Journal of Behavioral Medicine

, Volume 41, Issue 5, pp 703–710 | Cite as

Poor sleep quality increases symptoms of depression and anxiety in postpartum women

  • Michele L. OkunEmail author
  • Roberta A. Mancuso
  • Calvin J. Hobel
  • Christine Dunkel Schetter
  • Mary Coussons-Read


This study evaluated the relationship between sleep quality and symptoms of depression and anxiety in women studied in pregnancy and postpartum. Scores on standardized measures of sleep (PSQI) at 6 months postpartum, and symptoms of anxiety and depression (OASIS, the PHQ9, and EPDS) were assessed by structured interviews in 116 women in pregnancy and/or postpartum. Poor sleep quality was significantly associated with greater symptoms of depression and anxiety. Women who had significantly higher OASIS (anxiety) scores (β = .530, p < .001), PHQ9 (depression) scores (β = .496, p < .001), and EPDS (postpartum depression and anxiety) scores (β = .585, p < .001) also had elevated total PSQI scores after adjustment for covariates, including prenatal depression and anxiety scores. Though inferences about causality are not feasible, these results support emerging research showing sleep quality is a risk factor for negative maternal affect in the postpartum period. Assessment of maternal sleep hygiene is worth consideration as a component of identifying women at risk for postpartum depression and anxiety.


Sleep quality Depression Anxiety Postpartum PSQI EPDS 



Pittsburgh Sleep Quality Index


Patient Health Questionnaire -9-item


Edinburgh Postnatal Depression Scale


Overall Anxiety Severity and Impairment Scale


Structured Clinical Interview for DSM-5



NIH (R01 HD073491: MPI Coussons-Read & Dunkel Schetter).

Compliance with ethical standards

Conflict of interest

Michele L. Okun, Roberta A. Mancuso, Calvin J. Hobel, Chris Dunkel Schetter and Mary Coussons-Read declare that they have no conflicts of interest.

Human and animal aights and Informed consent

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all patients for being included in the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Michele L. Okun
    • 1
    Email author
  • Roberta A. Mancuso
    • 1
    • 4
  • Calvin J. Hobel
    • 2
    • 3
  • Christine Dunkel Schetter
    • 2
  • Mary Coussons-Read
    • 1
  1. 1.University of Colorado Colorado SpringsColorado SpringsUSA
  2. 2.University of California Los AngelesLos AngelesUSA
  3. 3.Miriam Jacobs Chair Maternal Fetal MedicineCedars Sinai Medical CenterLos AngelesUSA
  4. 4.Regis UniversityDenverUSA

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