1
|
Hoopsick RA, Yockey RA. A national examination of suicidal ideation, planning, and attempts among United States adults: Differences by military veteran status, 2008-2019. J Psychiatr Res 2023; 165:34-40. [PMID: 37459776 DOI: 10.1016/j.jpsychires.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 09/03/2023]
Abstract
There is a widening disparity in suicide deaths between United States (U.S.) military veterans and nonveterans. However, it is unclear if there are similar differences in suicidal ideation, planning, and attempts that often precipitate these deaths. A better understanding of trends in suicidal thoughts and behaviors could illuminate opportunities for prevention. We examined pooled cross-sectional data (N = 479,801 adults) from the 2008 to 2019 National Survey on Drug Use and Health. We examined differences in past-year suicidal ideation, suicide planning, and suicide attempts between U.S. veterans (n = 26,508) and nonveterans (n = 453,293). We conducted post hoc analyses to examine for differences in these relationships by race/ethnicity and sex. Lastly, we examined trends in these outcomes over time and tested for differences in trends by veteran status. Overall, veterans had significantly greater odds of past-year suicidal ideation (aOR = 1.33, 95% CI 1.20 to 1.47) and suicide planning (aOR = 1.52, 95% CI 1.30 to 1.78) compared to nonveterans. However, the association between veteran status and past-year suicide attempt was not statistically significant (aOR = 1.29, 95% CI 1.00 to 1.68). These relationships did not differ by race/ethnicity or sex (ps > 0.05). Among all adults, there were significant linear increases in past-year suicidal ideation, planning, and attempts (ps < 0.001). However, these trends did not differ between veterans and nonveterans (ps > 0.05). Veterans may be more likely to experience suicidal thoughts and behaviors than nonveteran adults. Upward trends in suicidal thoughts and behaviors among both veterans and nonveterans from 2008 to 2019 highlight opportunities for intervention.
Collapse
Affiliation(s)
- Rachel A Hoopsick
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, 1206 S. Fourth St., 2017 Khan Annex, Huff Hall, Champaign, IL, 61820, USA.
| | - R Andrew Yockey
- Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, School of Public Health, 709C, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA.
| |
Collapse
|
2
|
Li S, Liu S, Zhang P, Lin Y, Cui Y, Gu Y, Wang J, Liu Z, Zhang B. Suicidal ideation in the general population in China after the COVID-19 pandemic was initially controlled. J Affect Disord 2023; 323:834-840. [PMID: 36529410 PMCID: PMC9754752 DOI: 10.1016/j.jad.2022.12.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 11/06/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The COVID-19 pandemic increases the risk of psychological problems including suicidal ideation (SI) in the general population. In this study, we investigated the risk factors of SI after the COVID-19 pandemic was initially controlled in China. METHODS We conducted an online questionnaire via JD Health APP in China in June 2020. Demographic data, feelings and experiences related to the COVID-19 pandemic and psychological problems were collected. The participants (n = 14,690) were divided into the non-SI and SI groups. A binary logistic regression analysis was used to examine the correlates of SI. RESULTS Nine percent of the participants (1328/14690) reported SI. The regression analysis showed that SI was positively associated with ethnic minority (OR = 1.42 [1.08-1.85]), age (e.g. 18-30 years: OR = 2.31 [1.67-3.20]), having history of mental disorders (OR = 2.75 [2.27-3.35]), daily life disturbance due to health problems (OR = 1.67 [1.38-2.01]), being around someone with the COVID-19 (OR = 1.58 [1.30-1.91]), being uncertain about effective disease control (OR = 1.23 [1.03-1.46]), and having depressive symptoms (OR = 4.40 [3.59-5.39]), insomnia symptoms (OR = 2.49 [2.13-2.90]) or psychological distress (OR = 1.87 [1.59-2.18]). LIMITATIONS The main limitation is that the cross-sectional design of this study could not allow us to further explore the causality of SI. CONCLUSIONS The prevalence of SI was relatively high in general population after the COVID-19 pandemic was initially controlled in China. SI should be monitored continually after the COVID-19 pandemic.
