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Sleep and Depression in Postpartum Women: A Population-Based Study
Open accessAbstract
STUDY OBJECTIVES: (1) To describe the prevalence of and risk factors for postpartum maternal sleep problems and depressive symptoms simultaneously, (2) identify factors independently associated with either condition, and (3) explore associations between specific postpartum sleep components and depression. DESIGN: Cross-sectional. SETTING: Population-based. PARTICIPANTS: All women (n = 4191) who had delivered at Stavanger University Hospital from October 2005 to September 2006 were mailed a questionnaire seven weeks postpartum. The response rate was 68% (n = 2830). INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Sleep was measured using the Pittsburgh Sleep Quality Index (PSQI), and depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS). The prevalence of sleep problems, defined as PSQI > 5, was 57.7%, and the prevalence of depression, defined as EPDS > or = 10, was 16.5%. The mean self-reported nightly sleep duration was 6.5 hours and sleep efficiency 73%. Depression, previous sleep problems, being primiparous, not exclusively breastfeeding, or having a younger or male infant were factors associated with poor postpartum sleep quality. Poor sleep was also associated with depression when adjusted for other significant risk factors for depression, such as poor partner relationship, previous depression, depression during pregnancy and stressful life events. Sleep disturbances and subjective sleep quality were the aspects of sleep most strongly associated with depression. CONCLUSIONS: Poor sleep was associated with depression independently of other risk factors. Poor sleep may increase the risk of depression in some women, but as previously known risk factors were also associated, mothers diagnosed with postpartum depression are not merely reporting symptoms of chronic sleep deprivation.
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“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 [71]
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Sleep Patterns Before, During, and After Deployment to Iraq and Afghanistan
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“In one study of 40 women, there was no significant difference in actigraphy variables between depressed and non-depressed women at 2 months postpartum (Dorheim et al. 2009b).”
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“As mulheres com depressão pós-parto apresentaram um sono de pior qualidade que mulheres sem depressão pós-parto, e a qualidade do sono piorou com o aumento da gravidade dos sintomas de depressão pós-parto.(61,70,71) Os padrões de sono da mãe melhoram com a amamentação,(13) ao passo que essa desregulação pode provocar…”
BackgroundThe relationship between sleep and postpartum mental disorders: A systematic review
Lawson, A., Murphy, K. E., Sloan, E. P., Uleryk, E. M., & Dalfen, A. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2015.01.017 · Cited by 175
Insomnia and Depressive Symptoms in Late Pregnancy: A Population-Based Study
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Davanzo, R., Copertino, M., Cunto, A. D., Minen, F., & Amaddeo, A. (2010) · Breastfeeding Medicine · doi:10.1089/bfm.2010.0019 · Cited by 119
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“This may indicate that the level of education was substantially higher than the 8.7% of women with higher education in the general population (Statistics Norway, 2017a), although the level of education among pregnant women in Norway is unknown.”
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“However, for many, sleep disruption continues throughout the postnatal period with 60% reporting poor sleep quality at 2 mo [1] and frequent night waking remaining common for up to 12 mo postnatal [14].”
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“This trend of sleeplessness is similar to results published in 2022, in which nearly 60% of postpartum women reported poor sleep quality two months after delivery [70].”
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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
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Validation of the WHOQOL‐BREF among women following childbirth
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Mood and Objective and Subjective Measures of Sleep During Late Pregnancy and the Postpartum Period
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“EPDS D Edinburgh Postnatal Depression Scale; DASS D Depression, Anxiety, and Stress Scale–21 Items); HADS D Hospital Anxiety and Depression Scale.”
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“In agreement with the previous report, sleep disturbances and subjective sleep quality were found to be strongly associated with depression in a large group of postpartum women (N = 4191, Dorheim et al. 2009).”
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Li, W., Ruan, W., Peng, Y., Lu, Z., & Wang, D. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.08.009 · Cited by 71
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“Limited psychological and financial resources are challenging in their own right; also these mothers may view their infants more negatively (Pinderhughes, Bates, Dodge, Pettit, & Zelli, 2000) and be less likely to respond sensitively to their infants when they are sleep deprived (Anderson & Platten, 2011; Dorheim et a…”
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“No prior studies to our knowledge have quantified associations between poor sleep quality during pregnancy and subsequent exclusive breastfeeding; however, in cross-sectional studies, mixed feeding has been associated with worse sleep quality than exclusive breastfeeding.(60,61) Our findings suggest that preexisting m…”
BackgroundBei, B., Pinnington, D. M., Quin, N., Shen, L., Blumfield, M., Wiley, J. F., Drummond, S. P. A., Newman, L. K., & Manber, R. (2021) · Psychological Medicine · doi:10.1017/s0033291721001860 · Cited by 64
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Circadian clock gene Per3 variants influence the postpartum onset of bipolar disorder
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“A disrupted sleep-wake cycle has been associated with postpartum depression independently of other risk factors [11].”
