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Thamby A, Bajaj A, L M, G SK, Gr G, K T, Ts J. Impaired mother-infant bonding: a community study from India. J Reprod Infant Psychol 2024; 42:528-539. [PMID: 36138562 DOI: 10.1080/02646838.2022.2125938] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 09/13/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Impaired mother-infant bonding (MIB) is associated with inadequate maternal skills and pose a higher risk for impaired learning, child abuse, and psychiatric disorders in children. There are approximately 24 million births annually in India; however, community data on MIB from India is lacking. METHODS The study reports the findings of a cross-sectional survey of 8189 mothers with children of age between 13 and 15 months from the state of Kerala, India. Bonding was assessed using the Mother-infant bonding scale (MIBS). Other correlates assessed include obstetric and birth history, chronic pain, postpartum depression and temperamental issues in the infant. RESULTS The prevalence of impaired MIB in our sample was 12.3%. Those in extended/joint family, experiencing postpartum complications, supplementary breastfeeding in the first 6 months, postpartum depression and temperamental issues in infant were found to be associated with increased MIBS scores in a multivariate mixed-effect zero-inflated poisson model. CONCLUSION Experience of impaired MIB is not uncommon among mothers in India. More needs to be done to explore these issues, especially among those with higher risk to ensure appropriate interventions to mitigate long-term consequences.
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Affiliation(s)
- Abel Thamby
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Aakash Bajaj
- Department of Biostatistics, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Manoj L
- National Health Mission (Kerala), Thiruvananthapuram, India
| | - Sunil Kumar G
- National Health Mission (Kerala), Thiruvananthapuram, India
| | - Gokul Gr
- National Health Mission (Kerala), Thiruvananthapuram, India
| | - Thennarasu K
- Department of Biostatistics, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Jaisoorya Ts
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
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Fischer AR, Doudell KR, Cundiff JM, Green SRM, Lavender CA, Gunn HE. Maternal Sleep Health, Social Support, and Distress: A Mixed-Methods Analysis of Mothers of Infants and Young Children in Rural US. Behav Sleep Med 2024:1-24. [PMID: 38600856 DOI: 10.1080/15402002.2024.2339818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
OBJECTIVES The purpose of this study was to explore sleep health in rural maternal populations through a social-ecological framework and identify risk and protective factors for this population. METHODS 39 individuals who are mothers of infants or children under the age of 5 years completed an online survey, 35 of which completed a subsequent semi-structured interview. Recruitment was limited to one rural community and was in partnership with community healthcare providers. Results were integrated using a convergent, parallel mixed-methods design. RESULTS Poor sleep health and high prevalence of insomnia symptoms in rural mothers were evident and associated with social support and maternal distress. Qualitative content from interviews indicated that well-established precipitating and perpetuating factors for insomnia may contribute to poor maternal sleep health. Results also revealed a gap in knowledge and language surrounding sleep health among rural mothers. CONCLUSIONS Sleep health is challenged during the transition to motherhood and rural mothers have less access to specialized perinatal and behavioral health care than their urban counterparts. In this sample, poor sleep was attributable to distress in addition to nocturnal infant and child sleep patterns which has implications for psychoeducation and promotion of sleep health in mothers. Sleep is a modifiable health indicator that is associated with several other maternal health outcomes and should be considered an element of a comprehensive maternal health for prevention and intervention across individual, interpersonal, and societal domains of the social-ecological model of sleep health.
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Affiliation(s)
| | - Kelly R Doudell
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | - Jenny M Cundiff
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | | | - Catherine A Lavender
- College of Community Health Sciences, University of Alabama, Tuscaloosa, AL, USA
| | - Heather E Gunn
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
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Kanekasu H, Shiraiwa Y, Taira S, Watanabe H. Primiparas' prenatal depressive symptoms, anxiety, and salivary oxytocin level predict early postnatal maternal-infant bonding: a Japanese longitudinal study. Arch Womens Ment Health 2024:10.1007/s00737-024-01441-5. [PMID: 38407602 DOI: 10.1007/s00737-024-01441-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 02/05/2024] [Indexed: 02/27/2024]
Abstract
PURPOSE It was reported that maternal-infant bonding failure predicts abusive parenting. Maternal-infant bonding is important to prevent child abuse. This study aimed to investigate the association between prenatal depressive symptoms, anxiety, cortisol, and oxytocin levels, and postnatal maternal-infant bonding. METHODS The participants completed a self-report prenatal questionnaire that included the Edinburgh Postnatal Depression Scale (EPDS) and State-Trait Anxiety Inventory (STAI) in the second trimester. Blood and saliva were collected in the second trimester. Cortisol levels were measured in plasma, while oxytocin levels were measured in saliva. Postnatal questionnaires, including the Mother-to-Infant Bonding Scale (MIBS), were administered at 2-5 days, 1 month, and 3 months postpartum. Multiple linear regression and generalized estimating equation (GEE) were conducted for analysis. RESULTS Sixty-six primiparas participated in the study. Prenatal depressive symptoms (EPDS ≥ 9) and anxiety (STAI-S ≥ 42) were observed in 21.2% and 28.8% of the participants, respectively. The median cortisol and oxytocin levels were 21.0 µg/dL and 30.4 pg/mL, respectively. Multivariate linear regression showed that postnatal social support, prenatal depressive symptoms, anxiety, and salivary oxytocin levels predicted MIBS scores at 2-5 days postpartum. At 1 month postpartum, household income, history of miscarriage, postnatal social support, and prenatal anxiety predicted MIBS scores. At 3 months postpartum, only postnatal social support predicted MIBS scores. The results of GEE showed that prenatal anxiety, oxytocin levels, postpartum period, household income, and postpartum social support were associated with MIBS scores. CONCLUSION Prenatal depressive symptoms, anxiety, and lower salivary oxytocin levels were predicted to worsen maternal-infant bonding at 2-5 days postpartum. Prenatal anxiety was predicted to cause the same 1 month postpartum. Measuring prenatal depressive symptoms, anxiety, and salivary oxytocin levels may render the assessment of the risk of maternal-infant bonding failure during the early postpartum period and intervene during pregnancy possible.
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Affiliation(s)
- Hitomi Kanekasu
- Department of Children and Women's Health, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan
| | | | - Shu Taira
- Faculty of Food and Agricultural Sciences, Fukushima University, Kanayagawa, Fukushima, 960-1248, Japan
| | - Hiroko Watanabe
- Department of Children and Women's Health, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan.
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Prowse KL, Law H, Raez-Villanueva S, Markovic F, Wang M, Borojevic R, Parsons SP, Vincent AD, Holloway AC, Ratcliffe EM. Effects of in utero exposure to fluoxetine on the gastrointestinal tract of rat offspring. Am J Physiol Gastrointest Liver Physiol 2023; 325:G528-G538. [PMID: 37724979 DOI: 10.1152/ajpgi.00223.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 09/13/2023] [Accepted: 09/13/2023] [Indexed: 09/21/2023]
Abstract
Perinatal exposure to selective serotonin reuptake inhibitors (SSRIs) has been shown to disrupt the development of serotonergic signaling pathways in the brain and enteric nervous system. Serotonin (5-hydroxytryptamine; 5-HT) signaling is critical for gastrointestinal homeostasis; changes in 5-HT expression and regulation have been associated with gastrointestinal diseases of motility and inflammation. We tested the hypothesis that perinatal exposure to the SSRI fluoxetine can influence the development of the gastrointestinal tract in exposed offspring. Female nulliparous Wistar rats were given fluoxetine (10 mg/kg) or vehicle control from 2 wk before mating until weaning; small and large intestines of female and male offspring were collected at postnatal days 1, 21 (P1, P21, respectively), and 6 mo of age. In histological preparations, the proportion of serotonergic neurons significantly increased in the colons of both female and male fluoxetine-exposed compared with control offspring at P21, a time point that signifies maximal exposure to fluoxetine. At 6 mo of age, male but not female fluoxetine-exposed offspring had a significant increase in circulating 5-HT, with a significant decrease in transcripts encoding the 5-HT2A receptor and monoamine oxidase as compared with control offspring. Measurement of spatiotemporal mapping of contractile activity of the small and large intestine at 6 mo of age revealed no changes in motility in the small bowel of fluoxetine-exposed offspring but revealed a significant increase in the frequency of colonic contractions in the female fluoxetine-exposed compared with control animals. Susceptibility to inflammation was examined at 6 mo using the dextran sulfate sodium model of acute colitis. In utero exposure to fluoxetine was not found to exacerbate colitis severity. These findings suggest that fluoxetine exposure during fetal and early postnatal development can lead to changes in serotonergic neurons at the peak of exposure with sex-specific changes in 5-HT signaling and colonic motility in adulthood.NEW & NOTEWORTHY There is increasing recognition of the relevance of in utero and early postnatal exposures in the developmental programming of the gastrointestinal tract. Perinatal exposure to selective serotonin reuptake inhibitors and antidepressant medications is of particular relevance as they are commonly prescribed during pregnancy, and serotonergic pathways play key roles during gastrointestinal development and in postnatal homeostasis. Here, we provide a comprehensive evaluation of clinically relevant outcomes of gastrointestinal motility and susceptibility to colitis in fluoxetine-exposed offspring and highlight changes in colonic serotonergic neurons at the peak of perinatal fluoxetine exposure with sex-dependent changes in serotonin signaling and colonic motility in adulthood.
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Affiliation(s)
- Katherine L Prowse
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Harriet Law
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | | | - Filip Markovic
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Megan Wang
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Rajka Borojevic
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Sean P Parsons
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Alexander D Vincent
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Alison C Holloway
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Elyanne M Ratcliffe
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
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Sultan P, Guo N, Kawai M, Barwick FH, Carvalho B, Mackey S, Kallen MA, Gould CE, Butwick AJ. Prevalence and predictors for postpartum sleep disorders: a nationwide analysis. J Matern Fetal Neonatal Med 2023; 36:2170749. [PMID: 36710393 DOI: 10.1080/14767058.2023.2170749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To describe the prevalence and predictors of postpartum sleep disorders. DESIGN A retrospective cohort study. SETTING Postpartum. POPULATION Commercially insured women delivering in California (USA) between 2011 and 2014. METHODS Using the Optum Clinformatics Datamart Database. MAIN OUTCOME MEASURES Prevalence of a postpartum sleep disorder diagnosis with and without a depression diagnosis up to 12 months following hospital discharge for inpatient delivery. We also identified predictors of a postpartum sleep disorder diagnosis using multivariable logistic regression. RESULTS We identified 3535 (1.9%) women with a postpartum sleep disorder diagnosis. The prevalence of sleep disorder diagnoses was insomnia (1.3%), sleep apnea (0.25%), and other sleep disorder (0.25%). The odds of a postpartum sleep disorder were highest among women with a history of drug abuse (adjusted odds ratio (aOR): 2.70, 95% confidence interval (CI): 1.79-4.09); a stillbirth delivery (aOR: 2.15, 95% CI: 1.53-3.01); and chronic hypertension (aOR: 1.82; 95% CI: 1.57-2.11). A comorbid diagnosis of a postpartum sleep disorder and depression occurred in 1182 women (0.6%). These women accounted for 33.4% of all women with a postpartum sleep disorder. The strongest predictors of a comorbid diagnosis were a history of drug abuse (aOR: 4.13; 95% CI: 2.37-7.21) and a stillbirth delivery (aOR: 2.93; 95% CI: 1.74-4.92). CONCLUSIONS Postpartum sleep disorders are underdiagnosed conditions, with only 2% of postpartum women in this cohort receiving a sleep diagnosis using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes. Insomnia was the most common disorder and one-third of women diagnosed with a postpartum sleep disorder had a co-morbid diagnosis of depression. Future studies are needed to improve the screening and diagnostic accuracy of postpartum sleep disorders.
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Affiliation(s)
- P Sultan
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - N Guo
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - M Kawai
- Department of Psychiatry and Behavioral Sciences, Division of Sleep Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - F H Barwick
- Department of Psychiatry and Behavioral Sciences, Division of Sleep Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - B Carvalho
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - S Mackey
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - M A Kallen
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - C E Gould
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - A J Butwick
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Ozdemir J, Ozcan S. Do postpartum insomnia, fatigue and depression affect the maternal role of primiparous women? Women Health 2023; 63:837-846. [PMID: 37919971 DOI: 10.1080/03630242.2023.2276150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 10/22/2023] [Indexed: 11/04/2023]
Abstract
Many factors negatively affect the motherhood role. Fatigue, insomnia and depression, which are among these factors, have not been investigated together in any study. Therefore, we carried out this study to determine the effect of insomnia, fatigue and depressive symptoms on the motherhood role in primiparous mothers. In this descriptive and cross-sectional study, we included 153 women who met the inclusion criteria using the simple, random sampling method. To determine the independent variables affecting the motherhood role, we used the backward regression model. In this study, we determined that the women's spending more energy while they performed the activities of daily living in the postpartum period, their suffering from insomnia due to baby care and their depressive symptoms affected their motherhood role by 32.6 percent. We also determined that there was a moderately significant relationship between insomnia, fatigue and depressive symptoms in the postpartum period. In particular, because depressive symptoms are the variable most related with the motherhood role (r = -0.520; p < .001), women should be followed-up regularly in the postpartum period from this aspect. It is also important to deal with insomnia in the early postpartum period, because it is a common problem in most women after childbirth.
