Prevalence and Correlates of Maternal and Infant Sleep Problems in a Low-Income US Sample

Social-ecological considerations for the sleep health of rural mothers

“…Role strain and socioeconomic-related stressors can be mitigated by the social support network. Indeed, social support is related to better sleep and psychological health among mothers of diverse socio-demographic backgrounds (Belete and Misgan 2019;Mersky et al 2020;Sinai and Tikotzky 2012). In rural families, close-knit communities, familial women, and parental partners comprise the core support systems (Gjesfjeld et al 2012;Reynolds and Walther 2020).…”

“…Social support enhances sleep health, particularly in already vulnerable populations (Mersky et al 2020), and rural mothers prefer informal, non-medical advice during the transition to parenthood (Mollard et al 2016(Mollard et al , 2017; therefore, existing social networks for rural mothers may be considered a resource in disseminating information about sleep health and promoting early intervention. Given the risk of false health information about maternal and infant sleep spreading through social networks (Craswell et al 2018;Rouhi et al 2019), collaboration between health professionals and communities could focus on accurate dissemination.…”

“…Integrating behavioral health services into rural primary care can also be achieved through increased screening for behavioral health problems (Drake et al 2014) and provider-led discussions of mental health during perinatal appointments (Bauman et al 2020). Additionally, focusing on strengthening social support (Mersky et al 2020) and fostering strong alliances between patients and their health care providers can help improve mental health outcomes for mothers and their families (Batra 2019). For example, peer support has been helpful in improving adherence to treatment for obstructive sleep apnea (Parthasarathy et al 2013) and a systematic review by Ramchand et al (2017) found that didactic peer support has led to behavioral changes that positively affect general health outcomes.…”

“…An emerging literature suggests that better sleep health is associated with interpersonal support (Gunn et al 2014 ; Kent de Grey et al 2018 , 2015 ; Troxel et al 2007 ). In partnered high-income mothers, tangible paternal involvement (e.g., nighttime infant caregiving) is associated with better sleep health (Tikotzky et al 2015 ) and at least one finding in a population of low-income mothers suggests social support is associated with better sleep health (Mersky et al 2020 ). In addition, belonging to a church community, which is more common in rural areas, is associated with lower odds of PPD (Cheadle and Dunkel Schetter 2018 ; Jesse and Swanson 2007 ).…”

“…In particular, poor health outcomes during the postpartum period are likely compounded in rural women due to the prevalence of financial strain in rural areas, lack of coordinated postnatal care, geographic isolation from medical services and mental health stigma (Hung et al 2017 ; Kozhimannil et al 2017 ; Levin and Hanson 2020 ; Mollard et al 2016 ; Nidey et al 2020 ). Moreover, within rural populations, socio-demographic differences and disparities contribute to elevated risk for poor sleep health and other related health outcomes (Doering et al 2017 ; Mersky et al, 2020 ). Individuals located at the margins of mainstream rural communities (e.g., migrant farm workers), with intersectional identities composed of multiple social positions embedded within systems of inequality (López and Gadsden 2016 ), may experience even more barriers to accessing healthcare (Ceballos et al 2013 ; Schminkey et al 2019 ), are currently underrepresented in research efforts (Hargraves 2002 ; Jackson et al 2020 ; Schminkey et al 2019 ), and are underserved in their communities (Henning-Smith et al 2017 ; Tangel et al 2019 ).…”