The Relationship between Sleep Quality, Depression, and Anxiety in Pregnant Women: A Cohort Study
AbstractAbstract Background and Objective: Sleep disturbances are common in women, especially during pregnancy. This can re-sult in emotional and psychological consequences in pregnant women. The aim of this study was to assess the preva-lence and identify the relationship between sleep quality, anxiety, and depression during pregnancy. Materials & Methods: This cohort study included 283 pregnant women. Participants completed Beck Depression Inventory, State-Trait Anxiety Inventory, and Pittsburgh Sleep Quality Index at first, second, and third gestational tri-mesters. Data were analyzed by descriptive statistics and Cramer’s V correlation technique.Results: The findings indicated that nearly 30% of participants suffered from depression. Mild depression reported from the first, second, and third trimesters was 18%, 11%, and 4.9%, respectively, while severe depression frequency was found to be 4.9% in the third trimester. Moreover, the highest proportion of mild anxiety was 28.3% in the first trimester, and moderate and severe anxiety had a prevalence of 4.9 and 14.1% in the third trimester, respectively. In the third trimester, sleep quality was lower and the prevalence of sleep problems was 75.26%. The findings also showed that there is a significant association between sleep problems and depression and anxiety (P < 0.0500).Conclusion: Psychological problems such as anxiety and depression were prevalent among the studied population of pregnant women. Thus, psychological counseling before pregnancy or early pregnancy in this population may pro-vide safer pregnancy, convenient delivery, and healthier newborns.
Lee KA, Gay CL. Sleep in late pregnancy pre-dicts length of labor and type of delivery. Am J Obstet Gynecol 2004; 191: 2041-6.
Kryger MH, Roth T, Dement WC. Principles and practice of sleep medicine. 6th ed. Philadelphia, PA: US Elsevier, 2017.
Lopes EA, Carvalho LB, Seguro PB, et al. Sleep disorders in pregnancy. Arq Neuropsiquiatr 2004; 62: 217-21.
Hedman C, Pohjasvaara T, Tolonen U, et al. Ef-fects of pregnancy on mothers' sleep. Sleep Med 2002; 3: 37-42.
Elliott AC. Primary care assessment and man-agement of sleep disorders. J Am Acad Nurse Pract 2001; 13: 409-17.
Okun ML, Roberts JM, Marsland AL, et al. How disturbed sleep may be a risk factor for adverse pregnancy outcomes. Obstet Gynecol Surv 2009; 64: 273-80.
Guendelman S, Pearl M, Kosa JL, et al. Associ-ation between preterm delivery and pre-pregnancy body mass (BMI), exercise and sleep during pregnancy among working women in Southern California. Matern Child Health J 2013; 17: 723-31.
Amir Ali Akbari S, Bolouri B, Sadegh Niat Haghighi KH, et al. Impacts of sleeping disturbances in the last month of pregnancy on the length of labor and way of delivery in women referring to the health cen-ters of Saghez, 2006. J Ilam Univ Med Sci 2007; 15: 8-16. [In Persian].
Evans J, Heron J, Francomb H, et al. Cohort study of depressed mood during pregnancy and after childbirth. BMJ 2001; 323: 257-60.
Tvmyans J. Investigates the depression in preg-nant women. Proceedings of the 4th International Con-gress on Obstetrics and Gynecology; 2000 Nov. 7-10; Tehran, Iran. [In Persian].
Omidvar SH, Kheyrkhah F, Azimi H. Depres-sion During pregnancy and its related factors. Hor-mozgan Med J 2007; 11: 213-9. [In Persian].
Sobel RM, Markov D. The impact of anxiety and mood disorders on physical disease: the worried not-so-well. Curr Psychiatry Rep 2005; 7: 206-12.
Reid KJ, Martinovich Z, Finkel S, et al. Sleep: A marker of physical and mental health in the elderly. Am J Geriatr Psychiatry 2006; 14: 860-6.
