The effect of sleep pattern changes on postpartum depressive symptoms

Beth A Lewis, Dwenda Gjerdingen, Katie Schuver, Melissa Avery, Bess H Marcus, Beth A Lewis, Dwenda Gjerdingen, Katie Schuver, Melissa Avery, Bess H Marcus

Abstract

Background: Research indicates that poor sleep is associated with postpartum depression; however, little is known regarding this relationship among postpartum women who are at high for postpartum depression. This study examined the relationship between changes in self-reported sleep patterns (from six weeks to seven months postpartum) and depressive symptoms at seven months postpartum among women who were at high risk for postpartum depression.

Methods: Participants (n = 122) were postpartum women who were at an increased risk for postpartum depression (personal or maternal history of depression) and had participated in a randomized exercise intervention trial. For the current trial, participants completed the Pittsburgh Sleep Quality Index and Patient Health Questionnaire-9 (PHQ-9; assessed depression) at six weeks and seven months postpartum.

Results: Overall, sleep problems significantly improved from six weeks to seven months postpartum. However, linear regression analyses indicated that worsening or minimal improvement of sleep problems were associated with higher depressive symptoms at seven month postpartum. Regarding the specific types of sleep problems, self-reported changes in sleep latency (i.e., how long it takes to fall asleep at night), daytime dysfunction (i.e., difficulty staying awake during the day), and sleep quality (i.e., subjective rating of sleep quality) were associated with higher levels of depressive symptoms.

Conclusions: Sleep problems typically improve during the postpartum phase. However, postpartum women who are at high risk for postpartum depression are at an increased risk for depressive symptoms later in the postpartum phase if sleep problems worsen or show only minimal improvement over time. Therefore, at the six-week postpartum clinic visit, women should receive education regarding potential worsening of sleep patterns and strategies for preventing sleep-related problems.

Trial registration: Registered with ClinicalTrials.gov ( NCT00961402 ) on August 18, 2009 prior to the start of the trial.

Keywords: Exercise; Physical activity; Postpartum depression; Sleep.

Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the University of Minnesota’s Institutional Review Board (# 0903S61462). Participants provided written consent to participate.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

