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.
Highlights
Insomnia is a very common problem, with around 11% of the general population fulfilling criteria for a diagnosis of insomnia disorder [1, 2]
It has been shown that cognitive behavioral therapy for insomnia (CBT-I) may alleviate depression [11], for those patients suffering from both diagnoses [12]
We aimed at investigating the prevalence of depression and suicidal ideation in consecutive patients with insomnia receiving internet-delivered CBT-I within psychiatric care, whether depressive symptoms and suicidal ideation improved with treatment, and the nature of the associations between changes in suicidal ideation, symptoms of depression, and symptoms of insomnia during internet-delivered CBT-I
Summary
Insomnia is a very common problem, with around 11% of the general population fulfilling criteria for a diagnosis of insomnia disorder [1, 2]. A limited number of recent studies have shown that suicidal ideations can improve with treatment of insomnia with CBT-I in veterans [13, 14]. Routines for getting daylight and exercise during the day and creating bed-time routines for consistency and winding down before going to bed Acceptance, mindfulness, attitudes and expectations about sleep Cognitive reappraisal and behavioral experiments focused on thoughts, rumination and worry about sleep Information and exercises about sleep hygiene such as avoiding caffeine later in the day, not drinking alcohol close to bedtime, keeping your bedroom cool and dark, and not having heavy meals at night Additional materials for working more with mindfulness, acceptance and cognitive reappraisal Summary, plan for the future and relapse prevention if necessary, the patient comes to the clinic for a face-toface assessment
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