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BACKGROUND: Vaccine hesitancy is driven by a heterogeneous and changing set of psychological, social and historical phenomena, requiring multidisciplinary approaches to its study and intervention. Past research has brought to light instances of both interpersonal and institutional trust playing an important role in vaccine uptake. However, no comprehensive study to date has specifically assessed the relative importance of these two categories of trust as they relate to vaccine behaviors and attitudes. METHODS: In this paper, we examine the relationship between interpersonal and institutional trust and four measures related to COVID-19 vaccine hesitancy and one measure related to general vaccine hesitancy. We hypothesize that, across measures, individuals with vaccine hesitant attitudes and behaviors have lower trust-especially in institutions-than those who are not hesitant. We test this hypothesis in a sample of 1541 Canadians. RESULTS: A deficit in both interpersonal and institutional trust was associated with higher levels of vaccine hesitant attitudes and behaviors. However, institutional trust was significantly lower than interpersonal trust in those with high hesitancy scores, suggesting that the two types of trust can be thought of as distinct constructs in the context of vaccine hesitancy. CONCLUSIONS: Based on our findings, we suggest that diminished institutional trust plays a crucial role in vaccine hesitancy. We propose that this may contribute to a tendency to instead place trust in interpersonally propagated belief systems, which may be more strongly misaligned with mainstream evidence and thus support vaccine hesitancy attitudes. We offer strategies rooted in these observations for creating public health messages designed to enhance vaccine uptake.
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Vacunas contra la COVID-19 , Confianza , Vacilación a la Vacunación , Humanos , Canadá , Vacunación/psicologíaRESUMEN
PURPOSE: While the prevalence of delusional themes appears to be consistent across geographic contexts, little is known about the relative prevalence of such themes within a given setting over periods of time. We therefore investigated delusional themes across 12 years of presentation to a catchment-based early intervention service for first episode psychosis (FEP). METHODS: Systematically collected data from 500 patients at an early intervention service for FEP were analyzed. Four cohorts of 3 years each, from 2006 to 2017, were used to compare the frequency of delusion themes across cohorts. We also integrated into the analysis baseline sociodemographic factors such as gender, age, and highest level of education and clinical factors such as anxiety, depression, suicidality, hallucinations, and primary diagnosis (affective or non-affective psychosis). RESULTS: Sex and education level were stable across cohorts, while patient age varied (p = 0.047). Clinical anxiety, depression, and suicidality at entry were also stable. Across cohorts, the proportion of patients with affective versus non-affective diagnosis differed (p = 0.050), with no differences in global rating of delusion severity or theme prevalence except for delusions of guilt or sin (p = 0.001). This single theme difference was not correlated with age or diagnosis. CONCLUSION: Our study suggests relatively stable prevalence of delusion themes across cohorts of individuals experiencing FEP. This demonstrates the potential utility of studying thematic content both for understanding delusions in clinical populations and in research. Future explorations of the relationships between delusion themes and across individual patient episodes should be conducted.
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Deluciones , Trastornos Psicóticos , Humanos , Deluciones/diagnóstico , Deluciones/epidemiología , Trastornos Psicóticos/diagnóstico , Trastornos Psicóticos/epidemiología , Trastornos Psicóticos/terapia , Alucinaciones/diagnóstico , Ansiedad/epidemiología , Trastornos de AnsiedadRESUMEN
Studies of socioeconomic disparities have largely focused on correlating brain measures with either composite measure of socioeconomic status (SES), or its components-family income or parental education, giving little attention to the component of parental occupation. Emerging evidence suggests that parental occupation may be an important and neglected indicator of childhood and adolescent SES compared to absolute measures of material resources or academic attainment because, while related, it may more precisely capture position in social hierarchy and related health outcomes. On the other hand, although cortical thickness and surface area are brain measures with distinct genetic and developmental origins, large-scale neuroimaging studies investigating regional differences in interaction of the composite measure of SES or its components with cortical thickness and surface area are missing. We set out to fill this gap, focusing specifically on the role of parental occupation on cortical thickness and surface area by analyzing magnetic resonance imaging scans from 704 healthy individuals (age = 3-21 years). We observed spatially distributed patterns of (parental occupation × age2 ) interaction with cortical thickness (localized at the left caudal middle frontal, the left inferior parietal and the right superior parietal) and surface area (localized at the left orbitofrontal cortex), indicating independent sources of variability. Further, with decreased cortical thickness, children from families with lower parental occupation exhibited lower self-esteem. Our findings demonstrate distinct influence of parental occupation on cortical thickness and surface area in children and adolescents, potentially reflecting different neurobiological mechanisms by which parental occupation may impact brain development.
