A Program Evaluation: Insomnia in Adults with Major Depression Disorder with Cognitive Behavioral Therapy for Insomnia (CBT-I)

Author

Taylor E. Wilson, University of Missouri-St. LouisFollow

Document Type

Dissertation

Degree

Doctor of Nursing Practice

Major

Nursing

Date of Defense

7-15-2025

Graduate Advisor

Amanda Finley

Committee

Wilma J. Calvert, PhD, MPE, MS, RN

Paul Thomlinson, Ph.D.

Abstract

Abstract

Problem: In 2023, Compass Health Network (CHN) data analysts found that 91% of CHN patients in the United States who have died by suicide reported problems with sleep, which was the highest risk factor for suicide. The objective of this program evaluation project is to evaluate CHN CBT-I effectiveness on patients ‘suicidality by improving their insomnia.

Methods: CHN quality improvement (QI) project used a quantitative method pre/post score design. Quantitative aggregate data was collected on the participants who met the inclusion criteria via retrospective and prospective chart review prior to CHN implementing the intervention. CBT-I clinicians collected PHQ-9, Columbia-Suicide Severity Rating Scale (C-SSRS), and Insomnia Severity Index (ISI) scores before and after implementing the intervention.

Results: A Wilcoxon-signed rank test revealed that there was no statistically significant difference between the pre-test and post-score for the following: suicidality intensity z = -1.342, p = .180, suicidality frequency z = -1.342, p = .180, insomnia severity z = -1.342, p = .180, or in PHQ-9 z = -.447, p = .655. Clinical significance has been identified when looking at the differences between pre-and post- scores. Participant 1 had a 4-point decrease in suicidality intensity and frequency, a 6-point decrease in insomnia severity, and a 1-point increase in depression severity. Participant 2 had a 1-point decrease in suicidality, intensity and frequency, a 13-point decrease in insomnia severity, and an 11-point decrease in depression severity.

Implications for Practice: There is insufficient evidence to conclude that the CHN CBT-I intervention is effective in reducing patient’s suicidality. Future PDSA cycles and data collection should take place for ongoing QI analysis.

Recommended Citation

Wilson, Taylor E., "A Program Evaluation: Insomnia in Adults with Major Depression Disorder with Cognitive Behavioral Therapy for Insomnia (CBT-I)" (2025). Dissertations. 1555.
https://irl.umsl.edu/dissertation/1555