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Introduction Previous research has shown that approximately 78% of college students who suffer from insomnia also endorsed depressive symptoms. Students with depression were 9.5 times more likely to have insomnia than students who did not have depression. There has also been evidence that Cognitive Behavioral Therapy for Insomnia (CBT-I) can reduce depression symptoms. However, the effectiveness of a self-guided mobile version of CBT-I (iCBT-I) in reducing depression among college students has yet to be evaluated. This study aims to assess depression symptoms among students who engaged in a self-guided iCBT-I intervention. Methods The study uses a between- and within-subjects design to assess biweekly changes in depression symptom severity before and after completing a four-week mobile intervention for insomnia (i.e., CBT-I Coach). Participants included 39 University of Arkansas college students with a baseline insomnia severity index score ≥ 15. Participants were randomized into the intervention group or a wait-list control group. Participants in both groups are asked to use the CBT-I Coach app for 4 weeks (control group began intervention after a four-week delay). Every four weeks, the Center for Epidemiological Studies Depression Scale was administered to assess depressive symptomology. Results Preliminary analyses showed a reduction in CES-D mean scores between baseline (M = 28.3) and week four (M = 25.4) of the intervention group. The intervention group also experienced a depression score rebound at week eight (M = 28.9). The wait-list control group experienced little change in mean CES-D scores from pre-to-post intervention, baseline (M = 23.4), week four (M = 24.2), week eight (M = 23.7). Conclusion These results may lend evidence for the short-term effectiveness of iCBT-I in reducing depression symptoms. This could allow for wider dissemination of this treatment modality across a population who suffer from comorbid insomnia and depression. Support (if any) K23 HL141581

The tendency to ruminate, magnify, and experience helplessness in the face of pain - known as pain catastrophizing - is a strong predictor of pain outcomes and is associated with adversity. The ability to maintain functioning despite adversity - referred to as resilience - also influences pain outcomes. Understanding the extent to which pain catastrophizing and resilience influence relations between adversity and daily pain in healthy African-American adults could improve pain risk assessment and mitigate racial disparities in the transition from acute to chronic pain. This study included 160 African-American adults (98 women). Outcome measures included daily pain intensity (sensory, affective) and pain impact on daily function (pain interference). Adversity measures included childhood trauma exposure, family adversity, chronic burden from recent stressors, and ongoing perceived stress. A measure of lifetime racial discrimination was also included. Composite scores were created to capture early-life adversity (childhood trauma, family adversity) versus recent-life adversity (perceived stress, chronic burden). Increased pain catastrophizing was correlated with increased adversity (early and recent), racial discrimination, pain intensity, and pain interference. Decreased pain resilience was correlated with increased recent-life adversity (not early-life adversity or racial discrimination) and correlated with increased pain intensity (not pain-related interference). Bootstrapped multiple mediation models revealed that relationships between all adversity/discrimination and pain outcomes were mediated by pain catastrophizing. Pain resilience, however, was not a significant mediator in these models. These findings highlight opportunities for early interventions to reduce cognitive-affective-behavioral risk factors for persisting daily pain among African-American adults with greater adversity exposure by targeting pain catastrophizing.

Introduction Insomnia and depression are closely linked. While poor sleep is often classified as a symptom of depression, research now supports that insomnia often precedes and predicts the onset of depression. One factor that may explain this relationship is sleep reactivity, or the tendency to experience sleep disturbances in response to stressful life events. Sleep reactivity is considered a vulnerability factor for insomnia. This study aimed to replicate recent findings that suggest sleep reactivity is also independently related to depression. Methods Survey data was collected from 236 U.S. adults (69.1% White, 61.9.3% Female, 18-85 y) regarding demographic information, sleep patterns, and general health and well-being. Depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale (CESD). Insomnia symptoms were assessed using the Insomnia Severity Index (ISI). Sleep reactivity was assessed using the Ford Insomnia Response to Stress Test (FIRST). A hierarchical multiple regression was conducted with total CESD scores as the dependent variable. Total ISI scores and gender were entered as covariates in model 1 and total FIRST scores as the predictor variable in model 2. Results The fitted regression for model 1 was statistically significant (R2 = 0.37, F(2,233) = 64.47, p < .001). It was found that both greater ISI and being female gender predicted depression scores (β = 1.04, p < .001, and β = 1.64, p = .05). For model 2, the regression was also significant (R2 = 0.38, F(3,232) = 47.60, p < .001). Greater FIRST scores were related to greater depressive symptoms (β = 0.23, p = .02), even after controlling for both insomnia symptoms and gender. Conclusion Sleep reactivity is independently related to depression symptoms, independent of insomnia. Future studies examining how multiple types of stress reactivity impact an individual’s risk for developing depression should be considered. Support (if any) K23 HL141581

