A digital cognitive behavioral therapy for insomnia (CBTI) was found to decrease risk for suicidal ideation (SI) among patients with insomnia, according to results of a study presented at the 36th Annual Meeting SLEEP 2022, held from June 4 to 8, 2022 in Charlotte, North Carolina.

Insomnia disorder has been associated with increased risk for suicidal thoughts and behaviors. Therapeutics for insomnia have been associated with suicide risk mitigation, but to date it remains unclear whether a digital CBTI may also be an effective mitigation strategy.

Community dwelling adults (N=658) with insomnia were recruited at the Henry Ford Health System for this single-site, randomized controlled trial. Study participants received either CBTI or attention control. The primary outcome was reduction in SI among patients who endorsed SI at baseline and the secondary outcome was reduction in SI among those without a history of SI.


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At baseline, 126 patients endorsed SI.

Among the subset of individuals who self-reported SI at baseline, 30.0% still reported SI following CBTI compared with 54.5% of those who received attention control (odds ratio [OR], 2.81; P =.006).

For the subset of patients without baseline SI (n=532), CBTI was not associated with decreased SI (P =.681).

CBTI was associated with an OR of 6.29 for insomnia remission compared with controls. The effect of CBTI on SI reduction was mediated by CBTI-associated insomnia remission (β-3.13; 95% CI, -5.28 to -0.96).

Despite no overall risk reduction for SI among those without baseline SI, a multivariate logistic regression found that posttreatment remission status indicated that this patient population had decreased SI risk following CBTI intervention (OR, 5.68; P =.007).

The study authors concluded, “Digital CBTI reduces risk for SI development in insomnia patients without pretreatment SI. These data support a role for digital insomnia therapeutics in SI prevention in this high-risk patient population. Moreover, digital CBTI reduces SI in insomnia patients with SI. These data indicate that digital CBTI can alleviate SI, but it [is] possible that adjunct treatment directly targeting SI may enhance suicide risk reduction.”

Reference

Kalmbach D, Cheng P, Reffi A, et al. Cognitive-behavioral therapy for insomnia alleviates and prevents suicidal ideation. Presented at SLEEP 2022; June 4-8; Charlotte, North Carolina. Abstract 682.