0157 From Adverse Childhood Experiences to Insomnia Severity and Treatment Preference: Maladaptive Sleep Beliefs as a Key Mechanism

Abstract Introduction Adverse childhood experiences (ACEs) are major predisposing factors for insomnia in adulthood and have been linked to a greater preference toward medication for insomnia over behavioral interventions. ACEs may also shape beliefs about sleep that are known to influence insomnia treatment preference. Whether ACEs affect insomnia and its treatment acceptability via maladaptive beliefs is unknown. We hypothesized that having more ACEs would be associated with more dysfunctional beliefs about sleep, thereby conferring risk for insomnia severity and preference for medication over behavioral interventions. Methods In this secondary analysis of the NOLO online survey study (N=442), we analyzed measures of the demographics survey, ACEs Questionnaire, Dysfunctional Beliefs and Attitudes about Sleep (DBAS-16) scale, Insomnia Severity Index, Insomnia Treatment Acceptability Subscales for behavioral (ITAS-B) and medication (ITAS-M), and Patient-Reported Outcomes Measurement Information System–Depression Scale. We conducted structural equation modeling (SEM) to examine the indirect paths of ACEs to insomnia, mediated by DBAS and depression. We also examined the direct and indirect effects of ACEs on treatment acceptability for medications and behavioral interventions, accounting for DBAS and depression. Results The SEM showed adequate global fit, χ²(24)=72.997, RMSEA=.068, CFI=.975. ACEs had a moderate total effect on insomnia severity (β=.51**), with mostly indirect effects (β=.36**), including ACEs to DBAS to insomnia (β=.23**) and ACEs to depression to insomnia (β=.12**). ACEs had a small total negative effect on ITAS-B (β=–.24**) that was almost entirely mediated by indirect effects (β=–.21**), including ACEs to depression to ITAS-B (β=–.08*) and ACEs to DBAS to insomnia to ITAS-B, adjusting for depression (β=–.13**). For ITAS-M, ACEs showed an indirect pathway that included ACEs to DBAS to ITAS-M (β=.19**). Conclusion Results support our hypothesis that dysfunctional beliefs about sleep confer risks for insomnia severity and impact treatment acceptability in the context of ACEs. While ACEs make treatment for insomnia generally less acceptable, through dysfunctional beliefs and depression, there is a relative preference for medication over behavioral intervention for insomnia. These findings highlight the importance of preventing ACEs and using targeted interventions that address dysfunctional beliefs, along with screening for clients' history of ACES and maladaptive schemas during treatment planning. Support (if any)