Relationships among depression, anxiety, and insomnia symptoms in perinatal women seeking mental health treatment
Open accessAbstract
BACKGROUND: Depression and anxiety symptoms are commonly experienced by women during the perinatal period. Changes in sleep and sleep quality are typical throughout pregnancy and early postpartum. However, little is known about relationships between insomnia symptoms and psychiatric symptoms in perinatal women. The objective of the present study is to characterize the burden of insomnia symptoms in perinatal women seeking outpatient psychiatric treatment and to examine relationships between insomnia and symptoms of depression and anxiety. METHODS: Data from 257 pregnant or postpartum women who sought outpatient psychiatric treatment at a university hospital-affiliated clinic were extracted from an existing clinical management database. Data included validated self-report measures assessing insomnia (Insomnia Severity Index [ISI]), mood (Edinburgh Postnatal Depression Scale [EPDS]), and generalized anxiety (Penn State Worry Questionnaire [PSWQ]). RESULTS: Fifty-two percent of women reported symptoms of insomnia, 75% reported symptoms of depression, and 61% reported symptoms of generalized anxiety. After controlling for PSWQ, the partial correlation between EPDS and ISI was 0.15 and 0.37 for pregnant and postpartum women, respectively. After controlling for EPDS, the partial correlation between PSWQ and ISI was 0.20 and 0.12 for pregnant and postpartum women, respectively. Women with clinically significant ISI scores had significantly higher odds for reporting symptoms consistent with depression (odds ratio [OR] 7.7) and generalized anxiety (OR 2.55) compared to women with lower ISI scores. CONCLUSIONS: Insomnia symptoms affected a significant proportion of the perinatal women in this sample. These symptoms are linked to symptoms of depression and anxiety in treatment-seeking pregnant and postpartum women. Perinatal women seen in psychiatric treatment settings should be routinely screened for sleep problems.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The prevalence of a probable diagnosis of perinatal insomnia ranges from 41 to 58% of perinatal women.
“The prevalence of a probable diagnosis of perinatal insomnia range from 41 to 58 % of perinatal women [54,71,72].”
From Non-Pharmacological Treatment of Insomnia (2012) · cites this paper as [72]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Detection of Postnatal Depression: Development of the 10-item Edinburgh Postnatal Depression Scale
Cox, J. L., Holden, J. M., & Sagovsky, R. (1987) · British Journal of Psychiatry · doi:10.1192/bjp.150.6.782 · Cited by 13,982 · see citing works
Validation of the Insomnia Severity Index as an outcome measure for insomnia research
Bastien, C. (2001) · Sleep Medicine · doi:10.1016/s1389-9457(00)00065-4 · Cited by 8,067 · see citing works
Development and validation of the Penn State Worry Questionnaire
Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovec, T. D. (1990) · Behaviour Research and Therapy · doi:10.1016/0005-7967(90)90135-6 · Cited by 5,099 · see citing works
Perinatal Depression: A Systematic Review of Prevalence and Incidence
Gavin, N. I., Gaynes, B. N., Lohr, K. N., Meltzer-Brody, S., Gartlehner, G., & Swinson, T. (2005) · Obstetrics & Gynecology · doi:10.1097/01.aog.0000183597.31630.db · Cited by 3,282 · see citing works
Goodman, S. H., & Gotlib, I. H. (1999) · Psychological Review · doi:10.1037/0033-295x.106.3.458 · Cited by 2,493 · see citing works
Sleep disturbance and psychiatric disorders: A longitudinal epidemiological study of young Adults
Breslau, N., Roth, T., Rosenthal, L., & Andreski, P. (1996) · Biological Psychiatry · doi:10.1016/0006-3223(95)00188-3 · Cited by 1,831 · cited 1× · see citing works
“19,20 To date, there are no studies of the relationships between insomnia symptoms and psychiatric symptoms in perinatal women who are seeking mental health treatment.”
Psychiatric Disorders in Pregnant and Postpartum Women in the United States
Vesga-López, O., Blanco, C., Keyes, K., Olfson, M., Grant, B. F., & Hasin, D. S. (2008) · Archives of General Psychiatry · doi:10.1001/archpsyc.65.7.805 · Cited by 1,065 · see citing works
Prevalence, course, and comorbidity of insomnia and depression in young adults.
Buysse, D. J., Angst, J., Gamma, A., Ajdacic, V., Eich, D., & Rössler, W. (2008) · Sleep · doi:10.1093/sleep/31.4.473 · Cited by 858 · see citing works
Validation of the Edinburgh postnatal depression scale (EPDS) in non-postnatal women
Cox, J. (1996) · Journal of Affective Disorders · doi:10.1016/0165-0327(96)00008-0 · Cited by 810 · see citing works
Diagnosing postpartum depression in mothers and fathers: whatever happened to anxiety?
