title: The relationship between sleep and postpartum mental disorders: A systematic review.
abstract: BACKGROUND
  Postpartum mental disorders (e.g., anxiety, depression, psychosis) are serious conditions that affect approximately 10-15% of women after childbirth, and up to 40% of women at risk for these disorders. Research reveals an association between poor sleep quality/quantity and symptoms of anxiety, depression and psychosis. The aim of this systematic review was to evaluate the available evidence for the relationship between sleep and postpartum mental disorders.
  
  
  METHODS
  Searches included MEDLINE, EMBASE, and EBM Reviews - Cochrane Central Register of Controlled Trials, PsycINFO and EBSCOHost CINAHL through June 30, 2014. Manual searching was performed on reference lists of included articles. Published primary research in any language was included.
  
  
  RESULTS
  There were 3187 unique titles/abstracts and 44 full-text articles reviewed. Thirty-one studies were included. Evidence was found for the impact of self-reported poor sleep during pregnancy and the postpartum on the development of postpartum depression, with not enough evidence for either postpartum anxiety or psychosis. The evidence for objectively assessed sleep and the development of postpartum disorders was mixed. Among the 31 studies included, 1 was strong, 13 were moderate and 17 were weak.
  
  
  CONCLUSIONS
  Research design, method of assessment, timing of assessment, recruitment strategies, representative adequacy of the samples and inclusion/exclusion criteria all varied widely. Many studies did not use tools validated for the perinatal population and had small sample sizes without power analysis.
  
  
  CONCLUSIONS
  Sleep interventions represent a potential low-cost, non-pharmacological prevention and treatment strategy for postpartum mental illness. Further high-quality research is needed on this topic area.
authors.affiliation: Mount Sinai Hospital, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada. Electronic address: alawson@mtsinai.on.ca.
authors.forename: Andrea
authors.initials: A
authors.lastname: Lawson
authors.affiliation: Mount Sinai Hospital, Department of Obstetrics & Gynecology, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Kellie E
authors.initials: KE
authors.lastname: Murphy
authors.affiliation: Mount Sinai Hospital, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Eileen
authors.initials: E
authors.lastname: Sloan
authors.affiliation: The Hospital for Sick Children, Library Sciences, Toronto, Ontario, Canada.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Uleryk
authors.affiliation: Mount Sinai Hospital, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Ariel
authors.initials: A
authors.lastname: Dalfen
mesh_terms: D002940:Circadian Rhythm; D015897:Comorbidity; D019052:Depression, Postpartum / Q000453:epidemiology* / Q000523:psychology*; D005260:Female; D006801:Humans; D008429:Maternal Welfare / Q000706:statistics & numerical data; D049590:Postpartum Period / Q000523:psychology*; D011247:Pregnancy; D012893:Sleep Wake Disorders / Q000453:epidemiology* / Q000523:psychology*
keywords: Mental health; Postpartum; Sleep; Systematic review