Abstract
Objective: To evaluate the effectiveness of Cognitive Behavioral Therapy for Insomnia in reducing suicidal behavior, associated with improvement in depressive symptoms. Methods: Randomized clinical trial in 2 groups: Group A whose therapeutic protocol included only medication and Group B: whose protocol included medication and TCCi lasting 8 weeks. Results: To our knowledge, this was the first clinical trial aiming to test the effectiveness of CBT in reducing the risk of suicide in patients with depression and insomnia. The findings contributed to the understanding of therapeutic effects in the management of depression and insomnia, and risk behaviors, and could help guide the development of new care protocols aimed at clinical and pharmacological support in reducing the risk of suicide. Conclusion: The work presents significant results that can guide a new intervention to reduce suicide cases, with practical possibilities of carrying out drug intervention associated with psychotherapy in the public health network, contributing to improving the effectiveness of patient treatment.
References
BACKHAUS J, et al. Eficácia a longo prazo de um tratamento de grupo cognitivo-comportamental de curto prazo para insônia primária. Eur. Arch. Psychiatry Clin. Neurosci., 2001; 251(1): 35-41.
BASTIEN CH, et al. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med., 2001; 2(4): 297-307.
BLOM K, et al. Acompanhamento de três anos comparando terapia cognitivo-comportamental para depressão com terapia cognitivo-comportamental para insônia, para pacientes com ambos os diagnósticos. Dorme, 2017; 40(8).
BUYSSE DJ, et al. Recommendations for a standard research assessment of insomnia. Sleep, 2006; 29: 1155-73.
BUYSSE DJ, et al. Eficácia do tratamento comportamental breve para insônia crônica em adultos mais velhos. Arch. Intern. Med., 2011; 171(10): 887-895.
DOLSEN MR, et al. Suicidal ideation and suicide attempts: associations with sleep duration, insomnia, and inflammation. Psychol. Med., 2020.
EIKELENBOOM M, et al. Um estudo longitudinal de 6 anos de preditores para tentativas de suicídio no transtorno depressivo maior. Psychol. Med., 2018; 49(6): 911-921.
FOLSTEIN MF, et al. Mini-mental state: A practical method for grading the cognitive state of patients for the clinician. J. Psychiatry. Res., 1975; 12: 189-198.
GEIGER-BROWN JM, et al. Cognitive behavioral therapy in persons with comorbid insomnia: A meta-analysis. Sleep Med. Rev., 2015; 23: 54-67.
HARRIS LM, et al. Sleep disturbances as risk factors for suicidal thoughts and behaviors: a meta-analysis of longitudinal studies. Sci. Rep., 2020; 10(1): 13888.
LAU JW, et al. The association between baseline insomnia symptoms and future suicide attempts within an intensive outpatient treatment program for suicide. Psychiatry Res., 2020; 287: 112527.
LAVIGNE JE, et al. Prescription medications for the treatment of insomnia and risk of suicide attempt: a comparative safety study. J. Gen. Intern. Med., 2019 ; 34(8): 1554-1563.
MASSAD E, et al. Métodos quantitativos em medicina. São Paulo: Editora Manole Ltda.; 2004.
MORIN CM, et al. Chronic insomnia. Lancet, 2012; 379: 1129-1141.
MORIN CM, et al. Intervenções não farmacológicas para insônia: uma meta-análise da eficácia do tratamento. Am. J. Psychiatry, 1994; 151(8): 1172-1180.
MORIN CM, COLECCHI C, STONE J, SOOD R, BRINK D. Terapias comportamentais e farmacológicas para insônia tardia: um estudo controlado randomizado. JAMA, 1999; 281(11): 991-999.
MULDER RT, JOYCE PR, FRAMPTON C. Relationships among measures of treatment outcome in depressed patients. J. Affect. Disord., 2003; 76(1-3): 127-135.
MURTAGH DR, et al. Identificando tratamentos psicológicos eficazes para insônia: uma meta-análise. J. Consult. Clin. Psychol., 1995; 63(1): 79-89.
SADLER P, et al. Cognitive behavior therapy for older adults with insomnia and depression: a randomized controlled trial in community mental health services. Sleep. doi: 10.1093/sleep/zsy104.
SHER L. Sleep, resilience and suicide. Sleep Med., 2020; 66: 284-285.
SMITH MT, et al. Metanálise comparativa de farmacoterapia e terapia comportamental para insônia persistente. Am. J. Psychiatry, 2002; 159(1): 5-11.
SIVERTSEN B, et al. Terapia cognitivo-comportamental versus zopiclona para tratamento de insônia primária crônica em adultos mais velhos: um estudo controlado randomizado. JAMA, 2006; 295(24): 2851-2858.
TAYLOR DJ, et al. Cognitive and behavioural therapy for insomnia (CBT-I) in psychiatric populations: A systematic review. Int. Rev. Psychiatry, 2014; 26: 205-213.
WANG X, et al. Systematic review and meta-analysis of the relationship between sleep disorders and suicidal behavior in patients with depression. BMC Psychiatry, 2019 Oct 17; 19(1): 303.
WILKS CR, et al. Raiva, apoio social e risco de suicídio em veteranos militares dos EUA. J. Psychiatr. Res., 2019; 109: 139-144.
ZHANG J, et al. Efeitos combinados da depressão e ansiedade sobre o suicídio: um estudo de autópsia psicológica de caso-controle na China rural. Psychiatry Res., 2019; 271: 370-373.
