Depression and Anxiety Symptoms at Two Months Postpartum in Women and Perceived Sleep Quality: A Cross‐Sectional Study

BACKGROUND: Sleep disturbances are frequent in the postpartum period and strongly associated with maternal mental health. The aim of this study was to examine the association between clinically significant depressive, anxiety, and comorbid symptoms and maternal perceptions of sleep quality at two months postpartum. Specifically, we aimed to (1) determine the proportion of women with clinically significant depressive symptoms, anxiety symptoms, or comorbid symptoms who report compromised sleep and (2) identify psychosocial and obstetric factors associated with compromised maternal sleep. METHODS: A cross-sectional study was conducted with 531 Portuguese women at 2 months postpartum, recruited as part of the INTERSECT project. Participants completed self-reported measures of depression and anxiety, the Edinburgh Postnatal Depression Scale (EPDS), the State-Trait Anxiety Inventory-State subscale (STAI-S), and two self-report items on perceived sleep difficulties: (1) not sleeping well unrelated to the infant's sleep pattern, and (2) difficulty initiating or maintaining sleep. Current mental health status was assessed via self-report and referred to the participant's subjective perception of ongoing mental health difficulties. Group comparisons were conducted according to mental health status: women without clinically significant symptoms (EPDS < 13 and STAI < 45; n = 426), women with clinically significant depression or anxiety symptoms (EPDS ≥ 13 or STAI-S ≥ 45; n = 49), and women with clinically significant depression and anxiety symptoms (EPDS ≥ 13 and STAI-S ≥ 45; n = 42). Kruskal-Wallis tests were used for continuous variables, and chi-square tests for categorical variables. Hierarchical logistic regression models were used to estimate psychosocial and obstetric predictors of compromised sleep. RESULTS: Clinically significant depression symptoms were reported by 10.9%, anxiety by 15.3%, and comorbidity by 7.9% of participants. Compared to women without clinically significant symptoms, those with clinically significant depression and anxiety symptoms were nearly more than twice as likely to report poor sleep unrelated to the infant (OR = 2.15, p < 0.05), whereas no significant association was observed for difficulty falling or staying asleep. Childbirth-related trauma and current mental health status predicted more sleep difficulties. DISCUSSION: Comorbid depression and anxiety symptoms emerged as the strongest correlate of compromised maternal sleep. These findings highlight the importance of routine assessment of sleep difficulties and mental health problems in the postpartum period.