    1. Hipwell AE, Goossens FA, Melhuish EC, Kumar R. Severe maternal psychopathology and infant-mother attachment. Dev Psychopathol. 2000;12:157–175. doi: 10.1017/S0954579400002030.
    1. Field T. Postpartum depression effects on early interactions, parenting, and safety practices: a review. Infant Beh Dev. 2010;33:1–6. doi: 10.1016/j.infbeh.2009.10.005.
    1. Barker ED, Jaffee SR, Uher R, Maughan B. The contribution of prenatal and postnatal maternal anxiety and depression to child maladjustment. Depress Anxiety. 2011;28:696–702. doi: 10.1002/da.20856.
    1. Herring SJ, Rich-Edwards JW, Oken E, Rifas-Shiman SL, Kleinman KP, Gillman MW. Association of postpartum depression with weight retention 1 year after childbirth. Obesity. 2008;16:1296–1301. doi: 10.1038/oby.2008.71.
    1. Paulson JF, Bazemore SD. Prenatal and postpartum depression in fathers and its association with maternal depression: a meta-analysis. JAMA. 2010;303:1961–1969. doi: 10.1001/jama.2010.605.
    1. Banti S, Mauri M, Oppo A, Borri C, Rambelli C, Ramacciotti D, Montagnani MS, Camilleri V, Cortopassi S, Rucci P, Cassano GB. From the third month of pregnancy to 1 year postpartum. Prevalence, incidence, recurrence, and new onset of depression. Results from the Perinatal Depression–Research & Screening Unit study. Compr Psychiatry. 2011;52:343–351. doi: 10.1016/j.comppsych.2010.08.003.
    1. Gaynes BN, Gavin N, Meltzer-Brody S, Lohr KN, Swinson T, Gartlehner G, Brody S, Miller WC. Perinatal depression: prevalence, screening accuracy, and screening outcomes. Evidence Report Technology Assessment (Summary) 2005;119:1–8.
    1. Le Strat Y, Dubertret C, Le Foll B. Prevalence and correlates of major depressive episode in pregnant and postpartum women in the United States. J Affect Disord. 2011;135:128–138. doi: 10.1016/j.jad.2011.07.004.
    1. O'Hara MW, Swain AM. Rates and risk of postpartum depression-a meta-analysis. Int Rev Psychiatry. 1996;8:37–54. doi: 10.3109/09540269609037816.
    1. Oppo A, Mauri M, Ramacciotti D, Camilleri V, Banti S, Borri C, Rambelli C, Montagnani MS, Cortopassi S, Bettini A, Ricciardulli S. Risk factors for postpartum depression: the role of the postpartum depression predictors inventory-revised (PDPI-R). Results from the Perinatal Depression-Research & Screening Unit (PNDReScU) study. Arch Womens Ment Health. 2009;12:239–249. doi: 10.1007/s00737-009-0071-8.
    1. Rich-Edwards JW, Kleinman K, Abrams A. Sociodemographic predictors of antenatal and postpartum depressive symptoms among women in a medical group practice. J Epidemiol Community Health. 2006;60:221–227. doi: 10.1136/jech.2005.039370.
    1. Gjerdingen D, Crow S, McGovern P, Miner M, Center B. Stepped care treatment of postpartum depression: impact on treatment, health, and work outcomes. J Am Board Fam Med. 2009;22:473–482. doi: 10.3122/jabfm.2009.05.080192.
    1. Bhati S, Richards KA. Systematic review of the relationship between postpartum sleep disturbance and postpartum depression. JOGNN. 2015;44:350–357. doi: 10.1111/1552-6909.12562.
    1. Dennis CL, Ross L. Relationships among infant sleep patterns, maternal fatigue, and development of depressive symptomatology. Birth. 2005;32:187–193. doi: 10.1111/j.0730-7659.2005.00368.x.
    1. Hiscock H, Bayer J, Gold L, Hampton A, Ukoumunne O, Wake M. Improving infant sleep and maternal mental health: a cluster randomised trial. Arch Dis Child. 2007;92:952–958. doi: 10.1136/adc.2006.099812.
    1. Kennedy HP, Gardiner A, Gay C, Lee KA. Negotiating sleep: a qualitative study of new mothers. J Perinat Neonatal Nurs. 2007;21:114–122. doi: 10.1097/01.JPN.0000270628.51122.1d.
    1. Lawson A, Murphy KE, Sloan E, Uleryk E, Dalfen A. The relationship between sleep and postpartum mental disorders: a systematic review. J Affect Disord. 2015;176:65–77. doi: 10.1016/j.jad.2015.01.017.
    1. Bei B, Milgrom J, Ericksen J, Trinder J. Subjective perception of sleep, but not its objective quality, is associated with immediate postpartum mood disturbances in healthy women. Sleep. 2010;33:531. doi: 10.1093/sleep/33.4.531.
    1. Coo Calcagni S, Bei B, Milgrom J, Trinder J. The relationship between sleep and mood in first-time and experienced mothers. Behav Sleep Med. 2012;10:167–179. doi: 10.1080/15402002.2012.668147.
    1. Huang CM, Carter PA, Guo JLA. Comparison of sleep and daytime sleepiness in depressed and non-depressed mothers during the early postpartum period. J Nurs Res. 2004;12:287–296. doi: 10.1097/.
    1. Dorheim SK, Bondevik GT, Eberhard-Gran M, Bjorvatn B. Sleep and depression in postpartum women: a population-based study. Sleep. 2009;32:847. doi: 10.1093/sleep/32.7.847.
    1. Goyal D, Gay CL, Lee KA. Patterns of sleep disruption and depressive symptoms in new mothers. J Perinat Neonat Nur. 2007;21:123–129. doi: 10.1097/01.JPN.0000270629.58746.96.
    1. Goyal D, Gay C, Lee K. Fragmented maternal sleep is more strongly correlated with depressive symptoms than infant temperament at three months postpartum. Arch Womens Ment Health. 2009;12:229–237. doi: 10.1007/s00737-009-0070-9.
    1. Posmontier B. Sleep quality in women with and without postpartum depression. JOGNN. 2008;37:722–737. doi: 10.1111/j.1552-6909.2008.00298.x.
