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Original Research March 1, 2022

Postpartum Thoughts of Infant-Related Harm and Obsessive-Compulsive Disorder: Relation to Maternal Physical Aggression Toward the Infant

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J Clin Psychiatry 2022;83(2):21m14006

ABSTRACT

Objective: Unwanted intrusive thoughts (UITs) of intentional infant-related harm are ubiquitous among new mothers and frequently raise concerns about infant safety. The purpose of this research was to assess the relation of new mothers’ UITs of intentional, infant-related harm and obsessive-compulsive disorder (OCD) with maternal aggression toward the infant and to document the prevalence of maternal aggression toward the infant.

Methods: From a prospective, province-wide, unselected sample of 763 English-speaking postpartum women, a total of 388 participants provided data for this portion of the research. Participants completed 2 questionnaires and interviews postpartum to assess UITs of infant-related harm, OCD (based on DSM-5 criteria), and maternal aggression toward the infant. Data for this research were collected from February 9, 2014, to February 14, 2017.

Results: Overall, few participants (2.9%; 95% CI, 1.5% to 4.7%) reported behaving aggressively toward their infant. Participants who reported UITs of intentional, infant-related harm (44.4%; 95% CI, 39.2% to 49.7%) were not more likely to report aggression toward their newborn compared with women who did not report this ideation (2.6%; 95% CI, 0.9% to 5.8%; and 3.1%; 95% CI, 1.3% to 6.2%, respectively). The same was true for women with and without OCD (1.9%; 95% CI, 0.3% to 6.4%; and 3.5%; 95% CI, 1.8% to 6.0%), respectively.

Conclusions: This study found no evidence that the occurrence of either UITs of intentional, infant-related harm or OCD is associated with an increased risk of infant harm. The prevalence of child abuse of infants in this sample (2.9%) is lower than reported in others (4%–9%). Findings provide critical and reassuring information regarding the relation between new mothers’ UITs of intentional harm and risk of physical violence toward the infant.

ABSTRACT

Objective: Unwanted intrusive thoughts (UITs) of intentional infant-related harm are ubiquitous among new mothers and frequently raise concerns about infant safety. The purpose of this research was to assess the relation of new mothers’ UITs of intentional, infant-related harm and obsessive-compulsive disorder (OCD) with maternal aggression toward the infant and to document the prevalence of maternal aggression toward the infant.

Methods: From a prospective, province-wide, unselected sample of 763 English-speaking postpartum women, a total of 388 participants provided data for this portion of the research. Participants completed 2 questionnaires and interviews postpartum to assess UITs of infant-related harm, OCD (based on DSM-5 criteria), and maternal aggression toward the infant. Data for this research were collected from February 9, 2014, to February 14, 2017.

Results: Overall, few participants (2.9%; 95% CI, 1.5% to 4.7%) reported behaving aggressively toward their infant. Participants who reported UITs of intentional, infant-related harm (44.4%; 95% CI, 39.2% to 49.7%) were not more likely to report aggression toward their newborn compared with women who did not report this ideation (2.6%; 95% CI, 0.9% to 5.8%; and 3.1%; 95% CI, 1.3% to 6.2%, respectively). The same was true for women with and without OCD (1.9%; 95% CI, 0.3% to 6.4%; and 3.5%; 95% CI, 1.8% to 6.0%), respectively.

Conclusions: This study found no evidence that the occurrence of either UITs of intentional, infant-related harm or OCD is associated with an increased risk of infant harm. The prevalence of child abuse of infants in this sample (2.9%) is lower than reported in others (4%–9%). Findings provide critical and reassuring information regarding the relation between new mothers’ UITs of intentional harm and risk of physical violence toward the infant.

