Sleep Quality and its Relationship with Depression During the First Year after Childbirth in Women referred to Tabriz Health Centers, 2017

Abstract

Abstract: Introduction: Physiological changes in postpartum period, as well as child care needs including night feeding and frequent waking affect maternal sleep quality and are important factors in impairing sleep quality during the first year after delivery. Understanding mother sleep quality and its socio-demographic and maternal health predictors can lead to appropriate measures for reducing the problems, and can increase maternal satisfaction and success in maternal role. The aim of this study was to determine maternal sleep quality and its relation with postpartum depression during the 2 to 12 months after delivery, as well as to determine predictive factors of sleep quality. Methods: This descriptive-analytical cross-sectional study was performed on 839 women with healthy child who were at the second (n = 207), fourth (n = 204), sixth (n = 205) and twelfth (n = 223) months after delivery, at Tabriz-Iran Health Centers during 2017-2018. Data were collected using demographic questionnaires, and standard questionnaires of Pittsburgh Sleep Quality (PSQI) and Edinburgh Postnatal Depression [EPDS). PSQI ≥ 5 was considered as poor sleep quality and EPDS ≥ 5 as depression. Pearson correlation was used to determine streght of correlation beteween sleep quality and depression score. Simple logistic regression was used to determine the factors related with poor sleep quality with p < 0.2 and then the predictors were determined using multivariate logistic analysis regression using backward strategy. Results: There were no significant differences between the women at different time-points after delivery in terms of socio-demographic (except marital satisfaction (p = 0.003) and physical health characteristics (p<0.05). Mean age of the women was 29.8 (SD 5.6) years. 13% were employed, 38% had academic education, and 74% had Cesarean delivery. The most common women health problems were: backache 30%, abnormal vagibal secretion (20%) and constipation (15%). Overally, there were no statistically significant differences in frequency of poor sleep quality (p = 0.079) and mean score of sleep quality (p = 0.075). However, compared to the second month after delivery, both frequency of poor sleep quality (70% vs 60%, p= 0.009) and the mean score (6.2 vs 5.6, p = 0.009) were significantly higher in the second month. There were no statistically significant differences between the women at different time-points after delivery in terms of mean score (p = 0.390) and frequency (p=0.136) of postpartum depression. Overally, 17.3% of the women had depression and mean score of depression was 7.5 (SD 5.3). There was a significant correlation between sleep quality and depression score (r = 0.44, p <0.001). Low back pain (OR 1.91, 95% CI 1.40 to 2.16; p <0.001), coldness of arms/legs (OR 2.17, 95% CI 3.61 to 1.30; p= 0.003), constipation (OR 1.64, 95% CI 1.04 to 2.57; p = 0.033); exclusive formula feeding (OR 1.82, 95% CI 1.10 to 3.02; p = 0.023), undesired child gender for both parents (OR 2.08, 95% CI 3.71 to 1.15; P = 0.016), infant age at two months (OR 1.60, 95% CI 1.17 to 2.19; p = 0.003) were predictors of poor sleep quality during the first year of postpartum. Conclusion: Poor sleep quality and depression are common among women within 2-12 months after delivery. Considering the correlation between sleep quality and depression, as well as the predictive role of most physical health problems and child feeding with formula for the poor sleep quality, health care peroviders should have special effort in reducing women’s problems during the first year after delivery and in encouraging them to have breatfeeding. The efforts could remove the deteriorating effect of poor sleep quality on maternal performance and could promote woman, child and family health.