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Poor Sleep Independently Linked to Postpartum Depression

Laurie Barclay, MD

July 8, 2009 — Poor sleep is linked to postpartum depression independently of other risk factors, according to the results of a cross-sectional, population-based study reported in the July issue of Sleep.

"It is important to ask a new mother suffering from tiredness about how poor sleep affects her daytime functioning and whether there are other factors in her life that may contribute to her lack of energy," lead author Signe Karen Dørheim, MD, PhD, a psychiatrist at Stavanger University Hospital in Stavanger, Norway, said in a news release. "There are also helpful depression screening questionnaires that can be completed during a consultation. Doctors and other health workers should provide an opportunity for postpartum women to discuss difficult feelings."

The goals of this study were to assess the prevalence of and risk factors for concurrent postpartum maternal sleep problems and depressive symptoms, to identify factors independently associated with either condition, and to examine associations between specific components of postpartum sleep and depression.

From October 2005 to September 2006, a total of 4191 women delivered at Stavanger University Hospital and were mailed a questionnaire 7 weeks after delivery, with a response rate of 68% (n = 2830). Mean maternal age at the time of reply was 30 years.

The Pittsburgh Sleep Quality Index (PSQI) evaluated sleep characteristics, with sleep problems defined as a PSQI score of more than 5. The Edinburgh Postnatal Depression Scale (EPDS) evaluated depressive symptoms, with depression defined as an EPDS score of 10 or higher.

The prevalence of sleep problems was 57.7%, and the prevalence of depression was 16.5%. Self-reported mean nightly sleep duration was 6.5 hours, and sleep efficiency was 73%.

Factors associated with poor postpartum sleep quality were depression, history of sleep problems, primiparity, not exclusively breast-feeding, or having a younger or male infant. After adjustment for other known risk factors for depression, including poor partner relationship, history of depression, depression during pregnancy, and stressful life events, poor sleep remained associated with depression. The aspects of sleep most strongly associated with depression were sleep disturbances and subjective sleep quality.

"Poor sleep was associated with depression independently of other risk factors," the study authors write. "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."

Limitations of this study include cross-sectional design precluding determination of causality and reliance on self-reported symptoms.

"The sleep of women with a history of depression may be more sensitive to the psychobiological (hormonal, immunological, psychological, and social) changes associated with childbirth," the study authors conclude. "Sleep could act as a moderator between these risk factors for depression and the precipitation of depression in women vulnerable to such sleep changes during the postpartum period. Longitudinal studies are needed to evaluate whether treatment of maternal sleep problems reduces depression and whether treatment of maternal depression improves sleep quality."

From Medscape Medical News

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