Hostname: page-component-8448b6f56d-42gr6 Total loading time: 0 Render date: 2024-04-19T01:23:02.736Z Has data issue: false hasContentIssue false
  • English
  • Français

Correlates and Predictors of New Mothers’ Responses to Postpartum Thoughts of Accidental and Intentional Harm and Obsessive Compulsive Symptoms

Published online by Cambridge University Press:  20 February 2018

Nichole Fairbrother ,
Dana S. Thordarson ,
Fiona L. Challacombe  and
John K. Sakaluk
Nichole Fairbrother*
Affiliation:
Island Medical Program/Psychiatry, University of British Columbia, Room 002, Pearkes Building, Queen Alexandra Centre for Children's Health, 2400 Arbutus Road, Victoria, British Columbia, V8N IV7, Canada
Dana S. Thordarson
Affiliation:
Division of Midwifery, Department of Family Practice, University of British Columbia, 320–5950 University Boulevard, Vancouver, British Columbia, V6T 1Z3, Canada
Fiona L. Challacombe
Affiliation:
Centre for Anxiety Disorders and Trauma, South London and Maudsley NHS Trust, 99 Denmark Hill, London SE5 8AZ, UK
John K. Sakaluk
Affiliation:
Department of Psychology, University of Victoria Room A240, Cornett Building, 3800 Finnerty Road (Ring Road), Victoria, British Columbia, V8P 5C2, Canada
*
Correspondence concerning this manuscript should be addressed to Nichole Fairbrother, Room 002, Pearkes Building, Queen Alexandra Centre for Children's Health, 2400 Arbutus Road, Victoria, BC, V8N IV7, Canada. E-mail: nicholef@uvic.ca
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Unwanted, intrusive thoughts of infant-related harm are a normal, albeit distressing experience for most new mothers. The occurrence of these thoughts can represent a risk factor for the development of obsessive compulsive disorder (OCD). As the early postpartum period represents a time of increased risk for OCD development, the transition to parenthood provides a unique opportunity to better understand OCD development. Aims: The purpose of this study was to assess components of cognitive behavioural conceptualizations of postpartum OCD in relation to new mothers’ thoughts of infant-related harm. Method: English-speaking pregnant women (n = 100) participated. Questionnaires were completed at approximately 36 weeks of gestation, and at 4 and 12 weeks postpartum. An interview to assess postpartum harm thoughts was administered at 4 and 12 weeks postpartum. Questionnaires assessed OC symptoms, OC-related beliefs, fatigue, sleep difficulties and negative mood. Results: Prenatal OC-related beliefs predicted postpartum OC symptoms, as well as harm thought characteristics and behavioural responses to harm thoughts. The severity of behavioural responses to early postpartum harm thoughts did not predict later postpartum OC symptoms, but did predict frequency and time occupation of accidental harm thoughts, and interference in parenting by intentional harm thoughts. Strong relationships between OC symptoms and harm thought characteristics, and concurrent sleep difficulties, negative mood and fatigue were also found. Conclusions: Findings provide support for cognitive behavioural conceptualizations of postpartum OCD and emphasize the importance of maternal sleep, fatigue and negative mood in the relationship between OC-related beliefs and maternal cognitive and behavioural responses to postpartum harm thoughts.