Matthey, S., Barnett, B., Howie, P., & Kavanagh, D. J. (2003) · Journal of Affective Disorders · doi:10.1016/s0165-0327(02)00012-5 · Cited by 547 · see citing works
Parity and Sleep Patterns During and After Pregnancy
Lee, K., ZAFFKE, M. E., & MCENANY, G. (2000) · Obstetrics and Gynecology · doi:10.1016/s0029-7844(99)00486-x · Cited by 445 · see citing works
Anxiety symptoms and disorders at eight weeks postpartum
Wenzel, A., Haugen, E. N., Jackson, L. C., & Brendle, J. R. (2005) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2004.04.001 · Cited by 366 · cited 1× · see citing works
“Perinatal depression affects 1 in 5 women, whereas anxiety disorders, although less studied than depression, are estimated to impact as many as 16% of women in the early postpartum period.(3,4) Impaired maternal functioning due to mental illness can affect bonding between mother and infant and have longer-term consequ…”
Sleep and depression in postpartum women: a population-based study
Dørheim, S. K., Bondevik, G. T., Eberhard-Gran, M., & Bjorvatn, B. (2009) · SLEEP · doi:10.1093/sleep/32.7.847 · Cited by 331 · see citing works
Precipitating Factors of Insomnia
Bastien, C., Vallières, A., & Morin, C. M. (2004) · Behavioral Sleep Medicine · doi:10.1207/s15402010bsm0201_5 · Cited by 236 · see citing works
Bei, B., Milgrom, J., Ericksen, J., & Trinder, J. (2010) · SLEEP · doi:10.1093/sleep/33.4.531 · Cited by 234 · see citing works
Maughan, A., Cicchetti, D., Toth, S. L., & Rogosch, F. A. (2007) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-007-9129-0 · Cited by 226 · see citing works
Sleep quality and depression during pregnancy: a prospective study
SKOUTERIS, H., GERMANO, C., WERTHEIM, E. H., PAXTON, S. J., & MILGROM, J. (2008) · Journal of Sleep Research · doi:10.1111/j.1365-2869.2008.00655.x · Cited by 190 · cited 1× · see citing works
“12 Similarly, in a Norwegian population-based study of > 4000 women at 7 weeks postpartum, subjective report of poor sleep quality was significantly associated with depression even after controlling for multiple risk factors.”
Normative longitudinal maternal sleep: the first 4 postpartum months
Montgomery‐Downs, H. E., Insana, S., Clegg-Kraynok, M. M., & Mancini, L. M. (2010) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2010.06.057 · Cited by 175 · see citing works
Patterns of Sleep Disruption and Depressive Symptoms in New Mothers
Goyal, D., Gay, C., & Lee, K. A. (2007) · The Journal of Perinatal & Neonatal Nursing · doi:10.1097/01.jpn.0000270629.58746.96 · Cited by 166 · see citing works
Sleep Hygiene Practices in a Population-Based Sample of Insomniacs
Jefferson, C. D., Drake, C. L., Scofield, H., Myers, E., McClure, T., Roehrs, T., & Roth, T. G. (2005) · SLEEP · doi:10.1093/sleep/28.5.611 · Cited by 158 · see citing works
Changes in sleep quality, but not hormones predict time to postpartum depression recurrence
Okun, M. L., Luther, J., Prather, A. A., Perel, J. M., Wisniewski, S., & Wisner, K. L. (2011) · Journal of Affective Disorders · doi:10.1016/j.jad.2010.07.015 · Cited by 154 · see citing works
Consequences of antenatal mental health problems for child health and development
Hollins, K. (2007) · Current Opinion in Obstetrics & Gynecology · doi:10.1097/gco.0b013e3282f1bf28 · Cited by 79 · see citing works
Depression and insomnia in women
Krystal, A. D. (2004) · Clinical cornerstone · doi:10.1016/s1098-3597(04)80022-x · Cited by 63 · see citing works
Evaluating Insomnia During Pregnancy and Postpartum
Lee, K. A., & Caughey, A. B. (2007) · Humana Press eBooks · doi:10.1007/978-1-59745-115-4_15 · Cited by 13 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- Bastien C, Vallires A, Morin C. Precipitating factors of in- somnia. Behav Sleep Med 2004;2:50-62.