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Corteza Cerebral/anatomía & histología , Desarrollo Humano/fisiología , Autoimagen , Factores Socioeconómicos , Adolescente , Adulto , Factores de Edad , Corteza Cerebral/diagnóstico por imagen , Niño , Preescolar , Escolaridad , Femenino , Humanos , Renta , Imagen por Resonancia Magnética , Masculino , Ocupaciones , Padres , Clase Social , Adulto JovenRESUMEN
Theory of mind, the ability to represent the mental states of others, is an important social cognitive process, which contributes to the development of social competence. Recent research suggests that interactions between gene and environmental factors, such as oxytocin receptor gene (OXTR) polymorphisms and maternal parenting behavior, may underlie individual differences in children's theory of mind. However, the potential influence of DNA methylation of OXTR remains unclear. The current study investigated the roles of OXTR methylation, maternal behavior, and their statistical interaction on toddlers' early emerging theory of mind abilities. Participants included a community sample of 189 dyads of mothers and their 2- to 3-year-old children, whose salivary DNA was analyzed. Results indicated that more maternal structuring behavior was associated with better performance, on a battery of three theory of mind tasks, while higher OXTR methylation within exon 3 was associated with poorer performance. A significant interaction also emerged, such that OXTR methylation was related to theory of mind among children whose mothers displayed less structuring, when controlling for children's age, sex, ethnicity, number of child-aged siblings, verbal ability, and maternal education. Maternal structuring behavior may buffer the potential negative impact of hypermethylation on OXTR gene expression and function.
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Receptores de Oxitocina , Teoría de la Mente , Preescolar , Femenino , Humanos , Conducta Materna , Oxitocina , Responsabilidad Parental , Receptores de Oxitocina/genéticaRESUMEN
The present study investigated the association of perinatal depression (PD) with differential methylation of 3 genomic regions among mother and child dyads: exon 3 within the oxytocin receptor (OXTR) gene and 2 intergenic regions (IGR) between the oxytocin (OXT) and vasopressin (AVP) genes. Maternal PD was assessed at 5 time-points during pregnancy and postpartum. Four groups were established based on Edinburgh Postnatal Depression Scale (EPDS) cut-off scores: no PD, prenatal or postpartum depressive symptoms only and persistent PD (depressive symptoms both prenatally and postpartum). Salivary DNA was collected from mothers and children at the final time-point, 2.9years postpartum. Mothers with persistent PD had significantly higher overall OXTR methylation than the other groups and this pattern extended to 16/22 individual CpG sites. For the IGR, only the region closer to the AVP gene (AVP IGR) showed significant differential methylation, with the persistent PD group displaying the lowest levels of methylation overall, but not for individual CpG sites. These results suggest that transient episodes of depression may not be associated with OXTR hypermethylation. Validation studies need to confirm the downstream biological effects of AVP IGR hypomethylation as it relates to persistent PD. Differential methylation of the OXTR and IGR regions was not observed among children exposed to maternal PD. The consequences of OXTR hypermethylation and AVP IGR hypomethylation found in mothers with persistent PDS may not only impact the OXT system, but may also compromise maternal behavior, potentially resulting in negative outcomes for the developing child.