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Affiliation(s)
- Jale Ozdemir
- Health Sciences University, Bursa Yüksek Ihtisas Training and Research Hospital Neonatal Intensive Care Unit, Bursa, Turkey
| | - Sadiye Ozcan
- Department of Obstetrics & Gynecological Nursing, Yalova University Faculty of Health Sciences, Yalova, Turkey
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Palagini L, Cipriani E, Caruso V, Sharma V, Gemignani A, Bramante A, Miniati M, Riemann D. Insomnia During the Perinatal Period and its Association with Maternal and Infant Psychopathology: A Systematic Review and Meta-Analysis. Curr Psychiatry Rep 2023; 25:617-641. [PMID: 37819491 DOI: 10.1007/s11920-023-01463-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE OF REVIEW While sleep serves important regulatory functions for mental health, sleep disturbances, in particular insomnia, may contribute to mental disorders. Since insomnia symptoms are frequent during the perinatal period, the aim of this work is to systematically review the potential association between perinatal insomnia and maternal and infant psychopathology. RECENT FINDINGS A systematic search was conducted according with PRISMA guidelines, and meta-analytic calculations were conducted. Totally, 34 studies were included and involved 835,021 perinatal women. Four meta-analysis yielded four statistically significant random-effect models. All models show that women with perinatal symptoms of insomnia possess increased odds of developing clinically relevant symptoms of depression OR = 3.69, p = 0.001 and anxiety OR = 2.81; p < 0.001, as well as increased suicidal risk OR = 3.28; p < 0.001, and distress in the newborn OR = 2.80 (P = 0.007). These findings emphasize the role of assessing and addressing insomnia during the perinatal period to mitigate its negative effect on maternal and infant mental health via sleep regulation.
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Affiliation(s)
- Laura Palagini
- Department of Experimental and Clinic Medicine, Section of Psychiatry, University of Pisa, Via Roma 67, 56100 Pisa, Italy.
| | - Enrico Cipriani
- Department of Surgical, Medical, Molecular, and Critical Area Pathology, University of Pisa, Via Savi, 10-56126 Pisa, Italy
| | - Valerio Caruso
- Department of Experimental and Clinic Medicine, Section of Psychiatry, University of Pisa, Via Roma 67, 56100 Pisa, Italy
| | - Verinder Sharma
- Department of Psychiatry, Western University, London, ON, Canada
- Department of Obstetrics & Gynaecology, Western University, London, ON, Canada
- Parkwood Institute Mental Health, St. Joseph's Health Care, London, ON, Canada
| | - Angelo Gemignani
- Department of Surgical, Medical, Molecular, and Critical Area Pathology, University of Pisa, Via Savi, 10-56126 Pisa, Italy
| | - Alessandra Bramante
- President of the Italian Section Marcè Society for Perinatal Psychopathology, Milan, Italy
| | - Mario Miniati
- Department of Experimental and Clinic Medicine, Section of Psychiatry, University of Pisa, Via Roma 67, 56100 Pisa, Italy
| | - Dieter Riemann
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Baumgartel K, Caplan E, Glover C, Louis J, Schreiber J. A Feasibility Study to Assess Sleep and Subsequent Breast Milk Volume Among Mothers With Hospitalized Preterm Infants. J Perinat Neonatal Nurs 2023; 37:295-302. [PMID: 37878514 PMCID: PMC10605565 DOI: 10.1097/jpn.0000000000000657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
BACKGROUND Sleep is essential for optimal health, and disturbed postpartum sleep is associated with compromised infant attachment. The postpartum experience of mothers with preterm infants is unlike the biological norm, as they are separated from their infants and often express breast milk. PURPOSE The purpose of this study was to examine the feasibility of conducting a clinical research study among women with hospitalized preterm infants. We also explored for associations between maternal sleep patterns and sleep-related psychological states and subsequent breast milk volume. METHODS Participants were recruited from Magee-Womens Hospital, located in Pittsburgh, Pennsylvania New mothers completed daily sleep and pumping logs and scales to measure stress, trauma, depression, fatigue, and sleep quality. RESULTS A total of 78 women were screened, 18 women consented, and a total of 8 participants completed the study. Screening from the postpartum unit increased recruitment. The participants experience worsening sleep quality over time, moderate stress, and fatigue. Stress, postnatal depression, and fatigue are negatively associated with milk volume. IMPLICATIONS FOR PRACTICE AND RESEARCH Postpartum recruitment with frequent follow-ups improved recruitment and retention. We present a preliminary association between maternal stress, fatigue, and depression, and subsequent breast milk volume. Sleep-related psychological states may negatively influence milk volume.
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Affiliation(s)
- Kelley Baumgartel
- University of South Florida College of Nursing, Tampa (Dr Baumgartel); University of Pittsburgh School of Nursing, Health Promotion and Development, Pittsburgh, Pennsylvania (Ms Caplan); University of Pittsburgh, Pittsburgh, Pennsylvania (Ms Glover); College of Medicine Obstetrics and Gynecology, COPH Dean's Office, University of South Florida, Tampa (Dr Louis); and Duquesne University School of Nursing, Pittsburgh, Pittsburgh (Dr Schreiber)
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Okun ML, Lac A. Postpartum Insomnia and Poor Sleep Quality Are Longitudinally Predictive of Postpartum Mood Symptoms. Psychosom Med 2023; 85:736-743. [PMID: 37506301 DOI: 10.1097/psy.0000000000001234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2023]
Abstract
OBJECTIVE Insomnia and poor sleep quality are frequently reported by perinatal women. Both are noted to increase the risk of postpartum depression, with less known about their association with postpartum anxiety. This study sought to assess whether perinatal sleep disturbances predicted depression and anxiety symptoms across each month of the first 6 months postpartum in women with a history of depression. METHODS Pregnant women without active depression at enrollment ( N = 159), 18 to 45 years of age, were recruited. In late pregnancy and for up to 6 months postpartum, women completed monthly online questionnaires including the Insomnia Symptom Questionnaire, Pittsburgh Sleep Quality Index, Edinburgh Postnatal Depression Scale, and Generalized Anxiety Disorder-7. Repeated-measures multilevel models were used to predict depression and anxiety across the postpartum. RESULTS The prevalence of insomnia was 20.4%, and the prevalence of poor sleep quality was 67.8% across the first 6 months postpartum. Postpartum insomnia and poor sleep quality at the between-subject and within-subject levels tended to uniquely predict greater depressive and anxiety symptoms, even after controlling for demographic characteristics, prenatal insomnia, and prenatal poor sleep quality. CONCLUSIONS Most of the women in our sample had sleep disturbances across the perinatal period. Consistent with the extant literature, postpartum insomnia and poor sleep quality, but not prenatal measures of sleep, longitudinally predicted greater postpartum depression and anxiety symptoms. The chronic sleep deprivation of insomnia and the subjective experience of poor sleep quality are uniquely relevant risks of postpartum mood disorders. Evaluation and mitigation of perinatal sleep disturbance are ideal opportunities to reduce postpartum mood disorders and subsequent health outcomes.
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Affiliation(s)
- Michele L Okun
- From the Biofrontiers Center (Okun) and Department of Psychology (Lac), University of Colorado Colorado Springs, Colorado Springs, Colorado
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Horwitz A, Bar-Shachar Y, Ran-Peled D, Finkelstein O, Ben-Zion H, Bar-Kalifa E, Meiri G, Tikotzky L. Sleep of mothers, fathers, and infants: a longitudinal study from pregnancy through 12 months. Sleep 2023; 46:zsad029. [PMID: 36788476 DOI: 10.1093/sleep/zsad029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 02/07/2023] [Indexed: 02/16/2023] Open
Abstract
STUDY OBJECTIVES This study assessed and compared mothers' and fathers' sleep trajectories from pregnancy and throughout the first year of the infant's life. We also examined associations between maternal, paternal, and infant sleep. METHODS Two hundred and thirty-two couples were recruited for the study during pregnancy. Data were collected during pregnancy and at 4, 8, and 12 months postpartum. Maternal, paternal, and infant sleep were monitored at home for seven nights, using actigraphy, sleep diaries, and the Insomnia Severity Index (ISI). RESULTS Mothers showed more impaired sleep quality than fathers, at all assessments, whereas fathers had shorter sleep duration. Based on the ISI, about 70% of mothers and 50% of fathers showed at least subclinical insomnia at the different assessments. Trajectory analyses (controlling for feeding method and sleeping arrangements) demonstrated a significant deterioration in diary-based and actigraphy sleep quality for both parents, from pregnancy to 4 months. Both parents and infants had an increase in sleep quality from 4 to 12 months, though some parental sleep variables showed a quadratic pattern with a decrease in sleep quality at 8 months. Statistically significant triadic associations at the different assessments were found between mothers', fathers', and infants' sleep. Maternal and infant sleep measures were more strongly correlated than paternal and infant sleep. CONCLUSIONS The findings highlight the importance of considering the family context of sleep, by demonstrating similarities and differences in the changes that sleep undergoes in new mothers and fathers and by showing how sleep is interrelated between all family members.
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Affiliation(s)
- Avel Horwitz
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yael Bar-Shachar
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Dar Ran-Peled
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Omer Finkelstein
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Hamutal Ben-Zion
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eran Bar-Kalifa
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Gal Meiri
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Liat Tikotzky
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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11
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Srimoragot M, Hershberger PE, Park C, Hernandez TL, Izci Balserak B. Infant feeding type and maternal sleep during the postpartum period: a systematic review and meta-analysis. J Sleep Res 2023; 32:e13625. [PMID: 35548942 DOI: 10.1111/jsr.13625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 11/29/2022]
Abstract
The aim of this meta-analysis was to examine the associations among infant feeding types, sleeping habits, and maternal sleep postpartum. Databases including Cumulative Index of Nursing and Allied-Health Literature (CINAHL), PubMed, and Google Scholar were searched in addition to reference lists from selected articles and other key references. A critical review of relevant articles from the data sources was conducted with attention to the infant feeding types and maternal night-time sleep. The methodological quality was assessed systematically. The pooled mean difference was calculated. Narrative summaries were also used. A total of 6,472 participants from seven studies were included in the meta-analysis. A random-effects model demonstrated a significantly higher maternal night-time sleep in breastfeeding mothers than non-breastfeeding mothers with a pooled standardized mean difference of 0.24 h (95% confidence interval 0.03-0.46, p = 0.026). Co-sleeping with infants during the night also increased the sleeping hours in breastfeeding mothers. Homogeneity was observed with a Tau2 of 0.0308 and I2 of 44.3%. Funnel plots, Egger's and Begg's tests revealed no evidence of publication bias. This systematic review and meta-analysis demonstrated that breastfeeding may be associated with a longer night-time sleep postpartum and the synthesis of the literature suggested that co-sleeping with the infant was associated with longer sleep duration in breastfeeding women. Further research into factors involving maternal decisions on infant feeding types and their effects on maternal sleep is needed to better understand the mothers' attitude toward infant feeding and their own sleep.
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Affiliation(s)
- Manassawee Srimoragot
- University of Illinois Chicago, Department of Biobehavioral Nursing Science, Chicago, Illinois, USA.,Faculty of Nursing, Mahidol University, Bangkoknoi, Bangkok, Thailand
| | - Patricia E Hershberger
- University of Illinois Chicago, Department of Health System Science, Chicago, Illinois, USA
| | - Chang Park
- University of Illinois Chicago, Department of Health System Science, Chicago, Illinois, USA
| | | | - Bilgay Izci Balserak
- University of Illinois Chicago, Department of Biobehavioral Nursing Science, Chicago, Illinois, USA
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Huang S, Xiao M, Hu Y, Tang G, Chen Z, Zhang L, Fu B, Lei J. Attitudes toward seeking professional psychological help among Chinese pregnant women: A cross-sectional study. J Affect Disord 2023; 322:163-172. [PMID: 36400148 DOI: 10.1016/j.jad.2022.11.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND There exists a gap between the high prevalence of mental health problems and negative attitudes toward seeking professional psychological help among Chinese pregnant women. This study aimed to investigate the attitudes and factors toward seeking professional psychological help among Chinese pregnant women to provide some suggestions for improving pregnant women's psychological help-seeking behaviors. METHODS A total of 1024 pregnant women were recruited. The Chinese version of the Attitude Toward Seeking Professional Psychological Help Scale (ATSPPH) was used to assess the attitudes toward professional psychological help-seeking. Demographic and socio-psychological factors were collected by self-developed questionnaire, Perceived Social Support Scale, Simplified Coping Style Questionnaire, and Patient Health Questionnaire-9 Scale. RESULTS 1006 pregnant women were included in the final analysis. Only 3.7 % of participants chose professionals as their first choice for psychological help-seeking. The attitudes toward seeking professional psychological help were relatively positive, with the highest score of stigma tolerance among four subscales in ATSPPH. Education level, perceived social support, and positive coping style had a positive predictive effect on the four subscales of ATSPPH. Women with prenatal depressive symptoms had a lower score in the subscales of recognition of need for psychotherapeutic help and confidence in mental health practitioner; women with higher scores of negative coping style had a lower score in the subscales of stigma tolerance and interpersonal openness. History of professional psychological help-seeking behaviors was only associated with the subscale of recognition of need for psychotherapeutic help; Maternal age was only associated with the subscale of interpersonal openness. CONCLUSION The attitudes toward seeking professional psychological help were relatively positive among Chinese pregnant women, and stigma tolerance was the significant barrier to professional psychological help-seeking. More attention should be paid to those women with older age, negative coping style, and women with prenatal depressive symptoms.
