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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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Identifying clusters from multidimensional symptom trajectories in postpartum women
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“7% [16], which had been observed in the seven weeks of postpartum period and it is 52.”
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“While research exists on the many impacts of postpartum sleep disturbances [24-26] no study has assessed how the timing and regularity of sleep among postpartum women could be related to daytime functioning.”
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“, 2009), and sleep disruption in pregnancy has been linked to the development of ‘maternity blues’, postnatal depression and puerperal psychosis (Dorheim et al., 2009).”
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Drozdowicz, E., Skalski, M., Gdańska, P., Mach, A., Januszko, P., Nowak, R. J., Węgrzyn, P., Wielgoś, M., & Radziwoń-Zaleska, M. (2017) · Metabolic Brain Disease · doi:10.1007/s11011-017-0079-0 · Cited by 20
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The neurobiology of parenting and infant-evoked aggression
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“Fragmented sleep during the perinatal period can be caused by hormonal alterations and a newborn with random/short sleep-wake patterns after childbirth [21-24].”
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“The longer the baby cries and fusses in the night, the more likely the negative impact on maternal anxiety levels and sleep efficiency (Dørheim et al. 2009; Goyal et al. 2009; Miller and LaRusso 2011).”
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Patterns and correlates of sleep duration in the Southern cohort community study
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“Depression has been associated with poor sleep in cross-sectional studies (48, 49), and this association has been confirmed by prospective studies (50, 51).”
ResultNo effect of oral l-tryptophan or alpha-lactalbumin on total tryptophan levels in breast milk
Dowlati, Y., Ravindran, A. V., Maheux, M., Steiner, M. S., Stewart, D. E., & Meyer, J. H. (2015) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2015.03.005 · Cited by 18
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“However, it is a relevant aspect, particularly during breastfeeding, since the relationship of poor sleep quality with depression and emotional status has been demonstrated in other studies, especially in women during the puerperium period [36,37].”
ResultAn analysis of whether sleep disorder will result in postpartum depression
Chung, T.-C., Chung, C., Peng, H.-J., Tsao, C., Chien, W., & Sun, H.-F. (2018) · Oncotarget · doi:10.18632/oncotarget.25219 · Cited by 17
“Studies noted that women experiencing their first birth and less than 25 years of age exhibited an increased risk of developing PPD if they had poor sleep quality or insomnia complaints during pregnancy [28, 32].”
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Breastfeeding and postpartum depression: state of the art review
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Sleep Quality and Quality of Life in Postpartum Woman
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“(26) nüfusa dayalı olarak planladıkları ve doğum sonrası 2830 kadında uyku ve depresyonu inceledikleri çalışmada, PUKİ toplam puan ortalamasını 6,3±3,1, alt boyut puan ortalamaları ise subjektif uyku kalitesi 1,0±0,7, uyku latansı 0,7±0,9, uyku süresi 1,1±0,8, alışılmış uyku etkinliği 1,6±1,1, uyku bozukluğu 1,0±0,5,…”
Kalogeropoulos, C., Burdayron, R., Laganière, C., Béliveau, M., Dubois‐Comtois, K., & Pennestri, M. (2021) · Sleep Medicine X · doi:10.1016/j.sleepx.2021.100036 · Cited by 15
“These results presented by Dørheim and colleagues [10] are in line with those of the present study, which indicate that perceptions of sleep quality relate more strongly to depression as compared to perceived sleep duration.”