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Metilación de ADN , Depresión/genética , Oxitocina , Efectos Tardíos de la Exposición Prenatal/genética , Efectos Tardíos de la Exposición Prenatal/psicología , Receptores de Oxitocina , Adulto , Preescolar , Depresión/complicaciones , Depresión Posparto/genética , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Conducta Materna , Relaciones Madre-Hijo/psicología , Madres/psicología , Neurofisinas/genética , Neurofisinas/metabolismo , Oxitocina/genética , Oxitocina/metabolismo , Embarazo , Complicaciones del Embarazo/genética , Complicaciones del Embarazo/psicología , Precursores de Proteínas/genética , Precursores de Proteínas/metabolismo , Receptores de Oxitocina/genética , Receptores de Oxitocina/metabolismo , Transducción de Señal/genética , Vasopresinas/genética , Vasopresinas/metabolismoRESUMEN
BACKGROUND: Synthetic oxytocin (synOT) is commonly used in labor management to induce and augment labor, and to prevent postpartum hemorrhage. However, its long-term consequences for maternal health and behavior are largely understudied. We examined the relationship between synOT and maternal oxytocin levels, breastfeeding, and maternal mental health at 2 months postpartum. METHODS: Women were recruited during pregnancy or within 48 hours of giving birth through obstetric practices and hospitals. A total of 386 women were visited in their homes at 2 months postpartum, where they completed questionnaires assessing breastfeeding, depression, anxiety, posttraumatic stress, and somatization. Oxytocin levels were obtained from blood samples and synOT dosage information was gathered from hospital charts. RESULTS: Intrapartum synOT dose was positively correlated with endogenous oxytocin levels at 2 months postpartum. Women who were exclusively breastfeeding at 2 months postpartum had received significantly less synOT compared with their nonexclusively breastfeeding counterparts. Higher synOT dose was associated with greater depressive, anxious, and somatization symptoms. SynOT dose was not associated with perinatal posttraumatic stress. CONCLUSIONS: The widespread use of synOT in managed labor warrants caution, as the influence of synOT on a new mother's well-being is evident at 2 months postpartum.
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Ansiedad/epidemiología , Lactancia Materna/estadística & datos numéricos , Depresión Posparto/epidemiología , Trabajo de Parto Inducido/estadística & datos numéricos , Salud Mental , Oxitócicos , Oxitocina , Trastornos Somatomorfos/epidemiología , Trastornos por Estrés Postraumático/epidemiología , Adulto , Femenino , Humanos , Trabajo de Parto , Oxitocina/sangre , Periodo Posparto , Embarazo , Factores de RiesgoRESUMEN
PURPOSE: Recent reports indicate that prenatal levels of the neuropeptide oxytocin (OT) are inversely related to depressive symptomatology and positively associated with more optimal interactive behaviors in mothers with high levels of cumulative psychosocial adversity (CPA). In the present pilot study, we aimed to identify factors associated with high versus low levels of OT in pregnant women with high levels of CPA. We hypothesized that insecurely attached women, and those who recently experienced stressful life events (SLE), would have lower levels of prenatal OT. METHODS: Thirty pregnant women with mood and anxiety disorders and high levels of CPA were recruited from the perinatal mental health service of a general hospital. Participants completed self-report measures of psychosocial stress and adult attachment style, and blood was then drawn to assess OT. RESULTS AND CONCLUSIONS: Lower OT levels were found among those who were insecurely attached, and among those who experienced SLE within the last year. In a multiple linear regression, both attachment security and SLE significantly contributed to a model of prenatal OT levels. These individual difference factors explained 38% of the variance in prenatal OT, which may in turn predict poorer maternal mental health and caregiving outcomes during the postpartum period.
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Acontecimientos que Cambian la Vida , Trastornos Mentales/complicaciones , Apego a Objetos , Oxitocina/sangre , Complicaciones del Embarazo/sangre , Estrés Psicológico/complicaciones , Adulto , Trastornos de Ansiedad/sangre , Trastornos de Ansiedad/complicaciones , Femenino , Humanos , Trastornos Mentales/sangre , Trastornos del Humor/sangre , Trastornos del Humor/complicaciones , Proyectos Piloto , Embarazo , Factores Socioeconómicos , Estrés Psicológico/sangreRESUMEN
Mothers with mood or anxiety disorders exhibit less optimal interactive behavior. The neuropeptide oxytocin (OT) has been linked to more optimal interactive behaviors in mothers without mental illness, and it may play a particularly beneficial role in mothers with mood or anxiety disorders given its antidepressant and anxiolytic functions. We compared the relationship between OT and interactive behavior in mothers with and without mental health problems. Participants included 20 women diagnosed with postpartum mood or anxiety disorders (clinical sample) and 90 women with low levels of depression and anxiety during pregnancy and postpartum (community sample). At 2 months' postpartum, blood was drawn to assess maternal OT levels, and mother-infant interaction was coded for maternal sensitivity, intrusiveness, remoteness, and depressiveness. Clinical mothers exhibited less sensitive, more intrusive, and more depressive interactive behaviors than did community mothers. The groups did not differ in OT levels. Mothers with higher OT levels were less intrusive with their infants. Higher OT levels were associated with less depressive interactive behavior only in clinical mothers. OT was associated with positive interactive behaviors in both groups. In clinical mothers, the calming and soothing effects of OT may promote more relaxed, energetic, and infant-focused interactive behaviors.
