{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T01:46:34Z","timestamp":1793411194282,"version":"4.5.0"},"reference-count":31,"publisher":"Cambridge University Press (CUP)","issue":"1","license":[{"start":{"date-parts":[[2025,6,2]],"date-time":"2025-06-02T00:00:00Z","timestamp":1748822400000},"content-version":"unspecified","delay-in-days":152,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["CNS Spectr."],"published-print":{"date-parts":[[2025]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Suicide accounts for over 700,000 deaths per year globally and remains a public health priority. Evidence suggests that sleep-related interventions may be effective in reducing depressive symptom severity and suicidal thoughts in patients diagnosed with depression and comorbid insomnia. This study aims to systematically review the efficacy of sedative-hypnotics and\/or cognitive behavioral therapy for insomnia (CBT-I) on measures of suicidality.<\/jats:p>\n                  <jats:p>In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, PubMed, Medline, Cochrane Library, Embase, Scopus, and Web of Science were searched from inception to July 30, 2024. Studies were included if they (1) were randomized controlled trials (RCTs) and (2) reported on suicide-related measures associated with sleep interventions as a primary outcome, secondary outcome, or a safety measure. We endeavored to define and operationalize suicidality as suicidal ideation (SI), suicide attempts (SA), and suicide completion (SC). In cases where study authors failed to separate these three dimensions, the term \u201csuicidality\u201d was applied.<\/jats:p>\n                  <jats:p>\n                    Eighteen studies were identified meeting inclusion criteria, comprised of studies investigating benzodiazepines (\n                    <jats:italic>n<\/jats:italic>\n                    = 2), Z-drugs (\n                    <jats:italic>n<\/jats:italic>\n                    =4), orexin receptor antagonists (ORAs) (\n                    <jats:italic>n<\/jats:italic>\n                    =8), and CBT-I (\n                    <jats:italic>n<\/jats:italic>\n                    =4). Zolpidem reduces SI as well as insomnia (linear association = 0.12,\n                    <jats:italic>p<\/jats:italic>\n                    &lt;0.05) as evidenced by improvement on both the Columbia-Suicide Severity Rating Scale (C-SSRS) and the Scale for Suicide Ideation (SSI). ORAs were not associated with either an increase or decrease in suicidality. CBT-I alleviates SI in patients with insomnia (\n                    <jats:italic>t<\/jats:italic>\n                    = \u22123.35,\n                    <jats:italic>p<\/jats:italic>\n                    &lt;0.05).\n                  <\/jats:p>\n                  <jats:p>Effectively treating insomnia is associated with reduced SI. Available evidence suggests that Food and Drug Administration (FDA)-approved sedative-hypnotics do not increase the risk of suicidality.<\/jats:p>","DOI":"10.1017\/s1092852925000318","type":"journal-article","created":{"date-parts":[[2025,6,2]],"date-time":"2025-06-02T04:18:24Z","timestamp":1748837904000},"source":"Crossref","is-referenced-by-count":12,"title":["A systematic review of anti-suicidal effects of sedative-hypnotics and cognitive behavioral therapy for insomnia"],"prefix":"10.1017","volume":"30","author":[{"given":"Kyle","family":"Valentino","sequence":"first","affiliation":[{"name":"Brain and Cognition Discovery Foundation"},{"name":"University of Toronto"},{"name":"University Health Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kayla","family":"Teopiz","sequence":"additional","affiliation":[{"name":"Brain and Cognition Discovery Foundation"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabrina","family":"Wong","sequence":"additional","affiliation":[{"name":"Brain and Cognition Discovery Foundation"},{"name":"University of Toronto"},{"name":"University Health Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gia Han","family":"Le","sequence":"additional","affiliation":[{"name":"Brain and Cognition Discovery Foundation"},{"name":"University Health Network"},{"name":"University of Toronto"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Badulescu","sequence":"additional","affiliation":[{"name":"University Health Network"},{"name":"University of Toronto"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danica","family":"Johnson","sequence":"additional","affiliation":[{"name":"University Health Network"},{"name":"University of Toronto"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger","family":"Ho","sequence":"additional","affiliation":[{"name":"Yong Loo Lin School of Medicine"},{"name":"National University of Singapore"},{"name":"Hong Kong University of Science and Technology (HKUST)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taeho Greg","family":"Rhee","sequence":"additional","affiliation":[{"name":"Yale School of Medicine"},{"name":"University of Connecticut School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5963-2676","authenticated-orcid":false,"given":"Bing","family":"Cao","sequence":"additional","affiliation":[{"name":"Southwest University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Rosenblat","sequence":"additional","affiliation":[{"name":"University of Toronto"},{"id":[{"id":"https:\/\/ror.org\/03dbr7087","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Toronto"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3968-3297","authenticated-orcid":false,"given":"Rodrigo","family":"Mansur","sequence":"additional","affiliation":[{"name":"University Health Network"},{"name":"University of Toronto"},{"id":[{"id":"https:\/\/ror.org\/03dbr7087","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Toronto"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4733-2523","authenticated-orcid":false,"given":"Roger S.","family":"McIntyre","sequence":"additional","affiliation":[{"name":"University of Toronto"},{"id":[{"id":"https:\/\/ror.org\/03dbr7087","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Toronto"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2025,6,2]]},"reference":[{"key":"S1092852925000318_r7","unstructured":"7. Center for Drug Evaluation and Research. Sleep disorder (sedative-hypnotic) drug information. FDA; 2023. https:\/\/www.fda.gov\/drugs\/postmarket-drug-safety-information-patients-and-providers\/sleep-disorder-sedative-hypnotic-drug-information"},{"key":"S1092852925000318_r5","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychires.2020.12.038"},{"key":"S1092852925000318_r14","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2021.676962"},{"key":"S1092852925000318_r27","doi-asserted-by":"publisher","DOI":"10.1192\/bjpo.bp.117.005231"},{"key":"S1092852925000318_r6","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2020.101895"},{"key":"S1092852925000318_r26","doi-asserted-by":"publisher","DOI":"10.14283\/jpad.2020.69"},{"key":"S1092852925000318_r10","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(22)00878-9"},{"key":"S1092852925000318_r2","unstructured":"2. Facts about suicide. Centers for Disease Control and Prevention. 2024. https:\/\/www.cdc.gov\/suicide\/facts\/index.html"},{"key":"S1092852925000318_r31","doi-asserted-by":"publisher","DOI":"10.1080\/14728214.2025.2452514"},{"key":"S1092852925000318_r28","doi-asserted-by":"publisher","DOI":"10.1111\/jsr.14133"},{"key":"S1092852925000318_r12","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/zsac251"},{"key":"S1092852925000318_r1","unstructured":"1. Suicide. World Health Organization. 2024. https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/suicide"},{"key":"S1092852925000318_r3","unstructured":"3. Suicide. 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