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J Affect Disord. 2017 Feb;209:195-200. doi: 10.1016/j.jad.2016.11.020. Epub 2016 Nov 18.

Poor sleep quality, antepartum depression and suicidal ideation among pregnant women.

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Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Electronic address:
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Instituto Nacional Materno Perinatal de Lima, Lima, Peru; Departamentos de Medicina y Ginecología y Obstetricia Universidad Nacional Mayor de San Marcos, Lima, Perú.
Center for Perinatal Studies, Swedish Medical Center, Seattle, WA, USA.
School of Sport and Exercise, Massey University, Wellington, New Zealand.
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology and Population Health. London School of Hygiene and Tropical Medicine, London, UK.
Asociación Civil PROESA, Lima, Peru; Universidad Peruana de Ciencias Aplicados, Lima, Peru.



To evaluate the independent and combined associations of maternal self-reported poor sleep quality and antepartum depression with suicidal ideation during the third trimester METHODS: A cross-sectional study was conducted among 1298 pregnant women (between 24 and 28 gestational weeks) attending prenatal clinics in Lima, Peru. Antepartum depression and suicidal ideation were assessed using the Patient Health Questionnaire-9 (PHQ-9). The Pittsburgh Sleep Quality Index (PSQI) questionnaire was used to assess sleep quality. Multivariate logistical regression procedures were used to estimate odds ratios (OR) and 95% confidence intervals (95% CI) after adjusting for putative confounders.


Approximately, 17% of women were classified as having poor sleep quality (defined using the recommended criteria of PSQI global score of >5 vs. ≤5). Further, the prevalence of antepartum depression and suicidal ideation were 10.3% and 8.5%, respectively in this cohort. After adjusting for confounders including depression, poor sleep quality was associated with a 2.81-fold increased odds of suicidal ideation (OR=2.81; 95% CI 1.78-4.45). When assessed as a continuous variable, each 1-unit increase in the global PSQI score resulted in a 28% increase in odds for suicidal ideation, even after adjusting for depression (OR=1.28; 95% CI 1.15-1.41). The odds of suicidal ideation was particularly high among depressed women with poor sleep quality (OR=13.56 95% CI 7.53-24.41) as compared with women without either risk factor.


This cross-sectional study utilized self-reported data. Causality cannot be inferred, and results may not be fully generalizable.


Poor sleep quality, even after adjusting for depression, is associated with antepartum suicidal ideation. Our findings support the need to explore sleep-focused interventions for pregnant women.


Depression; Peru; Pregnancy; Sleep; Suicide

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