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Trastornos de Ansiedad/sangre , Depresión Posparto/sangre , Conducta Materna/psicología , Relaciones Madre-Hijo/psicología , Oxitocina/sangre , Adulto , Femenino , Humanos , Encuestas y CuestionariosRESUMEN
The hormone oxytocin (OT) is of particular interest in the study of childbearing women, as it has a role in the onset and course of labor and breastfeeding. Recent research has linked OT to maternal caregiving behavior towards her infant, and to postpartum depressive symptomatology. There is also evidence that psychosocial adversity affects the oxytocin system. The present study investigated the relationship of endogenous OT in women during pregnancy and at 8weeks postpartum to psychosocial stress, maternal symptoms of depression, and maternal sensitive behavior. It was hypothesized that OT would mediate the effects of maternal depressive symptoms on maternal interactive behavior. We also tested the hypothesis that psychosocial stress would moderate the relationship between OT and maternal depressive symptoms and sensitive behavior. A community sample of 287 women was assessed at 12-14weeks of gestation, 32-34weeks of gestation, and 7-9weeks postpartum. We measured plasma OT, maternal symptoms of depression and psychosocial stress. At the postpartum home visit, maternal behavior in interaction with the infant was videotaped, and then coded to assess sensitivity. In the sample as a whole, OT was not related to maternal depressive symptoms or to sensitive maternal behavior. However, among women who reported high levels of psychosocial stress, higher levels of plasma OT were associated with fewer depressive symptoms and more sensitive maternal behavior. These results suggest that endogenous OT may act as a buffer against the deleterious effects of stress, thereby protecting high risk women from developing depressive symptoms and promoting more sensitive maternal interactive behavior.
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Depresión/metabolismo , Depresión/psicología , Conducta Materna/fisiología , Oxitocina/metabolismo , Complicaciones del Embarazo/metabolismo , Complicaciones del Embarazo/psicología , Estrés Psicológico/metabolismo , Estrés Psicológico/psicología , Adulto , Envejecimiento/psicología , Depresión Posparto/metabolismo , Depresión Posparto/psicología , Femenino , Humanos , EmbarazoRESUMEN
INTRODUCTION: The first aim of our study was to validate the French version of the Reading the Mind in the Eyes test, a theory of mind test. The second aim was to test whether cultural differences modulate performance on this test. METHODS: A total of 109 participants completed the original English version and 97 participants completed the French version. Another group of 30 participants completed the French version twice, one week apart. RESULTS: We report a similar overall distribution of scores in both versions and no differences in the mean scores between them. However, 2 items in the French version did not collect a majority of responses, which differed from the results of the English version. Test-retest showed good stability of the French version. As expected, participants who do not speak French or English at home, and those born in Asia, performed worse than North American participants, and those who speak English or French at home. CONCLUSIONS: We report a French version with acceptable validity and good stability. The cultural differences observed support the idea that Asian culture does not use theory of mind to explain people's behaviours as much as North American people do.
