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Sleep Quality Predicts Persistence of Parental Postpartum Depressive Symptoms and Transmission of Depressive Symptoms from Mothers to Fathers

  • Original Article
  • Published:
Annals of Behavioral Medicine

Abstract

Background

Early parenthood is a time of chronic sleep disturbance and also of heightened depression risk. Poor sleep quality has been identified both as a predictor of postpartum depressive symptoms and as a consequence.

Purpose

This study sought to clarify causal pathways linking sleep and postpartum depression via longitudinal path modeling. Sleep quality at 6 months postpartum was hypothesized to exacerbate depressive symptoms from 1 month through 1 year postpartum in both mothers and fathers. Within-couple associations between sleep and depression were also tested.

Methods

Data were drawn from a low-income, racially and ethnically diverse sample of 711 couples recruited after the birth of a child. Depressive symptoms were assessed at 1, 6, and 12 months postpartum, and sleep was assessed at 6 months postpartum.

Results

For both partnered mothers and fathers and for single mothers, depressive symptoms at 1 month postpartum predicted sleep quality at 6 months, which in turn predicted depressive symptoms at both 6 and 12 months. Results held when infant birth weight, breastfeeding status, and parents’ race/ethnicity, poverty, education, and immigration status were controlled. Mothers’ and fathers’ sleep quality and depressive symptoms were correlated, and maternal sleep quality predicted paternal depressive symptoms both at 6 and at 12 months.

Conclusions

Postpartum sleep difficulties may contribute to a vicious cycle between sleep and the persistence of depression after the birth of a child. Sleep problems may also contribute to the transmission of depression within a couple. Psychoeducation and behavioral treatments to improve sleep may benefit new parents.

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References

  1. Yim IS, Tanner Stapleton LR, Guardino CM, Hahn-Holbrook J, Dunkel Schetter C. Biological and psychosocial predictors of postpartum depression: systematic review and call for integration. Annu Rev Clin Psychol 2015;11:99–137. doi:10.1146/annurev-clinpsy-101414-020426.

    Article  PubMed  Google Scholar 

  2. O’Hara MW, McCabe JE. Postpartum depression: current status and future directions. Annu Rev Clin Psychol 2013;9:379–407. doi:10.1146/annurev-clinpsy-050212-185612.

    Article  PubMed  Google Scholar 

  3. Zajicek-Farber ML. Postnatal depression and infant health practices among high-risk women. J Child Fam Stud 2008;18:236–245. doi:10.1007/s10826-008-9224-z.

    Article  Google Scholar 

  4. Moehler E, Brunner R, Wiebel A, Reck C, Resch F. Maternal depressive symptoms in the postnatal period are associated with long-term impairment of mother-child bonding. Arch Womens Ment Health 2006;9:273–278. doi:10.1007/s00737-006-0149-5.

    Article  CAS  PubMed  Google Scholar 

  5. Paulson JF, Bazemore SD. Prenatal and postpartum depression in fathers and its association with maternal depression: a meta-analysis. J Am Med Assoc 2010;303:1961–1969. doi:10.1001/jama.2010.605.

    Article  CAS  Google Scholar 

  6. Garfield CF, Duncan, G, Rutsohn, J, McDade TW, Adam EK, Coley RL, & Chase-Lansdale PL. A longitudinal study of paternal mental health during transition to fatherhood as young adults. Pediatrics, 2014; 836–843.

  7. Pinheiro RT, Magalhães PVS, Horta BL, Pinheiro KAT, Da Silva RA, Pinto RH. Is paternal postpartum depression associated with maternal postpartum depression? Population-based study in Brazil. Acta Psychiatr Scand 2006;113:230–232. doi:10.1111/j.1600-0447.2005.00708.x.

    Article  CAS  PubMed  Google Scholar 

  8. Swain AM, O’Hara MW, Starr KR, Gorman LL. A prospective study of sleep, mood, and cognitive function in postpartum and nonpostpartum women. Obstet Gynecol 1997;90:381–386. doi:10.1016/S0029-7844(97)89252-6.

    Article  CAS  PubMed  Google Scholar 

  9. Gay CL, Lee KA, Lee S-Y. Sleep patterns and fatigue in new mothers and fathers. Biol Res Nurs 2004;5:311–318. doi:10.1177/1099800403262142.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Lopresti AL, Hood SD, Drummond PD. A review of lifestyle factors that contribute to important pathways associated with major depression: diet, sleep and exercise. J Affect Disord 2013;148:12–27. doi:10.1016/j.jad.2013.01.014.

