0378 Improvements in Prenatal Insomnia Predict Lower Depression Severity During Postpartum in Low- and High-Income Women

Abstract Introduction Low socioeconomic status increases the risk of prenatal and postpartum depression. Additionally, women of low-income status are disproportionately impacted by insomnia and poor sleep during pregnancy, which could contribute to poorer mental and physical health. Treating insomnia during pregnancy has the potential to reduce the risk of postpartum depression. We examined whether after accounting for baseline and psychosocial risk of depression, improvements in prenatal insomnia predicted lower postpartum depression in low- and high-income women. Methods We selected low- (< $55,000/year; n=35) and high-income (≥$100,000/year; n=59) participants drawn from a randomized, multi-site, controlled trial of CBT-I for perinatal insomnia. The study excluded women with depressive disorders. Treatments consisted of five sessions during pregnancy and one at 6 weeks postpartum. Participants completed the Insomnia Severity Index (ISI), Edinburgh Postpartum Depression Scale (EPDS), and Perinatal Risk Questionnaire (PRQ) at baseline. ISI and EPDS were additionally completed 8 weeks after randomization and at 8, 18, and 30 weeks postpartum. Separate generalized estimating equation models were conducted for each group. Women were included if they completed at least one postpartum assessment. Results After accounting for baseline ISI, a 1-unit reduction in ISI at post-treatment was associated with a reduction of .18 units in the average postpartum EPDS scores among participants in the low-income group (p=.048) and .21 units among the high-income group (p=.008). Baseline EPDS was a significant predictor of the average postpartum EDPS in the low-income group, such that a 1-unit increase in baseline EPDS increased postpartum EPDS by .32 units (p=.015), but was not a predictor in the high-income group. Baseline ISI and PRQ and time were not significant predictors (ps>.05). Conclusion Predictors of postpartum depression severity were different for low- and high-income pregnant women with insomnia. We found that the effect of treating prenatal insomnia on reducing postpartum depressive symptom severity was stronger for high- versus low-income women and that baseline depression symptoms predicted postpartum depression symptoms among low- but not high-income women. The results suggest that to optimally reduce postpartum depressive symptoms among low-income women, treatment will need to address additional risk factors beyond insomnia. Support (if any) NR013662