Disparities in trauma outcomes and care are well established for adults, but the extent to which similar disparities are observed in pediatric trauma patients requires further investigation. The objective of this study was to evaluate the unique contributions of social determinants (race, gender, insurance status, community distress, rurality/urbanicity) on trauma outcomes after controlling for specific injury-related risk factors.All pediatric (age 18) trauma patients admitted to a single level 1 trauma center with a statewide, largely rural, catchment area from January 2010 to December 2020 were retrospectively reviewed (n = 14,398). Primary outcomes were receipt of opioids in the emergency department, post-discharge rehabilitation referrals, and mortality. Multivariate logistic regressions evaluated demographic, socioeconomic, and injury characteristics. Multilevel logistic regressions evaluated area-level indicators, which were derived from abstracted home addresses.Analyses adjusting for demographic and injury characteristics revealed that Black children (n = 6255) had significantly lower odds (OR = 0.87) of being prescribed opioid medications in the emergency department compared to White children (n = 5883). Children living in more distressed and rural communities had greater odds of receiving opioid medications. Girls had significantly lower odds (OR = 0.61) of being referred for rehabilitation services than boys. Post hoc analyses revealed that Black girls had the lowest odds of receiving rehabilitation referrals compared to Black boys and White children.Results highlight the need to examine both main and interactive effects of social determinants on trauma care and outcomes. Findings reinforce and expand into the pediatric population the growing notion that traumatic injury care is not immune to disparities.

BACKGROUND: Racial disparities in trauma care have been reported for a range of outcomes, but the extent to which these remain after accounting for socioeconomic and environmental factors remains unclear. The objective of this study was to evaluate the unique contributions of race, health insurance, community distress, and rurality/urbanicity on trauma outcomes after carefully controlling for specific injury-related risk factors. METHODS: All adult (age >=18) trauma patients admitted to a single Level 1 trauma center with a statewide, largely rural, catchment area from January 2010 to December 2020 were retrospectively reviewed. Primary outcomes were mortality, rehabilitation referral, and receipt of opioids in the emergency department. Demographic, socioeconomic, and injury characteristics as well as indicators of community distress and rurality based on home address were abstracted from a trauma registry database. RESULTS: Analyses revealed that Black patients (n=13,073) were younger, more likely to be male, more likely to suffer penetrating injuries, and more likely to suffer assault-based injuries compared to White patients (n=10,946; all p

Suicide is a major and preventable public health issue and research has identified several distal risk factors for determining individuals at risk for a suicide attempt. However, understanding imminent processes could enhance individualized safety plan formulations and interventions. Motivation for suicide attempt (MfSA) reflects why an individual engages in a specific attempt. Research indicates such motives can be organized into major factors, but consensus on the number, and their correlates, has not been reached. The sample consisted of 190 patients who attempted suicide within 24 hours of hospitalization and completed the MfSA within the Suicide Attempt-Self Injury Interview. Exploratory factor and correlational analyses were conducted to identify the factors that underlie MfSA. Regression analyses were conducted to examine the relations of MfSA factors to distal suicide risk factors and suicide-related attempt characteristics. Two underlying MfSA factors were identified. Interpersonal MfSA was associated with lower age and higher problematic alcohol use. Intrapersonal MfSA was related to having previous suicide attempts, more past year negative life events, and higher depressive symptoms. The modified MfSA is easy to administer, and its factors show unique associations with important suicide-related constructs. The results could inform safety planning procedures to prevent future death by suicide.