Point prevalence of perinatal obsessive-compulsive disorder (OCD) gradually increases and peaks at close to 9% at about 8 weeks postpartum before declining, researchers found in a study published in the Journal of Clinical Psychiatry.
The researchers collected data from February 2014 through February 2017 from 580 women living in British Columbia, Canada. Women completed online questionnaires and a telephone interview in late pregnancy (mean=36.89 weeks, standard deviation (SD)=1.96) and twice postpartum: at a mean of 9.9 weeks (SD=1.94) and at a mean of 21.27 weeks (SD=3.83). They were followed from late pregnancy (at 32 weeks gestation or later) through up to 38 weeks postpartum.
Of the 580 participants, 270 provided data for 3 interviews, 182 for 2 interviews and 122 for only 1 interview. Diagnostic data were collected retrospectively for 101 patients who missed the prenatal interview and 49 who missed the early postpartum interview.
They were assessed for OCD using the Structured Clinical Interview for DSM-5 (SCID-5).
Researchers asked participants about OC symptoms they had experienced in the past 2 weeks at each interview. Participants also were asked to identify the 2-week period during pregnancy or afterward when their OC symptoms were the most intense. They were asked about infant-related harm thoughts and associated behaviors postpartum.
Estimated point prevalence of OCD diagnosis from the model was 2.6% (95% CI .4-4.8) at 6 weeks prior to delivery, 8.3% (95% CI 5.4-11.2) at 10 weeks postpartum and 6.1% (95% CI 3.3-8.8) at 20 weeks postpartum. Estimated average point prevalence during the prenatal period was 2.9% (95% CI 2.7-3.2) and 7.0% (95% CI 6.9-7.2) during the postpartum period. Weighted period prevalence during pregnancy (n=375) was estimated at 7.8% (95% CI 5.1-12.0).
At the beginning of the postpartum period, 93 of 535 participants had a diagnosis of OCD. The period prevalence through the final postpartum interview at 38 weeks was estimated with logistic regression as 16.9% (95% CI 14.0-20.2). Period prevalence through 8.8 weeks was 6.9%. Up to 13 weeks, it was 7.8%.
Incidence of new OCD diagnoses was estimated at 4.7 (95% CI 3.2-6.1) new cases per 1,000 women per week postpartum, with a total of 49 new cases reached by 22 weeks postpartum. The average person time of follow-up was 18 weeks. Cumulative incidence of new cases of OCD was 5% for 4 weeks, 6% for 8 weeks, 7% for 12 weeks, and 8% for 16 weeks postpartum, respectively. By 6 months postpartum, cumulative incidence rose to 9%.
Of the 100 women who reported symptoms during the perinatal period that were consistent with a diagnosis of OCD, 60 reported that clinical levels of OCD began during the pregnancy or postpartum.
These prevalence estimates are higher than those found in previous studies, which the researchers attributed to more comprehensive evaluation of perinatal-specific OC symptoms and differences between DSM-IV and DSM-5 diagnostic criteria. This study was the first to use DSM-5 diagnostic criteria.
Limitations included the fact that some women joined the study after childbirth and may have been attracted to the study because of their experience of postpartum intrusive thoughts and that the history of OCD prior to participation was collected only for participants who experienced OCD symptoms.
The study authors said, “Our study suggests that when women are encouraged to report their perinatal specific symptoms, and current diagnostic criteria are applied, estimates for perinatal OCD may be higher than previously believed.”
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. Published online March 23, 2021. doi: 10.4088/JCP.20m13398