scholarly journals A pathogenic cycle between insomnia and cognitive arousal fuels perinatal depression: exploring the roles of nocturnal cognitive arousal and perinatal-focused rumination

SLEEP ◽  
2021 ◽  
Author(s):  
David A Kalmbach ◽  
Philip Cheng ◽  
Christopher L Drake
Keyword(s):  
Perinatal Depression ◽  
Mixed Effects Models ◽  
Perinatal Complications ◽  
Prospective Data ◽  
Cognitive Arousal ◽  
Gestational Week ◽  
Perseverative Thinking ◽  
Perinatal Women ◽  
Insomnia Symptoms ◽  
Prospective Analyses

Abstract Study Objectives 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. Methods 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. Results 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. Conclusion 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.

740 Insomnia, cognitive arousal, and perinatal-focused rumination fuel perinatal depression

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A289-A289
Author(s):  
Andrea Cuamatzi Castelan ◽  
David Kalmbach ◽  
Philip Cheng ◽  
Christopher Drake
Keyword(s):  
Perinatal Depression ◽  
Perinatal Complications ◽  
Prospective Data ◽  
Ample Opportunity ◽  
Cognitive Arousal ◽  
Gestational Week ◽  
Perseverative Thinking ◽  
Perinatal Women ◽  
Insomnia Symptoms ◽  
Prospective Analyses

Abstract Introduction 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 non-perinatal 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. Methods Seventy pregnant women completed sociodemographic information and baseline sleep and mood symptoms between gestational weeks 25–30. Beginning at gestational week 30, participants completed 17 weekly online surveys assessing insomnia, depression, and three cognitive arousal indices (nocturnal cognitive arousal, perseverative thinking, perinatal-focused rumination). Mixed effects models were conducted to test hypotheses. Results Women were at elevated risk of screening positive for depression when experiencing high levels of insomnia (OR=2.36, 95%CI=1.28, 4.35), nocturnal cognitive arousal (OR=3.05, 95%CI=1.60, 5.79), perinatal-focused rumination (OR=2.05, 95%CI=1.11, 3.79), and perseverative thinking (OR=7.48, 95%CI=3.90, 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. Conclusion Perseverating at night, particularly on perinatal concerns, fuels insomnia. In turn, lying awake at night provides ample opportunity for perseverating. This cycle feeds perinatal depression. Daytime cognitive arousal may indirectly disrupt sleep as perseverating during the day persists into the night. Support (if any):

747 Suicidal Ideation Associated with Cognitive Hyperarousal, Rumination and Insomnia in Depressed Perinatal Women

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A291-A292
Author(s):  
Lily Arnett ◽  
David Kalmbach ◽  
Brian Ahmedani ◽  
Bizu Gelaye ◽  
Christopher Drake ◽  
...  
Keyword(s):  
Suicidal Ideation ◽  
Cognitive Activity ◽  
Late Pregnancy ◽  
Future Research ◽  
Blood Institute ◽  
Cognitive Arousal ◽  
Early Postpartum ◽  
National Heart Lung ◽  
Perseverative Thinking ◽  
Perinatal Women

Abstract Introduction This prospective study explored associations among clinical insomnia, nocturnal cognitive hyperarousal, and nocturnal perinatal-focused rumination with suicidal ideation (SI) in perinatal women with mild-to-moderate depression. Methods From late pregnancy through early postpartum, 39 women with depression completed 17 weekly surveys assessing insomnia, depression, suicidal ideation, perceived stress, and three cognitive arousal indices. Results Women with nocturnal cognitive hyperarousal at baseline, relative to those with low nocturnal cognitive arousal, were at greater risk for developing new onset SI in late pregnancy or early postpartum (33% vs 1%). Moreover, nocturnal perinatal-focused rumination was independently associated with SI. SI-risk was highest when women reported clinical insomnia combined with nocturnal cognitive hyperarousal (OR=5.66, p=.037) or perinatal-focused rumination (OR=11.63, p=.018). Daytime perseverative thinking was not uniquely associated with SI. Conclusion Cognitive hyperarousal and perinatal-focused rumination at night are uniquely associated with SI among perinatal women with depression. Moreover, insomnia augments the suicidogenicity of nighttime cognitive activity. Future research should determine whether alleviating nocturnal cognitive arousal, pregnancy- and fetal/infant-related concerns, and insomnia with psychotherapy reduces SI for women with perinatal depression. Support (if any) This study was funded by the American Academy of Sleep Medicine (198-FP-18, PI: Kalmbach). Dr. Cheng’s effort was supported by the National Heart, Lung, and Blood Institute (K23-HL13866, PI: Cheng).

scholarly journals Social Support—A Protective Factor for Depressed Perinatal Women?

