Abstract
Objective: Unwanted, intrusive thoughts (UITs) of infant-related harm are a common postpartum phenomenon and can be classified into thoughts of accidental harm (TAHs) and thoughts of intentional harm (TIHs). Our study’s objective was to complete a comprehensive, comparative analysis of TAHs and TIHs by commenting on their prevalence, course, characteristics (time, distress, and impairment) and most intense period.
Methods: A total of 763 English-speaking pregnant women across British Columbia were recruited to participate in a prospective cohort study. Study data were collected between February 2014 and February 2017. UITs were assessed by semistructured interviews twice during the postpartum period.
Results: The prevalence of TAHs and TIHs in the postpartum period was 95.8% and 53.9%, respectively. The most common TAHs included thoughts of the baby suffocating or dying from sudden infant death syndrome; the most common TIHs included thoughts of neglect. On average, TAHs are more prevalent, time-consuming, and result in greater interference compared to TIHs. The most intense period for TAHs (5.74 weeks postpartum) and TIHs (within first 8 weeks postpartum) was identified. During this period, over 40% of participants reported moderate or extreme distress related to UITs. For most, UITs decreased in frequency or completely resolved by 6 months postpartum, and most participants did not report clinically significant symptoms.
Conclusion: UITs are a normative and typically self-resolving occurrence in the postpartum period. UITs’ most intense period signifies a time of heightened vulnerability. Increased education is necessary to normalize and reduce distress associated with UITs.
J Clin Psychiatry 2024;85(3):23m15145
Author affiliations are listed at the end of this article.
Abstract
Objective: Unwanted, intrusive thoughts (UITs) of infant-related harm are a common postpartum phenomenon and can be classified into thoughts of accidental harm (TAHs) and thoughts of intentional harm (TIHs). Our study’s objective was to complete a comprehensive, comparative analysis of TAHs and TIHs by commenting on their prevalence, course, characteristics (time, distress, and impairment) and most intense period.
Methods: A total of 763 English-speaking pregnant women across British Columbia were recruited to participate in a prospective cohort study. Study data were collected between February 2014 and February 2017. UITs were assessed by semistructured interviews twice during the postpartum period.
Results: The prevalence of TAHs and TIHs in the postpartum period was 95.8% and 53.9%, respectively. The most common TAHs included thoughts of the baby suffocating or dying from sudden infant death syndrome; the most common TIHs included thoughts of neglect. On average, TAHs are more prevalent, time-consuming, and result in greater interference compared to TIHs. The most intense period for TAHs (5.74 weeks postpartum) and TIHs (within first 8 weeks postpartum) was identified. During this period, over 40% of participants reported moderate or extreme distress related to UITs. For most, UITs decreased in frequency or completely resolved by 6 months postpartum, and most participants did not report clinically significant symptoms.
Conclusion: UITs are a normative and typically self-resolving occurrence in the postpartum period. UITs’ most intense period signifies a time of heightened vulnerability. Increased education is necessary to normalize and reduce distress associated with UITs.
J Clin Psychiatry 2024;85(3):23m15145
Author affiliations are listed at the end of this article.
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References (25)
- Abramowitz JS, Schwartz SA, Moore KM. Obsessional thoughts in postpartum females and their partners: content, severity, and relationship with depression. J Clin Psychol Med Settings. 2003;10(3):157–164.
- Brok EC, Lok P, Oosterbaan DB, et al. Infant-related intrusive thoughts of harm in the postpartum period: a critical review. J Clin Psychiatry. 2017;78(8):e913–e923. PubMed CrossRef
- Abramowitz JS, Khandker M, Nelson CA, et al. The role of cognitive factors in the pathogenesis of obsessive–compulsive symptoms: a prospective study. Behav Res Ther. 2006;44(9):1361–1374. PubMed CrossRef
- Fairbrother N, Woody SR. New mothers’ thoughts of harm related to the newborn. Arch Womens Ment Health. 2008;11(3):221–229. PubMed CrossRef
- Clark DA, Palacio Gonzalez AD. Obsessive-compulsive disorder. In: Emmelkamp P, Ehring T, eds. The Wiley Handbook of Anxiety Disorders, Volume I: Theory and Research; Volume II: Clinical Assessment and Treatment. Wiley-Blackwell; 2014:497–534. http://ezproxy.library.ubc.ca/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2015-01137-024&login.asp&site=ehostlive&scope=site.