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Affiliation(s)
- Sasa Huang
- Xiang Ya Nursing School of Central South University, 172 Tongzipo Road, Yuelu District, Changsha 410013, Hunan, China
| | - Meili Xiao
- Xiang Ya Nursing School of Central South University, 172 Tongzipo Road, Yuelu District, Changsha 410013, Hunan, China
| | - Ying Hu
- Xiang Ya Nursing School of Central South University, 172 Tongzipo Road, Yuelu District, Changsha 410013, Hunan, China
| | - Guanxiu Tang
- Department of Geriatrics, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha 410013, Hunan, China
| | - Zhihong Chen
- Pediatric Intensive Care Unit, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha 410013, Hunan, China
| | - Lijuan Zhang
- Department of Emergency Pediatrics, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha 410013, Hunan, China
| | - Bing Fu
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha 410013, Hunan, China
| | - Jun Lei
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha 410013, Hunan, China.
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13
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Hall K, Patel R, Evans J, Greenwood R, Hicks J. The relationship between perinatal circadian rhythm and postnatal depression: an overview, hypothesis, and recommendations for practice. SLEEP SCIENCE AND PRACTICE 2022. [DOI: 10.1186/s41606-022-00081-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
AbstractPostnatal depression (PND) is an important public health problem with far-reaching consequences for mothers, families, and society. Current treatment approaches tend to focus on the depressive symptoms of the mother. We propose the need for a shift in the conceptualisation of PND and its management, by focusing on circadian rhythm as an early manifestation of mother-infant synchrony. We have reviewed the relevant interdisciplinary literature to formulate a hypothesis and suggest recommendations for practice. We hypothesise that, after a mother’s circadian rhythm becomes ‘desynchronised’ immediately following birth, persistence of this disruption is implicated in the development of PND. This has important implications for novel treatment strategies in the critical and vulnerable postnatal period, for example the use of outdoor-based interventions and light.
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Schnatschmidt M, Lollies F, Schlarb AA. Can a parental sleep intervention in an individual setting improve the maternal and paternal sense of competence and parent-child interaction in parents of young sleep-disturbed children? findings from a single-arm pilot intervention study. BMC Psychol 2022; 10:243. [PMID: 36316716 PMCID: PMC9623967 DOI: 10.1186/s40359-022-00945-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 09/07/2022] [Accepted: 10/07/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In early childhood sleep and regulatory problems, parental factors are often impaired but essential to overcoming them. This study aims to examine, in parents of young sleep-disturbed children, whether mothers' and fathers' sense of parenting competence were increased and dysfunctional parent-child interactions reduced with a parental sleep intervention, whether these changes were sustained over a 12-month follow-up period and if children's symptomatic parameters could be related factors. METHODS A total of 57 families with sleep-disturbed children aged 6 months to 4 years entered this single-arm pilot study. Each parent pair participated in six weekly individual face-to-face sessions of a multimodal cognitive-behavioral sleep intervention. The Parenting Sense of Competence Scale, Parental Stress Index Short Form, Child's Sleep Diary and Child's Questionnaire on Crying, Eating and Sleeping were obtained pre-, post-, 3, 6 and 12 months after the intervention. RESULTS Maternal sense of competence and dysfunctional mother-child interaction improved significantly up to 6 months after the intervention. Factors related to lower maternal competence were the child's more frequent nightly food intake and more crying due to defiance; factors related to dysfunctional mother-child interaction were more frequent crying episodes, more crying due to defiance and more eating difficulties; factors related to increased maternal competence were less duration of child's night waking, less bed-sharing and lower frequency of crying episodes; factors related to increased paternal competence were less child's nightly food intake and fewer episodes of unexplained and unsoothable crying; and factors related to improved father-child interaction were less frequent child's night waking and fewer unexplained and unsoothable crying episodes. CONCLUSION For parents of sleep-disturbed young children, an intervention that addresses the child's sleep could be promising to increase the parental sense of competence and reduce dysfunctional parent-child interactions, especially for mothers. Child symptomatic parameters may change, together with the parental sense of competence and parent-child interaction of both parents, after the intervention. Mothers with children with more severe symptomatology perceive their parenting competence as lower on average and their mother-child interaction as more dysfunctional. Future research with a larger sample and a randomized controlled design is needed. TRIAL REGISTRATION The study was retrospectively registered at the German Clinical Trials Register (ID: DRKS00028578; registration date: 21.03.2022).
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Affiliation(s)
- Marisa Schnatschmidt
- grid.7491.b0000 0001 0944 9128Faculty of Psychology and Sports Science, Department of Psychology, Clinical Psychology and Psychotherapy of Childhood and Adolescence, Bielefeld University, P.O.P. 10 01 31, DE-33501 Bielefeld, Germany
| | - Friederike Lollies
- grid.7491.b0000 0001 0944 9128Faculty of Psychology and Sports Science, Department of Psychology, Clinical Psychology and Psychotherapy of Childhood and Adolescence, Bielefeld University, P.O.P. 10 01 31, DE-33501 Bielefeld, Germany
| | - Angelika A. Schlarb
- grid.7491.b0000 0001 0944 9128Faculty of Psychology and Sports Science, Department of Psychology, Clinical Psychology and Psychotherapy of Childhood and Adolescence, Bielefeld University, P.O.P. 10 01 31, DE-33501 Bielefeld, Germany
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15
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Zanetti N, D'Souza L, Tchernegovski P, Blunden S. Parents' perceptions of the quality of infant sleep behaviours and practices: A qualitative systematic review. INFANT AND CHILD DEVELOPMENT 2022. [DOI: 10.1002/icd.2369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Nina Zanetti
- Faculty of Education Monash University Clayton Victoria Australia
| | - Levita D'Souza
- Faculty of Education Monash University Clayton Victoria Australia
| | | | - Sarah Blunden
- Appleton Institute of Behavioural Science, School of Health, Medical and Applied Sciences Central Queensland University Rockhampton Queensland Australia
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16
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Persistence and prevalence of sleep-disordered breathing after delivery: A scoping review of longitudinal and cross-sectional studies. Sleep Med Rev 2022; 65:101674. [DOI: 10.1016/j.smrv.2022.101674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 07/04/2022] [Accepted: 07/19/2022] [Indexed: 11/21/2022]
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17
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Astbury L, Bennett C, Pinnington DM, Bei B. Does breastfeeding influence sleep? A longitudinal study across the first two postpartum years. Birth 2022; 49:540-548. [PMID: 35191089 PMCID: PMC9546104 DOI: 10.1111/birt.12625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 02/05/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The association between breastfeeding and sleep of the gestational parent is poorly understood. This longitudinal study investigated how breastfeeding is associated with total nighttime sleep duration and sleep efficiency (percentage of total sleep time in bed) in nulliparous participants over the first two postpartum years. METHODS Nulliparous participants (N = 155, Mage = 33.45, SDage = 3.50) self-reported patterns of breastfeeding via telephone interviews and sleep via self-report at 1.5, 3, 6, 12 and 24 months postpartum. Data were analyzed using mixed-effects models, with breastfeeding variables as predictors and sleep variables as outcomes, controlling for relevant covariates. RESULTS Neither the presence of breastfeeding nor the percentage of human milk in infants' total diets was significantly associated with participants' sleep duration or sleep quality (P-values > 0.08). This finding held after controlling for the number of nighttime feeds (P-values > 0.11). However, greater numbers of nighttime feeds, regardless of feeding content, were strongly associated with shorter sleep duration and poor sleep efficiency (P-values < 0.05). On average, with each additional nighttime feed, nocturnal sleep duration decreased by 6.6-8.4 minutes, and sleep efficiency decreased by 2.88%-3.02%. CONCLUSIONS Data from this study showed that breastfeeding per se was not associated with shorter or poor nocturnal sleep, but the number of nighttime feeds was. Sharing nighttime infant care amongst different carers in the household could help reduce postpartum sleep disturbance and ameliorate its negative impact on wellbeing.
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Affiliation(s)
- Laura Astbury
- Turner Institute for Brain and Mental HealthSchool of Psychological SciencesFaculty of Medicine, Nursing and Health SciencesMonash UniversityClaytonVictoriaAustralia
| | - Christie Bennett
- Department of Nutrition and Dietetics and FoodBe Active Eat Sleep (BASE) FacilitySchool of Clinical SciencesMonash UniversityClaytonVictoriaAustralia
| | - Donna M. Pinnington
- Turner Institute for Brain and Mental HealthSchool of Psychological SciencesFaculty of Medicine, Nursing and Health SciencesMonash UniversityClaytonVictoriaAustralia,Centre for Women’s Mental HealthDepartment of PsychiatryUniversity of MelbourneRoyal Women’s HospitalMelbourneVictoriaAustralia
| | - Bei Bei
- Turner Institute for Brain and Mental HealthSchool of Psychological SciencesFaculty of Medicine, Nursing and Health SciencesMonash UniversityClaytonVictoriaAustralia,Centre for Women’s Mental HealthDepartment of PsychiatryUniversity of MelbourneRoyal Women’s HospitalMelbourneVictoriaAustralia
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18
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Ragni B, Barni D, Bevilacqua F, Aite L, Bucci S, Gentile S, Grimaldi Capitello T, De Stasio S. Post-partum depressive dimensions, co-parenting, infants’ health, and sleep quality: how are they related in the first year postpartum? CHILDRENS HEALTH CARE 2022. [DOI: 10.1080/02739615.2022.2110496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
| | - Daniela Barni
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | | | - Lucia Aite
- Unit of Clinical Psychology, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Silvia Bucci
- Unit of Clinical Psychology, Bambino Gesù Children’s Hospital, Rome, Italy
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19
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Jordan S, Bromley R, Damase-Michel C, Given J, Komninou S, Loane M, Marfell N, Dolk H. Breastfeeding, pregnancy, medicines, neurodevelopment, and population databases: the information desert. Int Breastfeed J 2022; 17:55. [PMID: 35915474 PMCID: PMC9343220 DOI: 10.1186/s13006-022-00494-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 06/27/2022] [Indexed: 11/16/2022] Open
Abstract
Background The pharmacoepidemiology of the long-term benefits and harms of medicines in pregnancy and breastfeeding has received little attention. The impact of maternal medicines on children is increasingly recognised as a source of avoidable harm. The focus of attention has expanded from congenital anomalies to include less visible, but equally important, outcomes, including cognition, neurodevelopmental disorders, educational performance, and childhood ill-health. Breastfeeding, whether as a source of medicine exposure, a mitigator of adverse effects or as an outcome, has been all but ignored in pharmacoepidemiology and pharmacovigilance: a significant ‘blind spot’. Whole-population data on breastfeeding: why we need them Optimal child development and maternal health necessitate breastfeeding, yet little information exists to guide families regarding the safety of medicine use during lactation. Breastfeeding initiation or success may be altered by medicine use, and breastfeeding may obscure the true relationship between medicine exposure during pregnancy and developmental outcomes. Absent or poorly standardised recording of breastfeeding in most population databases hampers analysis and understanding of the complex relationships between medicine, pregnancy, breastfeeding and infant and maternal health. The purpose of this paper is to present the arguments for breastfeeding to be included alongside medicine use and neurodevelopmental outcomes in whole-population database investigations of the harms and benefits of medicines during pregnancy, the puerperium and postnatal period. We review: 1) the current situation, 2) how these complexities might be accommodated in pharmacoepidemiological models, using antidepressants and antiepileptics as examples; 3) the challenges in obtaining comprehensive data. Conclusions The scarcity of whole-population data and the complexities of the inter-relationships between breastfeeding, medicines, co-exposures and infant outcomes are significant barriers to full characterisation of the benefits and harms of medicines during pregnancy and breastfeeding. This makes it difficult to answer the questions: ‘is it safe to breastfeed whilst taking this medicine’, and ‘will this medicine interfere with breastfeeding and/ or infants’ development’?
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Affiliation(s)
- Sue Jordan
- Faculty of Medicine, Health and Life Science, Swansea University, Swansea, Wales, UK.
| | - Rebecca Bromley
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Christine Damase-Michel
- Faculté de Médecine, Center for Epidemiology and Research in POPulation Health (CERPOP), Université Toulouse III, CHU Toulouse INSERM, Pharmacologie Médicale, Toulouse, France
| | - Joanne Given
- Faculty Life & Health Sciences, University of Ulster, Co Antrim, Newtownabbey, N Ireland, UK
| | - Sophia Komninou
- Faculty of Medicine, Health and Life Science, Swansea University, Swansea, Wales, UK
| | - Maria Loane
- Faculty Life & Health Sciences, University of Ulster, Co Antrim, Newtownabbey, N Ireland, UK
| | - Naomi Marfell
- Faculty of Medicine, Health and Life Science, Swansea University, Swansea, Wales, UK
| | - Helen Dolk
- Faculty Life & Health Sciences, University of Ulster, Co Antrim, Newtownabbey, N Ireland, UK
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20
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Ran-Peled D, Bar-Shachar Y, Horwitz A, Finkelstein O, Bar-Kalifa E, Meiri G, Tikotzky L. Objective and subjective sleep and caregiving feelings in mothers of infants: a longitudinal daily diary study. Sleep 2022; 45:6569230. [DOI: 10.1093/sleep/zsac090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 03/28/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study Objectives
This study explored the links between mothers’ objective and subjective sleep and their caregiving feelings toward their infant (i.e. patience for the infant, desire to be with the infant, and anger toward the infant), using a diary study design. We were particularly interested in examining whether nights of lower sleep quality within individual mothers predict more negative maternal caregiving feelings the following day.
Methods
The sample included 151 women, who were recruited during pregnancy. Data were collected at 4 and 8 months after delivery. Maternal sleep was monitored at home for seven nights using actigraphy and sleep diaries. Mothers rated their caregiving feelings each evening.
