title: Effects of cognitive behavioral therapy for insomnia on suicidal ideation in veterans.
abstract: OBJECTIVE
  To examine the effects of cognitive behavioral therapy for insomnia (CBT-I) on suicidal ideation among Veterans with insomnia.
  
  
  METHODS
  Longitudinal data collected in the course of an uncontrolled evaluation of a large-scale CBT-I training program.
  
  
  METHODS
  Outpatient and residential treatment facilities.
  
  
  METHODS
  Four hundred five Veterans presenting for treatment of insomnia.
  
  
  METHODS
  Cognitive behavioral therapy for insomnia (CBT-I).
  
  
  RESULTS
  At baseline, 32% of patients, compared with 21% at final assessment, endorsed some level of suicidal ideation [χ(2)(df = 1) = 125; P < 0.001]. After adjusting for demographic variables and baseline insomnia severity, each 7-point decrease in Insomnia Severity Index (ISI) score achieved during CBT-I treatment was associated with a 65% (OR = 0.35; 95% CI = 0.24 to 0.52) reduction in odds of suicidal ideation. The effect of change in insomnia severity on change in depression severity was also significant. After controlling for change in depression severity and other variables in the model, the effect of change in insomnia severity on change in suicidal ideation remained significant.
  
  
  CONCLUSIONS
  This evaluation of the largest dissemination of CBT-I in the United States found a clinically meaningful reduction in suicidal ideation among Veterans receiving CBT-I. The mechanisms by which effective treatment of insomnia with CBT-I reduces suicide risk are unknown and warrant investigation. The current results may have significant public health implications for preventing suicide among Veterans.
authors.affiliation: Sierra-Pacific Mental Illness Research, Education, and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA.|Stanford University School of Medicine, Palo Alto, CA.
authors.forename: Mickey
authors.initials: M
authors.lastname: Trockel
authors.affiliation: Mental Health Services, U.S. Department of Veterans Affairs Central Office, Washington, DC.|Education Development Center, Inc., New York, NY.|Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.
authors.forename: Bradley E
authors.initials: BE
authors.lastname: Karlin
authors.affiliation: Stanford University School of Medicine, Palo Alto, CA.
authors.forename: C Barr
authors.initials: CB
authors.lastname: Taylor
authors.affiliation: Mental Illness Research, Education, and Clinical Center, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA.|Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Gregory K
authors.initials: GK
authors.lastname: Brown
authors.affiliation: Sierra-Pacific Mental Illness Research, Education, and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA.|Stanford University School of Medicine, Palo Alto, CA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Manber
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015928:Cognitive Behavioral Therapy; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D059020:Suicidal Ideation; D013405:Suicide / Q000523:psychology*; D016896:Treatment Outcome; D014481:United States; D014728:Veterans / Q000523:psychology*; D055815:Young Adult; D000092864:Suicide Prevention
keywords: Veterans; cognitive behavioral therapy; dissemination; insomnia, suicidal ideation