How Postpartum Women With Depressive Symptoms Manage Sleep Disruption and Fatigue

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The management of sleep and fatigue can be daunting for postpartum women (Kennedy, Gardiner, Gay, & Lee, 2007; Runquist, 2007). Sleep disruption is common in postpartum women due to newborns’ irregular patterns of sleeping and feeding and immature circadian rhythms (McGuire, 2013). Sleep disruption is a significant component of postpartum fatigue and compromises daytime functioning and possibly even safety (Coo, Milgrom, & Trinder, 2014; Insana, Williams, & Montgomery‐Downs, 2013; Malish, Arastu, & O'Brien, 2016; Piteo et al., 2013). Researchers are beginning to investigate the complex and reciprocal interplay between parents and infants pertaining to the development of infant sleep patterns (Philbrook & Teti, 2016; Posmontier, 2008).
Sleep disruption and fatigue also are common symptoms in persons with major depressive disorder, showing bidirectional relationships with depressive symptoms and with clinical depression (Giallo, Gartland, Woolhouse, & Brown, 2016; Lawson, Murphy, Sloan, Uleryk, & Dalfen, 2015; Piteo et al., 2013; Posmontier, 2008). These symptoms may be resistant to antidepressant treatment and may continue to impair functioning even after clinical depression is treated to remission (Fava et al., 2014; Zajecka, 2013). In postpartum women, interventions to improve maternal mood by improving sleep have had mixed results, in part due to methodological limitations, and most sleep intervention studies have excluded women with a history of major depressive disorder (Doering & Dogan, 2016; Kempler, Sharpe, Miller, & Bartlett, 2015; Lawson et al., 2015).
Researchers are calling for inclusion of underrepresented racial and ethnic groups and diverse socioeconomic contexts in studies of postpartum sleep, fatigue, and depression to improve representation of groups who are more likely to suffer from health disparities (Bhati & Richards, 2015; Goyal, Gay, & Lee, 2010; Goyal, Wang, Shen, Wong, & Palaniappan, 2012; Posmontier, 2008). Although some researchers are beginning to examine postpartum sleep and fatigue in low‐income women (Doering & Durfor, 2010; Lee & Gay, 2011; Runquist, 2007) or examine depression symptoms in low‐income mothers (Abrams & Curran, 2009), no published reports were found on the everyday experience and management of postpartum sleep and fatigue by low‐income women who also have depressive symptoms.
Because more than 10% of postpartum women meet the criteria for major depressive disorder (Hoertel et al., 2015), we argue that women with depressive symptoms may require more personalized attention by outpatient and home visiting nurses to maximize intervention efficacy and improve health outcomes. This may be especially important in women whose depressive symptoms are sub‐clinical and do not meet a threshold to qualify for depression treatment, or for whom rates of detection, evaluation, and treatment are low (Anderson et al., 2006; Goodman & Tyer‐Viola, 2010; Kelly, Zatzick, & Anders, 2001; Kim et al., 2010).
Interventions to address the modifiable depression risk factors of sleep disruption and postpartum fatigue may slow or stop the trajectory toward clinical depression (Giallo et al., 2016). A grounded theory research approach can generate theories of complex human health processes and guide intervention development (Reed & Runquist, 2007). The purpose of this study was to generate a grounded theory of the process used by postpartum women with depressive symptoms to manage sleep and fatigue.
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