title: Association of poor subjective sleep quality with suicidal ideation among pregnant Peruvian women.
abstract: OBJECTIVE
  To examine the independent and joint relationships of poor subjective sleep quality and antepartum depression with suicidal ideation among pregnant women.
  
  
  METHODS
  A cross-sectional study was conducted among 641 pregnant women attending prenatal care clinics in Lima, Peru. Antepartum depression and suicidal ideation were assessed using the Patient Health Questionnaire-9 scale. Antepartum subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Logistic regression procedures were performed to estimate odds ratios (aOR) and 95% confidence intervals (95% CI) adjusted for confounders.
  
  
  RESULTS
  Overall, the prevalence of suicidal ideation in this cohort was 16.8% and poor subjective sleep quality was more common among women endorsing suicidal ideation as compared to their counterparts who did not (47.2% vs. 24.8%, P<.001). After adjustment for confounders including maternal depression, poor subjective sleep quality (defined using the recommended criteria of PSQI global score of >5 vs. ≤5) was associated with a 1.7-fold increased odds of suicidal ideation (aOR=1.67; 95% CI 1.02-2.71). When assessed as a continuous variable, each 1-unit increase in the global PSQI score resulted in an 18% increase in odds for suicidal ideation, even after adjusting for depression (aOR=1.18; 95% CI 1.08-1.28). Women with both poor subjective sleep quality and depression had a 3.5-fold increased odds of suicidal ideation (aOR=3.48; 95% CI 1.96-6.18) as compared with those who had neither risk factor.
  
  
  CONCLUSIONS
  Poor subjective sleep quality was associated with increased odds of suicidal ideation. Replication of these findings may promote investments in studies designed to examine the efficacy of sleep-focused interventions to treat pregnant women with sleep disorders and suicidal ideation.
authors.affiliation: Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA. Electronic address: bgelaye@hsph.harvard.edu.
authors.forename: Bizu
authors.initials: B
authors.lastname: Gelaye
authors.affiliation: Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
authors.forename: Yasmin V
authors.initials: YV
authors.lastname: Barrios
authors.affiliation: Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
authors.forename: Qiu-Yue
authors.initials: QY
authors.lastname: Zhong
authors.affiliation: Department of Medicine, Cayetano Heredia Peruvian University, Lima, Peru.
authors.forename: Marta B
authors.initials: MB
authors.lastname: Rondon
authors.affiliation: Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Christina P C
authors.initials: CP
authors.lastname: Borba
authors.affiliation: Universidad Peruana de Ciencias Aplicadas, Lima, Peru; Asociación Civil PROESA, Lima, Peru.
authors.forename: Sixto E
authors.initials: SE
authors.lastname: Sánchez
authors.affiliation: Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Henderson
authors.affiliation: Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Williams
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000523:psychology*; D012892:Sleep Deprivation / Q000523:psychology*; D059020:Suicidal Ideation; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Depression; Pregnancy; Sleep quality; Suicide; Suicide ideation