Mindfulness and nocturnal rumination are independently associated with symptoms of insomnia and depression during pregnancy

David A. Kalmbach*, Thomas Roth, Philip Cheng, Jason C. Ong, Elana Rosenbaum, Christopher L. Drake

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Background: Insomnia and depression are highly prevalent perinatal complications. Ruminating on stress is etiologically implicated in both disorders, and ruminating while trying to fall asleep has been linked to insomnia and depression during pregnancy. Incompatible with rumination is everyday mindfulness, i.e., living with intentional and nonjudgmental awareness of internal and external experiences in the present moment. Responding to stress mindfully may protect against stress-related perinatal complications such as insomnia and depression. The present study described the association between everyday mindfulness and nocturnal rumination, and examined whether these trait characteristics were independently related to perinatal insomnia and depression. Methods: Cross-sectional and secondary analysis of existing data from 65 pregnant women recruited from a multisite hospital in Metro Detroit, MI, USA. Subjects completed online surveys including the Insomnia Severity Index, Edinburgh Postnatal Depression Scale, Presleep Arousal Scale, and the revised Cognitive and Affective Mindfulness Scale. Results: Over half (53.8%) of women screened positive for clinical insomnia and 12.3% screened positive for major depression. Women high in mindfulness, relative to those low in mindfulness, reported less nocturnal rumination (Cohen's d=1.16), insomnia symptoms (Cohen's d=1.24), and depressive symptoms (Cohen's d=1.35). Multivariate linear regression revealed that both mindfulness (β=-.24, p=.03) and rumination (β=.38, p<.01) were independently associated with insomnia. Similarly, a multivariate model showed that mindfulness (β=-.41, p<.001) and rumination (β=.35, p<.01) were independently associated with depression. Conclusions: Ruminating in bed at night is strongly associated with insomnia and depression during pregnancy, whereas mindfulness may potentially protect against these stress-related perinatal complications.

Original languageEnglish (US)
Pages (from-to)185-191
Number of pages7
JournalSleep Health
Issue number2
StatePublished - Apr 2020


  • Cognitive arousal
  • Emotion regulation
  • Perinatal
  • Prenatal
  • Sleep
  • Stress

ASJC Scopus subject areas

  • Behavioral Neuroscience


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