Skip to content

Sleep and Depression: Double Threats for Moms

(originally published in CCAS Spotlight)

Sleepless nights are a fact of pregnancy. But a study by a clinical psychology doctoral student suggests that the combined risks of sleep deprivation and depression follow women throughout their pregnancies and into the postpartum period.

Stock photo of the tummy of a pregnant woman who is laying down on her side

December 12, 2018

From the hormonal fluctuations of early pregnancy to the kicking fetus of the later stages to the late-night demands of newborns, lack of sleep goes hand-in-hand with parenthood. In fact, 75 percent of pregnant women report some sleep disruption—and experts believe that number may be low.

But while a certain amount of fatigue comes with the territory, sleep disturbance is also linked to depression. And the two conditions can be a crisis combination for women during and after pregnancy. In an on-going interdisciplinary study led by third-year clinical psychology doctoral candidate Sammy S. Dhaliwal, a clearer picture is emerging of the role of sleep disturbances and its link to depression during the often-overlooked perinatal period that encompasses pregnancy and continues through the first 12 months postpartum. Dhaliwal is working with a 25-member team that includes psychology faculty advisers and fellow graduate students, GW medical students, researchers from Children's National Medical Center in Washington, D.C., and technology consultants from Apple and Deloitte. Dhaliwal recently received a $33,500 grant from the National Institutes of Health to see the research to its completion.

“The results from this project will provide the field with new and important knowledge about sleep, an understudied but necessary research endeavor to inform existing interventions for perinatal women,” said Associate Professor of Psychology Huynh-Nhu (Mimi) Le, Dhaliwal’s primary faculty advisor.

As many as one-in-five new mothers experience some degree of postpartum depression, from appetite shifts and low energy to thoughts of harming themselves or their babies. The numbers are likely similar for women throughout their pregnancies, Dhaliwal suggests, but there’s little current research covering pregnancy through postpartum. That’s a significant hole, she notes, since the single largest predictor of postpartum depression is depression during pregnancy. “If you become newly depressed during pregnancy, you are almost guaranteed to become or to remain depressed in the postpartum period if untreated,” she said. And while the American College of Obstetricians and Gynecologists recommends that OB-GYNs screen patients at least once during the perinatal period for depression, there is little emphasis on sleep disruption, Dhaliwal said.

“Postpartum, women have their sleep disturbed by things like crying babies or getting up to breastfeed. We all recognize that. But we have to understand that it also can be hard to sleep with a baby growing inside you. We need better tools for assessing [sleep disruptions in] both periods,” she said.

Two Way Street

The “bi-directional” relationship between sleep and depression is a “two-way street," Dhaliwal explained, with sleep deprivation serving as both a symptom and a risk-factor for depression. Her research set out to explore whether the sleep disruption she expected to see from pregnant and postpartum women contributed to new onsets of depression.

Dhaliwal’s team is in the process of recruiting 50 women without a history of depression or sleep disorders from the Obstetrics and Gynecology Division at the George Washington University Hospital System. The researchers are following the participants through a 10-day, nine-night protocol, from pregnancy (third trimester, week 28) through postpartum (week 6). Using a daily diary phone app, the team can track how and when sleep impacts mood among pregnant and postpartum women, with a focus on negative daily stress appraisals. The key to the study, Dhaliwal says, is a “within-person” design that compares each woman’s unique sleep characteristics from pregnancy to postpartum. “We don’t compare separate groups of women. We compare one woman’s worst day to her best day. And we do it during her pregnancy and then again postpartum.”

The study, which is scheduled to conclude in the spring, may have significant implications for mothers and their entire families, Dhaliwal said, noting that perinatal depression has been linked to detrimental outcomes from low birth weight to poor scholastic achievement to childhood depression. “Depression during pregnancy or postpartum affects not just the mom but the baby too,” she said. “It has the potential to change the trajectory of a child's life.”

Samia and dissertation advisor, Dr. Mimi Le

 

Congratulations to Samia Ortiz-Hernandez, who successfully defended her dissertation, "Voices of Low-Income Latinos During the Transition to Parenthood". Her committee included Mimi Le (Chair), Christina Gee, Sandraluz Lara-Cinosomo (U of Illinois, Urbana-Champaign), Deborah Perry (Georgetown University), and Cindy Rohrbeck. Samia will also start a 2-year postdoctoral fellowship in neuropsychology at the VA in DC in September. Congrats, Samia!!

Congrats to Applied Social Psychology doctoral student Sidney Holt on the 2017 Outstanding Student Abstract award at the American Public Health Association (APHA) conference! Her abstract was entitled, “I Live in this Neighborhood Too, Though”: Psychosocial Effects of Gentrification on Black men in DC.

The abstract details analyses that Holt conducted based on focus groups with Black men from Menhood, a National Institutes of Health-funded study designed to examine the effects of neighborhood and individual-level stressors and resilience on sexual risk for Black men who live in Washington, DC.  Holt’s supervising professor, Dr. Lisa Bowleg is the Principal Investigator of Menhood.

Holt’s research highlighted that gentrification led participants to experience heightened police presence within their neighborhoods and in turn, increased discriminatory encounters with police; segregation and social exclusion from their new White neighbors; restricted mobility within their neighborhoods; fear of displacement; loss of belonging and sense of community; and self-blame and a sense of powerlessness to stop gentrification.  All of these experiences have the potential to negatively impact health and well-being.  Holt’s work fills an important gap within the social and behavioral science literature.  Holt notes that although media attention about gentrification in DC has increased in recent years —DC was the second fastest gentrifying city in the U.S. from 2000 to 2010 — it’s relatively rare that researchers seek to learn about gentrification primarily from the perspective of long-time, low-income Black residents.  Holt says that she hopes that her work will prompt researchers, policymakers and health providers to consider the social and mental health effects of gentrification, and not conceptualize gentrification primarily as an urban development phenomenon with only economic and political ramifications.