Collapse
Affiliation(s)
- Shuangyan Li
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China; Guangdong - Hong Kong - Macao Greater Bay Area Center for Brain Science and Brain - Inspired Intelligence, Southern Medical University, Guangzhou, China
| | - Shuai Liu
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China; Guangdong - Hong Kong - Macao Greater Bay Area Center for Brain Science and Brain - Inspired Intelligence, Southern Medical University, Guangzhou, China
| | - Puxiao Zhang
- First Clinical Medical College, Xinjiang Medical University, Urumqi, China
| | - Yanmei Lin
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China; Guangdong - Hong Kong - Macao Greater Bay Area Center for Brain Science and Brain - Inspired Intelligence, Southern Medical University, Guangzhou, China
| | - Yingru Cui
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China; Guangdong - Hong Kong - Macao Greater Bay Area Center for Brain Science and Brain - Inspired Intelligence, Southern Medical University, Guangzhou, China
| | - Yue Gu
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China; Guangdong - Hong Kong - Macao Greater Bay Area Center for Brain Science and Brain - Inspired Intelligence, Southern Medical University, Guangzhou, China
| | - Jiajia Wang
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China; Guangdong - Hong Kong - Macao Greater Bay Area Center for Brain Science and Brain - Inspired Intelligence, Southern Medical University, Guangzhou, China
| | - Zhongchun Liu
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Bin Zhang
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China; Guangdong - Hong Kong - Macao Greater Bay Area Center for Brain Science and Brain - Inspired Intelligence, Southern Medical University, Guangzhou, China.
| |
Collapse
|
3
|
Kramer EB, Gaeddert LA, Jackson CL, Hostetter TA, Forster JE, Nazem S. The association among insomnia symptom severity, comorbid symptoms, and suicidal ideation in two veteran cohorts meeting diagnostic criteria for insomnia disorder. J Clin Psychol 2023; 79:1420-1433. [PMID: 36696685 DOI: 10.1002/jclp.23488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 12/15/2022] [Accepted: 01/10/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Examine the association between insomnia symptom severity and suicidal ideation (SI), after adjusting for clinical comorbidity in veterans meeting diagnostic criteria for insomnia disorder. METHODS Secondary data analyses of psychometrically validated baseline assessments of depression, posttraumatic stress disorder (PTSD), and anxiety symptoms from two online insomnia intervention randomized clinical trials (n = 232; n = 80) were conducted. Multiple linear regression was used to determine the association between insomnia symptom severity and SI, after controlling for clinical comorbidity and demographics. RESULTS Insomnia symptom severity was significantly correlated with comorbid depression, PTSD, and anxiety symptoms in both cohorts and significantly correlated with SI in one. After controlling for demographics and clinical comorbidity, insomnia symptom severity was not significantly associated with SI in linear regression models. CONCLUSION Findings extend insomnia-suicide research by providing evidence that insomnia symptom severity may not confer a unique risk for SI above comorbid mental health symptoms in veterans meeting diagnostic criteria for insomnia disorder.
Collapse
Affiliation(s)
- Emily B Kramer
- U.S. Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, Colorado, USA
| | - Laurel A Gaeddert
- U.S. Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, Colorado, USA
| | - Christine L Jackson
- U.S. Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, Colorado, USA
| | - Trisha A Hostetter
- U.S. Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, Colorado, USA
| | - Jeri E Forster
- U.S. Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, Colorado, USA.,Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Sarra Nazem
- U.S. Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, Colorado, USA.,U.S. Department of Veterans Affairs, National Center for PTSD, Dissemination & Training Division, Menlo Park, California, USA
| |
Collapse
|
4
|
Kalmbach DA, Cheng P, Ahmedani BK, Peterson EL, Reffi AN, Sagong C, Seymour GM, Ruprich MK, Drake CL. Cognitive-behavioral therapy for insomnia prevents and alleviates suicidal ideation: insomnia remission is a suicidolytic mechanism. Sleep 2022; 45:zsac251. [PMID: 36242607 PMCID: PMC9742891 DOI: 10.1093/sleep/zsac251] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/21/2022] [Indexed: 11/11/2022] Open
Abstract
