Archives of Women's Mental Health

, Volume 13, Issue 5, pp 403–410 | Cite as

The obsessive–compulsive spectrum in the perinatal period: a prospective pilot study

Original Article
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Abstract

This study aims to describe the phenomenology of obsessive–compulsive symptoms (OCS) and disorders (OCD) in perinatal women and to explore the relationship of OCS/OCD to postpartum depression. A prospective longitudinal study of 44 women screened with the Obsessive–Compulsive Inventory—Revised (OCI-R) and Edinburgh Postnatal Depression Scale (EPDS) between 30 and 37 weeks of pregnancy. Twenty-four women completed a diagnostic interview and the Yale–Brown Obsessive–Compulsive Scale (Y-BOCS) before delivery and were contacted postpartum to repeat the EPDS and Y-BOCS. In the third trimester, 32% reported high levels of anxiety and/or depressive symptoms (EPDS ≥ 10 and/or OCI-R ≥ 15) and 29% of those who completed the diagnostic interview met criteria for OCD. At 1 month postpartum, 12.5% had new OCS (Y-BOCS ≥ 8) and 25% had new high levels of depressive symptoms (EPDS ≥ 10). OCS increased in intensity postpartum but did not change in character. OCD and OCS may be of greater prevalence during the perinatal period than previously recognized. The high rates provide new information and require replication in larger, more diverse populations. Research in the perinatal period must expand beyond the exploration of depression to include anxiety disorders and specifically OCD.

Keywords

Postpartum depression Maternal depression Anxiety disorders Obsessive–compulsive disorder 
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Notes

Acknowledgments

The authors wish to thank the women who participated in the study and acknowledge Holly I.M. Wadkins and Elizabeth Anson for their contributions in data collection and management.

Funding

Funding for this project was provided by a grant from the Obsessive Compulsive Foundation (Chaudron). Dr. Chaudron’s work on this study was also supported in part by a grant from the National Institute of Mental Health Award K23 MH64476 (Chaudron).

Disclosures

No conflicts of interest for Dr. Chaudron or Dr. Nirodi.

