1138 — Development, Results and Refinement of a Primary Care-Based Insomnia Intervention for Depressed Veterans with and without Suicidal Ideation

Pigeon WR, Center of Excellence for Suicide Prevention; Funderburk J, Center for Integrated Healthcare; Bishop TM, Center of Excellence for Suicide Prevention; Crean HF, Center of Excellence for Suicide Prevention;

Objectives:
Insomnia is associated with increased suicidal ideation (SI). Since insomnia, depression, and/or SI are frequently observed in Primary Care (PC), a brief form of cognitive-behavioral therapy for insomnia (CBT-I) was tested among Veterans receiving PC services who had insomnia and depression with and without SI.

Methods:
Twenty-seven participants were randomized to receive either CBT-I (n = 13) delivered in two, 30-40 minute, face-to-face sessions plus two, 15-20 minute phone sessions or sleep hygiene (SH; n = 14) delivered in one face-to-face plus one phone session. Repeated measures ANOVAs were used to test the effect of CBT-I on insomnia, depression and SI at post-treatment and 3-month follow-up.

Results:
Compared to SH, the brief CBT-I intervention had mostly large effects (Hedge's g's ranging from 0.79 to 1.11) on both insomnia severity and sleep diary measures of sleep continuity at post-treatment with moderate effects at the three month follow-up. Although Veterans in each condition experienced reductions in depression severity; there was no significant group by time interaction. At baseline 56% of the sample endorsed SI; this rate was 19% at post-treatment and 29% three months later. A Wilcoxon signed rank test, however, indicated no between group differences in SI rates. Quantitative and qualitative feedback from participants supported acceptability of the intervention and provided guidance for refining the program.

Implications:
Our study experience and the large post-treatment effects of brief CBT-I observed suggest that a brief PC-based insomnia intervention is feasible to deliver to Veterans with comorbid insomnia and depression. Despite improvements in sleep, overall levels of depression remained elevated, suggesting that additional treatment considerations are warranted. Interestingly, SH had greater than minimal treatment effects, suggesting that SH might be a useful stage in a stepped care approach. Finally, while underpowered to detect effects on SI outcomes, promising reductions in SI were observed.

Impacts:
An insomnia intervention that is brief in both frequency and duration of sessions is a promising approach to treating Veterans in PC who may be at increased risk for suicidal thoughts and behaviors due to co-occurring insomnia and depression