Association between mental health and sleep quality among Forcibly Displaced Rohingya pregnant women living in Cox’s Bazar, Bangladesh: a cross-sectional observation

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BACKGROUND: Poor sleep quality during pregnancy is associated with adverse health and developmental outcomes for both mother and fetus. Various factors may influence sleep quality, including mental health problems, stressful life circumstances, pregnancy, illness, and socio-demographic conditions. These links have been explored in refugees and asylees residing in high-income countries. There is a notable gap in the literature regarding the association of mental health and sleep quality among conflict and displacement-affected populations residing in low- and middle-income countries and exposed to ongoing instability, unpredictability, and other stressful life events. This study aimed to examine the relationship between mental health and sleep quality among Forcibly Displaced Rohingya pregnant women living in Cox’s Bazar, Bangladesh. METHODS: This study utilized data from the recruitment (February 2023 to March 2024) of pregnant Rohingya women. We measured sleep quality using the Pittsburgh Sleep Quality Index (PSQI), Hopkins Symptom Checklist-25 (HSCL-25) to evaluate anxiety and depression, and Harvard Trauma Questionnaire (HTQ-4) to measure post-traumatic stress disorder (PTSD). Prevalence rates of anxiety, depression, PTSD, and poor sleep quality were calculated. Independent sample t-tests and Pearson’s Chi-squared tests were used to assess the associations between sleep quality and other factors. Simple and multiple modified Poisson regression models with robust variance were conducted to calculate the unadjusted prevalence ratios (PRs) and adjusted prevalence ratios (aPRs) with 95% confidence intervals (CIs) to find the relationships between mental health factors and sleep quality. RESULTS: Among 2,322 pregnant women with a mean (± SD) age of 21.1 (± 5.2) years, 1,461 (62.9%) experienced anxiety, 991 (42.7%) had depression, and 294 (13.5%) had elevated PTSD symptoms. A total of 1,436 (61.8%) participants reported poor sleep quality. The adjusted prevalence ratio of poor sleep quality was significantly higher among those with anxiety (aPR = 1.24, 95% CI: 1.14–1.35), depression (aPR = 1.34, 95% CI: 1.25–1.44), and PTSD (aPR = 1.22, 95% CI: 1.15–1.30). CONCLUSIONS: A significant proportion of Forcibly Displaced Rohingya pregnant women in Cox’s Bazar, Bangladesh, suffer from poor sleep quality, which is strongly associated with anxiety, depression, and PTSD. Mental health interventions should also incorporate approaches to improve sleep quality in this vulnerable population. This is particularly important given the known links between sleep and fetal development. CLINICAL TRIAL REGISTRATION: This study was not a clinical trial; therefore, no trial registration number applies.

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