- Fairbrother N, Collardeau F, Woody SR, et al. Postpartum thoughts of infant related harm and obsessive-compulsive disorder: relation to maternal physical aggression toward the infant. J Clin Psychiatry. 2022;83(2):21m14006. PubMed CrossRef
- Abramowitz JS, Nelson CA, Rygwall R, et al. The cognitive mediation of obsessive-compulsive symptoms: a longitudinal study. J Anxiety Disord. 2007;21(1):91–104. PubMed CrossRef
- Barrett R, Wroe AL, Challacombe FL. Context is everything: an investigation of responsibility beliefs and interpretations and the relationship with obsessive compulsive symptomatology across the perinatal period. Behav Cogn Psychother. 2016;44(3):318–330. PubMed CrossRef
- Abramowitz JS, Meltzer-Brody S, Leserman J, et al. Obsessional thoughts and compulsive behaviors in a sample of women with postpartum mood symptoms. Arch Womens Ment Health. 2010;13(6):523–530. PubMed CrossRef
- Collardeau F, Corbyn B, Abramowitz J, et al. Maternal unwanted and intrusive thoughts of infant-related harm, obsessive-compulsive disorder and depression in the perinatal period: study protocol. BMC Psychiatry. 2019;19(1):94. PubMed CrossRef
- Goodman WK, Price LH, Rasmussen SA, et al. The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Arch Gen Psychiatry. 1989;46(11):1006–1011. PubMed CrossRef
- Goodman WK, Price LH, Rasmussen SA, et al. The Yale-Brown Obsessive Compulsive Scale. II. Validity. Arch Gen Psychiatry. 1989;46(11):1012–1016. PubMed CrossRef
- López-Pina JA, Sánchez-Meca J, López-López JA, et al. The Yale–Brown Obsessive Compulsive Scale: a reliability generalization meta-analysis. Assessment. 2015;22(5):619–628. PubMed
- Woody SR, Steketee G, Chambless DL. Reliability and validity of the Yale-Brown Obsessive-Compulsive Scale. Behav Res Ther. 1995;33(5):597–605. PubMed CrossRef
- Deacon BJ, Abramowitz JS. The Yale-Brown Obsessive Compulsive Scale: factor analysis, construct validity, and suggestions for refinement. J Anxiety Disord. 2005;19(5):573–585. PubMed CrossRef
- IBM Corp. IBM SPSS Statistics for Windows, Version 24.0. IBM Corp; 2016.
- R Core Team. R: a language and environment for statistical computing. 2023. https://www.R-project.org/
- Confidence interval of a proportion. Accessed September 5, 2023. http://vassarstats.net/prop1.html
- Significance of the Difference Between Two Independent Proportions. Accessed September 5, 2023. http://vassarstats.net/propdiff_ind.html
- Confidence Interval for the Difference Between Two Independent Proportions. Accessed September 5, 2023. http://vassarstats.net/prop2_ind.html
- Perinatal Services BC. British Columbia Perinatal Data Registry; 2014. (unpublished data).
- DeBell M, Krosnick JA. Computing Weights for American National Election Study Survey Data. 2009:nes012427.
- Pasek J. Anesrake: ANES raking implementation. R Package Version 0.80; 2018.
- Wood SN. Generalized Additive Models: An Introduction with R. 2nd ed. CRC Press/Taylor & Francis Group; 2017.
- Fairbrother N, Collardeau F, Albert AYK, et al. High prevalence and incidence of obsessive-compulsive disorder among women across pregnancy and the postpartum. J Clin Psychiatry. 2021;82(2):20m13398. PubMed CrossRef
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