Sleep to Reduce Incident Depression Effectively in Peripartum

Overview

Perinatal depression (PND) is the most common complication in pregnancy and postpartum, which increases risk for adverse perinatal outcomes such as preterm birth, maternal suicidal thoughts, and impaired mother-infant bonding. Insomnia often precedes PND cases and may serve as an entry point for interventions preventing PND. The proposed project is a large-scale clinical trial to test the effectiveness of a mindfulness-based sleep program designed for pregnant women to improve sleep and alleviate cognitive arousal to reduce risk for PND across pregnancy and postpartum.

Detailed description

Perinatal depression (PND) affects nearly 20% of pregnant and postpartum women, with estimates soaring above 30% during the COVID-19 pandemic. Prospective data show insomnia often precedes PND incidence and relapse cases by more than doubling risk for major depression. This is highly relevant to a large segment of the pregnant population as \~20% of women meet diagnostic criteria for insomnia disorder by the end of pregnancy. Fortunately, insomnia is a modifiable risk factor for PND, and insomnia may serve as an entry point to prevent PND incidence and relapse. The investigators have identified cognitive arousal as a promising candidate factor for alleviating insomnia and preventing depression via insomnia therapy. Indeed, undertreatment of cognitive arousal in pregnancy is associated with insomnia non-remission and continued depression after therapy. Moreover, patient stakeholders identify 'calming a busy mind at night' as a critical target for improving sleep during pregnancy. In effort to enhance alleviation of cognitive arousal to optimize clinical outcomes, the investigators developed Perinatal Understanding of Mindful Awareness for Sleep (PUMAS). PUMAS places behavioral sleep strategies within a mindfulness intervention framework to develop an insomnia therapy specifically for pregnant women: RCT data show that PUMAS yields large effects on insomnia, depression, and cognitive arousal.

This study is a hybrid effectiveness-implementation RCT of 500 women with DSM-5 insomnia disorder (without PND) who are randomized to PUMAS or treatment-as-usual. The investigators will evaluate the effectiveness of PUMAS for alleviating insomnia and preventing PND across pregnancy and the first postpartum year. The investigators will also evaluate whether PUMAS engages a key candidate mechanism (high cognitive arousal) that is operative for addressing these clinical outcomes in the effectiveness context.

Interventions

• Behavioral Perinatal Understanding of Mindful Awareness for Sleep (PUMAS)
  Mindfulness-based sleep program for pregnant women.
• Other Treatment-as-usual (TAU)
  Usual practices from real-world care experiences.

Primary outcome measures

• Comparative effectiveness between PUMAS and standard care on changes in insomnia symptoms. [Time frame: The investigators will examine change in ISI from Pretreatment Baseline to Posttreatment (8 weeks after baseline), and monthly for 1 year after childbirth..]
• Comparative effectiveness of PUMAS and standard care on prevention of perinatal depression. [Time frame: The investigators will examine onset of perinatal depression (EPDS scores 13 or higher) at posttreatment (8 weeks after baseline) and assessed monthly for 1 year after childbirth.]

Secondary outcome measures (1)

• Comparative effectiveness between PUMAS and standard care on nocturnal cognitive arousal symptoms. [Time frame: The investigators will examine changes in PSASC from Pretreatment baseline to Posttreatment (8 weeks later).]

Eligibility criteria

Inclusion criteria

• Singleton pregnancy, gestational week 14-31 at screening.
• DSM-5 Insomnia Disorder (≥1 month duration).
• Insomnia Severity Index (ISI) score ≥ 11.
• Edinburgh Postnatal Depression Scale score<13 at screening.
• No current DSM-5 Major Depression.
• Reliable internet access for treatment and assessments.
• Not currently engaged in therapy for major depression or insomnia disorder.
• Age 18 years or older.

Exclusion criteria

• High risk pregnancy (pre-eclampsia, placenta previa w/ hemorrhage, other conditions deemed serious risk to mother or fetus; hypertension and diabetes are allowed).
• Active suicidal intent.
• Night or rotating shift work, anticipated travel across time 3 or more time zones in the 2 months after baseline screening.
• Untreated RLS (treated RLS is OK).
• Excessive daytime sleepiness; Epworth Sleepiness Scale>15.
• Uncontrolled sleep or mental disorder inappropriate or unsafe for sleep restriction (narcolepsy, bipolar, epilepsy, etc.).

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Double blind

Primary purpose

Treatment

Study locations

United States · 1 center

• Henry Ford Medical Center — Novi

Identifiers

NCT: NCT06430333 · STRIDE P

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