Nocturnal cognitive hyperarousal,perinatal-focused rumination,and insomnia are associated with suicidal ideation in perinatal women with mild to moderate depression

ObjectivesThis prospective study explored associations among insomnia, nocturnal cognitive hyperarousal, and nocturnal perinatal-focused rumination with suicidal ideation (SI) in perinatal women with depression.MethodsFrom late pregnancy through early postpartum, 39 depressed women completed 17 weekly surveys assessing SI, insomnia, depression, stress, and cognitive arousal.ResultsWomen with nocturnal cognitive hyperarousal at baseline, relative to those with low cognitive arousal, were at greater risk for new onset SI (33% vs 1%). Moreover, nocturnal perinatal-focused rumination was independently associated with SI. SI-risk was highest when women reported clinical insomnia combined with nocturnal cognitive hyperarousal (OR = 5.66, p = 0.037) or perinatal-focused rumination (OR = 11.63, p = 0.018). Daytime perseverative thinking was not uniquely associated with SI.ConclusionsNocturnal cognitive arousal predicts the development of new onset SI, and perinatal-focused rumination is also uniquely associated with SI-risk in late pregnancy and early parenting. Critically, SI-risk is highest when perinatal women endorsed insomnia and high cognitive arousal at the same time. Future research should determine whether alleviating nocturnal cognitive arousal, pregnancy- and fetal/infant-related concerns, and insomnia with psychotherapy reduces SI for women with perinatal depression.