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Internet-Based Insomnia Intervention Shows Promise in Reducing Suicidal Ideation in Veterans

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A recent study has highlighted the potential of internet-delivered cognitive behavioural therapy for insomnia (iCBT-I) in alleviating symptoms of insomnia and suicidal ideation among veterans. The study, conducted by a team of researchers from several prestigious institutions, evaluated the effectiveness of an unguided iCBT-I programme called “Sleep Healthy Using the Internet” (SHUTi) in veterans who have a high risk of suicide. The findings were published in the journal Translational Behavioral Medicine.

The study focused on veterans from Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn who exhibited clinically significant insomnia and elevated levels of suicidal ideation. These participants were part of a larger randomised controlled trial (RCT) assessing SHUTi. The intervention aimed to examine whether the SHUTi programme could improve insomnia severity, suicidal ideation, and other associated correlates such as depression, post-traumatic stress disorder (PTSD), anxiety, hostility, and hopelessness.

The results revealed a significant improvement in insomnia severity among participants who used the SHUTi programme compared to those who were part of an Insomnia Education Website (IEW) control group. The SHUTi group experienced a large reduction in insomnia symptoms, with a robust effect size of -1.08, indicating substantial clinical improvement.

While the reduction in suicidal ideation in the SHUTi group was not statistically significant, the effect size was small to medium, suggesting a positive trend. Specifically, the SHUTi group showed a greater reduction in suicidal ideation scores compared to the IEW group, albeit not reaching statistical significance .

Moreover, the study found significant improvement in hopelessness among SHUTi participants, with a medium effect size. Other suicide risk correlates, including depression, PTSD symptoms, irritability, and concentration, also showed small to medium non-significant effect sizes favouring the SHUTi intervention. This suggests that while the changes were not statistically significant, they were clinically relevant and warrant further investigation.

These findings underscore the potential of digital health interventions in addressing sleep disturbances and reducing suicide risk among veterans. Insomnia is a well-documented risk factor for suicidal ideation and behaviours, making it a critical target for suicide prevention efforts. Traditional in-person cognitive behavioural therapy for insomnia (CBT-I) has proven effective, but its accessibility is often limited due to logistical barriers such as travel, scheduling conflicts, and the availability of trained clinicians.

Internet-based interventions like SHUTi offer a scalable and accessible alternative, allowing veterans to receive evidence-based treatment regardless of their geographic location or personal circumstances. This is particularly important for veterans, who may face unique challenges in accessing mental health care.

The study’s authors advocate for larger, well-powered RCTs to further explore the effectiveness of iCBT-I in reducing suicidal ideation and related risk factors. Future research should focus on understanding the mechanisms through which insomnia interventions may impact suicide risk and identifying the specific components of the intervention that are most beneficial.

It is crucial to examine the long-term effects of such interventions and their applicability across diverse populations. The current study’s sample was predominantly male, White, and non-Hispanic, highlighting the need for research involving more representative and varied cohorts.

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