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

• Published in: Sleep medicine 2020-01, Vol.65, p.62-73
• Main Authors: Kalmbach, David A., Cheng, Philip, Ong, Jason C., Ciesla, Jeffrey A., Kingsberg, Sheryl A., Sangha, Roopina, Swanson, Leslie M., O'Brien, Louise M., Roth, Thomas, Drake, Christopher L.
• Format: Article
• Language: English
• Subjects: Adult; Cognitive arousal; Depressive Disorder, Major - epidemiology; Female; Humans; Perinatal; Pre-sleep arousal; Pregnancy; Pregnant Women - psychology; Prenatal; Prevalence; Psychiatric Status Rating Scales; Sleep Initiation and Maintenance Disorders - epidemiology; Stress; Suicidal Ideation; Suicidality; Surveys and Questionnaires
• ISSN: 1389-9457; 1878-5506
• DOI: 10.1016/j.sleep.2019.07.010

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