Dataset Information

Depression and suicidal ideation in pregnancy: exploring relationships with insomnia, short sleep, and nocturnal rumination.

ABSTRACT:

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. CLINICALTRIALS.

Gov identifier

NCT03596879.

SUBMITTER: Kalmbach DA

PROVIDER: S-EPMC6980654 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Publications

Depression and suicidal ideation in pregnancy: exploring relationships with insomnia, short sleep, and nocturnal rumination.

Kalmbach David A DA Cheng Philip P Ong Jason C JC Ciesla Jeffrey A JA Kingsberg Sheryl A SA Sangha Roopina R Swanson Leslie M LM O'Brien Louise M LM Roth Thomas T Drake Christopher L CL

Sleep medicine 20190722

<h4>Background</h4>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.<h4>Methods</h4>In this study, 267 pregnant women were recruited from obstetric clinics and completed online surveys on sleep, depre ...[more]

PMID: 31710876

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Project description:Depression is among the most prevalent perinatal complications, yet modifiable risk factors remain elusive. Over half of perinatal women endorse clinical insomnia symptoms, which are etiologically implicated in depression in nonperinatal samples. Yet, prospective data on perinatal insomnia and depression are mixed. We sought to clarify temporal associations of insomnia and depression during peripartum, and to investigate cognitive arousal as a potential mechanism facilitating this relationship. Seventy pregnant women completed sociodemographic information and baseline sleep and mood symptoms between gestational weeks 25 and 30. Beginning at gestational week 30, participants completed 17 weekly online surveys assessing insomnia, depression, and three cognitive arousal indices (nocturnal cognitive arousal, perseverative thinking, and perinatal-focused rumination). Mixed effects models were conducted to test hypotheses. Women were at risk for depression when experiencing insomnia (odds ratio [OR] = 2.36, 95% confidence interval [CI] = 1.28 to 4.35), nocturnal cognitive arousal (OR = 3.05, 95% CI = 1.60 to 5.79), perinatal-focused rumination (OR = 2.05, 95% CI = 1.11 to 3.79), and perseverative thinking (OR = 7.48, 95% CI = 3.90 to 14.32). Prospective analyses revealed bidirectional effects between insomnia and cognitive arousal, and both predicted future depression. Nocturnal cognitive arousal mediated 23-43% of the effect of insomnia on depression. Insomnia mediated 12%-18% of the effect of nocturnal cognitive arousal on depression. A similar pattern was observed with perinatal-focused rumination. Depression did not predict insomnia. Nocturnal cognitive arousal, including ruminating on perinatal concerns while trying to fall asleep, fuels insomnia. In turn, lying awake at night provides an opportunity for nocturnal cognitive arousal. This cycle feeds perinatal depression. Daytime cognitive arousal may indirectly disrupt sleep as perseverating during the day persists into the night.

Project description:ObjectiveInsomnia has been linked to suicidal ideas and suicide death in cross-sectional and longitudinal population-based studies. A link between insomnia and suicide has not been previously examined in the setting of a clinical trial. Herein we describe the relationship between insomnia and suicidal thinking during the course of a clinical trial for depression with insomnia.MethodsSixty patients aged 41.5±12.5 years (2/3 women) with major depressive episode and symptoms of insomnia received open-label fluoxetine for 9 weeks and also received blinded, randomized eszopiclone 3mg or placebo at bedtime after the first week of fluoxetine. Insomnia symptoms were assessed with the Insomnia Severity Index (ISI), and suicidal ideation was assessed with The Scale for Suicide Ideation (SSI). Depression symptoms were assessed with the depressed mood item and the anhedonia item from the Hamilton Rating Scale for Depression-24 (HRSD24), as well as a sum score for all non-sleep and non-suicide items from the HRSD (HRSD20). Measurements were taken at baseline and weeks 1, 2, 4, 6, and 8. SSI was examined by generalized linear mixed models for repeated measures as the outcome of interest for all 60 participants with ISI and various mood symptoms as independent variables, with adjustment for age, gender, treatment assignment, and baseline SSI.ResultsHigher levels of insomnia corresponded to significantly greater intensity of suicidal thinking (p<0.01). The depressed mood item of the HRSD, and the sum of the HRSD20, both corresponded to greater suicidal thinking (p<0.001). The anhedonia item did not correspond with suicidal thinking. When both ISI and the depressed mood item, or ISI and the anhedonia item, were included together in the same model, the ISI remained an independent predictor of suicidal thinking.ConclusionsThe results support the concept that insomnia may be a useful indicator for suicidal ideation and now extend this idea into clinical trials. Insomnia remains an independent indicator of suicidal ideation, even taking into account the core symptoms of depression such as depressed mood and anhedonia. The complaint of insomnia during a depression clinical trial might indicate that more direct questioning about suicide is warranted.