Results
Multilevel modeling (controlling for depressive symptoms, feeding method, and background variables) revealed that actigraphic and subjective sleep variables were associated with maternal caregiving feeling, both at the between- and within-person levels. For example, lower sleep percent predicted reduced levels of maternal patience for the infant at 4 and 8 months (between-person effect). Moreover, when a mother had a lower sleep percent on a given night (compared to her average), she reported lower levels of patience for her infant the following day (within-person prospective effect).
Conclusions
The findings demonstrate, for the first time, that maternal nightly variations in objective and subjective sleep quality predict daily changes in maternal feelings toward her infant at two different assessment points. Improving maternal sleep quality might be an important target for future interventions which may help mothers to feel more positively toward their infants.
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Affiliation(s)
- Dar Ran-Peled
- Department of Psychology, Ben-Gurion University of the Negev , Beer-Sheva , Israel
| | - Yael Bar-Shachar
- Department of Psychology, Ben-Gurion University of the Negev , Beer-Sheva , Israel
| | - Avel Horwitz
- Department of Psychology, Ben-Gurion University of the Negev , Beer-Sheva , Israel
| | - Omer Finkelstein
- Department of Psychology, Ben-Gurion University of the Negev , Beer-Sheva , Israel
| | - Eran Bar-Kalifa
- Department of Psychology, Ben-Gurion University of the Negev , Beer-Sheva , Israel
| | - Gal Meiri
- Faculty of Health Sciences, Ben-Gurion University of the Negev , Beer-Sheva , Israel
| | - Liat Tikotzky
- Department of Psychology, Ben-Gurion University of the Negev , Beer-Sheva , Israel
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21
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Sultan P, Ando K, Elkhateb R, George RB, Lim G, Carvalho B, Chitneni A, Kawai R, Tulipan T, Blake L, Coker J, O’Carroll J. Assessment of Patient-Reported Outcome Measures for Maternal Postpartum Depression Using the Consensus-Based Standards for the Selection of Health Measurement Instruments Guideline: A Systematic Review. JAMA Netw Open 2022; 5:e2214885. [PMID: 35749118 PMCID: PMC9233232 DOI: 10.1001/jamanetworkopen.2022.14885] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
IMPORTANCE Maternal depression is frequently reported in the postpartum period, with an estimated prevalence of approximately 15% during the first postpartum year. Despite the high prevalence of postpartum depression, there is no consensus regarding which patient-reported outcome measure (PROM) should be used to screen for this complex, multidimensional construct. OBJECTIVE To evaluate psychometric measurement properties of existing PROMs of maternal postpartum depression using the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) guideline and identify the best available patient-reported screening measure. EVIDENCE REVIEW This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. PubMed, CINAHL, Embase, and Web of Science were searched on July 1, 2019, for validated PROMs of postpartum depression, and an additional search including a hand search of references from eligible studies was conducted in June 2021. Included studies evaluated 1 or more psychometric measurement properties of the identified PROMs. A risk-of-bias assessment was performed to evaluate methods of each included study. Psychometric measurement properties of each PROM were rated according to COSMIN criteria. A modified Grading of Recommendations Assessment, Development, and Evaluation approach was used to assess the level of evidence supporting each rating, and a recommendation class (A, recommended for use; B, further research required; or C, not recommended) was given based on the overall quality of each included PROM. FINDINGS Among 10 264 postpartum recovery studies, 27 PROMs were identified. Ten PROMs (37.0%) met the inclusion criteria and were used in 43 studies (0.4%) involving 22 095 postpartum women. At least 1 psychometric measurement property was assessed for each of the 10 validated PROMs identified. Content validity was sufficient in all PROMs. The Edinburgh Postnatal Depression Scale (EPDS) demonstrated adequate content validity and a moderate level of evidence for sufficient internal consistency (with sufficient structural validity), resulting in a recommendation of class A. The other 9 PROMs evaluated received a recommendation of class B. CONCLUSIONS AND RELEVANCE The findings of this systematic review suggest that the EPDS is the best available patient-reported screening measure of maternal postpartum depression. Future studies should focus on evaluating the cross-cultural validity, reliability, and measurement error of the EPDS to improve understanding of its psychometric properties and utility.
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Affiliation(s)
- Pervez Sultan
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Kazuo Ando
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Rania Elkhateb
- Library, University of Arkansas for Medical Sciences, Little Rock
| | - Ronald B. George
- Department of Anesthesiology, University of California, San Francisco
| | - Grace Lim
- Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Brendan Carvalho
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Ahish Chitneni
- Physical Medicine and Rehabilitation, NewYork–Presbyterian–Columbia and Cornell, New York, New York
| | | | - Tanya Tulipan
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lindsay Blake
- Library, University of Arkansas for Medical Sciences, Little Rock
| | - Jessica Coker
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock
| | - James O’Carroll
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
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22
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Erten Ö, Biyik İ, Soysal C, Ince O, Keskin N, Tascı Y. Effect of the Covid 19 pandemic on depression and mother-infant bonding in uninfected postpartum women in a rural region. BMC Pregnancy Childbirth 2022; 22:227. [PMID: 35305584 PMCID: PMC8934050 DOI: 10.1186/s12884-022-04580-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/14/2022] [Indexed: 11/30/2022] Open
Abstract
Background Postpartum depression and maternal-infant attachment scores were examined in uninfected women during the COVID 19 pandemic in Kutahya, a rural province in Turkey's North Aegean region. Methods This cohort study was conducted in the Kutahya Health Sciences University Hospital obstetrics unit between April 2021 and August 2021. 178 low-risk term pregnant women who gave birth were given the surveys Edinburgh Postpartum Depression Scale and Mother-to-Infant Bonding Scale (MIBQ) 6 weeks after birth. The Edinburgh Postpartum Depression Scale was used to determine postpartum depression and the Mother-to-Infant Bonding Scale was used to determine maternal attachment. Results In this study, the postpartum depression rate was calculated as 17.4%. When depressed and non-depressed patients were compared, education level, maternal age, BMI, MIBQ score, history of previous pregnancies, route of delivery, previous operation history, economic status, employment status and pregnancy follow-up information were found to be similar (p > 0.05). The ratings on the Mother-to-Infant Bonding Scale were found to be similar in depressed and non-depressed patients (p > 0.05). The odds of maternal depression for patients who received guests at home was 3.068 (95%CI [1.149–8.191]) times the odds of patients who did not receive guests at home. Conclusions Although a relationship has been found between accepting guests in the postpartum period and postpartum depression, it is necessary to investigate in further studies whether there is a causal relationship.
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Quin N, Lee JJ, Pinnington DM, Newman L, Manber R, Bei B. Differentiating perinatal Insomnia Disorder and sleep disruption: a longitudinal study from pregnancy to 2 years postpartum. Sleep 2022; 45:6497951. [PMID: 34989808 PMCID: PMC9013000 DOI: 10.1093/sleep/zsab293] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 12/07/2021] [Indexed: 01/07/2023] Open
Abstract
STUDY OBJECTIVES Insomnia Disorder diagnoses require persistent sleep complaints despite "adequate sleep opportunity." Significant Perinatal Sleep Disruption makes this diagnosis challenging. This longitudinal study distinguished between Insomnia Disorder and Perinatal Sleep Disruption and their sleep and mental health correlates. METHODS One hundred sixty-three nulliparous females (age M ± SD = 33.35 ± 3.42) participating in a randomized controlled trial repeated the Insomnia Disorder module of the Duke Structured Interview for Sleep Disorders and Patient-Reported Outcome Measurement Information System measures for sleep and mental health at 30- and 35-weeks' gestation, and 1.5, 3, 6, 12, and 24 months postpartum (944 interviews, 1009 questionnaires completed). We compared clinical features when Diagnostic and Statistical Manual of Mental Disorders (DSM-5) Insomnia Disorder criteria (without the Duration criterion) were: (1) met (Insomnia Disorder), (2) not met only because of the sleep opportunity criteria (Perinatal Sleep Disruption), and (3) not met due to other criteria (Low Complaint). RESULTS Proportions of Insomnia Disorder were 16.0% and 19.8% during early and late third trimester, and ranged 5.3%-11.7% postpartum. If the sleep opportunity criteria were not considered, rates of Insomnia would be 2-4 times higher (21.4%-40.4%) across time-points. Mixed-effects models adjusting for covariates showed that compared to Low Complaint, both Insomnia Disorder and Perinatal Sleep Disruption scored significantly higher on insomnia and sleep disturbance scales, sleep effort, and sleep-related impairments (p values < .01), but depression and anxiety were comparable (p values > .12). CONCLUSION Assessing sleep complaints without considering sleep opportunities can result in over-diagnosis of Insomnia Disorder in the perinatal periods. Insomnia Disorder and Perinatal Sleep Disruption were both associated with adverse sleep and mood outcomes, and need to be carefully differentiated and appropriately addressed. Clinical Trial Registration: The SEED Project (Sleep, Eat, Emotions, and Development): A randomized controlled pilot study of a perinatal sleep intervention on sleep and wellbeing in mothers and infants. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371634, Australian New Zealand Clinical Trials Registry: ACTRN12616001462471.
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Affiliation(s)
- Nina Quin
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia,Women’s Mental Health Service, Royal Women’s Hospital, Parkville, VIC, Australia
| | - Jin Joo Lee
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia,Women’s Mental Health Service, Royal Women’s Hospital, Parkville, VIC, Australia
| | - Donna M Pinnington
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia,Women’s Mental Health Service, Royal Women’s Hospital, Parkville, VIC, Australia
| | - Louise Newman
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Rachel Manber
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Bei Bei
- Corresponding author. Bei Bei, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, 18 Innovation Walk, Clayton Campus, VIC 3800, Australia.
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Quin N, Tikotzky L, Stafford L, Fisher J, Bei B. Preventing postpartum insomnia by targeting maternal versus infant sleep: a protocol for a randomized controlled trial (the Study for Mother-Infant Sleep “SMILE”). SLEEP ADVANCES 2022; 3:zpab020. [PMID: 35156040 PMCID: PMC8824577 DOI: 10.1093/sleepadvances/zpab020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/23/2021] [Indexed: 11/19/2022]
Abstract
Symptoms of insomnia are common during the perinatal periods and are linked to adverse parent/infant outcomes. Theories on insomnia development (e.g. 3P model) suggest that significant sleep disruption (e.g. nighttime infant care) can precipitate, while unhelpful sleep-related cognitions/behaviors can perpetuate parental insomnia symptoms. This study aims to examine how two interventions, one addressing infant sleep as the precipitator, the other targeting maternal sleep-related cognitions/behaviors as the perpetuator, might prevent postpartum insomnia. Participants are 114 nulliparous females 26 to 32 weeks gestation, with self-reported insomnia symptoms (Insomnia Severity Index scores ≥ 8). Participants are randomized to one of three conditions and receive: (1) a “responsive bassinet” used until 6 months postpartum, designed to boost/consolidate infant sleep and target infant sleep as a precipitator of insomnia, (2) therapist-assisted cognitive behavioral therapy for insomnia, addressing unhelpful sleep-related cognitions/behaviors as perpetuators of insomnia, or (3) a sleep hygiene booklet (control condition). The primary outcome is maternal insomnia symptoms. Secondary outcomes include maternal sleep duration/quality, mental health (e.g. depression, anxiety), and wellbeing-related variables (e.g. sleep-related impairment). Outcomes are assessed using validated instruments at 26–32 and 35–36 weeks’ gestation, and 2, 6, and 12 months postpartum. This study adopts an early-intervention approach and longitudinally compares two distinct approaches to prevent postpartum insomnia in an at-risk population. If interventions are efficacious, findings will demonstrate how interventions targeting different mechanisms mitigate insomnia symptoms in perinatal populations. This will provide empirical evidence for future development of multi-component sleep intervention to improve mother-infant wellbeing. Clinical Trial Registration: The Study for Mother-Infant Sleep (The SMILE Project): reducing postpartum insomnia using an infant sleep intervention and a maternal sleep intervention in first-time mothers. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377927, Australian New Zealand Clinical Trials Registry: ACTRN12619001166167.
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Affiliation(s)
- Nina Quin
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Women’s Mental Health Service, Royal Women’s Hospital, Melbourne, Victoria, Australia
| | - Liat Tikotzky
- Department of Psychology, Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | - Lesley Stafford
- Women’s Mental Health Service, Royal Women’s Hospital, Melbourne, Victoria, Australia
- School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Jane Fisher
- Global and Women’s Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Bei Bei
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Women’s Mental Health Service, Royal Women’s Hospital, Melbourne, Victoria, Australia
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Kalmbach DA, Cheng P, Roth A, Roth T, Swanson LM, O'Brien LM, Fresco DM, Harb NC, Cuamatzi-Castelan AS, Reffi AN, Drake CL. DSM-5 insomnia disorder in pregnancy: associations with depression, suicidal ideation, and cognitive and somatic arousal, and identifying clinical cutoffs for detection. SLEEP ADVANCES : A JOURNAL OF THE SLEEP RESEARCH SOCIETY 2022; 3:zpac006. [PMID: 35391758 PMCID: PMC8981986 DOI: 10.1093/sleepadvances/zpac006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/18/2022] [Indexed: 11/23/2022]
Abstract
Study Objectives The study had three primary goals. First, we estimated survey-assessed DSM-5 insomnia disorder rates in pregnancy, and described associated sociodemographics, and sleep-wake and mental health symptoms. Second, we derived cutoffs for detecting DSM-5 insomnia disorder using common self-report measures of sleep symptoms. Third, we identified clinically relevant cut-points on measures of nocturnal cognitive and somatic arousal. Methods Ninety-nine women (85.9% in the 2nd trimester) completed online surveys including DSM-5 insomnia disorder criteria, the Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), Presleep Arousal Scale's Cognitive (PSASC) and Somatic (PSASS) factors, and Edinburgh Postnatal Depression Scale. Results DSM-5 insomnia disorder rate was 19.2%. Insomnia was associated with depression, suicidality, nocturnal cognitive and somatic arousal, and daytime sleepiness. An ISI scoring method that aligns with DSM-5 criteria yielded excellent metrics for detecting insomnia disorder and good sleep. Regarding quantitative cutoffs, ISI ≥ 10 and ISI ≥ 11 (but not ISI ≥ 15) were supported for detecting DSM-5 insomnia, whereas ISI ≤ 7 and ISI ≤ 9 performed well for detecting good sleep. PSQI cutoff of 5 was supported for detecting insomnia and good sleep. The optimal cutoff for nocturnal cognitive arousal was PSASC ≥ 18, whereas the optimal cutoff for somatic arousal was PSASS ≥ 13. Conclusions Insomnia disorder affects a large segment of pregnant women. Empirically derived cutoffs for insomnia, good sleep, cognitive arousal, and somatic arousal may inform case identification and future perinatal sleep research methodology.
