Effect of Cognitive Behavioral Therapy on symptoms of insomnia, depression and suicide risk

FAGUNDES, D. Effect of Cognitive Behavioral Therapy for Insomnia in Depression and Suicide [Thesis]. Recife: Health Sciences Center, Federal University of Pernambuco; 2025. INTRODUCTION: There is growing interest in understanding the relationship between sleep and suicide. Although insomnia is commonly cited as a critical risk factor for suicidal thoughts and behaviours, the evidence on the treatment and control of insomnia and its effects on reducing such behaviours is still unclear. OBJECTIVES: To evaluate the effect of CBTi , in patients diagnosed with Unipolar Depression with symptoms of insomnia, on suicidal behaviour. METHODS: This is an intervention, cross-sectional and analytical study. Data was collected using three validated and translated instruments. The study consisted of individuals aged 18 to 60 diagnosed with unipolar depression and who reported suicidal ideation with the intention of dying in the last week and/or attempted suicide in the last month. There were two randomised groups: Group A whose therapeutic protocol included a medication (Amitriptyline 25 mg) and Group B whose protocol included a pharmacological intervention with the medication (Amitriptyline 25 mg) and weekly CBT sessions with a protocol duration of 8 weeks. The primary outcomes included the assessment of insomnia severity (Insomnia Severity Index - ISI), suicide risk (Columbia Suicide Risk Rating Scale - C-SSRS) and the secondary outcomes included the severity of depressive symptoms (Montgomery Depression Scale - MDS). Primary and secondary outcome measures were collected at weeks 0, 2, 4, 6 and 8 of the interventions. RESULTS: The study included 10 individuals selected from psychiatric outpatient care, with a higher prevalence of females and an average age of 30-50 years, who showed improvements in the symptoms mood and sleep, as well as changes in suicidal thoughts over the 8 weeks of observation and intervention. CONCLUSION : The individuals assessed with the pharmacological and psychotherapeutic interventions showed a significant response, with an improvement in depressive symptoms, insomnia and suicidal behaviour in the first few weeks of the study. These data point to the need to take a broader look at patients with mood and sleep-related complaints in psychiatric clinical practice, allowing for a more focused intervention and faster progress in the psychopathological examination and psychiatric condition.