Keywords

intrusive thoughtsobsessive compulsive disordernew mothers
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 46 , Issue 4 , July 2018 , pp. 437 - 453
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abramowitz, J. S. and Deacon, B. J. (2006). Psychometric properties and construct validity of the Obsessive Compulsive Inventory-Revised: replication and extension with a clinical sample. Journal of Anxiety Disorders, 20, 1016–1035. doi: 10.1016/j.janxdis.2006.03.001Google Scholar
Abramowitz, J. S., Khandker, M., Nelson, C. A., Deacon, B. J. and Rygwall, R. (2006). The role of cognitive factors in the pathogenesis of obsessive-compulsive symptoms: a prospective study. Behaviour Research and Therapy, 44, 1361–1374. doi: 10.1016/j.brat.2005.09.011CrossRefGoogle ScholarPubMed
Abramowitz, J. S., Nelson, C. A., Rygwall, R. and Khandker, M. (2007). The cognitive mediation of obsessive-compulsive symptoms: a longitudinal study. Journal of Anxiety Disorders, 21, 91–104. doi: 10.1016/j.janxdis.2006.05.003CrossRefGoogle ScholarPubMed
Abramowitz, J. S., Tolin, D. F. and Diefenbach, G. J. (2005). Measuring change in OCD: Sensitivity of the obsessive-compulsive inventory-revised. Journal of Psychopathology and Behavioral Assessment, 27, 317–324. doi: 10.1007/s10862-005-2411-yGoogle Scholar
Ahmad, T. F. E., Suleiman, R. and Shougah, D. (1994). Mixed anxiety depression in pregnancy: the influence of misconceptions. Arab Journal of Psychiatry, 5, 103–113.Google Scholar
Backhaus, J., Junghanns, K., Broocks, A., Riemann, D. and Hohagen, F. (2002). Test–retest reliability and validity of the pittsburgh sleep quality index in primary insomnia. Journal of Psychosomatic Research, 53, 737–740. doi: 10.1016/S0022-3999(02)00330-6CrossRefGoogle ScholarPubMed
Barrett, R., Wroe, A. L. and Challacombe, F. L. (2016). Context is everything: an investigation of responsibility beliefs and interpretations and the relationship with obsessive-compulsive symptomatology across the perinatal period. Behavioural and Cognitive Psychotherapy, 44, 318. doi: 10.1017/S1352465815000545Google Scholar
Beck, A. T., Steer, R. A. and Brown, G. K. (1996). Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation.Google Scholar
Belza, B. (1990). Multidimensional Assessment of Fatigue (MAF) Scale: User's Guide. Available at: http://www.son.washington.edu/research/maf/users-guide.aspGoogle Scholar
Belza, B. L. (1995). Comparison of self-reported fatigue in rheumatoid arthritis and controls. Journal of Rheumatology, 22, 639.Google ScholarPubMed
Belza, B. L., Henke, C. J., Yelin, E. H., Epstein, W. V. and Gilliss, C. L. (1993). Correlates of fatigue in older adults with rheumatoid arthritis. Nursing Research, 42, 93–99. doi: 10.1097/00006199-199303000-00006Google Scholar
Belza, B., Steele, B. G., Cain, K., Coppersmith, J., Howard, J. and Lakshminarayan, S. (2005). Seattle obstructive lung disease questionnaire: sensitivity to outcomes in pulmonary rehabilitation in severe pulmonary illness. Journal of Cardiopulmonary Rehabilitation, 25, 107–114. doi: 10.1097/00008483-200503000-00011Google Scholar
Bormann, J., Shively, M., Smith, T. L. and Gifford, A. L. (2001). Measurement of fatigue in HIV-positive adults: reliability and validity of the global fatigue index. Journal of the Association of Nurses in AIDS Care, 12, 75–83. doi: 10.1016/S1055-3290(06)60146-5CrossRefGoogle ScholarPubMed
Buysse, D. J., Reynolds, C. F., Monk, T. H., Berman, S. R. and Kupfer, D. J. (1989). The pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Research, 28, 193–213. doi: 10.1016/0165-1781(89)90047-4CrossRefGoogle ScholarPubMed
