# Sleep to Reduce Incident Depression Effectively in Peripartum - (STRIDE P)

> **NIH NIH R01** · HENRY FORD HEALTH + MICHIGAN STATE UNIVERSITY HEALTH SCIENCES · 2024 · $992,063

## Abstract

Project Abstract.
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 precedes over half of PND
incidence and relapse cases more than doubling risk for major depression. This is highly significant 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. Although cognitive-behavioral therapy for insomnia (CBTI) alleviates
insomnia during pregnancy, it yields modest effects on PND and undertreats cognitive arousal (heightened
cognitive activity, particularly in the forms of rumination and worry at night). Our team 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 and wellbeing during pregnancy. In effort to enhance alleviation of cognitive arousal to
optimize clinical outcomes, we developed Perinatal Understanding of Mindful Awareness for Sleep (PUMAS).
PUMAS places behavioral sleep strategies within a mindfulness intervention framework with all components
tailored specifically for pregnancy. RCT data show that PUMAS yields large effects on insomnia, depression,
and cognitive arousal relative to control, whereas CBTI alleviates insomnia but has mixed or minimal effects on
PND and cognitive arousal. Our R34 pilot RCT shows PUMAS patients are more satisfied with their care than
pregnant women treated with CBTI, and that clinic leadership and providers rate PUMAS as acceptable, feasible,
and appropriate for implementation. PUMAS has immense potential to change the management of prenatal
insomnia and to curb PND rates via preventive care. We propose a large-scale RCT of 500 women with DSM-5
insomnia disorder (without PND) who are randomized to PUMAS or sleep education control. We will evaluate
the effectiveness of PUMAS for alleviating insomnia and preventing PND across pregnancy and the first
postpartum year. This project will not only test PUMAS effectiveness for insomnia and PND prevention but will
also investigate whether PUMAS engages a key candidate mechanism (high cognitive arousal) that is operative
for addressing these clinical outcomes in the effectiveness context (PAR-21-130). We will recruit pregnant
women from the 23 women’s health clinics and 5 maternal-fetal medicine clinics across HFH, centrally located
in Metro Detroit. This application directly addresses research objectives under PAR-21-130, which states:
“preventive and therapeutic interventions [should target] factors that...

## Key facts

- **NIH application ID:** 10952575
- **Project number:** 1R01MH129549-01A1
- **Recipient organization:** HENRY FORD HEALTH + MICHIGAN STATE UNIVERSITY HEALTH SCIENCES
- **Principal Investigator:** CHRISTOPHER L DRAKE
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $992,063
- **Award type:** 1
- **Project period:** 2024-08-01 → 2028-02-29

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10952575

## Citation

> US National Institutes of Health, RePORTER application 10952575, Sleep to Reduce Incident Depression Effectively in Peripartum - (STRIDE P) (1R01MH129549-01A1). Retrieved via AI Analytics 2026-05-21 from https://api.ai-analytics.org/grant/nih/10952575. Licensed CC0.

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