BackgroundPre-pregnancy Restless Legs Syndrome (Willis-Ekbom Disease) Is Associated with Perinatal Depression
Wesström, J., Skalkidou, A., Manconi, M., Fulda, S., & Poromaa, I. S. (2014) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.3704 · Cited by 57
“The content of the questions and scoring for RLS are: (1) Do you have, or have you had, recurrent uncomfortable feelings or sensations in your legs while you are sitting or lying down? (yes/no); (2) Do you, or have you had, a recurrent need or urge to move your legs while you were sitting or lying down? (yes/no); (3)…”
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“5% in Norway [63-66].”
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“Sleep deprivation is also associated with antenatal stress and PPD [45,46].”
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Kuo, S., Yang, Y., Kuo, P., Tseng, C., & Tzeng, Y. (2012) · Journal of Obstetric, Gynecologic & Neonatal Nursing · doi:10.1111/j.1552-6909.2011.01331.x · Cited by 45
Postpartum Depressive Symptomatology: Results from a Two‐Stage US National Survey
Beck, C. T., Gable, R. K., Sakala, C., & Declercq, E. R. (2011) · Journal of Midwifery & Women s Health · doi:10.1111/j.1542-2011.2011.00090.x · Cited by 44
Optimizing parent-infant sleep from birth to 6 months: a new paradigm
Whittingham, K., & Douglas, P. (2014) · Infant Mental Health Journal · doi:10.1002/imhj.21455 · Cited by 43
“Research has shown that poor maternal sleep efficiency, in common with adult sleep difficulties generally, is predicted by elevated sympathetic nervous system arousal (Dorheim et al., 2009; Goyal et al., 2009), and we deliberately target this arousal and the cognitive, metacognitive, and behavioral processes that may…”
BackgroundKrawczak, E. M., Minuzzi, L., Hidalgo, M. P. L., & Frey, B. N. (2016) · Archives of Women s Mental Health · doi:10.1007/s00737-016-0612-x · Cited by 50
“Another large sample, crosssectional study of 4191 women during the postpartum which found that poor subjective sleep, as measured by the PSQI, was associated with depressive symptoms (Dorheim et al. 2009).”
BackgroundKhadka, R., Hong, S. A., & Chang, Y. (2019) · International Health · doi:10.1093/inthealth/ihz032 · Cited by 42
Associations Between Physical Activity and Postpartum Depressive Symptoms
Demissie, Z., Siega‐Riz, A. M., Evenson, K. R., Herring, A. H., Dole, N., & Gaynes, B. N. (2011) · Journal of Women s Health · doi:10.1089/jwh.2010.2091 · Cited by 41
Assarian, F., Moravveji, A., Ghaffarian, H., Eslamian, R., & Atoof, F. (2014) · Iranian Red Crescent Medical Journal · doi:10.5812/ircmj.14839 · Cited by 41
Postpartum Insomnia and Poor Sleep Quality Are Longitudinally Predictive of Postpartum Mood Symptoms
Okun, M. L., & Lac, A. (2023) · Psychosomatic Medicine · doi:10.1097/psy.0000000000001234 · Cited by 45
“Most of the research has focused on sleep either during the prenatal period (29,44,45) or in the postpartum period (27,28,31,46,47).”
BackgroundResultKalmbach, D. A., Cheng, P., & Drake, C. L. (2021) · SLEEP · doi:10.1093/sleep/zsab028 · Cited by 44
“Depression rates are estimated at 19%–26% in pregnant and postpartum women with insomnia compared to just 4% among perinatal women without insomnia [5, 14, 19].”
BackgroundMaternal sleep and depressive symptoms: Links with infant Negative Affectivity
Tikotzky, L., Chambers, A. S., GAYLOR, E. E., & Manber, R. (2010) · Infant Behavior and Development · doi:10.1016/j.infbeh.2010.07.012 · Cited by 41
McEvoy, K., Rayapati, D., Cole, K. O. W., Erdly, C., Payne, J. L., & Osborne, L. M. (2019) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.7924 · Cited by 41
Parental sleep experiences on the pediatric oncology ward
McLoone, J. K., Wakefield, C. E., Yoong, S. L., & Cohn, R. J. (2012) · Supportive Care in Cancer · doi:10.1007/s00520-012-1547-z · Cited by 40
Osnes, R. S., Eberhard‐Gran, M., Follestad, T., Kallestad, H., Morken, G., & Roaldset, J. O. (2020) · Behavioral Sleep Medicine · doi:10.1080/15402002.2020.1743705 · Cited by 39
Longitudinal Change in Sleep and Daytime Sleepiness in Postpartum Women
Filtness, A. J., MacKenzie, J., & Armstrong, K. (2014) · PLoS ONE · doi:10.1371/journal.pone.0103513 · Cited by 37
“With reportedly 16.5% of new mothers experiencing PPD [33] future investigation into SDI within this group could provide valuable understanding.”
