افسردگی دوران بارداری و بیخوابی در زنان باردار: نقش پیش بینی کننده نشخوار شبانه و ذهن آگاهی

فصلنامه زن و جامعه

دوره 13، شماره 49، اردیبهشت 1401، صفحه 171-184   

نوع مقاله: مقاله پژوهشی

شناسه دیجیتال (DOI): 10.30495/jzvj.2022.25953.3355

نویسنده

مریم طالبی^*

دکترای تخصصی روانشناسی، استادیار گروه روانشناسی موسسه آموزش عالی غیرانتفاعی راه دانش بابل، مازندران، ایران

تاریخ دریافت: 20 شهریور 1399،  تاریخ بازنگری: 09 آذر 1400،  تاریخ پذیرش: 04 اسفند 1400 

چکیده

دوران بارداری و ایام پس از زایمان، از حساس ترین دوران زندگی زنان محسوب می شود. این دوران به همان اندازه که از نظر جسمانی مورد توجه قرار می گیرد، از نظر روانی و اجتماعی نیز حایز اهمیت است اختلالات خواب و افسردگی از شکایات شایع دوران بارداری است. این اختلالات که در نتیجه تغییرات فیزیولوژیکی و هورمونی در حاملگی رخ می دهند از علل متفاوتی برخوردارند و می تواند زمینه ساز بسیاری از اختلالات حین بارداری باشد. هدف از انجام این پژوهش تبیین نقش نشخوار شبانه و ذهن آگاهی در پیش بینی افسردگی و بی خوابی است. جامعه شامل زنان مراجعه کننده به کلینیک های زنان و زایمان شهر تهران بود که 136نفر از آنان به صورت در دسترس انتخاب شدند. جهت گردآوری داده ها از پرسشنامه های شدت بیخوابی، افسردگی ادینبورگ، برانگیختگی پیش از خواب و مقیاس تجدید نظر شده شناختی-عاطفی ذهن آگاهی استفاده شد. داده ها به روش رگرسیون، توسط نرم افزار SPSS 24 مورد تجزیه و تحلیل قرار گرفتند. بین بیخوابی و برانگیختگی قبل از خواب با افسردگی در زنان باردار رابطه مثبت وجود داشت. همچنین نشخوار شبانه رابطه مثبتی با هر دو متغیر افسردگی دوران بارداری و بیخوابی و ذهن آگاهی رابطه منفی با افسردگی دوران بارداری و بیخوابی دارد.
نتایج پژوهش حاضر نشان می دهد که با کاهش فرایندهای فکری نشخوارگونه میزان افسردگی کاهش می یابد، و مداخله‌های ذهن‌آگاهانه در خصوص بیخوابی و افسردگی، باعث بهبود و تنظیم استرس و حالات روانی در دوران پیش از زایمان می شود.

کلیدواژه‌ها

افسردگی؛ بارداری؛ بیخوابی؛ نشخوار شبانه؛ ذهن آگاهی

عنوان مقاله [English]

Pregnancy depression and insomnia in pregnant women: The predictive role of nocturnal rumination and mindfulness

نویسندگان [English]

maryam talebi

PhD in Psychology, Assistant Professor, Department of Psychology, Non-Profit Higher Education Institute, Babol, Mazandaran, Iran

چکیده [English]

Pregnancy and postpartum are the most sensitive periods in a woman's life. This period is as important physically as it is physically and psychologically. Sleep disorders and depression are common complaints during pregnancy. These disorders, which occur as a result of physiological and hormonal changes in pregnancy, have different causes and can be the cause of many disorders during pregnancy. The aim of this study was to explain the role of nocturnal rumination and mindfulness in predicting depression and insomnia. The population included women referring to gynecology and obstetrics clinics in Tehran, 136 of whom were selected by convenience sampling. In order to collect data, questionnaires of insomnia severity, Edinburgh depression, pre-sleep arousal and revised cognitive-emotional scale of mindfulness were used. Data were analyzed by SPSS 24 software. There was a positive relationship between insomnia and arousal before sleep and depression in pregnant women. Also, nocturnal rumination has a positive relationship with both variables of depression during pregnancy and insomnia and mindfulness has a negative relationship with both depression during pregnancy and insomnia.
The results of the present study show that the rate of depression decreases with the reduction of ruminant thought processes, and mindful interventions on insomnia and depression improve and regulate stress and mental states in the prenatal period.