2019 ◽  
Vol 16 (8) ◽  
pp. 1426 ◽  
Author(s):  
Jeannette Milgrom ◽  
Yafit Hirshler ◽  
John Reece ◽  
Charlene Holt ◽  
Alan W. Gemmill
Keyword(s):  
Social Support ◽  
Child Development ◽  
Protective Factor ◽  
Perinatal Depression ◽  
Psychological Treatment ◽  
Controlled Trial ◽  
Late Pregnancy ◽  
Antenatal Depression ◽  
Depression And Anxiety ◽  
Perinatal Women

Social support before and after childbirth is a possible protective factor for perinatal depression. Currently, there is a lack of longitudinal studies beyond the first year postpartum exploring the relationship of social support with depression and anxiety. Social support is also a possible protective factor for adverse child development, which is a known consequence of perinatal depression. The present study followed up a cohort of depressed women (n = 54) from a randomised controlled trial of psychological treatment for antenatal depression. We examined the trajectory of the relationships between perceived social support (Social Provisions Scale), depression (Beck Depression Inventory), and anxiety (Beck Anxiety Inventory) twice in pregnancy and twice postpartum up to two years. The influence of social support on child development and parenting-related stress was also explored. Two aspects of social support, Reassurance of Worth and Reliable Alliance, were strongly related to perinatal depression and anxiety, particularly when predicting symptoms in late pregnancy. However, the effect of postnatal depression on child development at 9 and 24 months post-birth was not mediated by social support. These results suggest the importance of adjusting current interventions for depressed perinatal women to focus on social support in late pregnancy and the first six months postpartum.

The effects of a mindfulness-based stress reduction programme on pre-sleep cognitive arousal and insomnia symptoms: a pilot study

2010 ◽  
Vol 27 (3) ◽  
pp. e299-e305 ◽  
Author(s):  
Andrea L. Cincotta ◽  
Philip Gehrman ◽  
Nalaka S. Gooneratne ◽  
Michael J. Baime
Keyword(s):  
Pilot Study ◽  
Stress Reduction ◽  
Cognitive Arousal ◽  
Mindfulness Based Stress Reduction ◽  
Insomnia Symptoms

The Effect of Malignancy on Outcomes Following Revascularization for Critical Limb Ischemia: A Case–Control Study

2018 ◽  
Vol 52 (5) ◽  
pp. 325-329
Author(s):  
Tom Calderbank ◽  
Ahmed Karim ◽  
Mike Wall ◽  
Arooj Syed ◽  
Robert S. M. Davies ◽  
...  
Keyword(s):  
Lower Limb ◽  
Case Control Study ◽  
Limb Ischemia ◽  
Case Control ◽  
Limb Amputation ◽  
Prospective Data ◽  
Using Data ◽  
Nested Case Control ◽  
Control Study ◽  
Prospective Analyses

Aim: Malignancy is common in patients presenting with critical lower limb ischemia (CLI). However, outcomes in patients with concomitant active malignancy and CLI have not been well defined in comparative prospective analyses. Using contemporary prospective data, we aimed to assess outcomes following revascularization in patients with CLI and active malignancy. Methods: A nested case–control study was performed using data from 2 tertiary referral centers for vascular disease. A total of 48 consecutive patients undergoing intervention for CLI who had a diagnosis of active malignancy were identified and matched to patients with CLI but no malignancy for age, sex, diabetes, and smoking. Patency rates and morbidity/mortality were assessed using duplex ultrasonography and regular clinical review. Results: A total of 48 consecutive patients (median age: 74.5 years; interquartile range: 68-80 years) with active malignancy and CLI were identified and case-matched (age, sex, diabetes, and smoking) to 48 patients undergoing intervention for CLI who had no malignancy. Major cardiovascular risk factors did not differ. All-cause mortality was 23% versus 12% ( P = .41) at 6 months and 54% versus 15% ( P < .001) at 12 months. None of the patients died due to complications relating directly to the lower limb intervention or within 30 days of the intervention. A total of 4 (8.3%) patients had required a major limb amputation at 6 months in both groups, compared with 5 (10.4%) patients with malignancy versus 4 (8.3%) patients without ( P = .73) at 12 months. Patency rates were similar at 12 months (73% vs 80%). Three patients had required reintervention in both groups (endovascular in all cases) at 12 months. Conclusion: Revascularization can be offered safely in selected patients with active malignancy; patency rates in those surviving to 1 year are similar to patients without malignancy.

scholarly journals Experiences with Technology and Telehealth Among Women with Perinatal Depression

2021 ◽  
Author(s):  
Uma Parameswaran ◽  
Ryoko Pentecost ◽  
Marcia Williams ◽  
Marcela Smid ◽  
Gwen Latendresse
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Perinatal Depression ◽  
Intervention Group ◽  
Qualitative Description ◽  
Wide Range ◽  
Positive Experiences ◽  
Childbearing Women ◽  
Perinatal Women

Abstract Background Perinatal depression (PD) affects 10-20% of childbearing women. Telehealth is increasingly utilized for mental health services to increase access to care and overcome COVID-19 pandemic barriers. Women’s perspectives on telehealth services for PD is unknown, however. This study's primary objective was to obtain the perspectives of women who participated in an 8-week group videoconference intervention for PD symptoms, including how technology impacted their experience. Methods We utilized theoretical sampling and included perinatal women who had completed the 8-week mindfulness-based cognitive-behavioral intervention group. Semi-structured focus groups with four to six women were conducted on a videoconference platform. Primary analysis used grounded theory and a secondary analysis used qualitative description and was conducted by two coding teams. The teams collaborated on the final themes across the analyses. Results Three groups, with a total of 17 participants were conducted. Composition consisted of seven postpartum and ten pregnant women from the 47 total participants. Identified core themes regarding their experiences of the videoconference intervention were: positive experiences, negative experiences, suggestions and ideas, and screening and communication. Conclusion This study provides growing evidence informed by perinatal women of positive experiences with engagement in a videoconference intervention for PD. Telehealth may be a reasonable and acceptable platform to increase access and retention for mental health services in childbearing women. Further, this pilot work showcases videoconferencing delivery for a wide range of effective and affordable mental health services in low-resource communities.

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