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

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.