Cognitive behavioral therapy for insomnia as a suicide prevention strategy: a protocol for a systematic review and...

Insomnia is a prevalent and debilitating sleep-wake disorder, with growing evidence indicating that it is an independent risk factor for suicidal ideation and behaviors. Cognitive behavioral therapy for insomnia is the recommended first-line treatment for chronic insomnia. However, its effect on suicidal ideation and behaviors in those with insomnia has not been well-characterized. Thus, the aim of the planned meta-analysis is to quantify the effects of cognitive behavioral therapy for insomnia on suicidal ideation, suicidal behaviors, and suicide deaths in adults with insomnia with and without comorbidities. This study will include randomized controlled trials comparing cognitive behavioral therapy for insomnia with a control condition with no presumed strong effect on insomnia in individuals with insomnia according to standardized diagnostic criteria or a clinically relevant screening score. Both published and unpublished randomized controlled trials will be retrieved through a systematic search in major databases and trial registries. The primary outcomes include suicidal ideation, suicidal behaviors, and suicide deaths, assessed post-treatment and at follow-ups. We will only consider randomized controlled trials reporting suicide-related outcomes and/or enrolling participants with suicidal ideation or behaviors. For continuous data, a random-effects meta-analysis will be conducted to estimate (standardized) mean differences. In the case of categorical data, a random-effects logistic regression meta-analysis model will be used. The risk of bias of the primary outcomes will be evaluated using the Cochrane Risk of Bias 2 tool. The certainty of evidence will be assessed using the Grading of Recommendations, Assessment, Development and Evaluation framework. Systematic review registration: PROSPERO-ID CRD420250628820.