ArticleSleep2021
A pathogenic cycle between insomnia and cognitive arousal fuels perinatal depression: exploring the roles of nocturnal cognitive arousal and perinatal-focused rumination.
Article in Sleep, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 1 of them a synthesis that pooled it.
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Who cites it
22 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Insomnia evaluation and treatment during peripartum: a joint position paper from the European Insomnia Network task force "Sleep and Women," the Italian Marcè Society and international experts task force for perinatal mental health.Archives of women's mental health · 2022Pooled it
- Trial
- The Interplay Between Emotion Dysregulation and Repetitive Thoughts in Insomnia Disorder: The Impact of Worry, Rumination and REM Sleep Instability.Journal of sleep research · 2026Article
- Beyond 'Baby Brain': Memory and Sleep Health During Pregnancy-A Biopsychosocial Perspective.Brain sciences · 2026Review
- Treating insomnia during pregnancy improves bedtime procrastination, rumination, anxiety, and positive affect: a randomized controlled trial of cognitive-behavioral and mindfulness-based therapies for prenatal insomnia.Sleep advances : a journal of the Sleep Research Society · 2026Article
- Subjective sleep quality, but not objective sleep measures, mediates the relationship between pre-sleep worrying and affective wellbeing.Journal of sleep research · 2025Article
- Sleep and psychiatric disorders: Bidirectional interactions and shared neurobiological mechanisms.PLOS mental health · 2025Review
- Insomnia and depression among bariatric surgery patients: the chain mediating effect of resilience and anxiety.Frontiers in psychiatry · 2025Article
- The Mediating Role of Negative Mood Affect in the Relationship Between Perceived Stress and Vulnerability to Insomnia Among Student Pharmacist Shift Workers.Nature and science of sleep · 2025Article
- The psychometric properties of the Turkish version of the Pre-sleep Arousal Scale.Sleep and biological rhythms · 2024Article
- Cortisol Regulation among Women Who Experience Suicidal Ideation during Pregnancy.Journal of affective disorders reports · 2023Article
- Mapping the associations of daily pain, sleep, and psychological distress in a U.S. sample.Journal of behavioral medicine · 2023Article
- Article
- Racial disparities in treatment engagement and outcomes in digital cognitive behavioral therapy for insomnia among pregnant women.Sleep health · 2023Article
- Common sleep disorders in pregnancy: a review.Frontiers in medicine · 2023Review
- Mindfulness-based therapy for insomnia alleviates insomnia, depression, and cognitive arousal in treatment-resistant insomnia: A single-arm telemedicine trial.Frontiers in sleep · 2023Article
- Reducing cognitive arousal and sleep effort alleviates insomnia and depression in pregnant women with DSM-5 insomnia disorder treated with a mindfulness sleep program.Sleep advances : a journal of the Sleep Research Society · 2023Article
- DSM-5 insomnia disorder in pregnancy: associations with depression, suicidal ideation, and cognitive and somatic arousal, and identifying clinical cutoffs for detection.Sleep advances : a journal of the Sleep Research Society · 2022Article
- The Acute Effects of Aerobic Exercise on Nocturnal and Pre-Sleep Arousal in Patients with Unipolar Depression: Preplanned Secondary Analysis of a Randomized Controlled Trial.Journal of clinical medicine · 2021Article
- Insomnia and cognitive arousal are important potential targets to reduce perinatal depression risk.Sleep · 2021Article
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3 authors.
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No grant is acknowledged in the PubMed record.
Abstract
STUDY
objectivesDepression 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.
methodsSeventy 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.
resultsWomen 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.
conclusionNocturnal 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.
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