Brief report
A prospective investigation of the relationships among sleep quality, physical symptoms, and depressive symptoms during pregnancy

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Abstract

The aim of this study was to examine the prospective relationship between pregnancy physical discomforts experienced during the second trimester and late pregnancy depressive symptoms, as well as the mediating effect of sleep quality on antenatal depressive symptomatology. Healthy pregnant women (N = 257) completed the Physical Symptoms Questionnaire, the Beck Depression Inventory, and the Pittsburgh Sleep Inventory at early–mid second trimester, and then again at late third trimester. Physical symptoms and sleep quality at the first time point were both correlated moderately with depressive symptoms at late pregnancy. Discomfort associated with physical symptoms was a better predictor of depressive symptoms than Frequency of symptoms, although a score combining Frequency, Discomfort and Effect of symptoms on life was the strongest predictor of depressive symptoms. Results of the hierarchical regression analyses of the mediation model indicated that physical symptoms at early–mid second trimester predicted depressive symptoms in the last trimester both directly, and via poor sleep quality (prospectively), which mediated the relationship. The clinical implications of these findings for antenatal care are discussed.

Introduction

Two common experiences of pregnancy include sleep problems and pregnancy-related physical symptoms or discomforts (Chou et al., 2003, Dzaja et al., 2005, Lee and Gay, 2004, Wallace et al., 1986), which are both associated with depressive symptoms (Chou et al., 2003, Goyal et al., 2007, Kamysheva et al., 2008, Field et al., 2007, Jomeen and Martin, 2007, Skouteris et al., 2008). Given the negative implications of antenatal depression on health and wellbeing of mother and child (Milgrom et al., 2008), the current study aimed to examine prospectively the relationships among sleep quality, depressive symptomatology, and physical symptoms during pregnancy. Based on substantial literature that links physical symptoms, pain and depression (Trivedi, 2004), it was hypothesized that poorer sleep quality and worse physical symptoms earlier during pregnancy would be related to greater depressive symptoms later in pregnancy. It was also hypothesized that physical symptoms earlier in pregnancy would predict sleep quality in late pregnancy and that sleep quality at this time point would be associated with depressive symptoms in late pregnancy (see Fig. 1).

Section snippets

Participants

Pregnant English speaking Australian women (N = 257) self selected for participation in this study (215 of these women were included in a previous cross-sectional study, Kamysheva et al., 2008).

Design

Participants completed measures at two time points: Time 1; T1, mean gestation weeks = 18.42 (SD = 1.22) and Time 2; T2, mean gestation weeks = 34.71 (SD = 1.74).

Depressive symptoms

Depressive symptoms were assessed using the validated and reliable 13-item short form Beck Depression Inventory (BDI; Beck and Beck, 1972, Beck et al.,

Results

Participants' age ranged from 18 to 42 years (M = 31.64 years, SD = 4.56). Forty-seven percent (n = 120) of women were primiparous. Most were married (76.7%; n = 197) or living with a de facto partner (17.9%; n = 46); 72.8% (n = 187) were university educated. Thirty percent of women (n = 76) reported a family annual income of over A$105,000 (approximately US$64,722), 27.5% (n = 71) between A$75 and 104,000, 24.2% (n = 62) between A$45 and 74,000, and 12.8% (n = 43) below A$44,000 (approximately US$27,121).

Discussion

The results indicated that pregnancy-related physical symptoms at 15–23 weeks gestation predicted, prospectively, increased depressive symptoms at 26–39 weeks. This supported the proposed hypotheses and extended findings of our previous research (Kamysheva et al., 2008), suggesting that women's experiences of physical symptoms may have clinical implications for the development of antenatal depression. Given symptoms of antenatal and postnatal depression are highly correlated, further research

Role of the funding source

An Australian Research Council Discovery Grant (DP0557181) awarded to EW, SP, HS and JM, funded the research reported here. The ARC had no role in the collection, analysis and interpretation of data, nor in writing the manuscript and in the decision to submit the manuscript for publication.

Conflict of interest

No conflict of interest declared.

Acknowledgements

We thank the Australian Research Council for their financial support. We extend our thanks and appreciation to the women who participated in this research. We are also grateful to Leanne Kelly and Carmela Germano for their assistance with data collection.

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