Insomnia and anxiety: Important pathologic correlates of postpartum depression

Postpartum depression (PPD) is a type of non-psychotic depression whose symptoms last anywhere from 2 months to a year. Its prevalence is higher in lower-and-middle-income countries (LMICs), but there is a lack of data on the perinatal population living with postnatal depression and its comorbidities, including insomnia and anxiety. However, screening for insomnia and anxiety in the perinatal period has not been incorporated in clinical practice. Moreover, the parameters of anxiety and insomnia in the perinatal population are different than those in the general population. This narrative review aims to elucidate upon perinatal insomnia and anxiety as important pathologic correlates of PPD. Second, we aim to derive an item list related to insomnia and anxiety specific to perinatal women in India. We utilized PubMed, Google, and Google Scholar as data sources to search for studies published between 1994 and 2024 using search keywords relevant to PPD both in the Indian and global context. We included 192 studies in our initial review, and 38 studies were included in the final analysis. We have ultimately generated a list of 34 items, combining parameters of insomnia and anxiety relevant to both the general and perinatal population, which can be used in their assessment. These items, if utilized to screen for insomnia and anxiety during antenatal and early postnatal visits, can be useful in determining the presence of PPD or its risk in perinatal women in India.