Project description:ObjectiveThe study investigated the prevalence of suicidal behavior and its association with depression, hopelessness, perceived burdensomeness, and thwarted belongingness in a sample of undergraduates in Nigeria.IntroductionSuicide is a leading cause of death among young adults globally. However, information about suicidal ideation, attempts, and relationships with psychiatric factors, perceived burdensomeness, and thwarted belongingness is sparse in Nigeria. The study investigated the prevalence of suicidal ideation and attempts and associated factors in a sample of undergraduates in Nigeria.MethodsWe collected data from a cross-sectional survey of 625 undergraduate students primarily recruited from universities, colleges of education, and polytechnics in Adamawa Central Senatorial Zone, Adamawa State, northeast Nigeria. The Suicidal Behaviors Questionnaire-Revised, the 15-item Interpersonal Needs Questionnaire, the 9-item Patient Health Questionnaire, and the 20-item version of the Beck Hopelessness Scale were administered to the participants. We used descriptive statistics and binary and multivariate logistic regressions for data analysis.ResultsA total of 616 students with a mean age of 21.41 ± 4.72 years completed the study. The prevalence of suicidal behavior was 34.9% (215/616). Having a female sex (adjusted odds ratio [AOR] = 8.37, 95% confidence interval (CI): 2.06, 34.03), depression (AOR = 45.15, 95% CI: 0.95, 5.11), hopelessness (AOR = 20.10, 95% CI: 5.56, 72.41), and perceived burdensomeness (AOR = 89.15, 95% CI: 29.63, 268.30) were associated with suicidal ideation. In addition, being a female (AOR = 1.69, 95% CI = 1.02, 2.83), being a 200-level student (AOR = 3.41, 95% CI = 1.46, 7.96), and being a 300-level student (AOR = 0.28, 95% CI = 0.11, 0.74) were associated with suicidal attempt.ConclusionThe study's findings show that suicidal behaviors (ideations and attempts) are prevalent among undergraduate students in northeast Nigeria. The findings underline the need for the development of mental health services and early identification and intervention for at-risk young people in Nigeria.

Project description:Study objectivesSleep disturbance is significantly associated with suicidal ideation. However, the majority of past research has examined the relationship between insomnia and suicidality. The current exploratory study examined the relationship of circadian rhythm dysregulation (eveningness, seasonality, and rhythmicity) with suicidality.MethodsWe examined the association of insomnia, eveningness, seasonality, and rhythmicity with suicidal ideation in 103 participants with depression, insomnia, and suicidality within a larger 8-week double-blinded randomized control trial primarily examining whether cautious use of zolpidem extended-release or placebo reduced suicidal ideation. All participants additionally received an open-label selective serotonin reuptake inhibitor. Methodological strengths of the current analyses included consideration of multiple sleep-wake constructs, adjustment for relevant covariates, investigation of relationships over the course of treatment, and use of both self-report measures and objective measurement with actigraphy.ResultsOver the course of treatment, self-reported eveningness and greater insomnia severity were independently correlated with greater suicidal ideation, whereas actigraphic delayed sleep timing was related to suicidal ideation at a trend level. At the end of treatment, those with greater suicidal ideation demonstrated lower actigraphic activity levels. There were no significant relationships between self-reported seasonality and actigraphic measures of sleep disturbance and suicidality.ConclusionsSelf-reported delays in sleep timing, objectively lower activity levels, and self-reported insomnia severity correlated independently with greater suicidal ideation in those with depression, insomnia, and suicidality. These exploratory findings highlight the need to consider sleep-wake constructs more broadly in those with suicidality in future research studies in order to improve more definitively both assessment and intervention efforts.Clinical trial registrationRegistry: ClinicalTrials.gov; Name: Reducing Suicidal Ideation through Insomnia Treatment; URL: https://clinicaltrials.gov/ct2/show/NCT01689909; Identifier: NCT01689909 Rumble ME, McCall MV, Dickson DA, Krystal AD, Rosenquist PB, Benca RM. An exploratory analysis of the association of circadian rhythm dysregulation and insomnia with suicidal ideation over the course of treatment in individuals with depression, insomnia, and suicidal ideation. J Clin Sleep Med. 2020;16(8):XXX-XXX.

Dataset Information

Depression and suicidal ideation in pregnancy: exploring relationships with insomnia, short sleep, and nocturnal rumination.

Background

Methods

Results

Conclusions

Gov identifier

Publications

Depression and suicidal ideation in pregnancy: exploring relationships with insomnia, short sleep, and nocturnal rumination.

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