Reducing Suicidal Ideation Through Insomnia Treatment (REST-IT): A Randomized Clinical Trial

McCall, William Vaughn; Benca, Ruth M.; Rosenquist, Peter B.; Youssef, Nagy A.; McCloud, Laryssa; Newman, Jill C.; Case, Doug; Rumble, Meredith E.; Szabo, Steven T.; Phillips, Molly; Krystal, Andrew D.

doi:10.1176/appi.ajp.2019.19030267

Cited by 119 publications

(82 citation statements)

References 83 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although depression is a main target for identifying suicidality, insomnia symptoms might outperform depression in predicting suicidal ideation (8). Further evidence suggests that treatment of insomnia through cognitive-behavioral therapy for insomnia (9) and through controlled-release zolpidem (10) can reduce suicidal ideation. As a potentially modifiable risk factor, insomnia may prove to be a useful target for suicide prevention.…”

Section: Introductionmentioning

confidence: 99%

Insomnia Is Associated With Frequency of Suicidal Ideation Independent of Depression: A Replication and Extension of Findings From the National Health and Nutrition Examination Survey

et al. 2020

View full text Add to dashboard Cite

Objective: Insomnia is associated with suicidality, although the mechanisms of this association are unclear. This study sought to replicate previous findings showing that insomnia symptoms but not sleep duration are associated with frequency of suicidal ideation in adults. We further investigated whether depression or sleep duration moderates the association between insomnia symptoms and frequency of suicidal ideation. Materials and Methods: We used the 2005-2006 cycle of the National Health and Nutrition Examination Survey to replicate previously reported findings from the 2007-2008 cycle. We used ordered logistic regression to determine whether insomnia symptoms were associated with frequency of suicidal ideation independently of depression and other potential confounds. To extend these findings, we tested whether depression or sleep duration moderated the association between insomnia symptoms and frequency of suicidal ideation. We further replicated these findings in parallel analyses using the combined data from the 2005-2006 and 2007-2008 cycles. Results: This study replicated previous results showing that insomnia symptoms are associated with frequency of suicidal ideation in the NHANES 2005-2006 cycle (OR = 1.09, p < 0.05), even after adjusting for potentially confounding variables, including depression. Neither depression nor sleep duration moderated this association. Difficulty with sleep maintenance insomnia symptoms were most robustly associated with frequency of suicidal ideation (OR ≥ 1.97, p < 0.05). Sleep duration was not robustly associated with suicidal ideation. Conclusions: In this study, we found that insomnia symptoms were uniquely associated with frequency of suicidal ideation. This association cannot be explained by the shared association with depression or sleep duration.

show abstract

Section: Introductionmentioning

confidence: 99%

Insomnia Is Associated With Frequency of Suicidal Ideation Independent of Depression: A Replication and Extension of Findings From the National Health and Nutrition Examination Survey

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Overall our observed “best guesses” accuracy rates were less than what was reported by Morin et al (1995) This may be explained the REST‐IT study's open‐label treatment with an SSRI in addition to blinded, randomized study drug at bedtime. The addition of the SSRI would be expected to confuse the guessing and attribution of the hypnotic effect, as patients with MDD and insomnia report improvement in insomnia even if they are assigned to SSRI plus placebo (McCall et al, 2019), consistent with the subjective sleep improvement previously described with fluoxetine monotherapy (Gillin, Rapaport, Erman, Winokur, & Albala, 1997).…”

Section: Discussionmentioning

confidence: 71%

Blinding and bias in a hypnotic clinical trial

McCall

Benca

Rumble

et al. 2020

Human Psychopharmacology

Self Cite

View full text Add to dashboard Cite

ObjectivesInformation is lacking regarding how commonly unblinding of treatment assignment occurs in hypnotic randomized clinic trials (RCTs). We now report the “best guesses” of clinical trial participants, versus study coordinators, versus study physicians in the study Reducing Suicidal Ideation Through Insomnia Treatment (REST‐IT).MethodsREST‐IT, a, 8‐week double‐blind RCT, compared zolpidem extended‐release (ER) versus placebo at bedtime in 103 adults with major depressive disorder with insomnia and suicidal ideation, and who received open label selective serotonin reuptake inhibitors. At the conclusion of study participation, 89 of the participants in this study, the study coordinators, and the study physicians each independently recorded their “best guess” of the treatment assigned.ResultsPatients guessed correctly 58.4% of the time, coordinators 53.9% of the time, and physicians 49.4% of the time, and none were different from chance alone. Agreement between patient/coordinator, patient/doctor, and coordinator/doctor dyads were 75%–78% with no significant differences in agreement between the dyads.Conclusions“Best guesses” of all parties were not different from chance, suggesting that the blind was maintained and that assessment bias was minimized in this RCT of zolpidem ER versus placebo. Our results may not apply to other hypnotics or other RCT designs.

show abstract

“…In this issue of the Journal of Clinical Sleep Medicine, Rumble and colleagues 4 review study indicating that chronic insomnia in humans leads to higher rates of verbally acknowledged suicidal ideation. In their own prior work, Rumble and colleagues 5 conducted a randomized clinical trial focused on specifically testing whether an insomnia intervention might reduce suicidal ideation in depressed patients. They tested whether bedtime use of zolpidem would reduce suicidal ideations.…”

mentioning

confidence: 99%

“…(In our threatened tornado analogy here, this would be akin to limiting one's sample to studying only violent-but not too violent-"ideational" storms linked to the possible development of "suicidal" tornados, and pretermit considerations about exact measurement for long-term latent influences, such as the high-risk contexts for the events.) The study's sampling constraints did provide the mandatory experimental controls that made possible the groundbreaking REST-IT trial 5 from which this study data are drawn. So these constraints limit the generalizability of the study's scope of direct clinical application, but, interestingly, not of the study's conceptual scope.…”

mentioning

confidence: 99%

The clinical problem of the lethality of insomnia: a new empirical exploration from a clinical trial

Moul

2020

Journal of Clinical Sleep Medicine

View full text Add to dashboard Cite

Reducing Suicidal Ideation Through Insomnia Treatment (REST-IT): A Randomized Clinical Trial

Cited by 119 publications

References 83 publications

Insomnia Is Associated With Frequency of Suicidal Ideation Independent of Depression: A Replication and Extension of Findings From the National Health and Nutrition Examination Survey

Insomnia Is Associated With Frequency of Suicidal Ideation Independent of Depression: A Replication and Extension of Findings From the National Health and Nutrition Examination Survey

Blinding and bias in a hypnotic clinical trial

The clinical problem of the lethality of insomnia: a new empirical exploration from a clinical trial

Contact Info

Product

Resources

About