Carpenter, J. S. and Andrykowski, M. A. (1998). Psychometric evaluation of the pittsburgh sleep quality index. Journal of Psychosomatic Research, 45, 5–13. doi: 10.1016/S0022-3999(97)00298-5Google Scholar
Cella, D., Yount, S., Sorensen, M., Chartash, E., Sengupta, N. and Grober, J. (2005). Validation of the functional assessment of chronic illness therapy fatigue scale relative to other instrumentation in patients with rheumatoid arthritis. Journal of Rheumatology, 32, 811–819.Google Scholar
Challacombe, F. L., Salkovskis, P. M., Woolgar, M., Wilkinson, E. L., Read, J. and Acheson, R. (2016). Parenting and mother‒infant interactions in the context of maternal postpartum obsessive-compulsive disorder: effects of obsessional symptoms and mood. Infant Behavior and Development, 44, 11–20.Google Scholar
Dozois, D. J. A., Dobson, K. S. and Ahnberg, J. L. (1998). A psychometric evaluation of the Beck Depression Inventory-II. Psychological Assessment, 10, 83–89. doi: 10.1037//1040-3590.10.2.83CrossRefGoogle Scholar
Fairbrother, N. and Abramowitz, J. S. (2007). New parenthood as a risk factor for the development of obsessional problems. Behaviour Research and Therapy, 45, 2155–2163. doi: 10.1016/j.brat.2006.09.019Google Scholar
Fairbrother, N. and Woody, S. R. (2007). Fear of childbirth and obstetrical events as predictors of postnatal symptoms of depression and post-traumatic stress disorder. Journal of Psychosomatic Obstetrics and Gynecology, 28, 239–242. doi: 10.1080/01674820701495065CrossRefGoogle ScholarPubMed
Fairbrother, N. and Woody, S. R. (2008). New mothers’ thoughts of harm related to the newborn. Archives of Women's Mental Health, 11, 221–229. doi: 10.1007/s00737-008-0016-7CrossRefGoogle ScholarPubMed
Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Fleischmann, R. L., Hill, C. L. et al. (1989). The Yale-Brown Obsessive Compulsive Scale I. Development, use and reliability. Archives of General Psychiatry, 46, 1006–1011. doi: 10.1001/archpsyc.1989.01810110048007CrossRefGoogle ScholarPubMed
Grady, C., Anderson, R. and Chase, G. A. (1998). Fatigue in HIV-infected men receiving investigational interleukin-2. Nursing Research, 47, 227–234. doi: 10.1097/00006199-199807000-00008CrossRefGoogle ScholarPubMed
Hall, W. A., Clauson, M., Carty, E. M., Janssen, P. A. and Saunders, R. A. (2006). Effects on parents of an intervention to resolve infant behavioral sleep problems. Pediatric Nursing, 32, 243.Google Scholar
Jump, R. L., Fifield, J., Tennen, H., Reisine, S. and Giuliano, A. J. (2004). History of affective disorder and the experience of fatigue in rheumatoid arthritis. Arthritis Care and Research, 51, 239–245. doi: 10.1002/art.20243Google Scholar
Kaltwasser, J. P., Kessler, U., Gottschalk, R., Stucki, G. and Möller, B. (2001). Effect of recombinant human erythropoietin and intravenous iron on anemia and disease activity in rheumatoid arthritis. Journal of Rheumatology, 28, 2430–2436.Google Scholar
Kleinknecht, R. A. and Thorndike, R. M. (1990). The mutilation questionnaire as a predictor of blood/injury fear and fainting. Behaviour Research and Therapy, 2, 429–437. doi: 10.1016/0005-7967(90)90163-DCrossRefGoogle Scholar
Larsen, K. E., Schwartz, S. A., Whiteside, S. P. and Khandker, M. (2006). Thought control strategies used by parents reporting postpartum obsessions. Journal of Cognitive Psychotherapy, 20, 435.CrossRefGoogle Scholar