    1. Tsai SY, Thomas KA. Sleep disturbances and depressive symptoms in healthy postpartum women: a pilot study. Res Nurs Health. 2012;35:314–323. doi: 10.1002/nur.21469.
    1. Park EM, Meltzer-Brody S, Stickgold R. Poor sleep maintenance and subjective sleep quality are associated with postpartum maternal depression symptom severity. Arch Womens Ment Health. 2013;16:539–547. doi: 10.1007/s00737-013-0356-9.
    1. American Psychiatric Association . Diagnostic and statistical manual of mental disorders. 5. Arlington: VA: American Psychiatric Publishing; 2013.
    1. Thomas KA, Spieker S. (2016). Sleep, depression, and fatigue in late postpartum. MCN Am J Matern Child Nurs. 2016;41:104–109. doi: 10.1097/NMC.0000000000000213.
    1. Tomfohr L, Buliga E, Letourneau N, Campbell T, Giesbrecht G. Trajectories of sleep quality and associations with mood during the perinatal period. Sleep. 2015;38(1237):45.
    1. Okun ML, Luther J, Prather AA, Perel JM, Wisniewski S, Wisner KL. Changes in sleep quality, but not hormones predict time to postpartum depression recurrence. J Affect Disord. 2011;130:378–384. doi: 10.1016/j.jad.2010.07.015.
    1. Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. J Psychiat Res. 1989;28:193–213. doi: 10.1016/0165-1781(89)90047-4.
    1. Hamilton MAA. Rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23:56–62. doi: 10.1136/jnnp.23.1.56.
    1. Galbally M, Lewis AJ, McEgan K, Scalzo K, Islam FM. Breastfeeding and infant sleep patterns: an Australian population study. J Paediatr Child Health. 2013;49:E147–E152. doi: 10.1111/jpc.12089.
    1. Kroenke K, Spitzer RL. The PHQ-9: a new depression diagnostic and severity measure. Psychiatr Ann. 2002;32:1–7. doi: 10.3928/0048-5713-20020901-06.
    1. Huang FY, Chung H, Kroenke K, Delucchi KL, Spitzer RL. Using the patient health questionnaire-9 to measure depression among racially and ethnically diverse primary care patients. J Gen Intern Med. 2006;21:547–552. doi: 10.1111/j.1525-1497.2006.00409.x.
    1. Dobscha SK, Corson K, Hickam DH, Perrin NA, Kraemer DF, Gerrity MS. Depression decision support in primary care: a cluster randomized trial. Ann Intern Med. 2006;145:477–487. doi: 10.7326/0003-4819-145-7-200610030-00005.
    1. Martin A, Rief W, Klaiberg A, Braehler E. Validity of the brief patient health questionnaire mood scale (PHQ-9) in the general population. Gen Hosp Psychiatr. 2006;28:71–77. doi: 10.1016/j.genhosppsych.2005.07.003.
    1. Gensichen J, Torge M, Peitz M, Wendt-Hermainski H, Beyer M, Rosemann T, Krauth C, Raspe H, Aldenhoff JB, Gerlach FM. Case management for the treatment of patients with major depression in general practices–rationale, design and conduct of a cluster randomized controlled trial–PRoMPT (primary care monitoring for depressive Patient's trial)[ISRCTN66386086]–study protocol. BMC Public Health. 2005;5:101. doi: 10.1186/1471-2458-5-101.
    1. Löwe B, Kroenke K, Herzog W, Gräfe K. Measuring depression outcome with a brief self-report instrument: sensitivity to change of the patient health questionnaire (PHQ-9) J Affect Disord. 2004;81:61–66. doi: 10.1016/S0165-0327(03)00198-8.
    1. First MB, Spitzer RL, Gibbons M, et al. Structured clinical interview for DSM-IV—clinical version (SCID-CV) (User’s guide and interview) Washington, D.C.: American Psychiatric Press, Inc.; 1997.
    1. Lewis BA, Gjerdingen DK, Avery MD, et al. Examination of a telephone-based exercise intervention for the prevention of postpartum depression: design, methodology, and baseline data from the healthy mom study. Contemp Clin Trials. 2012;33:1150–1158. doi: 10.1016/j.cct.2012.07.015.
    1. Lewis BA, Gjerdingen DK, Avery MD, Guo H, Sirard JR, Bonikowske AR, Marcus BHA. Randomized trial examining a physical activity intervention for the prevention of postpartum depression: the healthy mom trial. Ment Health Phys Act. 2014;7:42–49. doi: 10.1016/j.mhpa.2013.11.002.
    1. Kutner M, Nachtsheim C, Neter J. Applied Linear Statistical Models. 4. Irwin: McGraw-Hill; 2004.
    1. Swanson LM, Flynn H, Adams-Mundy JD, Armitage R, Arnedt JT. (2013). An open pilot of cognitive-behavioral therapy for insomnia in women with postpartum depression. Beh Sleep Med. 2013;11:297–307. doi: 10.1080/15402002.2012.683902.
    1. McBean AL, Montgomery-Downs HE. What are postpartum women doing while the rest of the world is asleep? J Sleep Res. 2015;24:270–278. doi: 10.1111/jsr.12265.
    1. Brummelte S, Galea LA. Postpartum depression: etiology, treatment and consequences for maternal care. Horm Behav. 2016;77:153–166. doi: 10.1016/j.yhbeh.2015.08.008.
    1. Parizek A, Mikesova M, Jirák R, Hill M, Koucký M, Pasková A, Velíková M, Adamcová K, Srámková M, Jandíková H, Dusková M. Steroid hormones in the development of postpartum depression. Physiol Res. 2014;63:S277–S282.
    1. Gress-Smith JL, Luecken LJ, Lemery-Chalfant K, Howe R. Postpartum depression prevalence and impact on infant health, weight, and sleep in low-income and ethnic minority women and infants. Matern Child Health J. 2012;16:887–893. doi: 10.1007/s10995-011-0812-y.
    1. Hiscock H, Wake M. Randomised controlled trial of behavioural infant sleep intervention to improve infant sleep and maternal mood. BMJ. 2002;324:1062. doi: 10.1136/bmj.324.7345.1062.

Source: PubMed

3
구독하다