Prevalence and Course of Unwanted, Intrusive Thoughts of Infant-Related Harm

Fanie Collardeau, PhD; Olivia L. U. Anglin, MD; Arianne Y. K. Albert, PhD; Jazlyn G. Mayhue, MD; Nichole Fairbrother, PhD

J Clin Psychiatry 2024;85(3):23m15145

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.

Continue Reading...

Did you know members enjoy unlimited free PDF downloads as part of their subscription? Subscribe today for instant access to this article and our entire library in your preferred format. Alternatively, you can purchase the PDF of this article individually.

Subscribe Now

Already a member? Login

Purchase PDF for $40

Members enjoy free PDF downloads on all articles. Join today

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