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

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

*Corresponding author for this work

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Sleep problems and depression are highly prevalent in pregnancy. Nocturnal rumination has been linked to insomnia and depression in non-pregnant samples, but remains poorly characterized in pregnancy. This study explored relationships of depression and suicidal ideation with insomnia, short sleep, and nocturnal rumination in mid-to-late pregnancy. Methods: In this study, 267 pregnant women were recruited from obstetric clinics and completed online surveys on sleep, depression, and nocturnal rumination. Results: Over half (58.4%) of the sample reported clinical insomnia on the Insomnia Severity Index, 16.1% screened positive for major depression on the Edinburgh Postnatal Depression Scale (EPDS), and 10.1% endorsed suicidal ideation. Nocturnal rumination was more robustly associated with sleep onset difficulties than with sleep maintenance issues. Depressed women were at greater odds of sleep onset insomnia (OR = 2.80), sleep maintenance insomnia (OR = 6.50), high nocturnal rumination (OR = 6.50), and negative perinatal-focused rumination (OR = 2.70). Suicidal ideation was associated with depression (OR = 3.64) and negative perinatal-focused rumination (OR = 3.50). A four-group comparison based on insomnia status and high/low rumination revealed that pregnant women with insomnia and high rumination endorsed higher rates of depression (35.6%) and suicidal ideation (17.3%) than good-sleeping women with low rumination (1.2% depressed, 4.9% suicidal). Women with insomnia alone (depression: 3.9%, suicidal: 5.9%) or high rumination alone (depression: 10.7%, suicidal: 7.1%) did not differ from good-sleeping women with low rumination. Conclusions: High rumination and insomnia are highly common in mid-to-late pregnancy and both are associated with depression and suicidal ideation. Depression and suicidal ideation are most prevalent in pregnant women with both insomnia and high rumination. ClinicalTrials.gov identifier: NCT03596879.

Original languageEnglish (US)
Pages (from-to)62-73
Number of pages12
JournalSleep Medicine
Volume65
DOIs
StatePublished - Jan 2020

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Suicidal Ideation
Sleep Initiation and Maintenance Disorders
Sleep
Depression
Pregnancy
Pregnant Women
Maintenance
Postpartum Depression
Obstetrics

Keywords

  • Cognitive arousal
  • Perinatal
  • Pre-sleep arousal
  • Prenatal
  • Stress
  • Suicidality

ASJC Scopus subject areas

  • Medicine(all)

Cite this

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. / Depression and suicidal ideation in pregnancy : exploring relationships with insomnia, short sleep, and nocturnal rumination. In: Sleep Medicine. 2020 ; Vol. 65. pp. 62-73.
@article{22cc1a136787451ab4909059dc797c42,
title = "Depression and suicidal ideation in pregnancy: exploring relationships with insomnia, short sleep, and nocturnal rumination",
abstract = "Background: Sleep problems and depression are highly prevalent in pregnancy. Nocturnal rumination has been linked to insomnia and depression in non-pregnant samples, but remains poorly characterized in pregnancy. This study explored relationships of depression and suicidal ideation with insomnia, short sleep, and nocturnal rumination in mid-to-late pregnancy. Methods: In this study, 267 pregnant women were recruited from obstetric clinics and completed online surveys on sleep, depression, and nocturnal rumination. Results: Over half (58.4{\%}) of the sample reported clinical insomnia on the Insomnia Severity Index, 16.1{\%} screened positive for major depression on the Edinburgh Postnatal Depression Scale (EPDS), and 10.1{\%} endorsed suicidal ideation. Nocturnal rumination was more robustly associated with sleep onset difficulties than with sleep maintenance issues. Depressed women were at greater odds of sleep onset insomnia (OR = 2.80), sleep maintenance insomnia (OR = 6.50), high nocturnal rumination (OR = 6.50), and negative perinatal-focused rumination (OR = 2.70). Suicidal ideation was associated with depression (OR = 3.64) and negative perinatal-focused rumination (OR = 3.50). A four-group comparison based on insomnia status and high/low rumination revealed that pregnant women with insomnia and high rumination endorsed higher rates of depression (35.6{\%}) and suicidal ideation (17.3{\%}) than good-sleeping women with low rumination (1.2{\%} depressed, 4.9{\%} suicidal). Women with insomnia alone (depression: 3.9{\%}, suicidal: 5.9{\%}) or high rumination alone (depression: 10.7{\%}, suicidal: 7.1{\%}) did not differ from good-sleeping women with low rumination. Conclusions: High rumination and insomnia are highly common in mid-to-late pregnancy and both are associated with depression and suicidal ideation. Depression and suicidal ideation are most prevalent in pregnant women with both insomnia and high rumination. ClinicalTrials.gov identifier: NCT03596879.",
keywords = "Cognitive arousal, Perinatal, Pre-sleep arousal, Prenatal, Stress, Suicidality",
author = "Kalmbach, {David A.} and Philip Cheng and Ong, {Jason C.} and Ciesla, {Jeffrey A.} and Kingsberg, {Sheryl A.} and Roopina Sangha and Swanson, {Leslie M.} and O'Brien, {Louise M.} and Thomas Roth and Drake, {Christopher L.}",
year = "2020",
month = "1",
doi = "10.1016/j.sleep.2019.07.010",
language = "English (US)",
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Kalmbach, DA, Cheng, P, Ong, JC, Ciesla, JA, Kingsberg, SA, Sangha, R, Swanson, LM, O'Brien, LM, Roth, T & Drake, CL 2020, 'Depression and suicidal ideation in pregnancy: exploring relationships with insomnia, short sleep, and nocturnal rumination', Sleep Medicine, vol. 65, pp. 62-73. https://doi.org/10.1016/j.sleep.2019.07.010

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.

