0154 Exploring Income as a Potential Risk Factor for Insomnia in the Acute Aftermath of Trauma

Abstract Introduction Insomnia is a common effect of acute trauma exposure. Insomnia is associated with various social determinants of health (SDoH), such as income level and urbanicity. One unexplored question is which SDoH are linked with insomnia within the acute aftermath of trauma. We examined the relationship between income, urbanicity and post-trauma insomnia severity among patients hospitalized in Detroit, MI following traumatic injury. Methods Patients (N = 88, Mage = 39.53 ± SD 14.31, 67% male, 67% Black or African American, 48% reported income ≤ $20,000, 76% Wayne county residents) hospitalized after experiencing traumatic injury were surveyed within five days of trauma (T1) to assess pre-trauma insomnia symptom severity (ISI) and depression symptom severity (PHQ-9), and again approximately one month later (T2) to evaluate post-trauma ISI. Annual household income and zip code were collected during hospitalization and coded as above or below $20,000 and residing within or outside of Wayne County, MI. Results Patients reporting an annual household income of ≤ $20,000 had significantly higher T2 ISI scores (N = 42, M = 15.68, SD = 7.07) than those in the higher income group (N = 46, M = 11.50, SD = 6.69; t(58.97) = 2.37, p = .021, 95% C.I. = 0.65, 7.70, g = 0.60) . Annual income of ≤ $20,000 remained significantly associated with more severe ISI at T2 after controlling for depression at T1 (β = –6.20, p = .019). However, the relationship between income and T2 insomnia was no longer significant after accounting for T1 ISI (r = –0.18, p = .158). Zip code was not correlated with T2 insomnia (p = .09). Conclusion An annual household income of $20,000 or less was prospectively associated with more severe insomnia after trauma, above and beyond pre-trauma depression symptoms. However, this correlation was not significant after accounting for pre-trauma insomnia. Future research should evaluate SDoH on a more granular level (census tract or neighborhood) to increase specificity and identify which SDoH affect post-trauma insomnia beyond the contribution of baseline sleep to inform future treatment for at-risk populations. Support (if any) Support was provided by the NIMH (K23MH134032; A.N.R.).