    Article  PubMed  Google Scholar 

  11. Okun, ML. Sleep and postpartum depression. Curr Opin Psychiatry, 2015; 28(6), 490–496.

    Article  PubMed  Google Scholar 

  12. Bhati, S., Richards, K. A systematic review of the relationship between postpartum sleep disturbance and postpartum depression. J Obstet Gynecol Neonatal Nurs, 2015: 350-357.

  13. Lawson, A., Murphy, K. E., Sloan, E., Uleryk, E., & Dalfen, A. The relationship between sleep and postpartum mental disorders: a systematic review. J Affect Disord 2015: 176, 65–77.

    Article  PubMed  Google Scholar 

  14. Park EM, Meltzer-Brody S, Stickgold R. Poor sleep maintenance and subjective sleep quality are associated with postpartum maternal depression symptom severity. Arch Womens Ment Health 2013;16:539–547. doi:10.1007/s00737-013-0356-9.

    Article  PubMed  Google Scholar 

  15. Gress-Smith JL, Luecken LJ, Lemery-Chalfant K, Howe R. Postpartum depression prevalence and impact on infant health, weight, and sleep in low-income and ethnic minority women and infants. Matern Child Health J 2012;16:887–893. doi:10.1007/s10995-011-0812-y.

    Article  PubMed  Google Scholar 

  16. Ramey SL, Schafer P, DeClerque JL, et al. The preconception stress and resiliency pathways model: a multi-level framework on maternal, paternal, and child health disparities derived by community-based participatory research. Matern Child Health J 2015;19(4):707–719. doi:10.1007/s10995-014-1581-1.

    Article  PubMed  Google Scholar 

  17. Dunkel Schetter C, Schafer P, Lanzi RG, et al. Shedding light on the mechanisms underlying health disparities through community participatory methods: the stress pathway. Perspect Psychol Sci 2013;8:613–633. doi:10.1177/1745691613506016.

    Article  PubMed  Google Scholar 

  18. Humes K, Jones NA, Ramirez RR. Overview of race and Hispanic origin, 2010. US Department of Commerce, Economics and Statistics Administration. US Census Bureau; 2011.

  19. DeNavas-Walt, CP, Smith B. 2010: Income, poverty, and health insurance coverage in the United States. 2011; US Census Bureau.

  20. Krieder, R. M., & Ellis, R. Living arrangements of children: 2009. Household Economic Studies, US Census Bureau; 2011.

  21. Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res 1989;28:193–213. doi:10.1016/0165-1781(89)90047-4.

    Article  CAS  PubMed  Google Scholar 

  22. Kumari M, Badrick E, Ferrie J, Perski A, Marmot M, Chandola T. Self-reported sleep duration and sleep disturbance are independently associated with cortisol secretion in the Whitehall II study. J Clin Endocrinol Metab 2009; 94, 4801–4809.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Reynolds CF, Redline S. The DSM-V sleep-wake disorders nosology: an update and an invitation to the sleep community. Sleep 2010; 33, 10.

    PubMed  PubMed Central  Google Scholar 

  24. Montazeri A, Torkan B, Omidvari S. Edinburgh Postnatal Depression Scale, EPDS, Depression 1987;150:188. doi:10.1186/1471-244X-7-11.

    Google Scholar 

  25. Matthey S, Barnett B, Kavanagh DJ, Howie P. Validation of the Edinburgh Postnatal Depression Scale for men, and comparison of item endorsement with their partners. J Affect Disord 2001;64:175–184. doi:10.1016/S0165-0327(00)00236-6.

    Article  CAS  PubMed  Google Scholar 

  26. Muthén L, Muthén B. Mplus User’s Guide (version 7.0); 2007.

  27. Sobel ME. Asymptotic confidence intervals for indirect effects in structural equation models. In: Leinhardt S, editor. Sociological methodology. American Sociological Association; Washington, DC: 1982. 290–312.

    Google Scholar 

  28. Lagerberg D., Magnusson M, Sundelin C. Drawing the line in the Edinburgh Postnatal Depression Scale (EPDS): a vital decision. Int J Adol Med & Health. 2011;23(1).

