Annabelle M. Mournet | Evan M. KleimanResearchers at the intersection of sleep and suicide research have advocated for investigation of sleep disturbances as a therapeutic target for the purposes of treating and preventing suicide. This study aims to provide the first systematic review and meta-analysis on the efficacy of sleep interventions to treat suicidal ideation. This systematic review and meta-analysis, registered with the International Prospective Register of Systematic Reviews, was conducted in PsycINFO, through Ovid. A sample of eight articles were deemed eligible and a total of 21 effect sizes were included.
Accordingly, with small effect sizes while employing either medication or therapy, there may be an additive effect of utilising both, which is worth investigating further. It is also important to consider that some psychological treatment approaches may be harmful and have iatrogenic effects on suicide risk (Ward-Ciesielski & Rizvi, 2020). While this was generally not found to be the case with regards to sleep interventions, future research should continue to investigate the impact of sleep interventions on suicide-related outcomes. Importantly, one study (Chan et al., 2022) did find a positive effect, such that the treatment was associated with increased SI; however, the effect size was incredibly small and was just barely
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Importantly, it is unclear the extent to which these studies were developed specifically with the aim of reducing SI through the use of a sleep intervention or whether researchers were seeking to treat one outcome and opted to also include a measure of SI to see the impact. F I G U R E 3 Forest plot. More negative values for standardised While some papers specifically state reducing SI as part of their aim mean difference (SMD) denotes that treatment was more effective. (e.g., McCall et al., 2019), this is less explicit in other instances (e.g., Sheaves et al., 2019). There is a need for increased sleep interventions developed with SI as the primary outcome to determine 4
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| D I S C U S S I O N whether there is a benefit to actively designing an intervention with the aim of reducing suicide-related outcomes, rather than it being a Considerable research has linked sleep disturbances to increased suisecondary, or even tertiary outcome. Notably, while the Egger's cide risk, with calls to action to investigate the efficacy of utilising regression test for funnel plot asymmetry was insignificant, many of sleep interventions to reduce SI and behaviours the non-significant studies that were published were studies where (Pigeon & the effect of the intervention on SI was examined as a secondary Caine, 2010). With an increase in recent study of such interventions, effect, rather than the primary aim, further underscoring the need for meta-analytical work was indicated to help guide future studies in this realm. This systematic review and meta-analysis revealed small effect studies with a primary aim of examining this question that report find-
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ings regardless of the significance of the findings. In particular, given Of note, while this review was designed to consider all suicidethat there are variations of CBT both intended to treat insomnia related outcomes, there were no studies found examining the effects (Edinger & Means, 2005) and prevent suicide (Bryan & Rudd, 2018), of sleep interventions on suicidal behaviour. Rather, all studies there may be value in research focused on incorporating components 13652869, 0, Downloaded from by Turkey Cochrane Evidence Aid, Wiley Online Library on [02/01/2024]. See the Terms and Conditions ( on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License MOURNET and KLEIMAN 5 of 6
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