کلیدواژه‌ها [English]

Depression, Pregnancy, Insomnia, Nocturnal rumination, Mindfulness

مراجع

1. Zhang Y, Wang S, Hermann A, Joly R, Pathak J. Development and validation of a machine learning algorithm for predicting the risk of postpartum depression among pregnant women. Journal of Affective Disorders. 2021;279:1-8.
2. Stickel S, Eickhoff S, Habel U, Stickeler E, Goecke T, Lang J, et al. Endocrine stress response in pregnancy and 12 weeks postpartum–Exploring risk factors for postpartum depression. Psychoneuroendocrinology. 2021;125:105122.
3. Khaled M, Corner GW, Morris A, Havaldar S, Luo E, Saxbe DE. Physiological Linkage in Pregnancy: Couples’ Cortisol, Negative Conflict Behavior, and Postpartum Depression. Biological Psychology. 2021:108075.
4. Osborne LM, Voegtline K, Standeven LR, Sundel B, Pangtey M, Hantsoo L, et al. High worry in pregnancy predicts postpartum depression. Journal of Affective Disorders. 2021;294:701-6.
5. Kalmbach DA, Ahmedani BK, Gelaye B, Cheng P, Drake CL. Nocturnal cognitive hyperarousal, perinatal-focused rumination, and insomnia are associated with suicidal ideation in perinatal women with mild to moderate depression. Sleep medicine. 2021;81:439-42.
6. Kalmbach DA, Cheng P, Drake CL. A pathogenic cycle between insomnia and cognitive arousal fuels perinatal depression: exploring the roles of nocturnal cognitive arousal and perinatal-focused rumination. Sleep. 2021;44(6):zsab028.
7. Arch JJ, Craske MG. Laboratory stressors in clinically anxious and non-anxious individuals: The moderating role of mindfulness. Behaviour research and therapy. 2010;48(6):495-505.
8. Cuamatzi-Castelan AS, Kalmbach DA, Atkinson R, Sangha R, Bazan L, O’Brien LM, et al. 0338 Insomnia in Late Pregnancy: Characterizing Phenotypes and Identifying Associated Factors. Sleep. 2019;42:A138.
9. Facco FL, Kramer J, Ho KH, Zee PC, Grobman WA. Sleep disturbances in pregnancy. Obstetrics & Gynecology. 2010;115(1):77-83.
10. Mindell JA, Cook RA, Nikolovski J. Sleep patterns and sleep disturbances across pregnancy. Sleep medicine. 2015;16(4):483-8.
11. Felder JN, Laraia B, Coleman-Phox K, Bush N, Suresh M, Thomas M, et al. Poor sleep quality, psychological distress, and the buffering effect of mindfulness training during pregnancy. Behavioral sleep medicine. 2018;16(6):611-24.
12. Wang W-J, Hou C-L, Jiang Y-P, Han F-z, Wang X-Y, Wang S-B, et al. Prevalence and associated risk factors of insomnia among pregnant women in China. Comprehensive Psychiatry. 2020;98:152168.
13. Tan EK, Tan EL. Alterations in physiology and anatomy during pregnancy. Best practice & research Clinical obstetrics & gynaecology. 2013;27(6):791-802.
14. Pien GW, Schwab RJ. Sleep disorders during pregnancy. Sleep. 2004;27(7):1405-17.
15. Kalmbach DA, Cheng P, Ong JC, Ciesla JA, Kingsberg SA, Sangha R, et al. Depression and suicidal ideation in pregnancy: exploring relationships with insomnia, short sleep, and nocturnal rumination. Sleep medicine. 2020;65:62-73.
16. DeJong H, Fox E, Stein A. Rumination and postnatal depression: A systematic review and a cognitive model. Behaviour research and therapy. 2016;82:38-49.
17. Chang JJ, Pien GW, Duntley SP, Macones GA. Sleep deprivation during pregnancy and maternal and fetal outcomes: is there a relationship? Sleep medicine reviews. 2010;14(2):107-14.
18. Gaté MA, Watkins ER, Simmons JG, Byrne ML, Schwartz OS, Whittle S, et al. Maternal parenting behaviors and adolescent depression: The mediating role of rumination. Journal of Clinical Child & Adolescent Psychology. 2013;42(3):348-57.