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Sleep, Anxiety, and Vitamin D Status and Risk for Peripartum Depression
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Sleep disorders related to deployment in active duty service members and veterans
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Relationship Between Mindfulness and Posttraumatic Stress in Women Who Experienced Stillbirth
Huberty, J., Green, J., Cacciatore, J., Buman, M. P., & Leiferman, J. A. (2018) · Journal of Obstetric, Gynecologic & Neonatal Nursing · doi:10.1016/j.jogn.2018.09.002 · Cited by 14
Effects of a Single Night of Postpartum Sleep on Childless Women’s Daytime Functioning
Mcbean, A. L., Kinsey, S., & Montgomery-Downs, H. (2016) · Physiology and Behavior · doi:10.1016/j.physbeh.2016.01.014 · Cited by 11
Infant Sleep Development: Location, Feeding and Expectations in the Postnatal Period
Russell, C. K., Robinson, L., & Ball, H. L. (2013) · The Open Sleep Journal · doi:10.2174/1874620901306010068 · Cited by 14
“Dørheim et al [30] found that mothers who exclusively breastfed experienced better quality sleep than mothers who combination fed (where infant receives both human and formula milk) and sleep quality did not differ from mothers who solely gave their infants formula milk.”
BackgroundRisk tolerance and fertility: Evidence from a lottery question in Italy
Bellani, D., & Arpino, B. (2022) · Journal of Marriage and the Family · doi:10.1111/jomf.12820 · Cited by 12
An Integrative Review of the Sleep Experiences of Mothers of Hospitalized Preterm Infants
Baumgartel, K. L., & Facco, F. (2018) · Nursing for Women s Health · doi:10.1016/j.nwh.2018.05.003 · Cited by 14
“Despite this, in the group with preterm infants, prematurity emerged as a factor associated with poorer sleep (D∅rheim et al., 2009).”
BackgroundInfluentialEEG coherence before and after giving birth
Sandoval, I. K., Ngoh, G., Wu, J., Crowley, M. J., & Rutherford, H. J. V. (2023) · Brain Research · doi:10.1016/j.brainres.2023.148468 · Cited by 12
Impact of sleep on postpartum health outcomes: a systematic review and meta-analysis
Khan-Afridi, Z., Ruchat, S.-M., Jones, P. A. T., Ali, M. U., Matenchuk, B. A., Leonard, S., Jantz, A. W., Leek, K. V., Maier, L. E., Osachoff, L., et al. (2025) · British Journal of Sports Medicine · doi:10.1136/bjsports-2024-109604 · Cited by 18
Kravdal, Ø. (2016) · Springer eBooks · doi:10.1007/978-3-319-32997-0_2 · Cited by 12
“There may be a period when parents get little sleep while a child is young (Dørheim et al. 2009), and there typically will be less time for adult leisure activities for many years.”
BackgroundCattarius, B. G., & Schlarb, A. A. (2016) · Somnologie · doi:10.1007/s11818-016-0064-6 · Cited by 11
Sleep quality and the evolution of the COVID-19 pandemic in five European countries
Jabakhanji, S. B., Lepinteur, A., Menta, G., Piper, A., & Vögele, C. (2022) · PLoS ONE · doi:10.1371/journal.pone.0278971 · Cited by 12
“Parents, and particularly first-time parents, report reduced sleep quality, a result more pronounced for women, whose sleep quality already suffers during pregnancy [45, 46], as compared to men [47, 48].”
