# Sleep to Reduce Incident Depression Effectively (STRIDE)

> **NIH NIH R01** · HENRY FORD HEALTH SYSTEM · 2022 · $607,279

## Abstract

Prevention of major depressive disorder (MDD) is a public health priority. Innovative strategies to identify
those at-risk for MDD are in critical need to appropriately direct preventive care. Individuals with insomnia are
>3 times more likely to develop depression than normal sleepers. Insomnia precedes ~50% of all incident and
relapse depression cases. Thus, insomnia may serve as an entry point for preventing MDD. Our preliminary
data not only show that insomnia treatment alleviates depressive symptoms, but may also reduce likelihood of
future depression development, thereby identifying insomnia a viable target for depression prevention.
 Identification and treatment of insomnia typically occurs in primary care and is commonly treated with
hypnotic medications. However, hypnotics have significant limitations, including residual impairment, injury due
to falls and accidents, and abuse potential. Cognitive-behavioral therapy for insomnia (CBT-I) is recommended
as first-line treatment for its safety advantages and superior treatment efficacy. Unfortunately, widespread
implementation of CBT-I is severely limited by the national shortage of trained practitioners in clinical practice.
Innovative stepped care approaches rooted in primary care hold potential to increase access to care, which
may improve insomnia therapeutics and reduce rates of MDD by targeting a robust yet modifiable risk factor in
insomnia. Our proposal uses digital CBT-I (dCBT-I) as a widely available first-line intervention to increase care
access and reduce need for specialist resources. Our proposal also adds clinician-based face-to-face CBT-I
only for treatment-resistant patients who need a more personalized and flexible approach from specialty care.
 We propose a large-scale stepped care clinical trial in the primary care setting that utilizes sequential,
multiple assignment, randomized trial (SMART) design to determine the effectiveness of dCBT-I alone and in
combination with face-to-face CBT-I for insomnia and the prevention of MDD. An important innovative
component of the trial is the 1- and 2-year follow-up assessments to determine the durability of effectiveness
over time and assess the impact on MDD incidence and relapse. Early risk-detection and prevention is
especially critical in those at elevated risk for depression to reduce health disparities. Thus, individuals with
elevated vulnerability to MDD (e.g., low socioeconomic status and racial minorities) will be included in
significant numbers to test for potential moderation of treatment effects stratified by risk.
 Finally, dCBT-I and CBT-I have been shown to reduce rumination (negative repetitive thinking), which may
help mitigate MDD development. As such, we will determine whether changes in rumination (a modifiable risk-
factor and potential key therapy target) mediates the effects of our stepped care model on MDD prevention.
 This project will test a highly scalable model of sleep care in a large primary care syste...

## Key facts

- **NIH application ID:** 10348176
- **Project number:** 5R01MH122636-03
- **Recipient organization:** HENRY FORD HEALTH SYSTEM
- **Principal Investigator:** CHRISTOPHER L DRAKE
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $607,279
- **Award type:** 5
- **Project period:** 2020-04-01 → 2024-02-29

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10348176

## Citation

> US National Institutes of Health, RePORTER application 10348176, Sleep to Reduce Incident Depression Effectively (STRIDE) (5R01MH122636-03). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10348176. Licensed CC0.

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