BackgroundInfluentialCross-Cultural Comparison of Maternal Sleep
Mindell, J. A. A., Sadeh, A., Kwon, R. K., & Goh, D. Y. T. (2013) · SLEEP · doi:10.5665/sleep.3132 · Cited by 37
Effects of sleep restriction during pregnancy on the mother and fetuses in rats
Pardo, G. V. E., Goularte, J. F., Hoefel, A. L., de Castro, A. L., Kucharski, L. C., Araújo, A. S. D. R., & Lucion, A. B. (2015) · Physiology & Behavior · doi:10.1016/j.physbeh.2015.11.037 · Cited by 38
Effati-Daryani, F., Mohammad‐Alizadeh‐Charandabi, S., Mirghafourvand, M., Taghizadeh, M., Bekhradi, R., & Zarei, S. (2018) · Women & Health · doi:10.1080/03630242.2017.1414101 · Cited by 38
“© 2018 Taylor & Francis comes as the pregnancy progresses with the prevalence of sleep disturbance reaching about 75% in the third trimester (Lee, Zaffke, and Mcenany 2000; Okun and CoussonsRead 2007; Mindell, Cook, and Nikolovski 2015) and nearly 60% in the postpartum (Dørheim et al. 2009).”
BackgroundMiranda, A. R., Scotta, A. V., Cortez, M. V., & Soria, E. A. (2021) · Midwifery · doi:10.1016/j.midw.2021.103072 · Cited by 38
Hughes, A., Gallagher, S. M., & Hannigan, A. (2015) · Maternal and Child Health Journal · doi:10.1007/s10995-015-1701-6 · Cited by 38
“Maternal depression has previously been associated with sleep disturbance in infants of other populations [8, 33, 34].”
BackgroundPostnatal Depression Is a Public Health Nursing Issue: Perspectives from Norway and Ireland
Glavin, K., & Leahy-Warren, P. (2013) · Nursing Research and Practice · doi:10.1155/2013/813409 · Cited by 47
“Support and information from the PHN at the home visit can have a preventive effect on depressive symptoms in postpartum women [20, 47].”
Mothers massaging their newborns with lotion versus no lotion enhances mothers' and newborns' sleep
Field, T., Gonzalez, G., Diego, M., & Mindell, J. (2016) · Infant Behavior and Development · doi:10.1016/j.infbeh.2016.08.004 · Cited by 34
Cognitive Behavioral Therapy for Insomnia and Women's Health
Nowakowski, S., & Meers, J. M. (2019) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2019.01.002 · Cited by 38
Valla, L., Helseth, S., Småstuen, M. C., Misvær, N., & Andenæs, R. (2022) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-021-04303-5 · Cited by 43
Sarberg, M., Bladh, M. K., Svanborg, E., & Josefsson, A. (2016) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-016-0917-9 · Cited by 36
“There are a number of studies that show an association between sleep during pregnancy and depression or depressive symptoms before delivery [17–19] and there is also a large survey describing an association between poor sleep quality postpartum and depression [20].”
BackgroundBehavioral Management of Sleep Problems in Infants Under 6 Months – What Works?
Crichton, G. E., & Symon, B. G. (2016) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0000000000000257 · Cited by 34
Metadata
- Authors
- Dørheim, S. K., Bondevik, G. T., Eberhard-Gran, M., & Bjorvatn, B.
- Affiliations
- Stavanger University Hospital (NO)
- University of Bergen (NO)
- Haukeland University Hospital (NO)
- Corresponding author
- Dørheim, Signe Karen
- Venue
- SLEEP
- Publisher
- Oxford University Press (OUP)
- Published
- 2009-07
- Volume
- 32
- Issue
- 7
- Pages
- 847-855
- ISSN
- 0161-8105 (ISSN-L)
- 1550-9109
- PMC
- PMC2704916
- OpenAlex
- W177648084
- Cited by
- 331
- References
- 52
- Citations by year
- 2026: 7 · 2025: 17 · 2024: 26 · 2023: 19 · 2022: 23 · 2021: 20 · 2020: 21 · 2019: 21 · 2018: 25 · 2017: 11 · 2016: 19 · 2015: 27 · 2014: 21 · 2013: 29 · 2012: 21
- FWCI
- 14.72
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- SLEEP (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- 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
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Health and Development
- Keywords
- postpartum depression, sleep quality, sleep disorders, depressive symptoms, risk factors, primiparity, breastfeeding, infant characteristics, couple relationships, sleep deprivation, antenatal depression
- MeSH terms
- Adult, Cross-Sectional Studies, Depressive Disorder, Female, Humans, Norway, Psychiatric Status Rating Scales, Puerperal Disorders, Surveys and Questionnaires, Risk Factors, Sleep, Sleep Deprivation, Sleep Wake Disorders, Stress, Psychological, Comorbidity, Prevalence, Odds Ratio, Postpartum Period, Young Adult
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