Mann, R., Gilbody, S. and Adamson, J. (2010). Prevalence and incidence of postnatal depression: what can systematic reviews tell us? Archives of Women's Mental Health, 13, 295–305. doi: 10.1007/s00737-010-0162-6Google Scholar
Meek, P. M., Nail, L. M., Barsevick, A., Schwartz, A. L., Stephen, S., Whitmer, K. et al. (2000). Psychometric testing of fatigue instruments for use with cancer patients. Nursing Research, 49, 181–190. doi: 10.1097/00006199-200007000-00001Google Scholar
Meyer, T. J., Miller, M. L., Metzger, R. L. and Borkovec, T. D. (1990). Development and validation of the Penn State Worry Questionnaire. Behaviour Research and Therapy, 28, 487–495. doi: 10.1016/0005-7967(90)90135-6Google Scholar
Monk, C. (2001). Stress and mood disorders during pregnancy: implications for child development. Psychiatric Quarterly, 72, 347–357. doi: 10.1023/A:1010393316106Google Scholar
Nerum, H., Halvorsen, L., Straume, B., Sørlie, T. and Øian, P. (2013). Different labour outcomes in primiparous women that have been subjected to childhood sexual abuse or rape in adulthood: a case-control study in a clinical cohort. BJOG: An International Journal of Obstetrics and Gynaecology, 120, 487–495. doi: 10.1111/1471-0528.12053Google Scholar
Newham, J. J., Wittkowski, A., Hurley, J., Aplin, J. D. and Westwood, M. (2014). Effects of antenatal yoga on maternal anxiety and depression: a randomized controlled trial. Depression and Anxiety, 31, 631–640. doi: 10.1002/da.22268CrossRefGoogle ScholarPubMed
Nieminen, K., Berg, I., Frankenstein, K., Viita, L., Larsson, K., Persson, U. et al. (2016). Internet-provided cognitive behaviour therapy of posttraumatic stress symptoms following childbirth: a randomized controlled trial. Cognitive Behaviour Therapy, 45, 287–306. doi: 10.1080/16506073.2016.1169626Google Scholar
Nieminen, K., Stephansson, O. and Ryding, E. L. (2009). Women's fear of childbirth and preference for cesarean section ‒ a cross-sectional study at various stages of pregnancy in sweden. Acta Obstetricia et Gynecologica Scandinavica, 88, 807–813. doi: 10.1080/00016340902998436Google Scholar
Nilsson, C., Lundgren, I., Karlstrom, A. and Hildingsson, I. (2012). Self reported fear of childbirth and its association with women's birth experience and mode of delivery: a longitudinal population-based study. Women and Birth: Journal of the Australian College of Midwives, 25, 114.Google Scholar
Nota, J. A., Schubert, J. R. and Coles, M. E. (2016). Sleep disruption is related to poor response inhibition in individuals with obsessive compulsive and repetitive negative thought symptoms. Journal of Behavior Therapy and Experimental Psychiatry, 50, 23–32.Google Scholar
Obsessive Compulsive Cognitions Working Group (2005). Psychometric validation of the obsessive belief questionnaire and interpretation of intrusions inventory ‒ part 2: Factor analyses and testing of a brief version. Behaviour Research and Therapy, 43, 1527–1542.Google Scholar
R Core Team (2016). R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing.Google Scholar
Rachman, S. (1998). A cognitive theory of obsessions: elaborations. Behaviour Research and Therapy, 36, 385–401. doi: 10.1016/s0005-7967(97)10041-9Google Scholar
Rhemtulla, M., Brosseau-Liard, P. É. and Savalei, V. (2012). When can categorical variables be treated as continuous? A comparison of robust continuous and categorical SEM estimation methods under suboptimal conditions. Psychological Methods, 17, 354–373. doi: 10.1037/a0029315.CrossRefGoogle ScholarPubMed