Skouteris H, Germano C, Wertheim EH, et al. Sleep quality and depression during pregnancy: A pro-spective study. J Sleep Res 2008; 17: 217-20.
Jomeen J, Martin CR. Assessment and relation-ship of sleep quality to depression in early pregnancy. J Reprod Infant Psychol 2007; 25: 87-99.
Dorheim SK, Bondevik GT, Eberhard-Gran M, et al. Subjective and objective sleep among depressed and non-depressed postnatal women. Acta Psychiatr Scand 2009; 119: 128-36.
Beck Aaron T, Steer RA, Carbin MG. Psycho-metric properties of the Beck depression Inventory: Twenty-five years of evaluation. Clin Psychol Rev 1988; 8: 77-100.
Azkhosh M. Application of psychological tests and diagnosis. Tehran, Iran: Ravan Publications, 2013. p. 224-6. [In Persian].
Esmaeili M. A survey of the influence of murita therapy on reducing the rate of anxiety in clients of counseling centers. Research in Clinical Psychology and Counseling 2011; 1: 15-30. [In Persian].
Buysse DJ, Reynolds CF 3rd, Monk TH, et al. The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Res 1989; 28: 193-213.
Signal TL, Paine SJ, Sweeney B, et al. The prevalence of symptoms of depression and anxiety, and the level of life stress and worry in New Zealand Maori and non-Maori women in late pregnancy. Aust N Z J Psychiatry 2017; 51: 168-76.
Rallis S, Skouteris H, McCabe M, et al. A pro-spective examination of depression, anxiety and stress throughout pregnancy. Women Birth 2014; 27: e36-e42.
Swanson LM, Pickett SM, Flynn H, et al. Rela-tionships among depression, anxiety, and insomnia symptoms in perinatal women seeking mental health treatment. J Womens Health (Larchmt) 2011; 20: 553-8.
Mindell JA, Cook RA, Nikolovski J. Sleep pat-terns and sleep disturbances across pregnancy. Sleep Med 2015; 16: 483-8.
Sharma SK, Nehra A, Sinha S, et al. Sleep dis-orders in pregnancy and their association with preg-nancy outcomes: A prospective observational study. Sleep Breath 2016; 20: 87-93.
Williams MA, Miller RS, Qiu C, et al. Associa-tions of early pregnancy sleep duration with trimester-specific blood pressures and hypertensive disorders in pregnancy. Sleep 2010; 33: 1363-71.
Okun ML, Kline CE, Roberts JM, et al. Preva-lence of sleep deficiency in early gestation and its as-sociations with stress and depressive symptoms. J Womens Health (Larchmt) 2013; 22: 1028-37.
Rezaei E, Moghadam ZB, Saraylu K. Quality of life in pregnant women with sleep disorder. J Family Reprod Health 2013; 7: 87-93.
Dorheim SK, Bjorvatn B, Eberhard-Gran M. In-somnia and depressive symptoms in late pregnancy: A population-based study. Behav Sleep Med 2012; 10: 152-66.
Qiu C, Gelaye B, Fida N, et al. Short sleep dura-tion, complaints of vital exhaustion and perceived stress are prevalent among pregnant women with mood and anxiety disorders. BMC Pregnancy Childbirth 2012; 12: 104.
Dorheim SK, Bjorvatn B, Eberhard-Gran M. Can insomnia in pregnancy predict postpartum depres-sion? A longitudinal, population-based study. PLoS One 2014; 9: e94674.
Khazaie H, Ghadami MR, Knight DC, et al. In-somnia treatment in the third trimester of pregnancy reduces postpartum depression symptoms: A random-ized clinical trial. Psychiatry Res 2013; 210: 901-5.
Skouteris H, Wertheim EH, Germano C, et al. Assessing sleep during pregnancy: A study across two time points examining the Pittsburgh Sleep Quality Index and associations with depressive symptoms. Women's Health Issues 2009; 19: 45-51.