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Affiliation(s)
- David A Kalmbach
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, MIUSA.,Department of Pulmonary & Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, MIUSA
| | - Philip Cheng
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, MIUSA
| | - Andrea Roth
- Pediatric Sleep Medicine, Thriving Minds Behavioral Health, Livonia, MIUSA
| | - Thomas Roth
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, MIUSA
| | - Leslie M Swanson
- Department of Psychiatry, University of Michigan, Ann Arbor, MIUSA
| | - Louise M O'Brien
- Departments of Obstetrics & Gynecology and Neurology, University of Michigan, Ann Arbor, MIUSA
| | - David M Fresco
- Department of Psychiatry, University of Michigan, Ann Arbor, MIUSA
| | - Nicholas C Harb
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, MIUSA
| | | | - Anthony N Reffi
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, MIUSA
| | - Christopher L Drake
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, MIUSA
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Kalmbach DA, O’Brien LM, Pitts DS, Sagong C, Arnett LK, Harb NC, Cheng P, Drake CL. Mother-to-Infant Bonding is Associated with Maternal Insomnia, Snoring, Cognitive Arousal, and Infant Sleep Problems and Colic. Behav Sleep Med 2022; 20:393-409. [PMID: 34047659 PMCID: PMC8627527 DOI: 10.1080/15402002.2021.1926249] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Emerging evidence links maternal and infant sleep problems to impairments in the mother-to-infant bond, but the independence and directionality of these associations remain unclear. The present study characterized concurrent and prospective effects of maternal sleep disturbances and poor infant sleep on the mother-infant relationship. As common sequalae of problematic sleep, nocturnal cognitive hyperarousal and daytime sleepiness were investigated as facilitating mechanisms. PARTICIPANTS Sixty-seven pregnant women enrolled in a prospective study on maternal sleep. METHODS Sociodemographic information and clinical symptoms were measured prenatally then weekly across the first two postpartum months. Women reported insomnia symptoms, sleep duration, snoring, daytime sleepiness, nocturnal cognitive arousal (broadly focused and perinatal-specific), perseverative thinking, depression, infant colic, infant sleep quality, and mother-infant relationship quality. Mixed effects models were conducted to test hypotheses. RESULTS Prenatal snoring and weak maternal-fetal attachment augured poorer postpartum bonding. Poor infant sleep was associated with increased odds for maternal insomnia and short sleep. Impairments in the mother-to-infant bond were linked to maternal insomnia, nocturnal perinatal-focused rumination, daytime sleepiness, depression, and poor infant sleep. Postnatal insomnia predicted future decreases in mother-infant relationship quality, and nocturnal cognitive hyperarousal partially mediated this association. CONCLUSIONS Both maternal and infant sleep problems were associated with poorer mother-to-infant bonding, independent of the effects of maternal depression and infant colic. Perseverative thinking at night, particularly on infant-related concerns, was linked to impaired bonding, rejection and anger, and infant-focused anxiety. Improving maternal and infant sleep, and reducing maternal cognitive arousal, may improve the maternal-to-infant bond.
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Affiliation(s)
- David A Kalmbach
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, Michigan.,Pulmonary & Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, Michigan
| | - Louise M O’Brien
- Departments of Obstetrics & Gynecology, and Neurology, University of Michigan Medical School, Ann Arbor, Michigan
| | - D’Angela S Pitts
- Department of Obstetrics & Gynecology, Henry Ford Health System, Detroit, Michigan
| | - Chaewon Sagong
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, Michigan
| | - Lily K Arnett
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, Michigan
| | - Nicholas C Harb
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, Michigan
| | - Philip Cheng
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, Michigan
| | - Christopher L Drake
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, Michigan
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Insomnia evaluation and treatment during peripartum: a joint position paper from the European Insomnia Network task force "Sleep and Women," the Italian Marcè Society and international experts task force for perinatal mental health. Arch Womens Ment Health 2022; 25:561-575. [PMID: 35419652 PMCID: PMC9072480 DOI: 10.1007/s00737-022-01226-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 03/27/2022] [Indexed: 12/22/2022]
Abstract
Insomnia symptoms are frequent during peripartum and are considered risk factors for peripartum psychopathology. Assessing and treating insomnia and related conditions of sleep loss during peripartum should be a priority in the clinical practice. The aim of this paper was to conduct a systematic review on insomnia evaluation and treatment during peripartum which may be useful for clinicians. The literature review was carried out between January 2000 and May 2021 on the evaluation and treatment of insomnia during the peripartum period. The PubMed, PsycINFO, and Embase electronic databases were searched for literature published according to the PRISMA guidance with several combinations of search terms "insomnia" and "perinatal period" or "pregnancy" or "post partum" or "lactation" or "breastfeeding" and "evaluation" and "treatment." Based on this search, 136 articles about insomnia evaluation and 335 articles on insomnia treatment were found and we conducted at the end a narrative review. According to the inclusion/exclusion criteria, 41 articles were selected for the evaluation part and 22 on the treatment part, including the most recent meta-analyses and systematic reviews. Evaluation of insomnia during peripartum, as for insomnia patients, may be conducted at least throughout a clinical interview, but specific rating scales are available and may be useful for assessment. Cognitive behavioral therapy for insomnia (CBT-I), as for insomnia patients, should be the preferred treatment choice during peripartum, and it may be useful to also improve mood, anxiety symptoms, and fatigue. Pharmacological treatment may be considered when women who present with severe forms of insomnia symptoms do not respond to nonpharmacologic therapy.
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Figueiredo B, Pinto TM, Costa R. Exclusive Breastfeeding Moderates the Association Between Prenatal and Postpartum Depression. J Hum Lact 2021; 37:784-794. [PMID: 33571030 DOI: 10.1177/0890334421991051] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Exclusive breastfeeding has a wide range of benefits for maternal health. However, the benefit of exclusive breastfeeding for maternal mental health needs to be further explored. RESEARCH AIM To determine the moderating role of exclusive breastfeeding at 3 months on the association between prenatal and postpartum depression. METHODS This study had a prospective, longitudinal, and comparative design with two groups and three assessment waves. The sample comprised 334 participants (70 depressed and 264 non-depressed) recruited at public health services in northern Portugal. Participants completed a measure of depression symptoms between the second and the third trimester of pregnancy and between 3 and 6 months, and a measure of breastfeeding status at 3 months. RESULTS Exclusive breastfeeding at 3 months moderated the association between prenatal and postpartum depression. Participants with prenatal depression who were exclusively breastfeeding at 3 months showed fewer symptoms of depression and lower rates of depression between 3 and 6 months postpartum, compared to participants with prenatal depression who were not exclusively breastfeeding. Participants without prenatal depression who were exclusively breastfeeding at 3 months showed similar depression symptoms and similar rates of depression between 3 and 6 months postpartum, compared to participants without prenatal depression who were not exclusively breastfeeding. CONCLUSION Exclusive breastfeeding has a potential protective influence on postpartum depression among women with prenatal depression. Public health policies targeting women with prenatal depression should be implemented and include practices to promote and support exclusive breastfeeding in order to enhance women's exclusive breastfeeding and mental health.
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Affiliation(s)
- Bárbara Figueiredo
- 56059 School of Psychology, University of Minho, Campus of Gualtar, Braga, Portugal
| | - Tiago Miguel Pinto
- 56059 School of Psychology, University of Minho, Campus of Gualtar, Braga, Portugal
| | - Raquel Costa
- 26706 EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Universidade Europeia, Lisboa, Portugal
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Tan XYJ, Choong SYX, Cheng LJ, Lau Y. Relaxation interventions for improving sleep outcomes in perinatal women: A systematic review and meta-analysis of randomized controlled trials. Midwifery 2021; 103:103151. [PMID: 34607056 DOI: 10.1016/j.midw.2021.103151] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 03/24/2021] [Accepted: 09/16/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Sleep problem is common amongst perinatal women, and stress may trigger and intensify sleep problems in a vicious cycle. Relaxation interventions are gradually being adopted to improve sleep quality in various populations, but little is known about their effectiveness in perinatal women. OBJECTIVE To evaluate the effects of relaxation interventions on sleep outcomes amongst all perinatal women aged 18 and above, and identify the essential type, regime and approach in designing relaxation intervention. DESIGN Systematic review and meta-analysis of 11 studies among 1046 perinatal women. DATA SOURCES We searched Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica dataBASE, PsycINFO, ProQuest Dissertations and Theses, PubMed and Web of Science from their inception until December 15, 2019. REVIEW METHODS Studies were assessed for clinical and statistical heterogeneity and considered for meta-analysis. Comprehensive Meta-analysis and The Cochrane Risk of Bias tool were used for meta-analyses and assessing of risk of bias, respectively. RESULTS A total of 6346 records were identified, and 11 randomised control trials were selected. Significantly large effects were found in relaxation interventions in improving sleep quality (Cohen's d = 2.55), disturbance (Cohen's d = 1.52), latency (Cohen's d = 1.82) and duration (Cohen's d = 1.14) when compared with those in the control groups. Subgroup analyses showed that antenatal women who performed progressive muscle relaxation (PMR) by themselves for preventive function and long-term practice showed improved sleep quality compared with their counterparts. CONCLUSION PMR is preferable as a supplementary intervention to current existing antenatal care. The grade of the overall evidence of the outcomes ranged from very low to low. IMPLICATIONS FOR PRACTICE The meta-analysis addressed the effect of relaxation interventions on sleep outcomes amongst perinatal women. Relaxation interventions may effectively improve sleep quality, disturbance, latency and duration amongst perinatal women early in antenatal period. However, further well-designed trials in large samples are required.
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Affiliation(s)
- Xing Yee Jolyn Tan
- Department of Nursing, Khoo Teck Puat Hospital, Yishun Health, National Healthcare Group, Singapore.
| | - Shanise Yi Xin Choong
- Department of Nursing, Khoo Teck Puat Hospital, Yishun Health, National Healthcare Group, Singapore.
| | - Ling Jie Cheng
- Health Systems and Behavioural Sciences Domain, Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
| | - Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Miranda AR, Scotta AV, Cortez MV, Soria EA. Triggering of postpartum depression and insomnia with cognitive impairment in Argentinian women during the pandemic COVID-19 social isolation in relation to reproductive and health factors. Midwifery 2021; 102:103072. [PMID: 34218023 PMCID: PMC8437687 DOI: 10.1016/j.midw.2021.103072] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 05/10/2021] [Accepted: 06/15/2021] [Indexed: 11/29/2022]
Abstract
Objective The 2019 coronavirus disease pandemic (COVID-19) required strict confinement measures that differentially impacted the individual's daily life. Thus, this work aimed to study postpartum women's mental health in Argentina during mandatory social isolation. Design A cross-sectional survey was conducted from May to July 2020, which included five validated questionnaires to assess postpartum depression (Postpartum Depression Screening Scale‐Short Form), insomnia (Insomnia Severity Index), memory complaints (Memory Complaint Scale), metacognition (Brief Metamemory and Metaconcentration Scale), and breastfeeding self-efficacy (Breastfeeding Self-Efficacy Scale-Short Form). Sociodemographic variables, social isolation characteristics, and breastfeeding practices were also collected. This study was conducted in accordance with the Declaration of Helsinki. Statistical analysis included zero-order correlations, multiple logistic regressions, and a set of structural equation models (SEM) to test direct and indirect effects. Goodness-of-fit indices were calculated for SEM. Setting Postpartum women were recruited from public hospitals, private health clinics, and online community recruitment in the Cordoba province (Argentina). Participants 305 postpartum women from Argentina. Measurements and findings 37% of women reported postpartum depression, 46% insomnia, 42% memory impairment, 60% low metaconcentration, 50% low metamemory, and 23% low breastfeeding efficacy. Also, significant associations were found demonstrating that social isolation promoted postpartum depression and insomnia were reciprocally related, which compromised female cognition and efficacy. This situation was aggravated in women during late postpartum, with previous children, and by low social support (e.g., family, health professionals), with non-exclusive breastfeeding being increased. Key conclusions This is the first study addressing postpartum women's mental status during social isolation in Argentina, which was a promoting factor for postpartum depression and insomnia that were reciprocally related. This situation was also aggravated by reproductive factors, such as late postpartum, multiparity, breastfeeding frequency, and non-exclusive breastfeeding. Additionally, breastfeeding self-efficacy depended on mental health status, and euthymia therefore favoured the practice of exclusive breastfeeding.