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Comparación Transcultural , Emigrantes e Inmigrantes/psicología , Etnicidad/psicología , Psicometría/normas , Teoría de la Mente , Adulto , Cultura , Empatía , Femenino , Humanos , Lenguaje , Masculino , Ontario , Reproducibilidad de los Resultados , VocabularioRESUMEN
Importance: Despite growing interest in the phenomenology of delusions in psychosis, at present little is known about their content and evolution over time, including whether delusion themes are consistent across episodes. Objective: To examine the course of delusions and thematic delusion content across relapse episodes in patients presenting to an early intervention service for psychosis. Design, Setting, and Participants: This longitudinal, observational study used clinical data systematically collected from January 2003 to March 2018 from a cohort of consenting patients with affective or nonaffective first-episode psychosis, followed up naturalistically for up to 2 years in an early intervention service for psychosis in Montréal, Quebec, Canada. Data included the thematic content and severity of delusions (scores ≥3 using the Scale for the Assessment of Positive Symptoms) and associated psychotic and nonpsychotic symptoms, both across an initial episode and, in the event of remission, a potential relapse. Data were analyzed from September 2021 to February 2023. Exposure: An early intervention service for psychosis, organized around intensive case management and a multidisciplinary team approach, which observed each patient for up to 2 years of care. Main Outcomes and Measures: The primary outcome was positive symptom relapse and remission, including the presence and content of delusions, which was coded per the Scale for the Assessment of Positive Symptoms and accepted definitions. The main statistical measures included repeated paired-sample t tests and binary logistic regression analyses. Results: Of 636 consenting patients, mean (SD) age was 23.8 (4.75) years; 191 patients were female, 444 were male, and 1 patient was nonbinary. Remission rates were high, and relapse rates were relatively low: 591 individuals had baseline delusions, of which 558 (94.4%) achieved remission. Of these 558 patients, only 182 (32.6%) had a subsequent relapse to a second or later episode of psychosis. Of the 182 patients who did relapse, however, a large proportion (115 [63.2%]) reported threshold-level delusions. Of these 115, 104 patients (90.4%) had thematic delusion content consistent with that reported during the index (first) episode. Those who relapsed with delusions had fewer delusion themes present during subsequent episodes of psychosis compared with the index episode and lower levels of other psychotic and nonpsychotic symptoms. Conclusions and Relevance: Specialized early intervention services for psychosis can achieve high rates of sustained remission. However, in this study, the minority of individuals with delusions who later relapsed experienced similar delusion themes during subsequent episodes. These findings raise important considerations for the conceptualization of delusions and have clinical implications for trajectories of illness and care.
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Face masks obscure a significant portion of the face, reducing the amount of information available to gauge the mental states of others-that is, to exercise the Theory of Mind (ToM) capacity. In three experiments, we assessed the effect of face masks on ToM judgements, measuring recognition accuracy, perceived valence, and perceived arousal in various sets of facial expressions comprising 45 different mental states. Significant effects of face masks were found in all three variables. Judgements of all expressions are less accurate when masked, but, while judgements of negative expressions do not show consistent changes in valence or arousal, positive expressions are perceived to be less positive and less intense. In addition, we identified face muscles associated with changes in perceived valence and arousal, shedding light on the mechanisms through which masks impact ToM judgements, which might be relevant for mitigation strategies. We discuss the implications of these findings in the context of the recent pandemic.
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Juicio , Teoría de la Mente , Máscaras , Teoría de la Mente/fisiología , Nivel de Alerta , Expresión Facial , Emociones/fisiologíaRESUMEN
Despite the centrality of empathy in human social life, there is no widely agreed definition or characterization of the concept of empathy. A common thread in many of the proposed definitions, however, is that empathy presupposes the discrimination of self and other on the grounds that, to empathize with another individual, the mental state of the target individual must first be distinguished from the empathizer's own mental state. The purpose of this study is to investigate this proposal empirically. We employed a paradigm in which participants rated the emotional valence and degree of arousal of 93 facial expressions of mental states. We asked participants to infer the mental state represented by each facial expression (the Other condition) as well as to describe the effect of the expression on their own mental state (the Self condition). An absolute difference score between the Other and the Self conditions was used as an index of a capacity for self-other discrimination. Empathy was measured using the Interpersonal Reactivity Index. Results show that individuals high in trait empathy discriminate between self and other to a significantly greater degree when judging mental states than individuals low in trait empathy. This suggests that the capacity for self-other discrimination may be a component of the capacity for empathy and that future investigations of the concept of empathy ought to retain it. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Emociones , Empatía , Humanos , Expresión FacialRESUMEN
Vaccine hesitancy remains a significant and evolving public health challenge. The COVID-19 pandemic has created a unique decision context with significant uncertainty caused by the novelty of the disease being targeted, unfamiliarity with the vaccines being offered, misinformation, and strong handed government measures. In an effort to extend our understanding of vaccine hesitancy to the high uncertainty decision environment presented by COVID-19, we present a novel taxonomy of the determinants of vaccine hesitancy, based on an inductive analysis of qualitative data gathered during the COVID-19 pandemic. We report on focus group data from a purposive sample of 18 Canadians with varying sociodemographic characteristics and COVID-19 vaccination attitudes. An inductive thematic analysis of this data reveals eight core themes related to vaccine hesitancy: values, trust, social environment, personal anecdotes, environmental fluctuation, prior knowledge, perceived risk & systems of care. We explore these core themes as well as 25 sub-themes, contrasting them with previous models of vaccine hesitancy and suggesting potential strategies for public health professionals.
