期刊
TRANSLATIONAL BEHAVIORAL MEDICINE
卷 9, 期 6, 页码 1169-1177出版社
OXFORD UNIV PRESS
DOI: 10.1093/tbm/ibz108
关键词
Depression; Insomnia; Posttraumatic stress disorder; Primary care; Suicide; Veteran
资金
- Department of Veterans Affairs (VA) Office of Research Development [I21HX001473]
- VA Advanced Fellowship Program in Mental Health Illness Research and Treatment
- VA Center of Excellence for Suicide Prevention at the Canandaigua VA Medical Center
- Center for Integrated Healthcare at the Syracuse VA Medical Center
Insomnia co-occurs frequently with major depressive disorder (MDD) and posttraumatic stress disorder ( PTSD); all three conditions are prevalent among primary care patients and associated with suicidal ideation (SI). The purpose of the article was to test the effects of a brief cognitive behavioral therapy for insomnia (bCBTi) and the feasibility of delivering it to primary care patients with SI and insomnia in addition to either MDD and/or PTSD. Fifty-four patients were randomized to receive either bCBTi or treatment-as-usual for MDD and/or PTSD. The primary outcome was SI intensity as measured by the Columbia-Suicide Severity Rating Scale; secondary clinical outcomes were measured by the Insomnia Severity Index, Patient Health Questionnaire for depression, and PTSD Symptom Checklist. Effect sizes controlling for baseline values and sample size were calculated for each clinical outcome comparing pre-post differences between the two conditions with Hedge's g. The effect size of bCBTi on SI intensity was small (0.26). Effects were large on insomnia (1.91) and depression (1.16) with no effect for PTSD. There was a marginally significant (p =.069) effect of insomnia severity mediating the intervention's effect on SI. Findings from this proof-of-concept trial support the feasibility of delivering bCBTi in primary care and its capacity to improve mood and sleep in patients endorsing SI. The results do not support bCBTi as a stand-alone intervention to reduce SI, but this or other insomnia interventions may be considered as components of suicide prevention strategies.
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