This study leverages psychiatric intake data from treatment-seeking perinatal women aiming to explore the understudied associations between childhood adversity, sleep quality, and severity of perinatal mental illness in this population. The sample is 578 perinatal women presenting for initial evaluation to a university-based perinatal psychiatry clinic. At intake, we collected demographics, adverse childhood experiences (ACEs), sleep quality, and diagnosis and symptom severity of depression, anxiety, and posttraumatic stress disorder (PTSD). Clinician-rated diagnoses showed that 65% of women met criteria for major depression, 23% for generalized anxiety disorder and 4% for PTSD; almost 30% of women had childhood adversity and 98.2% reported poor perinatal sleep quality. Regression analyses revealed differential associations between ACEs and sleep quality and perinatal mood symptoms; ACEs were significantly associated with pregnancy and postpartum PTSD, whereas sleep quality was associated with perinatal depression and generalized anxiety. Screening for ACEs and sleep quality during perinatal intake has high clinical utility, as these two factors significantly contribute to symptom severity across peripartum.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
American Psychiatric Association (2000) DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text Revision. American Psychiatric Association, Washington, DC
Barrios YV, Gelaye B, Zhong Q, Nicolaidis C, Rondon MB, Garcia PJ, Sanchez PAM, Sanchez SE, Williams MA (2015) Association of childhood physical and sexual abuse with intimate partner violence, poor general health and depressive symptoms among pregnant women. PLoS One 10:e0116609. https://doi.org/10.1371/journal.pone.0116609
Bei B, Milgrom J, Ericksen J, Trinder J (2010) Subjective perception of sleep, but not its objective quality, is associated with immediate postpartum mood disturbances in healthy women. Sleep 33:531–538
Biaggi A, Conroy S, Pawlby S, Pariante CM (2016) Identifying the women at risk of antenatal anxiety and depression: a systematic review. J Affect Disord 191:62–77. https://doi.org/10.1016/j.jad.2015.11.014
Breslau N, Chilcoat HD, Kessler RC, Davis GC (1999) Previous exposure to trauma and PTSD effects of subsequent trauma: results from the Detroit Area Survey of Trauma. Am J Psychiatry 156:902–907. https://doi.org/10.1176/ajp.156.6.902
Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 28:193–213
Byatt N, Biebel K, Moore Simas TA, Sarvet B, Ravech M, Allison J, Straus J (2016) Improving perinatal depression care: the Massachusetts Child Psychiatry Access Project for Moms General hospital psychiatry 40:12–17. https://doi.org/10.1016/j.genhosppsych.2016.03.002
Chapman DP, Whitfield CL, Felitti VJ, Dube SR, Edwards VJ, Anda RF (2004) Adverse childhood experiences and the risk of depressive disorders in adulthood Journal of affective disorders 82:217–225. https://doi.org/10.1016/j.jad.2003.12.013
Carney CE, Segal ZV, Edinger JD, Krystal AD (2007) A comparison of rates of residual insomnia symptoms following pharmacotherapy or cognitive-behavioral therapy for major depressive disorder. The Journal of Clinical Psychiatry 68:254–260
Committee on Obstetric Practice (2015) The American College of Obstetricians and Gynecolgists Committee Opinion no. 630. Screening for perinatal depression. Obstet Gynecol 125(5):1268–1271. https://doi.org/10.1097/01.AOG.0000465192.34779.dc
Corp. I (2013) IBM SPSS statistics for windows, 22nd edn. IBM Corp, Armonk
Cox EQ, Sowa NA, Meltzer-Brody SE, Gaynes BN (2016) The perinatal depression treatment cascade: baby steps toward improving outcomes. The Journal of clinical psychiatry 77:1189–1200. https://doi.org/10.4088/JCP.15r10174
Cox J, Holden J, Sagovsky R (1987) Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry 150:782–786. https://doi.org/10.1192/bjp.150.6.782
Creamer M, Bell R, Failla S (2003) Psychometric properties of the Impact of Event Scale - revised. Behav Res Ther 41:1489–1496
Cristea IA, Huibers MJH, David D, Hollon SD, Andersson G, Cuijpers P (2015) The effects of cognitive behavior therapy for adult depression on dysfunctional thinking: a meta-analysis. Clin Psychol Rev 42:62–71. https://doi.org/10.1016/j.cpr.2015.08.003
Dekel S, Stuebe C, Dishy G (2017) Childbirth induced posttraumatic stress syndrome: a systematic review of prevalence and risk factors. Front Psychol 8:560. https://doi.org/10.3389/fpsyg.2017.00560
Dennis C-L, Chung-Lee L (2006) Postpartum depression help-seeking barriers and maternal treatment preferences: a qualitative systematic review. Birth 33:323–331. https://doi.org/10.1111/j.1523-536X.2006.00130.x