Cited by
Sorted by citations
Chronic sleep loss during pregnancy as a determinant of stress: impact on pregnancy outcome
Palagini, L., Gemignani, A., Banti, S., Manconi, M., Mauri, M., & Riemann, D. (2014) · Sleep Medicine · doi:10.1016/j.sleep.2014.02.013 · Cited by 220 · see citing works
Khoury, J. E., Atkinson, L., Bennett, T., Jack, S. M., & Gonzalez, A. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.01.027 · Cited by 195 · see citing works
Blackmore, E. R., Gustafsson, H., Gilchrist, M., Wyman, C., & G O’Connor, T. (2016) · Journal of Affective Disorders · doi:10.1016/j.jad.2016.03.008 · Cited by 186 · see citing works
Trajectories of Sleep Quality and Associations with Mood during the Perinatal Period
Tomfohr, L. M., Buliga, E., Letourneau, N. L., Campbell, T. S., & Giesbrecht, G. F. (2015) · Sleep · doi:10.5665/sleep.4900 · Cited by 182 · see citing works
A randomized controlled trial of digital cognitive behavioral therapy for insomnia in pregnant women
Kalmbach, D. A., Cheng, P., O'Brien, L. M., Swanson, L. M., Sangha, R., Sen, S., Guille, C., Cuamatzi-Castelan, A., Henry, A. L., Roth, T., et al. (2020) · Sleep Medicine · doi:10.1016/j.sleep.2020.03.016 · Cited by 154 · see citing works
Self-citationAn Open Pilot of Cognitive-Behavioral Therapy for Insomnia in Women with Postpartum Depression
Swanson, L. M., Flynn, H., Adams-Mundy, J. D., Armitage, R., & Arnedt, J. T. (2013) · Behavioral Sleep Medicine · doi:10.1080/15402002.2012.683902 · Cited by 98 · see citing works
Self-citationNon-Pharmacological Treatment of Insomnia
Siebern, A. T., Suh, S., & Nowakowski, S. (2012) · Neurotherapeutics · doi:10.1007/s13311-012-0142-9 · Cited by 88 · see citing works
Neri, E., Agostini, F., Salvatori, P., Biasini, A., & Monti, F. (2015) · Frontiers in Psychology · doi:10.3389/fpsyg.2015.01234 · Cited by 86 · see citing works
Objective and subjective sleep during pregnancy: links with depressive and anxiety symptoms
Volkovich, E., Tikotzky, L., & Manber, R. (2016) · Archives of Women's Mental Health · doi:10.1007/s00737-015-0554-8 · Cited by 75 · see citing works
Perinatal Insomnia and Mental Health: a review of recent literature
Swanson, L. M., Kalmbach, D. A., Raglan, G. B., & O’Brien, L. M. (2020) · Current Psychiatry Reports · doi:10.1007/s11920-020-01198-5 · Cited by 70 · see citing works
Self-citationBonacquisti, A., Cohen, M. J., & Schiller, C. E. (2017) · Archives of Women's Mental Health · doi:10.1007/s00737-017-0735-8 · Cited by 63 · see citing works
Furtado, M., Van Lieshout, R. J., Van Ameringen, M., Green, S. M., & Frey, B. N. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.02.064 · Cited by 50 · see citing works
Ibrahim, S., & Foldvary-Schaefer, N. (2012) · Neurologic Clinics · doi:10.1016/j.ncl.2012.02.001 · Cited by 24 · see citing works
Trajectory of maternal depression and parasomnias
Guttier, M. C., Halal, C. S., Matijasevich, A., Del‐Ponte, B., Tovo‐Rodrigues, L., Barros, F., Bassani, D. G., & Santos, I. S. (2024) · Journal of Sleep Research · doi:10.1111/jsr.13870 · Cited by 1 · see citing works
- Authors
- Swanson, L. M., Pickett, S. M., Flynn, H., & Armitage, R.
- Affiliations
- University of Michigan (US)
- Oakland University (US)
- Corresponding author
- Swanson, Leslie M.
- Venue
- Journal of Women s Health
- Publisher
- SAGE Publications
- Published
- 2011-04
- Volume
- 20
- Issue
- 4
- Pages
- 553-558
- ISSN
- 1059-7115 (ISSN-L)
- 1540-9996
- 1931-843X
- OpenAlex
- W2097606407
- Cited by
- 135
- References
- 24
- Citations by year
- 2026: 1 · 2025: 9 · 2024: 4 · 2023: 9 · 2022: 11 · 2021: 15 · 2020: 12 · 2019: 22 · 2018: 6 · 2017: 3 · 2016: 6 · 2015: 12 · 2014: 10 · 2013: 9 · 2012: 6
- FWCI
- 7.84
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Locations
- Journal of Women s Health (publishedVersion)
- PubMed (publishedVersion)
- Deep Blue (University of Michigan) (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Keywords
- insomnia, perinatal depression, postpartum anxiety, generalized anxiety disorder, pregnancy, postpartum period, sleep disorders, Insomnia Severity Index, Edinburgh Postnatal Depression Scale, Penn State Worry Questionnaire, sleep screening
- MeSH terms
- Adult, Anxiety, Depression, Female, Hospitals, University, Humans, Sleep Initiation and Maintenance Disorders, Mental Health Services, Middle Aged, Outpatient Clinics, Hospital, Pregnancy, Psychiatric Status Rating Scales, Severity of Illness Index, Logistic Models, Perinatal Care, Pregnant People, Postpartum Period, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