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Affiliation(s)
- Agustín Ramiro Miranda
- Universidad Nacional de Córdoba, Facultad de Ciencias Médicas, Escuela de Fonoaudiología. Bv. de la Reforma, Ciudad Universitaria, 5014 Córdoba, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas, CONICET, INICSA. Bv. de la Reforma, Ciudad Universitaria, 5014 Córdoba, Argentina
| | - Ana Veronica Scotta
- Universidad Nacional de Córdoba, Facultad de Ciencias Médicas, Escuela de Fonoaudiología. Bv. de la Reforma, Ciudad Universitaria, 5014 Córdoba, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas, CONICET, INICSA. Bv. de la Reforma, Ciudad Universitaria, 5014 Córdoba, Argentina
| | - Mariela Valentina Cortez
- Universidad Nacional de Córdoba, Facultad de Ciencias Médicas, Escuela de Fonoaudiología. Bv. de la Reforma, Ciudad Universitaria, 5014 Córdoba, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas, CONICET, INICSA. Bv. de la Reforma, Ciudad Universitaria, 5014 Córdoba, Argentina
| | - Elio Andrés Soria
- Consejo Nacional de Investigaciones Científicas y Técnicas, CONICET, INICSA. Bv. de la Reforma, Ciudad Universitaria, 5014 Córdoba, Argentina; Universidad Nacional de Córdoba, Facultad de Ciencias Médicas, Cátedra de Biología Celular, Histología y Embriología, Instituto de Biología Celular. Bv. de la Reforma, Ciudad Universitaria, 5014 Córdoba, Argentina.
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Sultan P, Ando K, Sultan E, Hawkins J, Blake L, Barwick F, Kawai M, Carvalho B. A systematic review of patient-reported outcome measures used to assess sleep in postpartum women using Consensus Based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines. Sleep 2021; 44:6278483. [PMID: 34013345 DOI: 10.1093/sleep/zsab128] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/02/2021] [Indexed: 12/12/2022] Open
Abstract
STUDY OBJECTIVES We performed a systematic review to identify the best patient-reported outcome measure (PROM) of postpartum sleep in women. METHODS We searched 4 databases for validated PROMs used to assess postpartum sleep. Studies were considered if they evaluated at least 1 psychometric measurement property of a PROM. An overall rating was assigned for each psychometric measurement property of each PROM based upon COSMIN criteria. A modified GRADE approach was used to assess the level of evidence and recommendations were then made for each PROM. RESULTS We identified 15 validation studies of 8 PROMs, in 9,070 postpartum women. An adequate number of sleep domains was assessed by 5 PROMs: Bergen Insomnia Scale (BIS), Pittsburgh Sleep Quality Index (PSQI), General Sleep Disturbance Scale (GSDS), Athens Insomnia Scale (AIS) and the Sleep Symptom Checklist (SSC). BIS and GSDS were the only PROMs to demonstrate adequate content validity and at least a low level of evidence of sufficient internal consistency, resulting in Class A recommendations. The BIS was the only PROM, which is easily accessible and free to use for non-commercial research, that achieved a Class A recommendation. CONCLUSION The BIS is the best currently available PROM of postpartum sleep. However, this PROM fails to assess several important domains such as sleep duration (and efficiency), chronotype, sleep-disordered breathing and medication usage. Future studies should focus on evaluating the psychometric measurement properties of BIS in the North American setting and in different cultural groups, or to develop a more specific PROM of postpartum sleep.
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Affiliation(s)
- P Sultan
- Associate Professor. Department of Anesthesiology, Perioperative and Pain Medicine. Stanford University School of Medicine, Stanford, CA, USA
| | - K Ando
- Assistant Professor. Department of Anesthesiology, Perioperative and Pain Medicine. Stanford University School of Medicine, Stanford, CA, USA
| | - E Sultan
- Clinical Instructor. Department of Anesthesiology, Perioperative and Pain Medicine. Stanford University School of Medicine, Stanford, CA, USA
| | - J Hawkins
- Medical Student. Stanford University School of Medicine, Stanford, CA, USA
| | - L Blake
- Associate Professor. UAMS Medical Library, UAMS, Little Rock, AR, USA SCIENC ES
| | - F Barwick
- Clinical Associate Professor, Division of Sleep Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine
| | - M Kawai
- Clinical Associate Professor, Division of Sleep Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine
| | - B Carvalho
- Professor. Department of Anesthesiology, Perioperative and Pain Medicine. Stanford University School of Medicine, Stanford, CA, USA
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Vertsberger D, Tikotzky L, Baruchi O, Knafo-Noam A. Parents' Perceptions of Infants' Nighttime Sleep Patterns Predict Mothers' Negativity: A Longitudinal Study. J Dev Behav Pediatr 2021; 42:307-313. [PMID: 33337599 DOI: 10.1097/dbp.0000000000000899] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/27/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Infants' sleeping patterns can influence parents' sleep and their well-being. Infants' sleeping problems can evoke negative emotions from their parents because of the influence the problems have on parents' lives. However, little is known regarding the associations between infants' night sleep patterns and parents' overall negativity toward their children. The objective of this study was to study this association. METHODS In a longitudinal design, we followed infants and their parents from 9 to 18 months. Overall, 392 families participated in the study. Parents' negativity and children's sleeping patterns were assessed with questionnaires. RESULTS Parents' negativity and children's sleeping problems showed moderate continuity through the study's 9-month period. Children's sleeping problems at 9 months predicted an increase in mothers' (but not fathers') negativity at 18 months. Parents' negativity was not associated with infants' sleep problems. CONCLUSION The results of this study suggest that already in infancy, children's tendencies, in this case sleep, can evoke negative emotions in their mothers and highlight infants' roles in the intricate parent-child relationship.
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Affiliation(s)
- Dana Vertsberger
- Department of Psychology, The Hebrew University of Jerusalem, Israel
| | - Liat Tikotzky
- Department of Psychology, Ben Gurion Universiy, Beer-Sheva, Israel
| | - Oriya Baruchi
- Department of Psychology, The Hebrew University of Jerusalem, Israel
| | - Ariel Knafo-Noam
- Department of Psychology, The Hebrew University of Jerusalem, Israel
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Adachi S, Tokuda N, Kobayashi Y, Tanaka H, Sawai H, Shibahara H, Takeshima Y, Shima M. Association between the serum insulin-like growth factor-1 concentration in the first trimester of pregnancy and postpartum depression. Psychiatry Clin Neurosci 2021; 75:159-165. [PMID: 33459438 PMCID: PMC8248044 DOI: 10.1111/pcn.13200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 12/07/2020] [Accepted: 01/12/2021] [Indexed: 12/13/2022]
Abstract
AIM Patients with major depression present with an increased serum insulin-like growth factor-1 (IGF-1) concentration. However, the longitudinal relationship between serum IGF-1 levels and depression development remains unclear. This study aimed to investigate the longitudinal association between the serum IGF-1 concentration in the first trimester of pregnancy and postpartum depression development using data obtained from the Japan Environment and Children's Study (JECS). METHODS The JECS included 97 415 pregnant women; among them, 8791 were enrolled in this study. Data regarding depression in the first trimester, postpartum depression development at 1 month after childbirth, and other covariates were collected using a self-administered questionnaire. Serum IGF-1 levels were measured in the first trimester of pregnancy. The participants were divided into four groups according to the serum IGF-1 level. RESULTS In the first trimester, serum IGF-1 levels were not significantly associated with psychological distress in pregnant women. In the longitudinal analyses, however, postpartum depression development in mothers within the highest quartile for serum IGF-1 concentration in the first trimester was significantly less common than in those within the lowest quartile (odds ratio 0.48, 95% confidence interval 0.30-0.79). CONCLUSION Pregnant women with a high serum IGF-1 concentration in the first trimester were less likely to develop postpartum depression than those with a low concentration. A high serum IGF-1 concentration during pregnancy may help to protect against postpartum depression development.
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Affiliation(s)
- Sho Adachi
- Hyogo Regional Center for the Japan Environment and Children's Study, Hyogo College of Medicine, Nishinomiya, Japan.,Department of Public Health, Hyogo College of Medicine, Nishinomiya, Japan
| | - Narumi Tokuda
- Hyogo Regional Center for the Japan Environment and Children's Study, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yoshiko Kobayashi
- Hyogo Regional Center for the Japan Environment and Children's Study, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hiroyuki Tanaka
- Department of General Medicine and Community Health Science, Sasayama Medical Center, Hyogo College of Medicine, Tamba-Sasayama, Japan
| | - Hideaki Sawai
- Department of Clinical Genetics, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hiroaki Shibahara
- Hyogo Regional Center for the Japan Environment and Children's Study, Hyogo College of Medicine, Nishinomiya, Japan.,Department of Obstetrics and Gynecology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yasuhiro Takeshima
- Hyogo Regional Center for the Japan Environment and Children's Study, Hyogo College of Medicine, Nishinomiya, Japan.,Department of Pediatrics, Hyogo College of Medicine, Nishinomiya, Japan
| | - Masayuki Shima
- Hyogo Regional Center for the Japan Environment and Children's Study, Hyogo College of Medicine, Nishinomiya, Japan.,Department of Public Health, Hyogo College of Medicine, Nishinomiya, Japan
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Maternal-infant bonding and perceptions of infant temperament: The mediating role of maternal mental health. J Affect Disord 2021; 282:1323-1329. [PMID: 33601711 DOI: 10.1016/j.jad.2021.01.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/30/2020] [Accepted: 01/10/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND There are associations between maternal mental health (anxiety and depression), maternal-infant bonding, and infant temperament. However, few studies have examined these variables simultaneously, and none have applied a parallel mediation analysis to consider maternal mental health as an explanatory variable. We aimed to examine these relationships, and whether mental health (anxiety and/or depression) mediates the observed association between maternal-infant bonding and infant temperament. METHODS Mothers with babies between zero and twelve months (N=527) were recruited to a cross-sectional online survey containing a battery of psychometric measures. RESULTS Correlation analyses examined relationships between the predictor (maternal-infant bonding), outcome (infant temperament), and mediator (maternal mental health; anxiety and/or depression). All associations were highly significant (p<.001). A parallel mediation (anxiety and/or depression) model was conducted, showing a significant indirect effect of maternal-infant bonding on infant temperament through anxiety, B = .04 (SE= .01) 95% CI= .01 to .07, but not through depression. LIMITATIONS Homogeneous sampling was an issue with mainly UK, married mothers, with higher socio-economic status and educational attainment participating. Therefore, further replication in diverse samples is required. CONCLUSION Associations were identified between maternal-infant bonding, infant temperament, and maternal mental health (anxiety and depression). However, only anxiety mediated the relationship between bonding and temperament. Healthcare professionals should consider the role of maternal anxiety when working with mothers who present with relational issues or report their infant as excessively challenging. These results signify the need to address maternal anxious and depressive symptoms as distinct issues considering their differential effects on parenting behaviour.
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Huang R, Yan C, Tian Y, Lei B, Yang D, Liu D, Lei J. Effectiveness of peer support intervention on perinatal depression: A systematic review and meta-analysis. J Affect Disord 2020; 276:788-796. [PMID: 32738663 DOI: 10.1016/j.jad.2020.06.048] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 03/21/2020] [Accepted: 06/23/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND It has been suggested that peer support intervention may offer an alternative approach to prevent or treat perinatal depression, but little is known about its effectiveness, economics, and satisfaction in the prenatal and postpartum populations. This review summarizes available evidence on the effectiveness, economics, and satisfaction of peer support intervention on perinatal depression. METHODS Multiple electronic databases were searched in five English databases (MEDLINE, Embase, Cochrane Library, Psyc INFO, and CINAHL) and three Chinese databases (Wang Fang, China National Knowledge Infrastructure, and Chinese Biomedical Literature Database) from inception to April 2019. Hand searching of references was also performed. Randomized controlled trials reporting peer support intervention targeting on perinatal depression were included. The quality of evidence was assessed using the Cochrane risk of bias tool. RESULTS Ten randomized controlled trials met the inclusion criteria and were included in the final analysis. Peer support intervention reduced standardized mean depressive scores (-0.37, 95% CI -0.66 to -0.08) and reduced risk ratio (0.69, 95% CI 0.49-0.96) of depression. LIMITATIONS Clinical heterogeneity was observed among the included studies in peer support intervention, suggesting the existence of potential mediators, such as intensity, frequency, or type of peer support intervention. CONCLUSION Peer support intervention may have the potential to effectively prevent perinatal depression or reduce the harm of perinatal depression. Future studies with better design/execution and larger sample size are needed to investigate potential mediators associated with the beneficial effects of peer support intervention on perinatal depression.
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Affiliation(s)
- Ruirui Huang
- Xiangya Nursing School of Central South University, 138 Tongzipo Road, Yuelu District, Changsha 410013, Hunan, China; School of Nursing, Hunan University of Medicine, Huaihua, Hunan, China
| | - Chunli Yan
- Department of Oncology, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha 410013, Hunan, China
| | - Yumei Tian
- School of Nursing, Hunan University of Medicine, Huaihua, Hunan, China
| | - Beimei Lei
- Xiangya Nursing School of Central South University, 138 Tongzipo Road, Yuelu District, Changsha 410013, Hunan, China
| | - Dongqi Yang
- Xiangya Nursing School of Central South University, 138 Tongzipo Road, Yuelu District, Changsha 410013, Hunan, China
| | - Dan Liu
- Department of Urology, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha 410013, Hunan, China
| | - Jun Lei
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha 410013, Hunan, China.