STUDY OBJECTIVES Insomnia is associated with elevated levels of suicidal thoughts and behaviors. Emerging evidence suggests that cognitive-behavioral therapy for insomnia (CBTI) may reduce suicidal ideation (SI). However, the role of digital therapeutics in both the alleviation and prevention of SI remains unclear, and treatment mechanisms facilitating SI reductions have not been clearly identified. METHODS A total of 658 adults with Diagnostic and Statistical Manual of Mental Disorders, 5th Edition insomnia disorder enrolled in a single-site randomized controlled trial evaluating the efficacy of digital CBTI relative to attention control. Outcomes were measured at pretreatment, posttreatment, and 1-year follow-up. RESULTS Before treatment, 126 patients endorsed SI (19.1% prevalence). Among those with baseline SI, CBTI patients reported lower SI rates at posttreatment (30.0% vs 54.5%, p = .005) and 1-year follow-up (29.6% vs 46.8%, p = .042) relative to control. PRODCLIN analysis estimated that half of suicidolytic effects of CBTI were mediated through insomnia remission. Among those without baseline SI, CBTI did not directly prevent new onset SI. However, insomnia remitters reported lower rates of new-onset SI at posttreatment relative to non-remitters (1.5% vs 6.5%, p = .009). Mediation analysis supported a significant indirect effect wherein CBTI increased the likelihood of insomnia remission, which was associated with SI prevention (αβ = -3.20, 95% CI = -5.74 to -0.87). CONCLUSION Digital CBTI reduces insomnia symptoms, which promotes SI alleviation and prevention. For nonsuicidal patients, digital CBTI may serve as a highly accessible monotherapy for improving sleep, thereby reducing the risk for SI. For suicidal patients, digital CBTI may be appropriately administered as an adjunct treatment to support mainline intervention more directly targeting suicidogenic thoughts.
Collapse
Affiliation(s)
- David A Kalmbach
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA
| | - Philip Cheng
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA
| | - Brian K Ahmedani
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, USA
| | - Edward L Peterson
- Department of Public Health Services, Henry Ford Health System, Detroit, MI, USA
- Department of Epidemiology, Henry Ford Health System, Detroit, MI, USA
| | - Anthony N Reffi
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA
| | - Chaewon Sagong
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA
| | - Grace M Seymour
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA
| | - Melissa K Ruprich
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA
| | - Christopher L Drake
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA
| |
Collapse
|
5
|
Tubbs AS, Killgore WDS, Karp JF, Fernandez FX, Grandner MA. Insomnia and the Interpersonal Theory of suicide among civilians, service members, and veterans. J Psychiatr Res 2022; 155:534-541. [PMID: 36194991 DOI: 10.1016/j.jpsychires.2022.09.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/19/2022] [Accepted: 09/23/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Insomnia is associated with suicide risk in civilian and military populations. Thwarted belongingness is proposed as a mediator of this relationship under the Interpersonal Theory of Suicide (IPTS). The present study explored how insomnia relates to suicidal ideation in conjunction with thwarted belongingness among civilians, Service members, and Veterans. METHODS Data from the Military Suicide Research Consortium for N = 6556 individuals (6316 with non-missing suicidal ideation status) were divided into 4 subgroups: civilians, never deployed Service members, previously deployed Service members, and Veterans. Robust Poisson models evaluated the associations between insomnia severity/subtype and current suicidal ideation, with bootstrap mediation models assessing thwarted belongingness as a mediator. RESULTS A 5-point increase in insomnia severity was associated with a 38% increased risk for current suicidal ideation among civilians, a 56% greater risk among never deployed Service members, an 83% greater risk among previously deployed Service members, and a 37% greater risk among Veterans. Moreover, active Service members showed greater associations between difficulty falling asleep and staying asleep with suicidal ideation than civilians. These associations were independent of covariates and only mediated by thwarted belongingness among Veterans. CONCLUSIONS The relationship between insomnia and suicide is not purely explained by thwarted belongingness except among Veterans. Future research should explore additional psychological and neurobiological mechanisms connecting insomnia and suicidality.
Collapse
Affiliation(s)
- Andrew S Tubbs
- Department of Psychiatry, University of Arizona College of Medicine - Tucson, Tucson, AZ, 85724, USA.