BackgroundResultHall, K. S., Patel, R., Evans, J., Greenwood, R., & Hicks, J. (2022) · Sleep Science and Practice · doi:10.1186/s41606-022-00081-x · Cited by 12
Øygarden, A. U., Småstuen, M. C., Abudayya, A., Glavin, K., Sæther, K. M., Solberg, B., Brekke, M., & Strøm, B. S. (2023) · Journal of Clinical Nursing · doi:10.1111/jocn.16608 · Cited by 11
Rognmo, K., Sivertsen, B., & Eberhard‐Gran, M. (2016) · Women s Health · doi:10.1177/1745505716668871 · Cited by 15
“29 A categorical variable was created, combining the symptom responses from T1 and T2 in the following manner: (1) insomnia symptoms at both T1 and T2 (persistent insomnia symptoms); (2) no insomnia symptoms at T1, symptoms at T2 (incident insomnia symptoms); (3) insomnia symptoms at T1, no symptoms at T2 (remitting i…”
MethodArmstrong, B., Weaver, R. G., Beets, M. W., Østbye, T., Kravitz, R. M., & Benjamin-Neelon, S. E. (2022) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0000000000001048 · Cited by 12
“Although sleep disturbance and depression share similarities regarding symptomatology and outcomes, poor sleep in the postnatal period seems to be independently associated with depression, rather than a reporting of chronic sleep deprivation symptoms.(6,8) Although infant sleep is clearly associated with maternal slee…”
BackgroundPeña, F., Serantes, D., Rivas, M., Castro, J. P., Torterolo, P., Rodríguez‐Camejo, C., Hernández, A., & Benedetto, L. (2024) · Physiology & Behavior · doi:10.1016/j.physbeh.2024.114522 · Cited by 9
Bais, B., Lindeboom, R., van Ravesteyn, L. M., Tulen, J. H. M., Hoogendijk, W. J. G., den Berg, M. P. L., & Kamperman, A. M. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16091587 · Cited by 10
“Two previous cross-sectional studies in peripartum women using the PSQI find associations between sleep parameters and depressive symptoms, although not consistently [23,24].”
Pre-pregnancy sleep duration and postpartum depression: a multicenter study in Japan
Matsuo, S., Ushida, T., Iitani, Y., Imai, K., Nakano‐Kobayashi, T., Moriyama, Y., Yoshida, S., Yamashita, M., Kajiyama, H., & Kotani, T. (2021) · Archives of Women s Mental Health · doi:10.1007/s00737-021-01136-1 · Cited by 10
Rosenbaum, D. L., Gillen, M. M., & Markey, C. N. (2021) · Appetite · doi:10.1016/j.appet.2021.105889 · Cited by 10
de Mola, C. L., Carpena, M. X., Dias, I. M., Meucci, R. D., Romero, P., & César, J. A. (2023) · Sleep Health · doi:10.1016/j.sleh.2023.05.003 · Cited by 10
Effects of sleep restriction during pregnancy on postpartum maternal behavior in female rats
Pires, G. N., Tufik, S., & Andersen, M. L. (2020) · Behavioural Processes · doi:10.1016/j.beproc.2020.104200 · Cited by 10
Goren, G., Sarid, O., Φιλίππου, Φ., & Taylor, A. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17176189 · Cited by 11
“Demographic risk factors include the mother being single [20,21], younger than 20 years [16,22], primiparous [23,24], having low education [16,25] and low economic status [26,27].”
BackgroundPires, G. N., de Oliveira, T. B., de Mello, V. F. F., Bezerra, A. G., Leenaars, C. H. C., Ritskes-Hoitinga, M. J., Tufik, S., & Andersen, M. L. (2021) · Journal of Sleep Research · doi:10.1111/jsr.13333 · Cited by 10
“(Dørheim et al., 2009; Koutra et al., 2018; Okun, 2016; Park et al., 2013).”
Nulty, A. K., Thompson, A. L., Wasser, H., & Bentley, M. E. (2021) · Sleep Health · doi:10.1016/j.sleh.2021.11.001 · Cited by 11
Is Maternal Fatigue Mediating the Relationship Between Maternal Depression and Child Outcomes?
White, C. P., & King, K. A. (2011) · Journal of Child and Family Studies · doi:10.1007/s10826-011-9452-5 · Cited by 10
“2004) and depression (Dorheim et al. 2009; Posmontier 2008).”
BackgroundTreating postpartum mood and anxiety disorders in primary care pediatrics
Umylny, P., Germán, M., & Lantiere, A. (2017) · Current problems in pediatric and adolescent health care · doi:10.1016/j.cppeds.2017.08.003 · Cited by 11
(2019) · ARC Journal of Nursing and Healthcare · doi:10.20431/2455-4324.0502005 · Cited by 10
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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