  29. Irwin MR. Why sleep is important for health: a psychoneuroimmunology perspective. Annu Rev Psychol 2014:1–30. doi:10.1146/annurev-psych-010213-115205.

  30. Black, DS, O’Reilly, G, Olmstead, R., Breen, E. and Irwin, ME. Mindfulness meditation and improvement in sleep quality and daytime impairment among older adults with sleep disturbances. JAMA 2015; jamanetwork/2015/imd/02_16_2015/ioi40149

  31. Morin CM, Vallières A, Guay B, et al. Cognitive behavioral therapy, singly and combined with medication, for persistent insomnia: a randomized controlled trial. J Am Med Assoc 2009;301:2005–2015. doi:10.1016/S8756-3452(09)79334-X.

    Article  CAS  Google Scholar 

  32. Manber R, Edinger JD, Gress JL, San Pedro-Salcedo MG, Kuo TF, Kalista T. Cognitive behavioral therapy for insomnia enhances depression outcome in patients with comorbid major depressive disorder and insomnia. Sleep 2008;31:489–495.

    PubMed  PubMed Central  Google Scholar 

  33. Kallestad H, Hansen B, Langsrud K, Ruud T, Morken G, Stiles TC, Gråwe RW. Impact of sleep disturbance on patients in treatment for mental disorders. BMC Psychiatry 2012; 12: 179, 1–8.

    Google Scholar 

  34. Stepanski, EJ, Rybarczyk B. Emerging research on the treatment and etiology of secondary or comorbid insomnia. Sleep Med Rev 2006; 10: 7–18.

    Article  PubMed  Google Scholar 

  35. Swanson LM, Flynn H, Adams-Mundy JD, Armitage R, Arnedt JT. An open pilot of cognitive-behavioral therapy for insomnia in women with postpartum depression. Behav Sleep Med, 2013; 11: 297–307.

    Article  PubMed  Google Scholar 

  36. Tomfohr-Madsen, LM, Clayborne, ZM, Rouleau, CM, Campbell, TS. Sleeping for two: an open-pilot study of cognitive behavioral therapy for insomnia in pregnancy. Behav Sleep Med. 2016; 1–17.

  37. Garland SN, Rouleau CR, Campbell T, Samuels C & Carlson, LE. The comparative impact of mindfulness-based cancer recovery (MBCR) and cognitive behavior therapy for insomnia (CBT-I) on sleep and mindfulness in cancer patients. EXPLORE: J Sci and Healing, 2015; 11: 445–454.

    Article  Google Scholar 

  38. Beddoe AE., Lee KA, Weiss SJ et al: Effects of mindful yoga on sleep in pregnant women: a pilot study. Biol Res Nurs 2010; 11: 363–370

    Article  PubMed  Google Scholar 

  39. Kent, RG, Uchino, BN, Cribbet, MR, Bowen K, Smith, TW. Social relationships and sleep quality. Ann Behav Med. 2015; 1–6.

  40. Kraemer HC, Stice E, Kazdin A, Offord D, Kupfer, D. How do risk factors work together? Mediators, moderators, and independent, overlapping, and proxy risk factors. Am J Psychiatry 2001; 158; 848–856.

    Article  CAS  PubMed  Google Scholar 

  41. Ramchandani P, Psychogiou L. Paternal psychiatric disorders and children’s psychosocial development. Lancet 2009;374:646–653. doi:10.1016/S0140-6736(09)60238-5.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Data used in the present study was gathered by the Child Community Health Network (CCHN), a community-based participatory research network supported through cooperative agreements with the Eunice Kennedy Shriver National Institute of Child Health and Human Development (U HD44207, U HD44219, U HD44226, U HD44245, U HD44253, U HD54791, U HD54019, U HD44226-05S1, U HD44245-06S1, R03 HD59584) and the National Institute for Nursing Research (U NR008929).