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Camisasca E, Di Blasio P, Milani L, Miragoli S. Postpartum depressive symptoms as a linking mechanism between maternal sleep and parenting stress: the conditional indirect effect by social support. CHILDRENS HEALTH CARE 2020. [DOI: 10.1080/02739615.2020.1824675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Elena Camisasca
- Psychology, Università Telematica eCampus, Novedrate, Italy
- C.R.I.d.e.e., Psychology Department, Catholic University of the Sacred Heart, Milano, Italy
| | - Paola Di Blasio
- C.R.I.d.e.e., Psychology Department, Catholic University of the Sacred Heart, Milano, Italy
| | - Luca Milani
- C.R.I.d.e.e., Psychology Department, Catholic University of the Sacred Heart, Milano, Italy
| | - Sarah Miragoli
- C.R.I.d.e.e., Psychology Department, Catholic University of the Sacred Heart, Milano, Italy
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Adachi Y, Katsuki T, Ueda M, Adachi K, Miyazaki S. Interrelationship between sleep quality of 1-month old infants and their mothers’ corresponding activities. Sleep Biol Rhythms 2020. [DOI: 10.1007/s41105-020-00286-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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38
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Wynter K, Francis LM, Fletcher R, McBride N, Dowse E, Wilson N, Di Manno L, Teague S, Macdonald JA. Sleep, mental health and wellbeing among fathers of infants up to one year postpartum: A scoping review. Midwifery 2020; 88:102738. [DOI: 10.1016/j.midw.2020.102738] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 04/14/2020] [Accepted: 04/28/2020] [Indexed: 12/22/2022]
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Camerota M, Gueron-Sela N, Grimes M, Propper CB. Longitudinal links between maternal factors and infant cognition: Moderation by infant sleep. INFANCY 2020; 25:128-150. [PMID: 32749038 DOI: 10.1111/infa.12321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/21/2019] [Accepted: 12/08/2019] [Indexed: 11/30/2022]
Abstract
The current study examined the moderating role of infant sleep in the link between maternal factors (i.e., maternal education, depressive symptoms, sleep disturbance) and infant cognition. Data come from 95 African American parent-child dyads. At 3 months of age, infant sleep was objectively measured using videosomnography and actigraphy, from which measures of sleep regulation and consolidation were calculated. Mothers also self-reported their level of education, depressive symptoms, and sleep quality. At 6 months of age, infants completed cognitive assessments, including a measure of general cognitive ability and observed attention behavior. Findings revealed that infant sleep quality interacted with maternal education and sleep disturbances to predict cognition. Specifically, the link between maternal education and infants' attention behavior was significant and positive for infants with better regulated sleep, but not for infants with poorly regulated sleep. Similarly, the link between maternal sleep disturbance and infant cognition depended on infant sleep quality. For infants with poorer sleep consolidation, increased maternal sleep disturbance predicted poorer infant general cognitive ability. For infants with better sleep consolidation, maternal sleep disturbance was positively related to both general cognitive ability and attention behavior. These findings suggest that infant sleep quality moderates the impact of environmental factors on cognitive functioning.
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Affiliation(s)
- Marie Camerota
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Noa Gueron-Sela
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Melissa Grimes
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Cathi B Propper
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Bai L, Whitesell CJ, Teti DM. Maternal sleep patterns and parenting quality during infants' first 6 months. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2020; 34:291-300. [PMID: 31724407 PMCID: PMC7102929 DOI: 10.1037/fam0000608] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The present study examined both between- and within-person effects of maternal sleep patterns on quality of mothering at bedtime during infants' first 6 months. Participants included 142 mothers who reported on their daily fall asleep and wake times across seven consecutive days with a daily sleep diary when infants were 1, 3, and 6 months old. At each age point, maternal emotional availability during one night of infant bedtime was observed and scored by trained observers who were blind to maternal sleep patterns. Multilevel modeling revealed that mothers with irregular sleep patterns, especially later average fall asleep times and greater average variability in sleep period across three age points, showed poorer parenting quality with infants at bedtime than other mothers. In addition, both between- and within-person effects of maternal sleep on bedtime parenting quality changed with infant age. Compared to mothers' individual averages across 1, 3, and 6 months, maternal short average sleep period, increased variability in sleep period, and later fall asleep times predicted poorer bedtime parenting quality at 6 months, but not at 1 or 3 months. Results emphasize the importance of maternal sleep regulation and sleep hygiene for maternal parenting quality, especially as infants get older. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Liu Bai
- Department of Human Development and Family Studies
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Huang R, Yang D, Lei B, Yan C, Tian Y, Huang X, Lei J. The short- and long-term effectiveness of mother-infant psychotherapy on postpartum depression: A systematic review and meta-analysis. J Affect Disord 2020; 260:670-679. [PMID: 31550613 DOI: 10.1016/j.jad.2019.09.056] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 08/29/2019] [Accepted: 09/09/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND It has been suggested that mother-infant psychotherapy may offer an alternative approach to treating postpartum depression, but little is known about its effectiveness. This review presents a summarized effectiveness of mother-infant psychotherapy on postpartum depression. METHODS Multiple electronic databases were searched including Pubmed, Cochrane Library, EMBase, MEDLINE, et al. Hand searching of references was also performed. Randomized controlled trials reporting on mother-infant psychotherapy targeting postpartum depression were included if they used a validated measure of prescribing appropriateness. Evidence quality was assessed using the Cochrane risk of bias tool. RESULTS A total of 13 randomized controlled trials met inclusion criteria and were included in the final analysis. In the short-term effect analysis, mother-infant psychotherapy reduced standardized mean depressive scores (-0.25, 95% CI -0.40, -0.09) and risk ratio (0.71, 95% CI 0.55, 0.91). In the long-term effect analysis, mother-infant psychotherapy did not improve maternal mood, mother-infant interaction and infant attachment. LIMITATIONS Clinical heterogeneity was observed among included studies in mother-infant psychotherapy intervention, suggesting the existence of potential moderators such as intensity, frequency, trimester of pregnancy or type of mother-infant psychotherapy. CONCLUSION Mother-infant psychotherapy appears to be effective for the treatment of maternal depression in the short-term. Future studies with better design/execution and larger sample size are needed to confirm the effect of mother-infant psychotherapy on short-term and to explore its effect on long-term depression.
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Affiliation(s)
- Ruirui Huang
- Xiang Ya Nursing School of Central South University, 138 Tongzipo Road, Yuelu District, Changsha 410013, Hunan Province, China; School of Nursing, Hunan University of Medicine, Huaihua, Hunan, China
| | - Dongqi Yang
- Xiang Ya Nursing School of Central South University, 138 Tongzipo Road, Yuelu District, Changsha 410013, Hunan Province, China
| | - Beimei Lei
- Xiang Ya Nursing School of Central South University, 138 Tongzipo Road, Yuelu District, Changsha 410013, Hunan Province, China
| | - Chunli Yan
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha 410013, Hunan Province, China
| | - Yumei Tian
- School of Nursing, Hunan University of Medicine, Huaihua, Hunan, China
| | - Xin Huang
- Department of Preventive Medicine, School of Medicine, Hunan Normal University, Changsha, Hunan, China
| | - Jun Lei
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha 410013, Hunan Province, China.
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Knappe S, Pfarr AL, Petzoldt J, Härtling S, Martini J. Parental Cognitions About Sleep Problems in Infants: A Systematic Review. Front Psychiatry 2020; 11:554221. [PMID: 33408648 PMCID: PMC7779594 DOI: 10.3389/fpsyt.2020.554221] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 11/20/2020] [Indexed: 12/17/2022] Open
Abstract
Introduction: Parental cognitions may directly and indirectly contribute to infant sleep outcomes. This review provides a systematic up-to-date overview of the associations between parental cognitions and infant sleep problems with special emphasis on temporal relationships and the content of parental cognitions. Methods: A systematic literature research in PubMed and Web of Science Core Collection sensu Liberati and PRISMA guidelines was carried out in March 2020 using the search terms (parent* AND infant* AND sleep* problem*), including studies with correlational or control group designs investigating associations between parental cognitions and sleep problems in children aged 1-6 years. Results: Twenty-three studies (published from 1985 to 2016) met inclusion criteria, of which 14 reported group differences or associations between parental sleep-related cognitions and child sleep outcomes. Nine papers additionally reported on the role of general parental child-related cognitions not directly pertaining to sleep. Findings from longitudinal studies suggest that parental cognitions often preceded child sleep problems. Cognitions pertaining to difficulties with limit-setting were especially prevalent in parents of poor sleepers and were positively associated with both subjective and objective measures of child sleep outcomes. Conclusions: Parental cognitions appear to play a pivotal role for the development and maintenance of sleep problems in young children, arguing that parents' attitudes and beliefs regarding child sleep inadvertently prompts parental behavior toward adverse sleep in offspring. Associations are however based on maternal reports and small to moderate effect sizes. Thus, additional parental factors such as mental health or self-efficacy, as well as additional offspring factors including temperamental dispositions and regulatory abilities, require consideration in further studies.
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Affiliation(s)
- Susanne Knappe
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Anna-Lisa Pfarr
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Johanna Petzoldt
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Samia Härtling
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,University of Meißen (FH) and Centre of Further Education, Meißen, Germany
| | - Julia Martini
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Department of Psychiatry and Psychotherapy, Faculty of Medicine, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
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The association between prenatal maternal anxiety disorders and postpartum perceived and observed mother-infant relationship quality. J Anxiety Disord 2019; 68:102148. [PMID: 31604204 DOI: 10.1016/j.janxdis.2019.102148] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 07/29/2019] [Accepted: 09/18/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Prenatal maternal anxiety disorders have been associated with adverse outcomes in offspring including emotional, behavioral and cognitive problems. There is limited understanding of the mechanisms underpinning these associations, although one possible candidate is an impaired mother-infant relationship. The authors investigated whether prenatal anxiety disorders were associated with poorer postpartum mother-infant relationship quality, measured by maternal self-reported bonding and observed mother-infant interactions. METHODS A cohort of 454 pregnant women recruited from an inner-city maternity service in London (UK) were assessed for mental disorders using the Structured Clinical Interview for DSM-IV and followed up at mid-pregnancy and 3-months postpartum. Depressive symptoms were assessed at baseline and mid-pregnancy (using the Edinburgh Postnatal Depression Scale). At three months postpartum, women were assessed for self-reported bonding difficulties (using the Postpartum Bonding Questionnaire) and a subsample (n = 204) participated in video-recorded mother-infant interaction, coded using the Child-Adult Relationship Experimental Index by an independent rater. RESULTS Prenatal anxiety disorders were associated with higher perceived bonding impairment, but not associated with observed poor mother-infant interaction quality. Higher levels of depressive symptoms were associated with lower maternal sensitivity. CONCLUSIONS Interventions for anxiety disorders in the perinatal period could be tailored to address anxieties about mother-infant relationship and co-morbid depressive symptoms.
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Yu HY, Wang SY, Quan CX, Fang C, Luo SC, Li DY, Zhen SS, Ma JH, Duan KM. Dexmedetomidine Alleviates Postpartum Depressive Symptoms following Cesarean Section in Chinese Women: A Randomized Placebo-Controlled Study. Pharmacotherapy 2019; 39:994-1004. [PMID: 31411762 DOI: 10.1002/phar.2320] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Few studies have investigated the prophylactic efficacy of dexmedetomidine (DEX) in postpartum depressive symptoms (PDS). A randomized double-blind placebo-controlled trial was conducted to investigate whether the administration of DEX, immediately after delivery and for patient-controlled intravenous analgesia (PCIA), can attenuate PDS. METHODS A total of 600 parturients scheduled for elective cesarean delivery under spinal anesthesia were randomly allocated into the control group (infusion with 0.9% normal saline after delivery and PCIA with sufentanil) and the DEX group (DEX infusion 0.5 μg/kg after delivery and PCIA with DEX plus sufentanil). The prevalence of postpartum depressive disorders was indicated by the Edinburgh Postnatal Depression Scale (EPDS). Postoperative analgesia, sedation, and sleep quality of parturients were also assessed. RESULTS Postpartum blues and PDS prevalence in the DEX, versus control, group were significantly lower (5.0% vs 14.1%, p<0.001; 5.7% vs 16.3%, p<0.001, respectively), especially in parturients with antenatal depression or moderate stress during pregnancy. Compared with the control group, the EPDS score at postpartum days 7 and 42 in the DEX group was significantly lower (4.23 ± 4.37 vs 1.93 ± 3.36, p<0.001; 4.68 ± 4.78 vs 1.99 ± 3.18, p<0.001, respectively), as was the incidence of postpartum self-harm ideation at postpartum days 7 and 42 in the DEX group versus the control group (1.1% vs 4.0%, p=0.03; 0.4% vs 2.9%, p=0.04, respectively). The pain score and the sleep quality in the DEX group were better than that in the control group (p<0.001). CONCLUSION The application of DEX in the early postpartum period can significantly attenuate the incidence of postpartum depressive disorders.