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  1. World Health Organization. Violence against children. WHO website. https://www.who.int/health-topics/violence-against-children#tab=tab_1. Updated 2021.
  2. Ellonen N, Kääriäinen J, Lehti M, et al. Comparing trends in infanticides in 28 countries, 1960–2009. J Scand Stud Criminol Crime Prev. 2015;16(2):175–193. CrossRef
  3. Regalado M, Sareen H, Inkelas M, et al. Parents’ discipline of young children: results from the National Survey of Early Childhood Health. Pediatrics. 2004;113(suppl 6):1952–1958. PubMed CrossRef
  4. Finkelhor D, Turner HA, Shattuck A, et al. Violence, crime, and abuse exposure in a national sample of children and youth: an update. JAMA Pediatr. 2013;167(7):614–621. PubMed CrossRef
  5. US Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. Child maltreatment 2012 [online]. Washington, DC: Government printing office; 2012. US Department of Health and Human Services website. https://www.acf.hhs.gov/archive/cb/report/child-maltreatment-2012. Updated 2012.
  6. Fujiwara T, Yamaoka Y, Kawachi I. Neighborhood social capital and infant physical abuse: a population-based study in Japan. Int J Ment Health Syst. 2016;10(1):13. PubMed CrossRef
  7. Fujiwara T, Yamaoka Y, Morisaki N. Self-reported prevalence and risk factors for shaking and smothering among mothers of 4-month-old infants in Japan. J Epidemiol. 2016;26(1):4–13. PubMed CrossRef
  8. Peltonen K, Ellonen N, Pösö T, et al. Mothers’ self-reported violence toward their children: a multifaceted risk analysis. Child Abuse Negl. 2014;38(12):1923–1933. PubMed CrossRef
  9. Reijneveld SA, van der Wal MF, Brugman E, et al. Infant crying and abuse. Lancet. 2004;364(9442):1340–1342. PubMed CrossRef
  10. Zolotor AJ, Robinson TW, Runyan DK, et al. The emergence of spanking among a representative sample of children under 2 years of age in North Carolina. Front Psychiatry. 2011;24(2):36. PubMed CrossRef
  11. Isumi A, Fujiwara T. Synergistic effects of unintended pregnancy and young motherhood on shaking and smothering of infants among caregivers in Nagoya City, Japan. Front Public Health. 2017;5:245. PubMed CrossRef
  12. Fairbrother N, Woody SR. New mothers’ thoughts of harm related to the newborn. Arch Women Ment Health. 2008;11(3):221–229. PubMed CrossRef
  13. Russell EJ, Fawcett JM, Mazmanian D. Risk of obsessive-compulsive disorder in pregnant and postpartum women: a meta-analysis. J Clin Psychiatry. 2013;74(4):377–385. PubMed CrossRef
  14. 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
  15. Hall PL, Wittkowski A. An exploration of negative thoughts as a normal phenomenon after childbirth. J Midwifery Womens Health. 2006;51(5):321–330. PubMed CrossRef
  16. Pirec V, Grabowski A. New mothers with disturbing thoughts: Treatment of obsessive-compulsive disorder and of psychosis in postpartum. In: Paarlberg KM, van de Wiel HBM, eds. Bio-Psycho-Social Obstetrics and Gynecology. Cham: Springer International Publishing; 2017:65–84.
  17. Fairbrother N, Janssen P, Antony MM, et al. Perinatal anxiety disorder prevalence and incidence. J Affect Disord. 2016;200:148–155. PubMed CrossRef
  18. Sharma V, Mazmanian D. Are We Overlooking Obsessive-Compulsive Disorder During and After Pregnancy? Some Arguments for a Peripartum Onset Specifier. Arch Womens Ment Health; 2020.
  19. Veale D, Freeston M, Krebs G, et al. Risk assessment and management in obsessive-compulsive disorder. Adv Psychiatr Treat. 2009;15(5):332–343. CrossRef
  20. Bramante A. Thoughts of harming the child: Obsessive compulsive disorder and differential diagnosis. In: Grussu P, Bramante A, eds. Manual of Perinatal Psychopathology: Psychopathological Profiles and Methods of Intervention. Trento: Edizioni Erickson; 2016.
  21. Salkovskis PM, Millar JFA. Still cognitive after all these years? perspectives for a cognitive behavioural theory of obsessions and where we are 30 years later. Aust Psychol. 2016;51(1):3–13. CrossRef
  22. 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
  23. Perinatal Services BC. Perinatal services British Columbia, number of facility births: April 1, 2008–March 31, 2009. Perinatal Services BC website. http://www.perinatalservicesbc.ca/Documents/Data-Surveillance/Maps-Tables/SurveillanceMapFacilityBirths20082009.pdf. Updated 2010.
  24. American Psychiatric Publishing. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. Fifth Edition. American Psychiatric Publishing; 2013.
  25. Bürkner PC. Brms: An R package for Bayesian multilevel models using stan. J Stat Softw. 2017;80(1):1–28. CrossRef
  26. R Core Team. R: a language and environment for statistical computing. R Foundation for statistical computing, Vienna, Austria. R Project website. http://www.R-project.org/. 2020.
  27. Fawcett EJ, Fairbrother N, Cox ML, et al. The prevalence of anxiety disorders during pregnancy and the postpartum period: a multivariate Bayesian meta-analysis. J Clin Psychiatry. 2019;80(4):18r12527. PubMed
  28. Fawcett EJ, Power H, Fawcett JM. Woman are at greater risk of OCD than men: a meta-analytic review of OCD prevalence worldwide. J Clin Psychiatry. 2020;81(4):19r13085. PubMed CrossRef
  29. Fawcett JM, Wakeham-Lewis R, Garland S, et al. Obsessive compulsive disorder prevalence may not increase with latitude: a re-analysis and extension of Coles et al. J Obsessive Compuls Relat Disord. 2020;25:100527. CrossRef
  30. Wagenmakers EJ, Lodewyckx T, Kuriyal H, et al. Bayesian hypothesis testing for psychologists: a tutorial on the Savage-Dickey method. Cognit Psychol. 2010;60(3):158–189. PubMed CrossRef
  31. Challacombe FL, Wroe AL. A hidden problem: consequences of the misdiagnosis of perinatal obsessive-compulsive disorder. Br J Gen Pract. 2013;63(610):275–276. PubMed CrossRef
  32. 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
  33. 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. CrossRef
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