The Concurrent and Longitudinal Relationship between Perinatal Sleep Difficulties and Depression in a Large Sample of High-Risk Women in South Africa.

RISK assessment; MIDDLE-income countries; EDINBURGH Postnatal Depression Scale; RESEARCH funding; INTIMATE partner violence; SOCIOECONOMIC factors; MENTAL illness; FOOD security; SEVERITY of illness index; POSTPARTUM depression; PREGNANT women; HIGH-risk pregnancy; DESCRIPTIVE statistics; HIV infections; LONGITUDINAL method; PSYCHOLOGY of mothers; STATISTICS; SOCIODEMOGRAPHIC factors; WOMEN'S health; INTERPERSONAL relations; ALCOHOL drinking; PSYCHOLOGICAL tests; DATA analysis software; MENTAL depression; PERINATAL period; SLEEP disorders; PATIENT aftercare; EDUCATIONAL attainment; LOW-income countries; DISEASE risk factors; PREGNANCY

Introduction: Perinatal depression and sleep difficulties are common among studies conducted in high income countries (HIC). This study examines the relationship between sleep difficulties and depression during the perinatal period and over an eight-year follow-up period in South Africa, a middle income country. Method: A population cohort of 1238 pregnant women (mean age = 26.33) in 24 township neighborhoods in South Africa were recruited and reassessed six times over the next 8 years post birth with follow-up rates of 96–83%. The relationship between maternal depressed mood and sleep difficulties was examined over time, as well as the relationship of sleep with other socioeconomic, environmental, and psychiatric risk factors. Results: Thirty-five percent of the women reported sleep difficulties during the perinatal period; whereas only 8% reported sleep difficulties at 8-year follow-up. Perinatal sleep difficulties were associated with lower income, lower educational attainment, less access to electricity, more food insecurity, higher rates of interpersonal violence and HIV, alcohol consumption, and depressed mood at 8 years. However, the severity of depressed mood was the strongest predictor of sleep problems longitudinally and cross-sectionally, after accounting for all other risk factors. Conclusions: We found that the severity of depressed mood is highly associated with sleep difficulties from pregnancy to 8 years post-birth and in a linear relationship, so that higher depressed mood is associated with more sleep problems. Trial Registration: ClinicalTrials.gov registration: # NCT00996528. Significance: Sleep is understudied among people living in poverty in LMIC's. To our knowledge this is the first study to (a) investigate the relationship between sleep difficulties and depression in a sample of high-risk, black women living in poverty in a LMIC and (b) study the relationship between sleep and depression continuously from the perinatal period through 8 years post-partum in a LMIC. The study finds that sleep difficulties and depression are highly correlated during this period even after accounting for other socioeconomic, environmental and psychiatric risk factors in this high-risk population. [ABSTRACT FROM AUTHOR]