Abstract
Objectives
In the United States, Black women are disproportionately afflicted with prenatal insomnia.
Although cognitive-behavioral therapy for insomnia (CBTI) may represent a strategy
to reduce disparities in insomnia, racial minorities attend fewer healthcare appointments
and have poorer outcomes from prenatal care and mental health treatment relative to
white patients. The present study examined differences in treatment engagement and
patient-reported outcomes in non-Hispanic Black and white pregnant women receiving
digital CBTI.
Methods
Secondary analysis of 39 pregnant women with clinical insomnia who received digital
CBTI. Treatment engagement was operationalized as the number of sessions completed
(≥4 considered an adequate dose). Treatment outcomes were assessed using the Insomnia
Severity Index (ISI; insomnia) and Pittsburgh Sleep Quality Index (PSQI; global sleep
disturbance).
Results
Black women were 4 times more likely than white women to discontinue CBTI before receiving
an adequate dose (8.3% vs. 33.3%). Regarding treatment outcomes, white women reported
a mean reduction of 5.75 points on the ISI and a reduction of 3.33 points on the PSQI
(Cohen's dz = 1.10-1.19). By comparison, Black women reported reductions of 2.13 points
on the ISI and 1.53 points on the PSQI, which were statistically non-significant.
Differences in treatment engagement did not account for the disparities in patient-reported
outcomes.
Conclusions
During pregnancy, Black women completed fewer CBTI sessions and experienced poorer
treatment outcomes in response to digital CBTI relative to white women. Enhancements
to insomnia therapy and its digital delivery may improve adherence and outcomes in
Black pregnant women.
Keywords
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Article info
Publication history
Published online: November 28, 2022
Accepted:
October 21,
2022
Received in revised form:
October 18,
2022
Received:
May 25,
2022
Identification
Copyright
© 2022 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.
