Brief Cognitive Behavioral Insomnia Treatment for Primary Care Veterans at Elevated Risk for Suicide: A Randomized...

Many patients at risk for suicide present in primary care (PC) where insomnia and other suicide risk factors are prevalent. Addressing insomnia in this milieu may augment suicide prevention strategies.

A randomized clinical trial was conducted to test the effectiveness of brief cognitive behavioral therapy for insomnia (bCBTi) for PC patients at risk for suicide recruited from three US Veterans Health Administration practices. The 194 participants (77% male; mean age 51.5 ± 13.6 years) with insomnia, co-occurring depression and/or posttraumatic stress disorder (PTSD) and recent death or suicide ideation, were randomized to receive four 30-min sessions of bCBTi or sleep hygiene over 6 weeks. Blinded assessments occurred every 6 weeks from baseline to 30 weeks. Change in Insomnia Severity Index (ISI) across 30 weeks was the primary outcome with co-secondary outcomes measured by the Scale for Suicidal Ideation (SSI), Patient Health Questionnaire-9 (PHQ-9), and PTSD Checklist (PCL).

Mixed-level modeling showed a significant condition effect at post-treatment (6 weeks) for ISI favoring bCBTi (t[df] = -4.58 [153]; p < 0.0001) which was maintained through 30 weeks (t[df] = 0.35 [141]; p > 0.05). PHQ-9 was lower at 6 weeks in the bCBTi condition (t[df] = -2.07 [155]; p = 0.04) maintained through 30 weeks (t[df] = -0.47 [137]; p > 0.05). No PCL differences and no difference in SSI at post-treatment. However, a significant time × condition effect from 6 to 30 weeks existed for SSI favoring bCBTi (t[df] = -2.60 [118]; p = 0.01).

The bCBTi intervention designed for PC settings effectively reduces insomnia severity with modest effects for depression and suicidal thoughts, offering an adjuvant to suicide prevention strategies.