Systematic review and meta-analysis of cognitive behavioral therapy for insomnia as a suicide prevention strategy

Insomnia is common and a modifiable risk factor for suicidal ideation and behaviors. Cognitive behavioral therapy for insomnia (CBT-I) is the recommended first-line treatment for insomnia, but its effect on suicidal ideation and behaviors remains unclear. Here we synthesize evidence from 19 randomized controlled trials ( N = 4,974 participants at baseline) on the effects of CBT-I on suicidal ideation severity, suicidal behaviors and suicide deaths in adults with insomnia. Compared with control conditions, CBT-I was associated with a 23% reduction in suicidal ideation severity post-intervention (ratio of means, 0.77; 95% confidence interval, 0.66–0.90; evidence certainty: high). The difference between CBT-I and control groups was unclear at follow-ups (evidence certainty: very low to moderate). Across nine trials, two CBT-I participants reported suicide attempts compared with none in control conditions. No suicide deaths occurred. CBT-I modestly reduces suicidal ideation severity, offering a potential adjunct to suicide prevention strategies.