In: Sleep Medicine, Vol. 65, 01.2020, p. 62-73.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Depression and suicidal ideation in pregnancy

T2 - exploring relationships with insomnia, short sleep, and nocturnal rumination

AU - Kalmbach, David A.

AU - Cheng, Philip

AU - Ong, Jason C.

AU - Ciesla, Jeffrey A.

AU - Kingsberg, Sheryl A.

AU - Sangha, Roopina

AU - Swanson, Leslie M.

AU - O'Brien, Louise M.

AU - Roth, Thomas

AU - Drake, Christopher L.

PY - 2020/1

Y1 - 2020/1

N2 - Background: Sleep problems and depression are highly prevalent in pregnancy. Nocturnal rumination has been linked to insomnia and depression in non-pregnant samples, but remains poorly characterized in pregnancy. This study explored relationships of depression and suicidal ideation with insomnia, short sleep, and nocturnal rumination in mid-to-late pregnancy. Methods: In this study, 267 pregnant women were recruited from obstetric clinics and completed online surveys on sleep, depression, and nocturnal rumination. Results: Over half (58.4%) of the sample reported clinical insomnia on the Insomnia Severity Index, 16.1% screened positive for major depression on the Edinburgh Postnatal Depression Scale (EPDS), and 10.1% endorsed suicidal ideation. Nocturnal rumination was more robustly associated with sleep onset difficulties than with sleep maintenance issues. Depressed women were at greater odds of sleep onset insomnia (OR = 2.80), sleep maintenance insomnia (OR = 6.50), high nocturnal rumination (OR = 6.50), and negative perinatal-focused rumination (OR = 2.70). Suicidal ideation was associated with depression (OR = 3.64) and negative perinatal-focused rumination (OR = 3.50). A four-group comparison based on insomnia status and high/low rumination revealed that pregnant women with insomnia and high rumination endorsed higher rates of depression (35.6%) and suicidal ideation (17.3%) than good-sleeping women with low rumination (1.2% depressed, 4.9% suicidal). Women with insomnia alone (depression: 3.9%, suicidal: 5.9%) or high rumination alone (depression: 10.7%, suicidal: 7.1%) did not differ from good-sleeping women with low rumination. Conclusions: High rumination and insomnia are highly common in mid-to-late pregnancy and both are associated with depression and suicidal ideation. Depression and suicidal ideation are most prevalent in pregnant women with both insomnia and high rumination. ClinicalTrials.gov identifier: NCT03596879.

AB - Background: Sleep problems and depression are highly prevalent in pregnancy. Nocturnal rumination has been linked to insomnia and depression in non-pregnant samples, but remains poorly characterized in pregnancy. This study explored relationships of depression and suicidal ideation with insomnia, short sleep, and nocturnal rumination in mid-to-late pregnancy. Methods: In this study, 267 pregnant women were recruited from obstetric clinics and completed online surveys on sleep, depression, and nocturnal rumination. Results: Over half (58.4%) of the sample reported clinical insomnia on the Insomnia Severity Index, 16.1% screened positive for major depression on the Edinburgh Postnatal Depression Scale (EPDS), and 10.1% endorsed suicidal ideation. Nocturnal rumination was more robustly associated with sleep onset difficulties than with sleep maintenance issues. Depressed women were at greater odds of sleep onset insomnia (OR = 2.80), sleep maintenance insomnia (OR = 6.50), high nocturnal rumination (OR = 6.50), and negative perinatal-focused rumination (OR = 2.70). Suicidal ideation was associated with depression (OR = 3.64) and negative perinatal-focused rumination (OR = 3.50). A four-group comparison based on insomnia status and high/low rumination revealed that pregnant women with insomnia and high rumination endorsed higher rates of depression (35.6%) and suicidal ideation (17.3%) than good-sleeping women with low rumination (1.2% depressed, 4.9% suicidal). Women with insomnia alone (depression: 3.9%, suicidal: 5.9%) or high rumination alone (depression: 10.7%, suicidal: 7.1%) did not differ from good-sleeping women with low rumination. Conclusions: High rumination and insomnia are highly common in mid-to-late pregnancy and both are associated with depression and suicidal ideation. Depression and suicidal ideation are most prevalent in pregnant women with both insomnia and high rumination. ClinicalTrials.gov identifier: NCT03596879.

KW - Cognitive arousal

KW - Perinatal

KW - Pre-sleep arousal

KW - Prenatal

KW - Stress

KW - Suicidality

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