0967 Network Analysis of Depression and Insomnia Among Pregnant Women

Abstract Introduction Pregnancy is a vulnerable period of lifespan characterized by a myriad of physiological and psychological changes and challenges. Whilst the existing research has documented the intricate relationship between insomnia and depression among expectant mothers, the use of sum scores of the measures in previous studies might have limited the understanding of the underlying mechanisms and key symptoms contributing to the development and persistence of these conditions. The current study aimed to examine the inter-relationship between the symptoms of insomnia and depression during the antenatal period using a networking approach. Methods A total of 480 pregnant women were recruited from the outpatient clinics of local hospitals and the community in Hong Kong. Insomnia and depressive symptoms were assessed by the Insomnia Severity Index (ISI) and the Edinburgh Postnatal Depression Scale (EPDS), respectively. A cutoff score ≥ 10 on the ISI indicated probable insomnia, and a cutoff ≥ 13 on EPDS indicated probable depression. Network analyses, utilizing expected influence (EI) and bridge expected influence (BEI), were conducted to determine central symptoms and bridge symptoms. Results Among the 480 expectant mothers (mean age: 33.0 ± 4.4 years, mean gestation week: 24.2 ± 5.9), the prevalence of probable insomnia and depression was 73.95% and 45.83%, respectively. The values of skewness and kurtosis of all symptoms were acceptable (skewness: -0.74 - 1.21, kurtosis: 1.91 - 3.47). Distress about sleep problems (ISI5) had the highest EI value, followed by Sadness (EPDS8), Unable to enjoy things (anhedonia) (EPDS2), and Feeling scared or panicky (EPDS5). Four bridge symptoms were identified: Difficulty initiating sleep (ISI-DIS), Difficulty sleeping (EPDS7), Feeling anxious/worried (EPDS4), and Distress about sleep problems (ISI5), suggesting that these symptoms exert simultaneous influence on both antenatal insomnia and depression, acting as a bridge connecting these two sets of symptoms. Conclusion Central symptoms and bridge symptoms identified in this network analysis should be targeted in the development of prevention and intervention strategies to address insomnia and depression among pregnant women. Support (if any) This work was funded by the Health and Medical Research Fund (HMRF, Ref. 20212091), the Food and Health Bureau, Hong Kong SAR, China.