the effects of cognitive behavioral therapy for insomnia (CBT-I) on suicidal ideation among Veterans with insomnia.
Longitudinal data collected in the course of an uncontrolled evaluation of a large-scale CBT-I training program.
Outpatient and residential treatment facilities.
Four hundred five Veterans presenting for treatment of insomnia.
Cognitive behavioral therapy for insomnia.
Measurement and Results:
At baseline, 32% of patients, compared with 21% at final assessment, endorsed some level of suicidal ideation [χ2(df = 1) = 125; P < 0.001]. After adjusting for demographic variables and baseline insomnia severity, each 7-point decrease in Insomnia Severity Index score achieved during CBT-I treatment was associated with a 65% (odds ratio = 0.35; 95% confidence intervals = 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.
This evaluation of the largest dissemination of cognitive behavioral therapy for insomnia (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.
Trockel M, Karlin BE, Taylor CB, Brown GK, Manber R. Effects of cognitive behavioral therapy for insomnia on suicidal ideation in veterans. SLEEP 2015;38(2):259–265.