Initial Low Levels of Suicidal Ideation Still Improve After Cognitive Behavioral Therapy for Insomnia in Regular Psychiatric Care

Overview

Journal Front Psychiatry

Specialty Psychiatry

Date 2021 Jul 15

PMID 34262491

Citations 2

Authors

Susanna Jernelov

Erik Forsell

Viktor Kaldo

Kerstin Blom

Affiliations

Soon will be listed here.

Abstract

Insomnia disorder is highly prevalent, and has been identified as a risk factor for many psychiatric problems, including depression, suicide ideation and suicide death. Previous studies have found that cognitive behavioral therapy for insomnia (CBT-I) reduce depression and suicidal ideation in samples with high levels of suicidal ideation. This study aims to investigate associations of CBT-I with suicidal ideation in a sample of 522 patients primarily seeking internet-delivered treatment for insomnia in regular psychiatric care. The sample had high pretreatment insomnia severity levels and a relatively high level of comorbid depression symptoms. Suicidal ideation levels were relatively low pretreatment but still improved significantly after CBT-I. Contrary to previous findings, the strongest predictor of changes in suicidal ideation were improvements in depressive symptoms, rather than improvements in insomnia. We conclude that suicidal ideation may not be a major problem in these patients primarily seeking treatment for insomnia, despite comorbid depressive symptoms, but that suicidal ideation still improves following CBT-i. Considering the increased risk for patients with untreated insomnia to develop depression, this finding is of interest for prevention of suicidal ideation.

Citing Articles

Associations between internet addiction and suicidal ideation in depressed adolescents: the mediating effect of insomnia as well as sex differences.

Liu L, Tian Y, Fan H, Wang J, Chen C, Liu Z BMC Psychiatry. 2024; 24(1):929.

PMID: 39695507 PMC: 11656905. DOI: 10.1186/s12888-024-06357-z.

Mediation effect of insomnia symptoms between positive psychotic like experiences and suicidal ideation among Lebanese young adults.

Farah N, Obeid S, Malaeb D, Haddad C, Fekih-Romdhane F, Hallit S BMC Psychiatry. 2023; 23(1):272.

PMID: 37081441 PMC: 10116113. DOI: 10.1186/s12888-023-04778-w.

References

Kang H, Bullman T, Smolenski D, Skopp N, Gahm G, Reger M . Suicide risk among 1.3 million veterans who were on active duty during the Iraq and Afghanistan wars. Ann Epidemiol. 2014; 25(2):96-100. DOI: 10.1016/j.annepidem.2014.11.020. View

Pigeon W, Funderburk J, Cross W, Bishop T, Crean H . Brief CBT for insomnia delivered in primary care to patients endorsing suicidal ideation: a proof-of-concept randomized clinical trial. Transl Behav Med. 2019; 9(6):1169-1177. DOI: 10.1093/tbm/ibz108. View

McCall W, Black C . The link between suicide and insomnia: theoretical mechanisms. Curr Psychiatry Rep. 2013; 15(9):389. PMC: 3791319. DOI: 10.1007/s11920-013-0389-9. View

Blom K, Jernelov S, Ruck C, Lindefors N, Kaldo V . Three-Year Follow-Up of Insomnia and Hypnotics after Controlled Internet Treatment for Insomnia. Sleep. 2016; 39(6):1267-74. PMC: 4863216. DOI: 10.5665/sleep.5850. View

Svanborg P, Asberg M . A new self-rating scale for depression and anxiety states based on the Comprehensive Psychopathological Rating Scale. Acta Psychiatr Scand. 1994; 89(1):21-8. DOI: 10.1111/j.1600-0447.1994.tb01480.x. View

Ballesio A, Aquino M, Feige B, Johann A, Kyle S, Spiegelhalder K . The effectiveness of behavioural and cognitive behavioural therapies for insomnia on depressive and fatigue symptoms: A systematic review and network meta-analysis. Sleep Med Rev. 2017; 37:114-129. DOI: 10.1016/j.smrv.2017.01.006. View

Blom K, Tarkian Tillgren H, Wiklund T, Danlycke E, Forssen M, Soderstrom A . Internet-vs. group-delivered cognitive behavior therapy for insomnia: A randomized controlled non-inferiority trial. Behav Res Ther. 2015; 70:47-55. DOI: 10.1016/j.brat.2015.05.002. View

Kroenke K, Spitzer R, Williams J . The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001; 16(9):606-13. PMC: 1495268. DOI: 10.1046/j.1525-1497.2001.016009606.x. View

Pigeon W, Britton P, Ilgen M, Chapman B, Conner K . Sleep disturbance preceding suicide among veterans. Am J Public Health. 2012; 102 Suppl 1:S93-7. PMC: 3496468. DOI: 10.2105/AJPH.2011.300470. View

10.

Ohayon M . Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev. 2003; 6(2):97-111. DOI: 10.1053/smrv.2002.0186. View

11.

Svanborg P, Ekselius L . Self-assessment of DSM-IV criteria for major depression in psychiatric out- and inpatients. Nord J Psychiatry. 2003; 57(4):291-6. DOI: 10.1080/08039480307281. View

12.

Titov N, Dear B, Nielssen O, Staples L, Hadjistavropoulos H, Nugent M . ICBT in routine care: A descriptive analysis of successful clinics in five countries. Internet Interv. 2018; 13:108-115. PMC: 6112100. DOI: 10.1016/j.invent.2018.07.006. View

13.

Ford D, Kamerow D . Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention?. JAMA. 1989; 262(11):1479-84. DOI: 10.1001/jama.262.11.1479. View

14.

Cheng P, Kalmbach D, Tallent G, Joseph C, Espie C, Drake C . Depression prevention via digital cognitive behavioral therapy for insomnia: a randomized controlled trial. Sleep. 2019; 42(10). PMC: 6783888. DOI: 10.1093/sleep/zsz150. View

15.

Trockel M, Karlin B, Taylor C, Brown G, Manber R . Effects of cognitive behavioral therapy for insomnia on suicidal ideation in veterans. Sleep. 2014; 38(2):259-65. PMC: 4288607. DOI: 10.5665/sleep.4410. View

16.

Bastien C, Vallieres A, Morin C . Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med. 2001; 2(4):297-307. DOI: 10.1016/s1389-9457(00)00065-4. View

17.

Mallon L, Broman J, Akerstedt T, Hetta J . Insomnia in sweden: a population-based survey. Sleep Disord. 2014; 2014:843126. PMC: 4052698. DOI: 10.1155/2014/843126. View

18.

Blom K, Jernelov S, Kraepelien M, Bergdahl M, Jungmarker K, Ankartjarn L . Internet treatment addressing either insomnia or depression, for patients with both diagnoses: a randomized trial. Sleep. 2014; 38(2):267-77. PMC: 4288608. DOI: 10.5665/sleep.4412. View

19.

Zuromski K, Cero I, Witte T . Insomnia symptoms drive changes in suicide ideation: A latent difference score model of community adults over a brief interval. J Abnorm Psychol. 2017; 126(6):739-749. DOI: 10.1037/abn0000282. View

20.

Bishop T, Walsh P, Ashrafioun L, Lavigne J, Pigeon W . Sleep, suicide behaviors, and the protective role of sleep medicine. Sleep Med. 2019; 66:264-270. DOI: 10.1016/j.sleep.2019.07.016. View