Maternal unwanted and intrusive thoughts of infant-related harm, obsessive-compulsive disorder and depression in the perinatal period: study protocol

Fanie Collardeau,Nichole Fairbrother,Bryony Corbyn,Patricia A Janssen,John Abramowitz,Sheila Woody

doi:10.1186/s12888-019-2067-x

Abstract

BackgroundUnwanted, intrusive thoughts of harm-related to the infant are reported by the vast majority of new mothers, with half of all new mothers reporting unwanted, intrusive thoughts of harming their infant on purpose. Thoughts of intentional harm, in particular, are distressing to women, their partners and the people who care for them. While maternal, unwanted and intrusive thoughts of infant-related harm are known to be associated with obsessive compulsive disorder (OCD) and depression, preliminary evidence suggests that they are not associated with an increased risk of harm to infants. Perinatal care providers and policy makers, as well as new mothers and their partners require evidence-based information in order to respond appropriately to these types of thoughts. The purpose of this research is to address important gaps regarding the (a) prevalence and characteristics of intrusive, unwanted thoughts of baby-related harm, (b) their association (or lack thereof) with child abuse, and (c) the prevalence and course of obsessive-compulsive disorder and depression in the perinatal period.MethodsParticipant were 763 English-speaking women and recruited during pregnancy. In this province-wide study in British Columbia, participants were recruited proportionally from hospitals, city centers and rural communities between January 23, 2014 and September 09, 2016. Participants were administered online questionnaires and diagnostic interviews over the phone at 33-weeks gestation, 7-weeks postpartum and 4-months postpartum. The study assessed intrusive and unwanted thoughts of harm related to the infant, obsessive-compulsive disorder (OCD) and major depressive episode (MDE) disorders and symptomatology, sleep, medical outcomes, parenting attitudes, and infant abuse.DiscussionThere is a scarcity of literature concerning maternal unwanted, intrusive, postpartum thoughts of infant-related harm and their relationship to child harming behaviors, OCD and depression. This longitudinal cohort study was designed to build on the existing research base to ensure that policy developers, child protection workers and health-care providers have the guidance they need to respond appropriately to the disclosure of infant-related harm thoughts. Thus, its main goals will be to investigate whether intrusive postpartum thoughts of infant-related harm are a risk factor for child abuse or the development of OCD.

Highlights

Unwanted, intrusive thoughts of harm-related to the infant are reported by the vast majority of new mothers, with half of all new mothers reporting unwanted, intrusive thoughts of harming their infant on purpose
Intrusive thoughts of harm are predictors of harming behaviors, acting to protect the infant is appropriate and necessary. If those unwanted, intrusive thoughts of infant-related harm are a common and normative postpartum experience which may predispose to mental health difficulties among vulnerable women, taking dramatic steps is unnecessary and may be harmful
This study aims to fill some of these gaps in knowledge and provide evidence upon which women, their partners, maternity care providers and policy makers can base decisions regarding the most appropriate course of action to take when a new mother discloses unwanted, intrusive thoughts of infant-related harm

Summary

Introduction

Intrusive thoughts of harm-related to the infant are reported by the vast majority of new mothers, with half of all new mothers reporting unwanted, intrusive thoughts of harming their infant on purpose. Between 70 and 100% of new mothers report unwanted, intrusive thoughts of infant-related harm with as many as half of all new mothers reporting unwanted, intrusive thoughts of harming their infant on purpose [1, 2, 3] These thoughts may include, for example, ideas of suffocation and sudden infant death syndrome (81.4–90%), accidents (83.7–92%), contamination (53.5–59%), or intentional harm (32.6–46%) [2, 3]. Intrusive thoughts of harm are predictors of harming behaviors, acting to protect the infant is appropriate and necessary If those unwanted, intrusive thoughts of infant-related harm are a common and normative postpartum experience which may predispose to mental health difficulties (e.g., obsessive compulsive disorder; OCD) among vulnerable women, taking dramatic steps (e.g., intense monitoring of the mother or removal of the infant) is unnecessary and may be harmful

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Conclusion