Lake County Health Department and Community Health Center and the NorthShore University Health System Community PI: K. Wagenaar; Academic PI: M. Shalowitz; Co-Invs: E. Adam, G. Duncan*, A. Schoua-Glusberg, C. McKinney, T. McDade, C. Simon; Project Coordinator: B. Clark-Kauffman

Baltimore: Baltimore City Healthy Start and Johns Hopkins University Community PI: M. Vance; Academic PI: C. S. Minkovitz; Co-Invs: P. O’Campo, P. Schafer; Project Coordinators: N. Sankofa, K. Walton

Los Angeles: Healthy African-American Families, Cedars-Sinai Medical Center, University of California, Los Angeles Community PI: L. Jones; Academic PI: C. Hobel; Co-PIs: C. Dunkel Schetter, M. C. Lu; Co-I: B. Chung; Project Coordinators: F. Jones, D. Serafin, D. Young

North Carolina: East Carolina University, NC Division of Public Health, NC Eastern Baby Love Plus Consortium, and University of North Carolina, Chapel Hill Community PIs: S. Evans, J. Ruffin, R. Woolard; Academic PI: J. Thorp; Co-Invs: J. DeClerque, C. Dolbier, C. Lorenz; Project Coordinators: L. S. Sahadeo, K. Salisbury

Washington, DC: Virginia Tech Carilion Research Institute, Virginia Tech, and Washington Hospital Center, and Developing Families Center Community PI: L. Patchen, Academic PI: S. L. Ramey and L. Klerman; Academic Co-PI: R. Lanzi; Co-Invs: M. Miodovnik, C. T. Ramey, L. Randolph; Project Coordinator: N. Timraz; Community Coordinator: R. German, J. Bond*

Data Coordination and Analysis Center (Pennsylvania State University) PI: V. M. Chinchilli; Project Coordinator: G. Snyder; Co-Invs: R. Belue, G. Brown Faulkner*, M. Hillemeier, I. Paul, M. L. Shaffer; Biostatisticians: E. Lehman, C. Stetter; Data Managers: J. Schmidt, K. Cerullo, S. Whisler; Programmers: J. Fisher, J. Boyer, M. Payton

NIH Program Scientists: V. J. Evans and T. Raju, Eunice Kennedy Shriver National Institute of Child Health and Human Development; L. Weglicki, National Institute of Nursing Research. Program Officers: M. Spittel* and M. Willinger, NICHD; and Y. Bryan*, NINR

Steering Committee Chairs E. Fuentes-Afflick* (University of California—San Francisco School of Medicine) and M. Phillippe (University of Vermont)

*Indicates those who participated in the planning phase of the CCHN

Authors’ Statement of Conflict of Interest and Adherence to Ethical Standards

Authors Darby E. Saxbe, Christine Dunkel Schetter, Christine M. Guardino, Sharon L. Ramey, Madeleine U. Shalowitz, John Thorp, Maxine Vance, and Eunice Kennedy Shriver National Institute for Child Health and Human Development Community Child Health Network declare that they have no conflict of interest. All procedures, including the informed consent process, were conducted in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.

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Authors and Affiliations

  1. Department of Psychology, University of Southern California, Los Angeles, CA, 90089, USA

    Darby E. Saxbe PhD

  2. Department of Psychology, University of California Los Angeles, Los Angeles, CA, 90095, USA

    Christine Dunkel Schetter PhD & Christine M. Guardino PhD

  3. Virginia Tech Carillion Research Institute, Blacksburg, VA, 24060, USA

    Sharon L. Ramey PhD

  4. NorthShore University HealthSystem Research Institute, Evanston, IL, 60208, USA

    Madeleine U. Shalowitz MD

  5. Pritzker School of Medicine, University of Chicago, Chicago, IL, 60637, USA

    Madeleine U. Shalowitz MD

  6. Department of Obstetrics and Gynecology, UNC Chapel Hill, Chapel Hill, NC, 27599, USA

    John Thorp MD

  7. Baltimore Healthy Start, Baltimore, MD, 21218, USA

    Maxine Vance MS, RN

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  1. Darby E. Saxbe PhD
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  2. Christine Dunkel Schetter PhD
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Eunice Kennedy Shriver National Institute for Child Health and Human Development Community Child Health Network

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Correspondence to Darby E. Saxbe PhD.

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Saxbe, D.E., Schetter, C.D., Guardino, C.M. et al. Sleep Quality Predicts Persistence of Parental Postpartum Depressive Symptoms and Transmission of Depressive Symptoms from Mothers to Fathers. ann. behav. med. 50, 862–875 (2016). https://doi.org/10.1007/s12160-016-9815-7

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