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In this issue: Preventing Suicide among Veterans
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March 2021

Improving Sleep to Reduce Suicide Risk among At-Risk Veterans

Feature Article


Takeaway: This study will establish the feasibility and effectiveness of treating insomnia in the primary care environment as a suicide prevention strategy.


Insomnia – the most common sleep disorder among Veterans – is both a risk factor for suicide and highly prevalent among conditions associated with suicide, such as depression and PTSD, which also are prevalent among Veterans. This clinical trial will build upon HSR&D-funded pilot work that demonstrated the feasibility of delivering a brief version of cognitive-behavioral therapy for insomnia (CBT-I) within primary care to Veterans experiencing insomnia. The next stage of this research is to establish the feasibility of delivering a brief, primary care-based, insomnia intervention utilizing primary care-mental health integration (PC-MHI) clinicians (as opposed to research staff), and to establish the effectiveness of the intervention on reducing the severity of factors that contribute to suicide risk and to improve other clinical markers in a definitive trial.

This ongoing study (January 2019 – June 2023) includes a clinical trial to test whether (and how) using brief behavioral insomnia treatment can not only improve sleep, but reduce other risk factors for suicide including the severity of depression, PTSD, and suicidal ideation among Veterans at risk for suicide. Secondary objectives are to:

  • Gather initial data on barriers and facilitators to implementation to aid future implementation efforts in VA primary care, and
  • Determine if the intervention improves attitudes towards psychotherapy treatments that address comorbid conditions.

Methods

Investigators are conducting a randomized clinical trial among 240 Veterans recruited from primary care clinics at three VA healthcare facilities who are experiencing either co-occurring depression or PTSD. These Veterans, who experienced suicidal ideation and insomnia, will be randomized to receive either a brief course of CBT-I or a sleep hygiene intervention of similar length. Assessments of suicidal thoughts and behaviors, insomnia, depression, and PTSD will be conducted at baseline, post-treatment, and every six weeks thereafter until six months post-treatment. Investigators will then determine how improvements in sleep and other symptoms (e.g. depression, PTSD) contribute to reductions in the severity of suicidal ideation. In addition, they will assess barriers and facilitators of intervention implementation in real-world clinical practice.

Findings

None to report at this time.

Anticipated Impact

By treating insomnia, a common problem that is both a risk factor for suicide and highly prevalent in common conditions associated with suicide such as depression and PTSD, findings from this study are expected to reduce the severity of suicidal ideation among Veterans, insomnia and a co-occurring condition.

Principal Investigator: Wilfred Pigeon, PhD, is Executive Director of VA’s Center of Excellence for Suicide Prevention in Canandaigua, NY.

Publications

None to report at this time.

View study abstract

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