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COVID-19 , Vacilación a la Vacunación , Humanos , Canadá/epidemiología , COVID-19/epidemiología , COVID-19/prevención & control , Vacunas contra la COVID-19 , Pandemias/prevención & control , Incertidumbre , Vacilación a la Vacunación/psicologíaRESUMEN
INTRODUCTION: We report a novel delusion, primarily persecutory in form, in which the patient believes that he is being filmed, and that the films are being broadcast for the entertainment of others. METHODS: We describe a series of patients who presented with a delusional system according to which they were the subjects of something akin to a reality television show that was broadcasting their daily life for the entertainment of others. We then address three questions, the first concerning how to characterise the delusion, the second concerning the role of culture in delusion, and the third concerning the implications of cultural studies of delusion for the cognitive theory of delusion. RESULTS: Delusions are both variable and stable: Particular delusional ideas are sensitive to culture, but the broad categories of delusion are stable both across time and culture. This stability has implications for the form a cognitive theory of delusion can take. CONCLUSIONS: Cultural studies of delusion have important contributions to make to the cognitive theory of delusion.
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Deluciones/diagnóstico , Trastornos Psicóticos/diagnóstico , Esquizofrenia/diagnóstico , Adulto , Cultura , Deluciones/psicología , Humanos , Masculino , Trastornos Psicóticos/psicología , Psicología del Esquizofrénico , TelevisiónRESUMEN
This article discusses how people living with schizophrenia experience, understand, and respond to their urban environment. Our study relies on experiential photo-voice data gathered with a sample of six people diagnosed with schizophrenia and living in non-institutional settings in Montréal, Canada, to identify how individuals in this community perceive the urban landscape. We adopt a therapeutic landscapes' framework that explores the urban fabric at three levels: physical, social, and symbolic. Research participants identified both health-denying and health-enhancing places within ordinary urban landscapes. Landscapes identified as health-denying are characterized by environmental stressors and loss of control, with construction sites an example highlighted by participants. Healing and restorative landscapes, as identified by participants, were physically attractive or quiet, socially safe and welcoming, and symbolically affirmative of one's identity, all factors worthy of further study. The findings are also policy-relevant: they suggest that people living with schizophrenia and their clinicians can develop strategies to make health-enhancing uses of urban landscapes; and that urban policies and practices can foster urban environments conducive to enhanced health and well-being, both for the community of people living with schizophrenia and the wider population of urban dwellers.
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Esquizofrenia , Humanos , Esquizofrenia/terapia , Ambiente , CanadáRESUMEN
Faces provide not only cues to an individual's identity, age, gender, and ethnicity but also insight into their mental states. The aim was to investigate the temporal aspects of processing of facial expressions of complex mental states for very short presentation times ranging from 12.5 to 100 ms in a four-alternative forced choice paradigm based on Reading the Mind in the Eyes test. Results show that participants are able to recognise very subtle differences between facial expressions; performance is better than chance, even for the shortest presentation time. Importantly, we show for the first time that observers can recognise these expressions based on information contained in the eye region only. These results support the hypothesis that the eye region plays a particularly important role in social interactions and that the expressions in the eyes are a rich source of information about other peoples' mental states. When asked to what extent the observers guessed during the task, they significantly underestimated their ability to make correct decisions, yet perform better than chance, even for very brief presentation times. These results are particularly relevant in the light of the current COVID-19 pandemic and the associated wearing of face coverings.
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OBJECTIVES: This study investigates the associations between sleep disturbances, delusional ideation (DI), and depressive symptomatology across the perinatal period. METHODS: A community sample of 316 mothers completed the Sleep Symptom Checklist, Peters Delusional Inventory, and Edinburgh Postnatal Depression Scale at three time points: second trimester of pregnancy (12-14 weeks gestation), third trimester (32-34 weeks gestation), and two months postpartum. RESULTS: Longitudinal path analysis revealed a bidirectional relationship between sleep disturbance and DI across pregnancy. Sleep disturbances in early pregnancy directly predicted symptoms of depression in late pregnancy and had an indirect effect on postpartum depression through DI in late pregnancy. CONCLUSIONS: Our results suggest that disturbed sleep during pregnancy plays a role in increased levels of DI and depressive symptoms during pregnancy and postpartum.