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. 2022 Aug 2;22(1):521.
doi: 10.1186/s12888-022-04164-y.

Antepartum sleep quality, mental status, and postpartum depressive symptoms: a mediation analysis

Yu Wang #  1   2 , Han Liu #  1 , Chen Zhang  1   3 , Cheng Li  3 , Jing-Jing Xu  1   2 , Chen-Chi Duan  1   2 , Lei Chen  1 , Zhi-Wei Liu  1 , Li Jin  3 , Xian-Hua Lin  3 , Chen-Jie Zhang  1   2 , Han-Qiu Zhang  1   2 , Jia-Le Yu  1   2 , Tao Li  1   2 , Cindy-Lee Dennis  4 , Hong Li  5 , Yan-Ting Wu  6   7
Affiliations

Antepartum sleep quality, mental status, and postpartum depressive symptoms: a mediation analysis

Yu Wang et al. BMC Psychiatry. .

Abstract

Background: Poor sleep quality and maternal mood disturbances are common during pregnancy and may play pivotal roles in the development of postpartum depression. We aim to examine the trajectories of sleep quality and mental health in women from early pregnancy to delivery and explore the mediating effects of sleep quality and mental status on the link between antepartum depressive symptoms and postpartum depressive symptoms.

Methods: In an ongoing prospective birth cohort, 1301 women completed questionnaires in the first, second and third trimesters and at 6 weeks postpartum. In each trimester, sleep quality was measured utilizing the Pittsburgh Sleep Quality Index (PSQI), and mental health was assessed with the Center for Epidemiologic Studies Depression Scale (CES-D), the Self-Rating Anxiety Scale (SAS) and the Perceived Stress Scale (PSS). Postpartum depressive symptoms were evaluated by the Edinburgh Postnatal Depression Scale (EPDS). The bootstrap method was used to test the mediation effect.

Results: The PSQI, CES-D, and SAS scores presented U-shaped curves across the antenatal period while the PSS score followed a descending trend. Antenatal sleep quality, depressive symptoms, anxiety symptoms and perceived stress all predicted depressive symptoms at 6 weeks postpartum. The influence of antepartum depressive symptoms on postpartum depressive symptoms was mediated by antepartum sleep quality and anxiety symptoms, which accounted for 32.14%, 39.25% and 31.25% in the first, second and third trimesters (P = 0.002, P = 0.001, P = 0.001, respectively).

Conclusions: Poor sleep quality and anxiety symptoms in pregnancy mediated the relationship between antepartum depressive symptoms and postpartum depressive symptoms. Interventions aimed at detecting and managing sleep quality and elevated anxiety among depressed women in pregnancy warrant further investigation as preventative strategies for postpartum depression.

Keywords: Mediating effect; Mental status; Perinatal depressive symptoms; Sleep quality.

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Conflict of interest statement

The authors have no competing interests to declare.

Figures

Fig.1
Fig.1
Comparison of psychological health of the participants during pregnancy between the two groups. a Sleep quality of participants during pregnancy between the two groups. b Depressive symptoms of participants during pregnancy between the two groups. c Anxiety symptoms of participants during pregnancy between the two groups. d Perceived stress of participants during pregnancy between the two groups
Fig. 2
Fig. 2
Mediation models for the relationship between antepartum depressive symptoms and postpartum depressive symptoms. a Mediation model of antepartum sleep quality and antepartum anxiety symptoms on the relationship between antepartum depressive symptoms and postpartum depressive symptoms in the first trimester. b Mediation model of antepartum sleep quality and antepartum anxiety symptoms on the relationship between antepartum depressive symptoms and postpartum depressive symptoms in the second trimester. c Mediation model of antepartum sleep quality and antepartum anxiety symptoms on the relationship between antepartum depressive symptoms and postpartum depressive symptoms in the third trimester
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