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Affiliation(s)
- He-Ya Yu
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Sai-Ying Wang
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Cheng-Xuan Quan
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Chao Fang
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Shi-Chao Luo
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Dan-Yang Li
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Shan-Shan Zhen
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Jia-Hui Ma
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Kai-Ming Duan
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha, China
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King LS, Rangel E, Simpson N, Tikotzky L, Manber R. Mothers' postpartum sleep disturbance is associated with the ability to sustain sensitivity toward infants. Sleep Med 2019; 65:74-83. [PMID: 31734620 PMCID: PMC10173890 DOI: 10.1016/j.sleep.2019.07.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 07/17/2019] [Accepted: 07/19/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND/OBJECTIVE Infancy is a period of rapid development when the quality of caregiving behavior may be particularly consequential for children's long-term functioning. During this critical period for caregiving behavior, parents experience changes in their sleep that may affect their ability to provide sensitive care. The current study investigated the association of mothers' sleep disturbance with both levels and trajectories of maternal sensitivity during interactions with their infants. METHODS At 18 weeks postpartum, mothers and their infants were observed during a home-based 10-minute "free play" interaction. Mothers' nighttime sleep was objectively measured using actigraphy and subjectively measured using sleep diaries. Maternal sensitivity was coded in two-minute intervals in order to characterize changes in sensitivity across the free play interaction. We used exploratory factor analysis to reduce the dimensionality of the objective and subjective measures of mothers' sleep, identifying a subjective sleep disturbance and an objective sleep continuity factor. RESULTS Using multi-level modeling, we found that mothers with poorer objective sleep continuity evidenced decreasing sensitivity toward their infants across the interaction. Mothers' self-reports of sleep disturbance were not associated with maternal sensitivity. CONCLUSIONS Although future research is necessary to identify the mechanisms that may explain the observed association between poor sleep continuity and the inability to sustain sensitivity toward infants, mothers' postpartum sleep continuity may be one factor to consider when designing interventions to improve the quality of caregiving. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov, NCT01846585.
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Affiliation(s)
- Lucy S King
- Department of Psychology, Stanford University, USA.
| | - Elizabeth Rangel
- Department of Psychiatry & Behavioral Sciences, Stanford University, USA
| | - Norah Simpson
- Department of Psychiatry & Behavioral Sciences, Stanford University, USA
| | - Liat Tikotzky
- Department of Psychology, Ben-Gurion University of the Negev, Israel
| | - Rachel Manber
- Department of Psychiatry & Behavioral Sciences, Stanford University, USA
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Pietikäinen JT, Polo-Kantola P, Pölkki P, Saarenpää-Heikkilä O, Paunio T, Paavonen EJ. Sleeping problems during pregnancy-a risk factor for postnatal depressiveness. Arch Womens Ment Health 2019; 22:327-337. [PMID: 30121844 DOI: 10.1007/s00737-018-0903-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 08/09/2018] [Indexed: 01/01/2023]
Abstract
In the general population, sleeping problems can precede an episode of depression. We hypothesized that sleeping problems during pregnancy, including insomnia symptoms, shortened sleep, and daytime tiredness, are related to maternal postnatal depressiveness. We conducted a prospective study evaluating sleep and depressive symptoms, both prenatally (around gestational week 32) and postnatally (around 3 months after delivery) in the longitudinal CHILD-SLEEP birth cohort in Finland. Prenatally, 1667 women returned the questionnaire, of which 1398 women participated also at the postnatal follow-up. Sleep was measured with the Basic Nordic Sleep Questionnaire (BNSQ) and depressive symptoms with a 10-item version of the Center for Epidemiological Studies Depression Scale (CES-D). Altogether, 10.3% of the women had postnatal depressiveness (CES-D ≥ 10 points). After adjusting for main background characteristics and prenatal depressiveness (CES-D ≥ 10), poor general sleep quality (AOR 1.87, 95% CI 1.21-2.88), tiredness during the day (AOR 2.19, 95% CI 1.41-3.38), short sleep ≤ 6 and ≤ 7 h, sleep latency > 20 min, and sleep loss ≥ 2 h were associated with postnatal depressiveness (all p < .050). Postnatally, after the adjustment for background characteristics, virtually all sleeping problems (i.e., difficulty falling asleep (AOR 7.93, 95% CI 4.76-13.20)), except frequent night awakenings per week or severe sleepiness during the day, were related to concurrent postnatal depressiveness. Thus, several prenatal and postnatal sleeping problems are associated with increased depressive symptoms 3 months postnatally. Screening of maternal prenatal sleeping problems, even without depressive symptoms during pregnancy or lifetime, would help to identify women at an increased risk for postnatal depressiveness.
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Affiliation(s)
- Johanna T Pietikäinen
- Department of Health Solutions, National Institute for Health and Welfare, Mannerheimintie 168, P.O. Box 30, 00271, Helsinki, Finland. .,Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Päivi Polo-Kantola
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland
| | - Pirjo Pölkki
- Department of Social Sciences, University of Eastern Finland, Kuopio, Finland
| | - Outi Saarenpää-Heikkilä
- Pediatric Clinics, Tampere University Hospital, Tampere, Finland.,Tampere Centre for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Tiina Paunio
- Department of Health Solutions, National Institute for Health and Welfare, Mannerheimintie 168, P.O. Box 30, 00271, Helsinki, Finland.,Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - E Juulia Paavonen
- Department of Health Solutions, National Institute for Health and Welfare, Mannerheimintie 168, P.O. Box 30, 00271, Helsinki, Finland.,Child Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Ding G, Niu L, Vinturache A, Zhang J, Lu M, Gao Y, Pan S, Tian Y. "Doing the month" and postpartum depression among Chinese women: A Shanghai prospective cohort study. Women Birth 2019; 33:e151-e158. [PMID: 31060983 DOI: 10.1016/j.wombi.2019.04.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 04/14/2019] [Accepted: 04/15/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND The Chinese postpartum custom of "doing the month" characterized by generous social support available through the traditional cultural practices was considered to protect women from postpartum depression in early puerperium. METHODS This study used data from the Shanghai Birth Cohort, a study of 2615 postpartum women from Shanghai, China, that was conducted between 2013 and 2016. Detailed information on the traditional "doing the month" practices and the on the Edinburgh Postnatal Depression Scale scores was collected from questionnaires administered on the 42nd day after childbirth. Logistic regression models were used to examine the association between the adopting traditional puerperium practices and postpartum depression. RESULTS The estimated prevalence of postpartum depression in women from the Shanghai area in China was 11.8% (n = 308) at six weeks postpartum. Women who went outside their homes during the first month postpartum showed higher risks of postpartum depression compared with those who never left the house (1-2 times: OR = 1.9, 95% CI = 1.4-2.4; 3-5 times: OR = 2.3, 95% CI = 1.5-3.5; ≥6 times: OR = 2.5, 95% CI = 1.2-5.1). Women with average sleep of 6 h or less per night were more likely to suffer from postpartum depression compared with those who slept 8 h (6 h: OR = 1.7, 95% CI = 1.2-2.4; less than 6 h : OR = 3.3, 95% CI = 2.2-5.0). Women who opened the house windows most of the time exhibited decreased risks of postpartum depression compared to those who never or rarely opened the windows (often: OR = 0.6, 95% CI = 0.4-0.9; always: OR = 0.4, 95% CI = 0.3-0.7). CONCLUSIONS Our results suggested that not all the activities of "doing the month" provided protection against developing PPD. This study emphasized the need for flexibility to fit and adjust the ritual into the modern life to enhance the positive effects of traditional practices on maternal health.
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Affiliation(s)
- Guodong Ding
- Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China.
| | - Lei Niu
- Department of Emergency, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Angela Vinturache
- Department Obstetrics & Gynecology, St. George's Hospital, St. George's University Hospitals NHS Foundation Trust, London, UK.
| | - Jun Zhang
- Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Min Lu
- Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China.
| | - Yu Gao
- Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Shuming Pan
- Department of Emergency, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Ying Tian
- Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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48
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Emamian F, Khazaie H, Okun ML, Tahmasian M, Sepehry AA. Link between insomnia and perinatal depressive symptoms: A meta-analysis. J Sleep Res 2019; 28:e12858. [PMID: 30983027 DOI: 10.1111/jsr.12858] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/07/2019] [Accepted: 03/11/2019] [Indexed: 11/27/2022]
Abstract
Evidence shows the possible link between insomnia and perinatal depressive symptoms. In order to find a convergent quantitative answer, we collected data via the search of Medline, EMBASE and reference tracking, which included nine studies (a total sample of 1,922 women). An aggregate effect size estimate (correlation coefficient) was generated using the comprehensive meta-analysis software. For the meta-analytic procedure, a random effects model was set a priori. Moderating factors, including study design, method of assessment of depression, geographical origin of data, publication year, mean age, % married, breastfeeding rate, quality and type of data, % primiparous and history of depression, were examined via categorical or univariate mixed-effects (method of moments) meta-regression methods. Heterogeneity and publication bias were examined using standard meta-analytic approaches. We found a significant, medium-size relationship between insomnia and perinatal depressive symptoms (point estimate, 0.366; 95% confidence interval [CI], 0.205-0.508; p < 0.001; n = 9) and this was significantly heterogeneous (Q, 118.77; df, 8; p < 0.001; I2 , 93.26%). The effect size estimate was significant for studies reporting no history of depression (point estimate, 0.364; 95% CI, 0.035-0.622; p < 0.05; n = 5) and for study design. With meta-regression, no moderating factor (age, marriage rate, breastfeeding rate, pregnancy history or publication year) significantly mediated the effect size estimate. The depression assessment scale used, but not other categorical variables, explained the magnitude of heterogeneity. We found that insomnia during the perinatal period is associated with depressive symptoms, which warrants screening pregnant mothers for insomnia and depression.
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Affiliation(s)
- Farnoosh Emamian
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences(KUMS), Kermanshah, Iran.,Department of Psychiatry, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences(KUMS), Kermanshah, Iran
| | - Michele L Okun
- BioFrontiers, University of Colorado, Colorado Springs, Colorado
| | - Masoud Tahmasian
- Institute of Medical Science and Technology, Shahid Beheshti University, Tehran, Iran
| | - Amir A Sepehry
- Division of Neurology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Counselling and Clinical Psychology, Adler University (Vancouver Campus), Vancouver, BC, Canada
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Hairston IS, Handelzalts JE, Lehman-Inbar T, Kovo M. Mother-infant bonding is not associated with feeding type: a community study sample. BMC Pregnancy Childbirth 2019; 19:125. [PMID: 30975095 PMCID: PMC6458683 DOI: 10.1186/s12884-019-2264-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 03/26/2019] [Indexed: 12/30/2022] Open
Abstract
Background Bonding refers to emotions and cognitions towards one’s infant. Breastfeeding is believed to facilitate bonding, yet only a handful of studies have empirically tested this assertion. This study aimed to confirm whether a positive association between breastfeeding and bonding exists and whether breastfeeding may be protective against the negative consequences of mood and sleep disturbances on bonding. Method A cross-sectional survey was administered to a convenience sample of Israeli mothers of infants ages 1–9 months. The main outcome measures were breastfeeding history, bonding (Postpartum Bonding Questionnaire, PBQ), mood (Edinburgh Postnatal Depression Scale, EPDS) and sleep (Pittsburgh Sleep Quality Index, PSQI). Results Two hundred seventy-one mothers (21–46 years) completed the survey. 65.7% reported current breastfeeding, 22.1% past breastfeeding, 12.2% never nursed. The PBQ correlated with both the EPDS and PSQI. Breastfeeding was associated with greater daytime fatigue, but not with any other sleep problem, and was not associated with bonding. This negative result was confirmed with Bayesian analysis demonstrating that the probability for the null hypothesis was 4.5 times greater than the hypothesized effect. Further, hierarchical regression revealed a positive relationship between bonding, daytime fatigue and depression symptoms only among women who were currently breastfeeding. Conclusions These findings suggest that among healthy mothers, breastfeeding may not be a central factor in mother-infant bonding, nor is it protective against the negative impact of mood symptoms and bonding difficulties. Theoretical and methodological bases of these findings are discussed. Electronic supplementary material The online version of this article (10.1186/s12884-019-2264-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ilana S Hairston
- Department of Psychology, Academic College of Tel-Hai, 1220800, Qiryat Shemona, Israel. .,Psychiatry Department, University of Michigan, Ann Arbor, 48109, USA.
| | | | - Tamar Lehman-Inbar
- School of Behavioral Science, Academic College of Tel Aviv, Jaffa, Israel
| | - Michal Kovo
- Obstetrics & Gynecology, Edith Wolfson Medical Center, Ha-Lochamim 62, Holon, Israel.,Affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Determinants of Insomnia among Mothers during Postpartum Period in Northwest Ethiopia. SLEEP DISORDERS 2019; 2019:3157637. [PMID: 31057976 PMCID: PMC6463557 DOI: 10.1155/2019/3157637] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/23/2019] [Accepted: 03/06/2019] [Indexed: 12/16/2022]
Abstract
Objective Postpartum period is a state of instability that may be accompanied by mood liability, anxiety, insomnia, and neuropsychiatric disturbance in women. This neuropsychiatric disturbance has a negative influence on the child's psychological and physical development. Our aim was to see the level of sleep difficulties among postpartum mothers in three obstetric care settings in Ethiopia. Method Institutional based cross-sectional study was conducted at one referral hospital and two health centers. A total of 988 postpartum mothers had been interviewed for sleep difficulties by using Athens Insomnia Scale (AIS). Adjusted Odd Ratio (AOR) and 95% Confidence Interval (CI) were used and P-value <0.05 was used for indicating significant variables. Result The prevalence of sleep difficulty between four to six weeks of postpartum period was 21.8% (215/988). Marital status of divorced/widowed/separated [AOR= 2.29, 95% CI (1.40, 6.08)], no educational opportunity [AOR= 2.35, 95% CI (1.57, 3.51)], having poor social support [AOR=2.82, 95% CI (1.63, 4.88)], alcohol use [AOR=1.58, 95% CI (1.13, 2.22)], history of depression [AOR=1.93, 95% CI (1.13, 3.31)], and who has poor support from husband [AOR=1.94, 95% CI (1.18, 3.18)] had association with sleep difficulty. Conclusion There is a high magnitude of sleep difficulties during four to six weeks of postpartum period in postpartum mothers and they are associated with many preventable risk factors.
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