Abstract :
Sleep disruptions, pregnancy-related pain, and antenatal depressive symptoms frequently co-occur, forming a cluster of interrelated conditions that are associated with negative outcomes for both mothers and their infants. In the context of antenatal care in Pakistan, addressing these challenges is complicated by a healthcare system that emphasizes biomedical aspects, pervasive stigma surrounding mental health, and limited resources for psychosocial assessment. The present study aimed to explore the relationships among these three domains in pregnant Pakistani women through a biopsychosocial lens. Utilizing a cross-sectional design, 250 participants attending antenatal clinics were assessed with Urdu-adapted instruments, including the Pittsburgh Sleep Quality Index (PSQI-U), a Numeric Rating Scale for Pain (NRS-U), and the Edinburgh Postnatal Depression Scale (EPDS-U). Findings indicated elevated mean scores across the sample: 8.4 (SD = 3.2) for sleep disturbance, 6.1 (SD = 1.8) for pain intensity, and 13.7 (SD = 5.4) for depressive symptoms. Correlation analyses revealed robust positive associations among all three variables (ranging from 0.44 to 0.52, all p < .001). Mediation analysis further indicated that pain intensity partially explained the link between sleep disturbance and depressive symptoms. In multivariate regression, both poor sleep quality (? = 0.35, p < .001) and heightened pain intensity (? = 0.29, p < .001) independently predicted depressive symptom severity, together accounting for 42% of the variance. These results highlight the complex interplay between somatic and psychological distress during pregnancy. The study suggests that incorporating culturally appropriate, simple screening measures for sleep and pain into routine antenatal care in Pakistan may provide a low-stigma avenue for early detection of psychological distress, fostering a more integrated, biopsychosocial approach and potentially improving perinatal health outcomes.