Depression and suicidal ideation in pregnancy: exploring relationships with insomnia, short sleep, and nocturnal rumination

Kalmbach, David A.; Cheng, Philip; Ong, Jason C.; Ciesla, Jeffrey A.; Kingsberg, Sheryl A.; Sangha, Roopina; Swanson, Leslie M.; O’Brien, Louise M.; Roth, Thomas; Drake, Christopher L.

doi:10.1016/j.sleep.2019.07.010

Cited by 69 publications

(62 citation statements)

References 81 publications

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“…Of the 24 articles included in the analyses, all were comprised of convenience samples and none assessed insomnia symptoms using a structured clinical interview. In terms of the scales used, 12 studies used the Insomnia Severity Index (Dolatian et al., 2014; Felder et al., 2019; Fernández‐Alonso et al., 2012; Kalmbach et al., 2020; Manber et al., 2013; Mindell et al., 2015; Mourady et al., 2017; Palagini et al., 2019; Sedov, Madsen, et al., 2018; Swanson et al., 2011; Umeno et al., 2020; Wang et al., 2020), five studies used the Women`s Health Initiative Insomnia Rating Scale (Facco et al., 2010; Kızılırmak et al., 2012; Ko et al., 2012; Louis et al., 2018; Nacar & Tashan, 2019), two studies used the Insomnia Symptoms Questionnaire (Okun, Buysse, et al., 2015; Okun & O’Brien, 2018), two studies used the Athens Insomnia Scale (Román‐Gálvez et al., 2018; Wołyńczyk‐Gmaj et al., 2017), two studies used the Bergen Insomnia Scale (Dorheim et al., 2012; Osnes et al., 2020), and one study used the Basic Nordic Sleep Questionnaire (Kiviruusu et al., 2020). Table 2 displays the included studies along with the scale used to measure insomnia, cut‐scores utilized to characterize groups, and mean scores as well as associated standard deviations.…”

Section: Resultsmentioning

confidence: 99%

“…Of the 24 articles, 22 reported a mean or median maternal age, which ranged from 25.2 to 32.5 years (Dorheim et al., 2012; Facco et al., 2010; Felder et al., 2019; Fernández‐Alonso et al., 2012; Kalmbach et al., 2020; Kiviruusu et al., 2020; Kızılırmak et al., 2012; Ko et al., 2012; Louis et al., 2018; Manber et al., 2013; Mourady et al., 2017; Nacar & Tashan, 2019; Okun, Buysse, et al., 2015; Okun & O’Brien, 2018; Osnes et al., 2020; Palagini et al., 2019; Román‐Gálvez et al., 2018; Sedov, Madsen, et al., 2018; Swanson et al., 2011; Umeno et al., 2020; Wang et al., 2020; Wołyńczyk‐Gmaj et al., 2017). Seventeen articles provided a mean or median gestational age for the sample, which ranged from 14 to 39 weeks (Dorheim et al., 2012; Facco et al., 2010; Felder et al., 2019; Fernández‐Alonso et al., 2012; Kalmbach et al., 2020; Kiviruusu et al., 2020; Ko et al., 2012; Manber et al., 2013; Mourady et al., 2017; Nacar & Tashan, 2019; Okun & O’Brien, 2018; Osnes et al., 2020; Palagini et al., 2019; Sedov, Madsen, et al., 2018; Umeno et al., 2020; Wang et al., 2020; Wołyńczyk‐Gmaj et al., 2017). Eleven articles provided information on prevalence of depression within the sample, which ranged from 9.8% to 68.0% (Dorheim et al., 2012; Kalmbach et al., 2020; Kiviruusu et al., 2020; Kızılırmak et al., 2012; Louis et al., 2018; Manber et al., 2013; Mourady et al., 2017; Nacar & Tashan, 2019; Osnes et al., 2020; Palagini et al., 2019; Swanson et al., 2011).…”

Section: Resultsmentioning

confidence: 99%

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Insomnia symptoms during pregnancy: A meta‐analysis

Sedov

Anderson

Dhillon

et al. 2020

Journal of Sleep Research

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Reports of sleep disturbances are common during pregnancy, yet estimates of prevalence of insomnia symptoms during pregnancy vary widely. The goals of the current review were to summarize the existing data on prevalence of insomnia symptoms during pregnancy and to explore potential moderators, including trimester, gestational age, maternal age, symptoms of anxiety and symptoms of depression. A systematic search of PubMed, PsycInfo and Web of Science was conducted for articles published from inception up to June 2020. In total, 24 studies with a total of 15,564 participants were included in the analysis. The overall prevalence of insomnia symptoms during pregnancy was 38.2%. Trimester was a significant moderator, such that prevalence of insomnia symptoms was higher in the third trimester (39.7%) compared to first (25.3%) and second (27.2%) trimesters. No other variables significantly moderated the prevalence of insomnia symptoms. The results of the current meta‐analysis suggest that the prevalence of insomnia symptoms is higher during pregnancy, particularly in the third trimester. Future research should examine the efficacy and safety of insomnia treatments with this population.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Insomnia symptoms during pregnancy: A meta‐analysis

Sedov

Anderson

Dhillon

et al. 2020

Journal of Sleep Research

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show abstract

“…Over half of our sample screened positive for clinically significant insomnia, but only 9 women reported an insomnia diagnosis. This suggests that upwards of 95% of the cases go undetected through mid and late pregnancy, which is of serious concern given the negative perinatal outcomes associated with insomnia and insufficient sleep,11–19 particularly since these women were actively engaged in routine prenatal care allowing opportunity for detection. Consistent with epidemiological and obstetric clinic data,1,10 sleep maintenance insomnia was the primary insomnia complaint, although sleep-onset symptoms were also elevated compared to the general population.…”

