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CBT reduces suicidal ideation among veterans treated for insomnia
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Veterans who underwent cognitive behavioral therapy for insomnia also exhibited reduced suicidal ideation, according to data published in Sleep.
“It was striking to see that the reduction in insomnia severity was associated with reduced suicidal ideation even after controlling for improvement in depression severity,” researcher Bradley Karlin, PhD, ABPP, Chief of Mental Health and Aging at the Education Development Center, Inc. in New York, said in a press release. “The results suggest that effective treatment of insomnia with [cognitive behavioral therapy for insomnia] is an important target for reducing suicide risk among veterans and others at risk for suicide.”
Bradley Karlin
Karlin and colleagues collected longitudinal data of 405 veterans (mean age, 52 years) who underwent cognitive behavioral therapy for insomnia (CBT-I) in outpatient and residential treatment institutions.
At baseline, 32% of patients (n = 128) reported suicidal ideation compared with 21% of patients (n = 86) at the conclusion of the study (P < .001), representing a 33% reduction of suicidal ideation during CBT-I, according to data.
The researchers also reported a 68% decreased odds of suicidal ideation, associated with each 10-point decrease in modified Beck Depression Inventory-II scores from baseline to the final assessment (P < .001). Additional data show a 142% increased odds for suicidal ideation, associated with each 10-point increase (P < .001), researchers wrote.
These findings suggest that CBT-I may potentially benefit a larger number of veterans, the researchers concluded. – by Samantha Costa
Disclosure: This study was supported by Mental Health Services, U.S. Department of Veterans Affairs Central Office. Karlin reports affiliations with the Education Development Center, Inc., and the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University. Please see the full study for a list of all other authors’ relevant financial disclosures.
Perspective
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Timothy I. Morgenthaler, MD
This important study by Trockel and colleagues emphasizes that the dedicated service of our men and women in in uniform comes with a higher price than deployment expenses alone. Over 2.5 million US servicemen and women have been deployed to Iraq or Afghanistan, and approximately 48,000 of those returning were obviously injured. Beyond that, our veterans are at high risk for substance misuse, depression, anxiety, and adjustment problems—and significant sleep problems affect as many as 40% of them.
There is increasing evidence of a link between insomnia and suicide. This study has important findings: nearly one-third of the veterans with insomnia complaints had suicidal ideation. Treating their insomnia with cognitive-behavioral therapy for insomnia (CBT-I), interventions that do not rely on medications—resulted in a 33% reduction in suicidal ideation, and a 50% or greater improvement in insomnia severity.
The implications are clear. First, insomnia is not benign. It clearly reduces the quality of life, and it appears linked with not only depression and suicide as well. Secondly, treatment helps both insomnia and suicidal ideation. Thirdly, our veterans need access to sleep specialists and others who can help deliver CBT-I. This problem is not one for the VA medical system only. The reality is that the VA cares for less than half of all US veterans, and the VA has recently demonstrated significant difficulties in caring for the 40% of veterans currently enrolled in the VA healthcare system. Over 1 million service men and women will likely separate from military service in the coming years. It is and will be increasingly common for OIF/OEF veterans to seek care outside of the VA system.
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