References

  1. Abramowitz JS, Schwartz SA, Moore KM et al (2003) Obsessive–compulsive symptoms in pregnancy and the puerperium: a review of the literature. J Anxiety Disord 17:461–478CrossRefPubMedGoogle Scholar
  2. Adouard F, Glangeaud-Freudenthal NM, Golse B (2005) Validation of the Edinburgh postnatal depression scale (EPDS) in a sample of women with high-risk pregnancies in France. Arch Womens Ment Health 8:89–95CrossRefPubMedGoogle Scholar
  3. Altemus M (2001) Obsessive–compulsive disorder during pregnancy and postpartum. In: Yonkers K, Little B (eds) Management of psychiatric disorder in pregnancy. Oxford University Press, New York, NY, pp 149–163Google Scholar
  4. Bartz JA, Hollander E (2008) Oxytocin and experimental therapeutics in autism spectrum disorders. Prog Brain Res 170:451–462CrossRefPubMedGoogle Scholar
  5. Bloch M, Daly RC, Rubinow DR (2003) Endocrine factors in the etiology of postpartum depression. Compr Psychiatry 44:234–246CrossRefPubMedGoogle Scholar
  6. Brandes M, Soares CN, Cohen LS (2004) Postpartum onset obsessive–compulsive disorder: diagnosis and management. Arch Womens Mental Health 7:99–110CrossRefGoogle Scholar
  7. Chaudron LH, Szilagyi PG, Kitzman HJ et al (2004) Detection of postpartum depressive symptoms by screening at well-child visits. Pediatrics 113:551–558CrossRefPubMedGoogle Scholar
  8. Chaudron LH, Szilagyi PG, Campbell AT et al (2007) Legal and ethical considerations: risks and benefits of postpartum depression screening at well-child visits. Pediatrics 119:123–128CrossRefPubMedGoogle Scholar
  9. Cox JL, Holden JM, Sagovsky R (1987) Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry 150:782–786CrossRefPubMedGoogle Scholar
  10. Foa EB, Huppert JD, Leiberg S et al (2002) The Obsessive–Compulsive Inventory: development and validation of a short version. Psychol Assess 14:485–496CrossRefPubMedGoogle Scholar
  11. Gaynes BN, Gavin N, Meltzer-Brody S, et al (2005) Perinatal depression: prevalence, screening accuracy, and screening outcomes. Evidence Report/Technology Assessment No. 119 (Prepared by the RTI-University of North Caroline Evidence-based Practice Center, under Contract No. 290-02-0016). AHRQ Publication No.05-E006-2. Agency for Healthcare Research and Quality, RockvilleGoogle Scholar
  12. Goodman WK, Price LH, Rasmussen SA et al (1989a) The Yale–Brown Obsessive Compulsive Scale. II. Validity. Arch Gen Psychiatry 46:1012–1016Google Scholar
  13. Goodman WK, Price LH, Rasmussen SA et al (1989b) The Yale–Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Arch Gen Psychiatry 46:1006–1011Google Scholar
  14. Kessler RC, Chiu WT, Demler O et al (2005) Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62:617–627CrossRefPubMedGoogle Scholar
  15. Kessler RC, McGonagle KA, Zhao S et al (1994) Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry 51:8–19PubMedGoogle Scholar
  16. Labad J, Menchon JM, Alonso P et al (2005) Female reproductive cycle and obsessive–compulsive disorder. J Clin Psychiatry 66:428–435CrossRefPubMedGoogle Scholar
  17. Matthey S (2008) Using the Edinburgh Postnatal Depression Scale to screen for anxiety disorders. Depress Anxiety 25:926–931CrossRefPubMedGoogle Scholar
  18. Matthey S, Henshaw C, Elliott S et al (2006) Variability in use of cut-off scores and formats on the Edinburgh Postnatal Depression Scale: implications for clinical and research practice. Arch Womens Ment Health 9(6):309–315CrossRefPubMedGoogle Scholar
  19. Morris-Rush JK, Freda MC, Bernstein PS (2003) Screening for postpartum depression in an inner-city population. Am J Obstet Gynecol 188:1217–1219CrossRefPubMedGoogle Scholar
  20. O'Connor TG, Heron J, Golding J et al (2002) Maternal antenatal anxiety and children's behavioural/emotional problems at 4 years. Report from the Avon Longitudinal Study of Parents and Children. Br J Psychiatry 180:502–508CrossRefPubMedGoogle Scholar
  21. O'Connor TG, Heron J, Golding J et al (2003) Maternal antenatal anxiety and behavioural/emotional problems in children: a test of a programming hypothesis. J Child Psychol Psychiatry 44:1025–1036CrossRefPubMedGoogle Scholar
  22. Olfson M, Broadhead WE, Weissman MM et al (1996) Subthreshold psychiatric symptoms in a primary care group practice. Arch Gen Psychiatry 53:880–886PubMedGoogle Scholar
  23. Olson AL, Dietrich AJ, Prazar G et al (2005) Two approaches to maternal depression screening during well child visits. J Dev Behav Pediatr 26:169–176CrossRefPubMedGoogle Scholar
  24. Spitzer RL, Williams JB, Gibbon M et al (1992) The Structured Clinical Interview for DSM-III-R (SCID). I: History, rationale, and description. Arch Gen Psychiatry 49:624–629PubMedGoogle Scholar
  25. Stein DJ, Hollander E, Simeon D et al (1993) Pregnancy and obsessive–compulsive disorder. Am J Psychiatry 150:1131–1132PubMedGoogle Scholar
  26. Su KP, Chiu TH, Huang CL et al (2007) Different cutoff points for different trimesters? The use of Edinburgh Postnatal Depression Scale and Beck Depression Inventory to screen for depression in pregnant Taiwanese women. Gen Hosp Psychiatry 29:436–441CrossRefPubMedGoogle Scholar
  27. Uguz F, Akman C, Kaya N et al (2007a) Postpartum-onset obsessive–compulsive disorder: incidence, clinical features, and related factors. J Clin Psychiatry 68:132–138CrossRefGoogle Scholar
  28. Uguz F, Gezginc K, Zeytinci IE et al (2007b) Obsessive–compulsive disorder in pregnant women during the third trimester of pregnancy. Compr Psychiatry 48:441–445CrossRefGoogle Scholar
  29. Uguz F, Gezginc K, Zeytinci IE et al (2007c) Course of obsessive–compulsive disorder during early postpartum period: a prospective analysis of 16 cases. Compr Psychiatry 48:558–561CrossRefGoogle Scholar
  30. Weissman AM, Levy BT, Hartz AJ et al (2004) Pooled analysis of antidepressant levels in lactating mothers, breast milk, and nursing infants. Am J Psychiatry 161:1066–1078CrossRefPubMedGoogle Scholar
  31. Wenzel A, Haugen EN, Jackson LC et al (2005) Anxiety symptoms and disorders at eight weeks postpartum. J Anxiety Disord 19(3):295–311CrossRefPubMedGoogle Scholar
  32. Williams JB, Gibbon M, First MB et al (1992) The Structured Clinical Interview for DSM-III-R (SCID). II. Multisite test–retest reliability. Arch Gen Psychiatry 49:630–636PubMedGoogle Scholar
  33. Williams KE, Koran LM (1997) Obsessive–compulsive disorder in pregnancy, the puerperium, and the premenstruum. J Clin Psychiatry 58:330–334PubMedGoogle Scholar
  34. Wisner KL, Peindl KS, Gigliotti T et al (1999) Obsessions and compulsions in women with postpartum depression. J Clin Psychiatry 60:176–180CrossRefPubMedGoogle Scholar
  35. Yonkers KA, Wisner KL, Stewart DE et al (2009) The management of depression during pregnancy: a report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists. Gen Hosp Psychiatry 31:403–413CrossRefPubMedGoogle Scholar
  36. Zambaldi CF, Cantilino A, Montenegro AC et al (2009) Postpartum obsessive–compulsive disorder: prevalence and clinical characteristics. Compr Psychiatry 50(6):503–509CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  1. 1.Department of PsychiatryUniversity of Rochester School of MedicineRochesterUSA
  2. 2.Department of PsychiatryThe Permanente Medical GroupSanta ClaraUSA

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