Changes in sleep quality, but not hormones predict time to postpartum depression recurrence
Open accessAbstract
Background Poor sleep quality, dysregulation of hormones and increased inflammatory cytokines are all associated with the risk for postpartum major depression (PPMD). We evaluated change over time in sleep quality and hormones during the first 17 weeks postpartum, as well as a single cytokine measure, and their association with PPMD recurrence.Methods Participants were pregnant women (N=56), with past histories of MDD/PPMD but not depressed in their current pregnancy. The Pittsburgh Sleep Quality Index (PSQI) and blood samples were collected 8 times during the first 17 weeks postpartum. Estradiol, prolactin and cortisol, and a single measure of IL-6 were assayed. Recurrence was determined by two consecutive 21-item Hamilton Rating Scale for Depression (HRSD) scores≥15 and clinician interview.Results In the analyses of time to PPMD recurrence, poor sleep quality, but none of the hormones, was associated with PPMD recurrence (p<.05) after controlling for medication assignment. With every one point increase in PSQI scores across time, a woman's risk for recurrence increased by approximately 25% There was no significant association between PSQI scores and IL-6 concentrations in early postpartum (χ(2)=0.98, p=.32).Conclusions Poor sleep quality across the first 17 weeks post-delivery increases the risk for recurrent PPMD among women with a history of MDD. Changes in the hormonal milieu were not associated with recurrence. Further exploration of the degree to which poor sleep contributes to hormonal and cytokine dysregulation and how they are involved in the pathophysiology of PPMD is warranted.
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Sleep disturbances among parents of infants are associated with increased postpartum depression, increased sleep disturbances among infants, and other adverse outcomes.
“Sleep disturbances among parents of infants are associated with increased postpartum depression,160–162 increased sleep disturbances among infants, and other adverse outcomes.”
From Sleep, Health, and Society (2017) · cites this paper as [160]
The association between poor sleep and subsequent depressive symptoms also holds true when sleep disturbance is experienced during the early postpartum period and postpartum depression develops at a later postpartum time.
“The association between poor sleep and subsequent depressive symptoms also holds true when sleep disturbance is experienced during the early postpartum period and postpartum depression develops at a later postpartum time [84,85].”
From Non-Pharmacological Treatment of Insomnia (2012) · cites this paper as [85]
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- Authors
- Okun, M. L., Luther, J., Prather, A. A., Perel, J. M., Wisniewski, S., & Wisner, K. L.
- Affiliations
- University of Pittsburgh (US)
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2011-05
- Volume
- 130
- Issue
- 3
- Pages
- 378-384
- ISSN
- 0165-0327 (ISSN-L)
- PMC
- PMC3006083
- OpenAlex
- W1997034087
- Cited by
- 154
- References
- 43
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 8 · 2023: 10 · 2022: 8 · 2021: 15 · 2020: 7 · 2019: 14 · 2018: 15 · 2017: 11 · 2016: 7 · 2015: 20 · 2014: 11 · 2013: 12 · 2012: 7
- FWCI
- 6.97
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Parent Project Muscular Dystrophy
- National Institutes of Health (UL1TR000005, 1r15nr008103-01a1)
- U.S. Public Health Service (MHR01 60335, MHR01 53735)
- National Institute of Mental Health (R01MH060335, R01MH053735)
- National Institute of Nursing Research (R15 NR008103, R00NR010813)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy-related medical research
- Keywords
- sleep quality, depression recurrence, estradiol, prolactin, cortisol, interleukin-6, inflammatory cytokines, hormonal dysregulation, postpartum period, maternal mental health, risk factors
- MeSH terms
- Adult, Major Depressive Disorder, Estradiol, Female, Humans, Hydrocortisone, Pregnancy, Recurrence, Risk Factors, Sleep, Sleep Wake Disorders, Time Factors, Interleukin-6, Depression, Postpartum, Postpartum Period
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