Section: Discussionmentioning

confidence: 99%

“…Prenatal sleep problems warrant serious attention by health-care professionals given that many perinatal complications are associated with insomnia and short sleep (e.g., more Caesarean sections, preterm birth, low birth weight, maternal depression, suicidality)11–19 and with SDB (e.g., pre-eclampsia, hypertension, diabetes, maternal depression) 4,6,7,20–22. Despite some mixed findings in the literature regarding trajectories of sleep symptoms across pregnancy, compelling evidence including prospective data suggest that sleep problems are most prevalent and severe in late pregnancy 3,5,10,11,23.…”

Section: Introductionmentioning

confidence: 99%

<p>Insomnia, Short Sleep, And Snoring In Mid-To-Late Pregnancy: Disparities Related To Poverty, Race, And Obesity</p>

Kalmbach¹,

Cheng²,

Sangha³

et al. 2019

NSS

Self Cite

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ObjectiveTo characterize sleep habits and parameters among women in mid-to-late pregnancy and to identify disparities associated with poverty, race, and obesity.DesignCross-sectional.SettingLarge multi-site health system in Metro Detroit.ParticipantsA total of 267 pregnant women (27.3% non-Hispanic black; gestational age: 27.99±1.20 weeks) completed online surveys on sleep quality, insomnia symptoms, sleep aid use, signs/symptoms of sleep-disordered breathing, and sociodemographics. Body mass index (BMI) and patient insurance were derived from medical records.ResultsAs high as 76.2% of the women reported global sleep disturbance, 30.6% endorsed snoring, 24.3% sleep <6 hrs/night, and over half screened positive for clinical insomnia. Yet, only 3.4% of the women reported an insomnia diagnosis and 3.0% reported a sleep apnea diagnosis. In unadjusted models, poverty, Medicaid coverage, self-identifying as black, and obesity before and during pregnancy (BMI ≥ 35) were associated with a wide range of sleep problems. However, adjusted models revealed specificity. Poverty was uniquely related to increased insomnia symptoms and trouble sleeping due to bad dreams. Obesity before pregnancy was related to poor sleep quality, snoring, sleep aids, and short sleep. Black women reported shorter sleep duration than white women but differed on no other sleep parameters.ConclusionClinical signs of insomnia and sleep-disordered breathing are common in mid-to-late pregnancy, but most cases go undetected. Problematic sleep disproportionately affects women in poverty, who self-identify as black, and who are obese before pregnancy. Poverty-related sleep issues are linked to insomnia, obesity-related disparities center on sleep-related breathing and medication use, and racial disparities relate to short sleep.

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“…Notably, sexual dysfunction is greater in menopausal women with low socioeconomic status (SES) 72. As women in poverty overly engage in ruminative coping,73 it is possible that poorer stress regulation contributes to disparities in sexual dysfunction related to SES.…”

Section: Discussionmentioning

confidence: 99%

<p>Sexual function and distress in postmenopausal women with chronic insomnia: exploring the role of stress dysregulation</p>

Kalmbach¹,

Kingsberg²,

Roth³

et al. 2019

NSS

Self Cite

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ObjectiveMenopause triggers changes in sexual function and many women develop sexual problems. Insomnia is common in postmenopausal women, and disturbed sleep has been linked to poor sexual health. Thus, postmenopausal women with insomnia may be especially vulnerable to developing sexual difficulties. This study estimated rates of sexual distress in postmenopausal women with chronic insomnia and explored associations between various facets of sexual health, insomnia symptoms, and insomnia-related stress dysregulation.DesignCross-sectional.SettingLarge multi-site health system in the US.Participants150 postmenopausal women diagnosed with DSM-5 chronic insomnia disorder (56.44±5.64 years) completed measures of sexual distress, sexual function, hot flashes, insomnia symptoms, depression, and stress dysregulation in the forms of cognitive-emotional arousal (worry, rumination), sleep reactivity, and somatic hyperarousal.ResultsNearly half of the sample endorsed clinically significant sexual distress (46.9%). Insomnia symptoms were largely associated with poor sexual arousal, orgasmic dysfunction, sexual distress, and sexual dissatisfaction. Insomnia-related stress dysregulation was similarly associated with these facets of sexual health but was also linked to problems with low desire and greater vaginal pain during sex. Hot flashes and depression were negatively associated with sexual health.ConclusionPostmenopausal women with chronic insomnia endorse high rates of sexual distress. Although compromised sexual function appears directly related to poor sleep itself, our data suggest that stress dysregulation may play vital role in sexual problems endorsed by postmenopausal insomniacs, particularly regarding low desire and vaginal pain. Prospective research is needed to characterize the evolution of these co-occurring symptoms.

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Depression and suicidal ideation in pregnancy: exploring relationships with insomnia, short sleep, and nocturnal rumination

Cited by 69 publications

References 81 publications

Insomnia symptoms during pregnancy: A meta‐analysis

Insomnia symptoms during pregnancy: A meta‐analysis

<p>Insomnia, Short Sleep, And Snoring In Mid-To-Late Pregnancy: Disparities Related To Poverty, Race, And Obesity</p>

<p>Sexual function and distress in postmenopausal women with chronic insomnia: exploring the role of stress dysregulation</p>

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