0976 A Brief Non-Pharmacological Insomnia Treatment for Military Suicidal Behaviors: A Sham-Controlled, Randomized Trial

Abstract Introduction Suicide represents a public health emergency among veterans, who die by suicide at alarming rates and show elevated sleep disturbances. Selective interventions for military suicide indication are scarce, and available treatments remains mismatched to the acute nature of a suicidal crisis. We sought to develop and test preliminary efficacy of a fast-acting, behavioral insomnia intervention for antisuicidal response in the context of a sham-controlled, randomized trial among veterans. Methods A multicomponent behavioral sleep intervention was developed, integrating: CBT for Insomnia (CBTi) and Imagery Rehearsal Treatment (IRT) within a rapid (4-session) format (SERVE: Sleep Enhancement for Returning Veterans). This was compared to active control, Arousal-Based Treatment of Insomnia (ABTI). Treatments were manualized and matched for therapist contact, materials (manuals, powerpoints, guidesheets), and passage of time. Raters were blind to treatment assignment. Inclusion criteria: (a) age>18, (b) clinically-significant sleep disturbance (Insomnia Severity Index (ISI>10)), (c) DSM-V-Defined Depression, or (d) current suicidal ideation (Columbia Suicidal Severity Rating Scale (CSSRS>1)). A comprehensive data and safety monitoring plan supported standardized risk assessment, safety planning, and triage. Outcomes were assessed at Baseline and Posttreatment (1,3 mos) according to primary (suicidal ideation), secondary (sleep indices), and exploratory (mood, stress indices) outcomes. Results Recruitment occurred by way of comprehensive military partnerships, clinic referrals, and community flyering. Of n=753 new contacts, n=436 participants were screened for inclusion. Of these, n=112 were interviewed by full-battery eligibility assessment, resulting in n=77 veterans enrolled and randomized to: Active Treatment (n=39) vs. Active Control (n=38). Feasibility analyses supported high rates of acceptance, tolerability, and safety. For the full sample, t-tests revealed large posttreatment reductions in suicidal ideation (CSSRS, p<.001; Depressive Symptom Inventory Suicidality Subscale (DSISS)), p<.001), sleep, mood, and stress outcomes (ISI, p<.01; DDNSI, p<.01; QIDS-SR, p<.01; PCL, p<.001). Effects were significant compared to control (DSISS, p<.01; ISI, p<.01). Conclusion A brief, non-pharmacological insomnia intervention resulted in antisuicidal response and large posttreatment improvements in sleep and well-being. This is the first known report testing non-medication insomnia treatment within a sham-controlled, randomized trial for military suicidal behaviors, where results support feasibility, safety, and therapeutic impact to suicidal risk. Support (if any) Work was supported by NIH (K23MH093490), DOD/MOMRP/MSRC funding (W81XWH-10-2-0178)