| | - William D S Killgore
- Department of Psychiatry, University of Arizona College of Medicine - Tucson, Tucson, AZ, 85724, USA
| | - Jordan F Karp
- Department of Psychiatry, University of Arizona College of Medicine - Tucson, Tucson, AZ, 85724, USA
| | | | | |
Collapse
|
6
|
Valladares-Garrido MJ, Picón-Reátegui CK, Zila-Velasque JP, Grados-Espinoza P, Hinostroza-Zarate CM, Failoc-Rojas VE, Pereira-Victorio CJ. Suicide Risk in Military Personnel during the COVID-19 Health Emergency in a Peruvian Region: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13502. [PMID: 36294081 PMCID: PMC9603104 DOI: 10.3390/ijerph192013502] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/11/2022] [Accepted: 10/14/2022] [Indexed: 06/16/2023]
Abstract
Military personnel represent a frontline group exposed to multiple stressors. These factors have increased during the COVID-19 pandemic, predisposing to the development of suicidal risk (SR). Given the few studies conducted in this population, we evaluated the prevalence of SR and its associated factors during the health emergency. A cross-sectional survey study was conducted in person among 514 participants in Lambayeque, Peru in 2021. The outcome was SR, and the exposures were depression (PHQ-9), anxiety (GAD-7), PTSD (PCL-C), and other sociodemographic variables. The prevalence of SR was 14.0% (95% CI: 11.12-17.31%) and was significantly higher in people with a family history of mental health (PR: 2.16; 95% CI: 1.13-4.15) and in those with moderate clinical insomnia (PR: 2.21; 95% CI: 1.19-4.12). Military personnel with high resilience had a lower prevalence of SR (PR: 0.54, CI: 0.31-0.95). Anxiety was associated with a higher prevalence of SR (PR: 3.27; 95% CI: 1.76-6.10). Our findings show that at least 1 out of 10 military personnel are at risk of suicide. Special attention should be paid to the associated factors to develop interventions and reverse their consequences. These results may be useful in policy implementation and general statistics of SR in the local and regional context.
Collapse
Affiliation(s)
- Mario J. Valladares-Garrido
- South American Center for Education and Research in Public Health, Universidad Norbert Wiener, Lima 02002, Peru
- Epidemiology Office, Hospital Regional Lambayeque, Chiclayo 14000, Peru
| | | | - J. Pierre Zila-Velasque
- Facultad de Medicina Humana, Universidad Nacional Daniel Alcides Carrion, Pasco 19001, Peru
- Red Latinoamericana de Medicina en la Altitud e Investigación (REDLAMAI), Pasco 19001, Peru
| | - Pamela Grados-Espinoza
- Facultad de Medicina Humana, Universidad Nacional Daniel Alcides Carrion, Pasco 19001, Peru
- Red Latinoamericana de Medicina en la Altitud e Investigación (REDLAMAI), Pasco 19001, Peru
| | | | - Virgilio E. Failoc-Rojas
- Research Unit for Generation and Synthesis Evidence in Health, Universidad San Ignacio de Loyola, Lima 02002, Peru
| | | |
Collapse
|
7
|
Tubbs AS, Fernandez FX, Grandner MA, Perlis ML. Emerging evidence for sleep instability as a risk mechanism for nonsuicidal self-injury. Sleep 2022; 45:6572076. [PMID: 35446956 PMCID: PMC9189961 DOI: 10.1093/sleep/zsac095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Andrew S Tubbs
- Department of Psychiatry, University of Arizona College of Medicine–Tucson , Tucson, AZ , USA
| | | | - Michael A Grandner
- Department of Psychiatry, University of Arizona College of Medicine–Tucson , Tucson, AZ , USA
| | - Michael L Perlis
- Department of Psychiatry, University of Pennsylvania , Philadelphia, PA, USA
| |
Collapse
|
8
|
Lee H, Nam S, Choi Y, Son B. Effectiveness of herbal medicines for the treatment of insomnia in Korean military service members: a prospective pilot study. BMJ Mil Health 2022; 169:285-286. [PMID: 35131887 DOI: 10.1136/bmjmilitary-2021-002070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 01/16/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Hyeonhoon Lee
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, Korea (the Republic of)
| | - S Nam
- Department of Korean Medicine, 28th Division, Yangju, Korea (the Republic of)
| | - Y Choi
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Korea (the Republic of)
| | - B Son
- Department of Korean Medicine, Combined Dispensary, 7th Corps, Icheon, Korea (the Republic of)
| |
Collapse
|
9
|
Edinger JD, Arnedt JT, Bertisch SM, Carney CE, Harrington JJ, Lichstein KL, Sateia MJ, Troxel WM, Zhou ES, Kazmi U, Heald JL, Martin JL. Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. J Clin Sleep Med 2021; 17:263-298. [PMID: 33164741 DOI: 10.5664/jcsm.8988] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION The purpose of this systematic review is to provide supporting evidence for a clinical practice guideline on the use of behavioral and psychological treatments for chronic insomnia disorder in adult populations. METHODS The American Academy of Sleep Medicine commissioned a task force of 9 experts in sleep medicine and sleep psychology. A systematic review was conducted to identify randomized controlled trials that addressed behavioral and psychological interventions for the treatment of chronic insomnia disorder in adults. Statistical analyses were performed to determine if the treatments produced clinically significant improvements in a range of critical and important outcomes. Finally, the Grading of Recommendations Assessment, Development, and Evaluation process was used to evaluate the evidence for making specific treatment recommendations. RESULTS The literature search identified 1,244 studies; 124 studies met the inclusion criteria, and 89 studies provided data suitable for statistical analyses. Evidence for the following interventions is presented in this review: cognitive-behavioral therapy for insomnia, brief therapies for insomnia, stimulus control, sleep restriction therapy, relaxation training, sleep hygiene, biofeedback, paradoxical intention, intensive sleep retraining, and mindfulness. This review provides a detailed summary of the evidence along with the quality of evidence, the balance of benefits vs harms, patient values and preferences, and resource use considerations.