Dorheim SK, Bondevik GT, Eberhard-Gran M, Bjorvatn B (2009) Sleep and depression in postpartum women: a population-based study. Sleep 32:847–855
Dube SR, Anda RF, Felitti VJ, Chapman DP, Williamson DF, Giles WH (2001) Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span: findings from the Adverse Childhood Experiences Study Jama 286:3089–3096
Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS (1998) Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults The Adverse Childhood Experiences (ACE) Study. Am J Prev Med 14:245–258
Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T (2005) Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol 106:1071–1083
Gay PC, Weaver TE, Loube D, Iber C (2006) Evaluation of positive airway pressure for sleep related breathing disorders in adults. Sleep 29:381–401
Gaynes B et al (2005) Perinatal depression: prevalence, screening accuracy, and screening outcomes vol evidence report/technology assessment no. 119. Prepared by the RTI-University of North Carolina evidence-based practice Centerunder contract no. 290-02-0016, Rockville, MD
Graham JW (2009) Missing data analysis: making it work in the real world. Annu Rev Psychol 60:549–576
Grote NK, Katon WJ, Russo JE, Lohr MJ, Curran M, Galvin E, Carson K (2015) Collaborative care for perinatal depression in socioeconomically disadvantaged women: a randomized trial. Depress Anxiety 32:821–834. https://doi.org/10.1002/da.22405
Huber A, McMahon C, Sweller N (2016) Improved parental emotional functioning after circle of security 20-week parent–child relationship intervention. J Child Fam Stud 25:2526–2540. https://doi.org/10.1007/s10826-016-0426-5
Jansson-Frojmark M, Norell-Clarke A (2016) Cognitive behavioural therapy for insomnia in psychiatric disorders. Curr Sleep Med Report 2:233–240. https://doi.org/10.1007/s40675-016-0055-y
Kliem S, Kröger C (2013) Prevention of chronic PTSD with early cognitive behavioral therapy. A meta-analysis using mixed-effects modeling. Behav Res Ther 51:753–761. https://doi.org/10.1016/j.brat.2013.08.005
Lawson A, Murphy KE, Sloan E, Uleryk E, Dalfen A (2015) The relationship between sleep and postpartum mental disorders: a systematic review. J Affect Disord 176:65–77. https://doi.org/10.1016/j.jad.2015.01.017
Li Y, Long Z, Cao D, Cao F (2017) Maternal history of child maltreatment and maternal depression risk in the perinatal period: a longitudinal study. Child Abuse Negl 63:192–201. https://doi.org/10.1016/j.chiabu.2016.12.001
McDonnell CG, Valentino K (2016) Intergenerational Effects of Childhood Trauma:Evaluating Pathways Among Maternal ACEs, Perinatal Depressive Symptoms, and Infant Outcomes Child Maltreatment 21:317–326. https://doi.org/10.1177/1077559516659556
Meltzer-Brody S, Larsen JT, Petersen L, Guintivano J, Florio AD, Miller WC, Sullivan PF, Munk-Olsen T (2017) Adverse life events increase risk for postpartum psychiatric episodes: a population-based epidemiologic study. Depress Anxiety 35:160–167. https://doi.org/10.1002/da.22697
Mersky JP, Janczewski CE (2018) Adverse Childhood Experiences and Postpartum Depression in Home Visiting Programs: Prevalence, Association, and Mediating Mechanisms Maternal and child health journal 22:1051–1058. https://doi.org/10.1007/s10995-018-2488-zhttps://doi.org/10.1007/s10995-018-2488-z
Muzik M, Bocknek EL, Broderick A, Richardson P, Rosenblum KL, Thelen K, Seng JS (2013) Mother-infant bonding impairment across the first 6 months postpartum: the primacy of psychopathology in women with childhood abuse and neglect histories. Arch Womens Ment Health 16:29–38. https://doi.org/10.1007/s00737-012-0312-0
Muzik M, Hamilton SE (2016) Use of antidepressants during pregnancy?: what to consider when weighing treatment with antidepressants against untreated depression. Matern Child Health J 20:2268–2279. https://doi.org/10.1007/s10995-016-2038-5
Muzik M, Rosenblum KL, Alfafara EA, Schuster MM, Miller NM, Waddell RM, Stanton Kohler E (2015) Mom power: preliminary outcomes of a group intervention to improve mental health and parenting among high-risk mothers. Arch Womens Ment Health 18:507–521. https://doi.org/10.1007/s00737-014-0490-z
Newman DA (2003) Longitudinal modeling with randomly and systematically missing data: a simulation of ad hoc, maximum likelihood, and multiple imputation techniques. Organ Res Methods 6:328–362
Oh W, Muzik M, McGinnis EW, Hamilton L, Menke RA, Rosenblum KL (2016) Comorbid trajectories of postpartum depression and PTSD among mothers with childhood trauma history: course, predictors, processes and child adjustment. J Affect Disord 200:133–141. https://doi.org/10.1016/j.jad.2016.04.037