Roscoe, J. A., Morrow, G. R., Hickok, J. T., Mustian, K. M., Griggs, J. J., Matteson, S. E. et al. (2005). Effect of paroxetine hydrochloride (Paxil®) on fatigue and depression in breast cancer patients receiving chemotherapy. Breast Cancer Research and Treatment, 89, 243–249. doi: 10.1007/s10549-004-2175-1Google Scholar
Rosseel, Y. (2012). lavaan: an R package for structural equation modeling. Journal of Statistical Software, 48, 1–36.Google Scholar
Russell, E. J., Fawcett, J. M. and Mazmanian, D. (2013). Risk of obsessive-compulsive disorder in pregnant and postpartum women: a meta-analysis. Journal of Clinical Psychiatry, 74, 377–385.Google Scholar
Ruscio, A. M., Stein, D. J., Chiu, W. T. and Kessler, R. C. (2010). The epidemiology of obsessive compulsive disorder in the National Comorbidity Survey Replication. Molecular Psychiatry, 15, 53–63.CrossRefGoogle ScholarPubMed
Saisto, T., Salmela-Aro, K., Nurmi, J. and Halmesmäki, E. (2001). Psychosocial characteristics of women and their partners fearing vaginal childbirth. BJOG: An International Journal of Obstetrics and Gynaecology, 108, 492–498.Google ScholarPubMed
Salomonsson, B., Gullberg, M. T., Alehagen, S. and Wijma, K. (2013). Self-efficacy beliefs and fear of childbirth in nulliparous women. Journal of Psychosomatic Obstetrics and Gynecology, 34, 116–121.Google Scholar
Stoll, K., Hauck, Y., Downe, S., Edmonds, J., Gross, M. M., Malott, A. et al. (2016). Cross-cultural development and psychometric evaluation of a measure to assess fear of childbirth prior to pregnancy. Sexual and Reproductive Healthcare, 8, 49–54.CrossRefGoogle ScholarPubMed
Straub, H., Adams, M., Kim, J. J. and Silver, R. K. (2012). Antenatal depressive symptoms increase the likelihood of preterm birth. American Journal of Obstetrics and Gynecology, 207, 329.Google Scholar
Sydsjö, G., Bladh, M., Lilliecreutz, C., Persson, A., Vyöni, H. and Josefsson, A. (2014). Obstetric outcomes for nulliparous women who received routine individualized treatment for severe fear of childbirth ‒ a retrospective case control study. BMC Pregnancy and Childbirth, 14, 1.Google Scholar
Sydsjö, G., Blomberg, M., Palmquist, S., Angerbjörn, L., Bladh, M. and Josefsson, A. (2015). Effects of continuous midwifery labour support for women with severe fear of childbirth. BMC Pregnancy and Childbirth, 15, 1.Google Scholar
Takegata, M., Haruna, M., Matsuzaki, M., Shiraishi, M., Okano, T. and Severinsson, E. (2015). Does antenatal fear of childbirth predict postnatal fear of childbirth? A study of japanese women. Open Journal of Nursing, 5, 144.Google Scholar
Wambach, K. A. (1998). Maternal fatigue in breastfeeding primiparae during the first nine weeks postpartum. Journal of Human Lactation, 14, 219–229. doi: 10.1177/089033449801400311CrossRefGoogle ScholarPubMed
Williams, A. R., Williams, P. D., Press, A., Piamjariyakul, U., Keeter, L. M., Schultz, J. and Hunter, K. (1999). Fatigue in mothers of infants discharged to the home on apnea monitors. Applied Nursing Research, 12, 69–77. doi: 10.1016/S0897-1897(99)80342-5Google Scholar
Winstead-Fry, P. (1998). Psychometric assessment of four fatigue scales with a sample of rural cancer patients. Journal of Nursing Measurement, 6, 111.CrossRefGoogle ScholarPubMed
Wynter, K., Rowe, H. and Fisher, J. (2013). Common mental disorders in women and men in the first six months after the birth of their first infant: a community study in Victoria, Australia. Journal of Affective Disorders, 151, 980–985. doi: http://dx.doi.org.ezproxy.library.ubc.ca/10.1016/j.jad.2013.08.021Google Scholar
Submit a response

Comments

No Comments have been published for this article.