Collapse
Affiliation(s)
- Jack D Edinger
- National Jewish Health, Denver, Colorado.,Duke University Medical Center, Durham, North Carolina
| | - J Todd Arnedt
- Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Suzanne M Bertisch
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | | | - Eric S Zhou
- Harvard Medical School, Dana-Farber Cancer Institute, Boston Children's Hospital, Boston, Massachusetts
| | - Uzma Kazmi
- American Academy of Sleep Medicine, Darien, Illinois
| | | | - Jennifer L Martin
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California.,VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, California
| |
Collapse
|
10
|
Koffel E, Hagedorn H. Provider perspectives of implementation of an evidence-based insomnia treatment in Veterans Affairs (VA) primary care: barriers, existing strategies, and future directions. Implement Sci Commun 2020; 1:107. [PMID: 33292865 PMCID: PMC7706055 DOI: 10.1186/s43058-020-00096-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 11/19/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Cognitive behavioral therapy for insomnia (CBT-I) is a highly effective nonpharmacological intervention that is widely considered the gold standard for insomnia treatment. Insomnia is a prevalent and debilitating public health concern. Up to one third of the general population struggles with chronic insomnia, greatly increasing the risk for chronic pain and inflammation, depression and suicide, and cognitive decline. Over the last 10 years, the Veterans Health Administration (VHA) evidence-based psychotherapy training program has trained nearly 1000 providers to deliver CBT-I in hospitals and clinics nationwide. Despite increased access, most patients with insomnia receive sleeping medications instead of CBT-I. This is particularly concerning for vulnerable populations, like older adults, who may be at increased risk of harms from medications. The goal of this study was to obtain a broad range of perspectives on CBT-I implementation from providers who commonly utilize and deliver CBT-I. This work identifies barriers and successful strategies used to overcome these barriers to guide future implementation efforts promoting evidence-based sleep care. METHODS Semi-structured interviews, using the Consolidated Framework for Implementation Research (CFIR) as a guide, were conducted with 17 providers from five Veterans Affairs (VA) facilities (8 primary care physicians, 4 primary care psychologists, and 5 CBT-I coordinators). We used a thematic analysis approach in which common ideas were identified across interviews and then grouped into larger conceptual themes. Data were concurrently collected and analyzed with rapid assessment process (RAP) techniques. RESULTS Findings suggested implementation barriers and facilitators related to the CFIR constructs of intervention characteristic (e.g., providers unfamiliar with primary evidence of CBT-I effectiveness), inner setting (e.g., sleep as a low relative priority in primary care), and outer setting (e.g., lack of external incentives for increasing CBT-I use), as well as several successful strategies, including use of local champions and supportive opinion leaders. CONCLUSIONS These findings suggest promising opportunities to improve implementation of CBT-I, especially at facilities with less well-established CBT-I programs. Formal implementation trials are needed to systematically determine the real-world impact of strategies such as enlisting CBT-I champions, informing opinion leaders about CBT-I services, and promoting network weaving among primary care, mental health, and sleep clinics.
Collapse
Affiliation(s)
- Erin Koffel
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, One Veterans Drive, Minneapolis, MN, 55417, USA.
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Hildi Hagedorn
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, One Veterans Drive, Minneapolis, MN, 55417, USA
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA
| |
Collapse
|