Okun ML, Kiewra K, Luther JF, Wisniewski SR, Wisner KL (2011) Sleep disturbances in depressed and nondepressed pregnant women. Depress Anxiety 28:676–685. https://doi.org/10.1002/da.20828
Resick PA, Galovski TE, O'Brien Uhlmansiek M, Scher CD, Clum GA, Young-Xu Y (2008) A randomized clinical trial to dismantle components of cognitive processing therapy for posttraumatic stress disorder in female victims of interpersonal violence. J Consult Clin Psychol 76:243–258. https://doi.org/10.1037/0022-006x.76.2.243
Robertson-Blackmore E, Putnam FW, Rubinow DR, Matthieu M, Hunn JE, Putnam KT, Moynihan JA, O’Connor TG (2013) Antecedent trauma exposure and risk of depression in the perinatal period. The Journal of clinical psychiatry 74:e942–e948. https://doi.org/10.4088/JCP.13m08364
Rosenblum KL, Muzik M, Morelen DM, Alfafara EA, Miller NM, Waddell RM, Schuster MM, Ribaudo J (2017) A community-based randomized controlled trial of mom power parenting intervention for mothers with interpersonal trauma histories and their young children. Archives of Women's Mental Health 20:673–686. https://doi.org/10.1007/s00737-017-0734-9
Ross LE, Murray BJ, Steiner M (2005) Sleep and perinatal mood disorders: a critical review. J Psychiatry Neurosci 30:247–256
Sameroff AJ, Seifer R, Baldwin A, Baldwin C (1993) Stability of intelligence from preschool to adolescence: the influence of social and family risk factors. Child Dev 64:80–97. https://doi.org/10.1111/j.1467-8624.1993.tb02896.x
Seeman S, Simpson N, Blank Y, Manber R (2017) 0352 correlations between adherence to CBT-I recommendations and CHANGE in insomnia severity: a report from an RCT on the treatment of perinatal insomnia. Sleep 40:A131. https://doi.org/10.1093/sleepj/zsx050.351
Skouteris H, Germano C, Wertheim E, Paxton S, Milgrom J (2008) Sleep quality and depression during pregnancy: a prospective study. J Sleep Res 17:217–220
Spitzer RL, Kroenke K, Williams JB, Lowe B (2006) A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 166:1092–1097. https://doi.org/10.1001/archinte.166.10.1092
Sundin EC, Horowitz MJ (2002) Impact of Event Scale: psychometric properties. Br J Psychiatry 180:205–209. https://doi.org/10.1192/bjp.180.3.205
Swanson L, Hamilton L, Muzik M (2014) The role of childhood trauma and PTSD in postnatal sleep disturbance. J Trauma Stress 27:689–694
Swanson LM, Pickett SM, Flynn H, Armitage R (2011, 2002) Relationships among depression, anxiety, and insomnia symptoms in perinatal women seeking mental health treatment. J Women's Health. https://doi.org/10.1089/jwh.2010.2371
Swinson RP (2006) The GAD-7 scale was accurate for diagnosing generalised anxiety disorder. Evid Based Med 11:184. https://doi.org/10.1136/ebm.11.6.184
Weiss DS, Marmar CR (1997) The impact of event scale-revised. In: Wilson JP, Keane TM (eds) Assessing psychological trauma and PTSD. Guilford, New York, pp 399–411
Yonkers KA, Wisner KL, Stewart DE, Oberlander TF, Dell DL, Stotland N, Ramin S, Chaudron L, Lockwood C (2009) The management of depression during pregnancy: a report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists. Obstet Gynecol 114:703–713. https://doi.org/10.1097/AOG.0b013e3181ba0632
Zayfert C, DeViva JC (2004) Residual insomnia following cognitive behavioral therapy for PTSD. J Trauma Stress 17:69–73
Zhong Q-Y, Gelaye B, Zaslavsky AM, Fann JR, Rondon MB, Sánchez SE, Williams MA (2015) Diagnostic validity of the generalized anxiety disorder - 7 (GAD-7) among pregnant women. PLoS One 10:e0125096. https://doi.org/10.1371/journal.pone.0125096
WIMH Group (Women and Infants Mental Health Group) comprises all faculty, staff, and trainees who are serving perinatal women presenting for specialized clinical care to the Women and Infants Mental Health Clinic at the Department of Psychiatry, University of Michigan.
Financial support was provided via internal funds through the Department of Psychiatry, University of Michigan. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Conflict of interest
The authors and the individuals in the WIMH Group declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
About this article
Cite this article
Menke, R.A., Swanson, L., Erickson, N.L. et al. Childhood adversity and sleep are associated with symptom severity in perinatal women presenting for psychiatric care. Arch Womens Ment Health 22, 457–465 (2019). https://doi.org/10.1007/s00737-018-0914-2
- Sleep quality
- Perinatal psychopathology
- Perinatal psychiatric care