19. Kalmbach DA, Castelan AC, Atkinson R, Sangha R, O'Brien L, Drake CL. Insomniacs in Late Pregnancy are Clinically Depressed: Exploring the Role of Nocturnal Rumination [1K]. Obstetrics & Gynecology. 2019;133:118S.
20. Alipour, Lamiiyan, Minur, Hajizadeh, Ibrahim. Quality of sleep in late pregnancy and postpartum depression. Iranian Journal of Obstetrics, Gynecology and Infertility. 2012;14(8):39-47.
21. Ong JC, Xia Y, Smith-Mason CE, Manber R. A randomized controlled trial of mindfulness meditation for chronic insomnia: Effects on daytime symptoms and cognitive-emotional arousal. Mindfulness. 2018;9(6):1702-12.
22. Lucena L, Frange C, Pinto ACA, Andersen ML, Tufik S, Hachul H. Mindfulness interventions during pregnancy: A narrative review. Journal of Integrative Medicine. 2020.
23. Kabat‐Zinn J. Mindfulness‐based interventions in context: past, present, and future. Clinical psychology: Science and practice. 2003;10(2):144-56.
24. Davidson RJ, Kabat-Zinn J, Schumacher J, Rosenkranz M, Muller D, Santorelli SF, et al. Alterations in brain and immune function produced by mindfulness meditation. Psychosomatic medicine. 2003;65(4):564-70.
25. Ellis A. Rational emotive behavior therapy and the mindfulness based stress reduction training of Jon Kabat-Zinn. Journal of rational-emotive and cognitive-behavior therapy. 2006;24(1):63-78.
26. Kalmbach DA, Cheng P, O’Brien LM, Swanson LM, Sangha R, Sen S, et al. A randomized controlled trial of digital cognitive behavioral therapy for insomnia in pregnant women. Sleep Medicine. 2020.
27. O'Mahen HA, Flynn HA, Nolen-Hoeksema S. Rumination and interpersonal functioning in perinatal depression. Journal of Social and Clinical Psychology. 2010;29(6):646-67.
28. Tester‐Jones M, Karl A, Watkins E, O'Mahen H. Rumination in dysphoric mothers negatively affects mother–infant interactions. Journal of Child Psychology and Psychiatry. 2017;58(1):38-45.
29. Ludwig DS, Kabat-Zinn J. Mindfulness in medicine. Jama. 2008;300(11):1350-2.
30. Kalmbach DA, Buysse DJ, Cheng P, Roth T, Yang A, Drake CL. Nocturnal cognitive arousal is associated with objective sleep disturbance and indicators of physiologic hyperarousal in good sleepers and individuals with insomnia disorder. Sleep medicine. 2020;71:151-60.
31. Dunn C, Hanieh E, Roberts R, Powrie R. Mindful pregnancy and childbirth: effects of a mindfulness-based intervention on women’s psychological distress and well-being in the perinatal period. Archives of women's mental health. 2012;15(2):139-43.
32. Nyklíček I, Truijens SE, Spek V, Pop VJ. Mindfulness skills during pregnancy: prospective associations with mother's mood and neonatal birth weight. Journal of psychosomatic research. 2018;107:14-9.
33. Aslami E, Alipour A, Aghayusefi A, Najib F. Assessing the effectiveness of mindfulness-based Islamic–spiritual schemas on anxiety of mothers pregnancy and infants physiological health. Quarterly Journal of Health Psychology. 2015;4(14):129-40.
34. Roth B, Robbins D. Mindfulness-based stress reduction and health-related quality of life: Findings from a bilingual inner-city patient population. Psychosomatic medicine. 2004;66(1):113-23.
35. Woolhouse H, Mercuri K, Judd F, Brown SJ. Antenatal mindfulness intervention to reduce depression, anxiety and stress: a pilot randomised controlled trial of the MindBabyBody program in an Australian tertiary maternity hospital. BMC pregnancy and childbirth. 2014;14(1):1-16.
36. DeSocio JE. Epigenetics, maternal prenatal psychosocial stress, and infant mental health. Archives of psychiatric nursing. 2018;32(6):901-6.