Depression and suicidal ideation in pregnancy: exploring relationships with insomnia, short sleep, and nocturnal rumination
Depression and suicidal ideation in pregnancy: exploring relationships with insomnia, short sleep, and nocturnal rumination
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DOI：
10.1016/j.sleep.2019.07.010
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发表时间：
2020-01-01
期刊：
影响因子：
4.8
通讯作者：
Drake, Christopher L.
中科院分区：
文献类型：
--
作者：
Kalmbach, David A.;Cheng, Philip;Drake, Christopher L.
背景：睡眠问题和抑郁在怀孕期间非常普遍。在未怀孕的样本中，夜间冥想与失眠和抑郁有关，但在怀孕时仍不是很好的特征。本研究旨在探讨产后抑郁及自杀意念与妊娠中晚期失眠、睡眠不足及夜间反省的关系。方法：从产科门诊招募267名孕妇，并完成睡眠、抑郁及夜间反省的在线调查。结果：超过半数(58.4%)的受试者报告临床失眠，16.1%的人在爱丁堡产后抑郁量表(EPDS)上筛查出重度抑郁，10.1%的人支持自杀意念。夜间冥想与入睡困难的关系比与睡眠维持问题的关系更密切。抑郁妇女出现睡眠失眠(OR=2.80)、睡眠维持性失眠(OR=6.50)、夜间反思症(OR=6.50)和阴性的围产期反思症(OR=2.70)的风险较高。自杀意念与抑郁(OR=3.64)和围产期消极沉思(OR=3.50)相关。基于失眠状态和高/低沉思的四组比较显示，失眠和高沉思的孕妇的抑郁和自杀意念的发生率(35.6%)和自杀意念(17.3%)高于睡眠良好的低沉思的孕妇(1.2%抑郁，4.9%自杀)。单纯失眠(抑郁：3.9%，自杀：5.9%)或高沉思(抑郁：10.7%，自杀：7.1%)的女性与睡眠良好的低反省的女性没有区别。结论：高沉思和失眠在妊娠中晚期非常常见，两者都与抑郁和自杀意念有关。抑郁和自杀念头在患有失眠和反思症的孕妇中最为普遍。(C)2019爱思唯尔B.V.保留所有权利。
Background: Sleep problems and depression are highly prevalent in pregnancy. Nocturnal rumination has been linked to insomnia and depression in non-pregnant samples, but remains poorly characterized in pregnancy. This study explored relationships of depression and suicidal ideation with insomnia, short sleep, and nocturnal rumination in mid-to-late pregnancy.Methods: In this study, 267 pregnant women were recruited from obstetric clinics and completed online surveys on sleep, depression, and nocturnal rumination.Results: Over half (58.4%) of the sample reported clinical insomnia on the Insomnia Severity Index, 16.1% screened positive for major depression on the Edinburgh Postnatal Depression Scale (EPDS), and 10.1% endorsed suicidal ideation. Nocturnal rumination was more robustly associated with sleep onset difficulties than with sleep maintenance issues. Depressed women were at greater odds of sleep onset insomnia (OR = 2.80), sleep maintenance insomnia (OR = 6.50), high nocturnal rumination (OR = 6.50), and negative perinatal-focused rumination (OR = 2.70). Suicidal ideation was associated with depression (OR = 3.64) and negative perinatal-focused rumination (OR = 3.50). A four-group comparison based on insomnia status and high/low rumination revealed that pregnant women with insomnia and high rumination endorsed higher rates of depression (35.6%) and suicidal ideation (17.3%) than good-sleeping women with low rumination (1.2% depressed, 4.9% suicidal). Women with insomnia alone (depression: 3.9%, suicidal: 5.9%) or high rumination alone (depression: 10.7%, suicidal: 7.1%) did not differ from good-sleeping women with low rumination.Conclusions: High rumination and insomnia are highly common in mid-to-late pregnancy and both are associated with depression and suicidal ideation. Depression and suicidal ideation are most prevalent in pregnant women with both insomnia and high rumination. (C) 2019 Elsevier B.V. All rights reserved.