Depression, Obsessive-Compulsive Disorder Symptoms May Predict Increased Postpartum Anxiety

Women reporting greater depression, intolerance of uncertainty, and obsessive-compulsive disorder (OCD) symptoms during pregnancy may experience increased anxiety in the postpartum period, according to a longitudinal study published by Journal of Affective Disorders.

The study included 35 pregnant women recruited primarily from the Women’s Health Concerns Clinic at St. Joseph’s Healthcare Hamilton in Ontario, Canada. Participants were age 18 to 41 with pre-existing diagnoses of anxiety disorders meeting Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, criteria.

At baseline (≥27 weeks gestation) and 6 months postpartum, investigators measured anxiety symptom severity using the Hamilton Anxiety Rating Scale (HAM-A). Patients completed questionnaires evaluating generalized anxiety, depressive symptom severity, intolerance of certainty, insomnia, childhood trauma, and obsessive-compulsive symptoms at baseline and follow-up. To compare baseline predictors between individuals who met HAM-A criteria for worsening anxiety and individuals who did not, investigators performed independent samples t-tests.

At 6 weeks postpartum, 17 women (48.6%) met the criteria for worsening anxiety, defined as an increase of ≥50% on HAM-A scores from baseline to follow-up. Investigators found that key predictors of increased anxiety in the postpartum period were depressive symptom severity, intolerance of uncertainty, and OCD symptoms occurring during the third trimester of pregnancy. Self-reported anxiety severity, subjective maternal sleep, and childhood trauma history were not associated with anxiety worsening at 6 weeks postpartum (all P .05).

Investigators suggested that through early and accurate identification of anxiety symptoms, women could be more closely monitored throughout pregnancy and the early postpartum period for signs of worsening anxiety. Subsequently, they could be introduced to preventative strategies, such as psychotherapeutic or psychopharmacologic treatments.

Investigators concluded, “Continued research is necessary in this field with larger and more diverse sample sizes to replicate our findings, as well as identify other potential predictors which may then be targeted through preventive treatment.”


Furtado M, Van Lieshout RJ, Van Ameringen M, Green SM, Frey BN. Biological and psychosocial predictors of anxiety worsening in the postpartum period: a longitudinal study. J Affect Disord. 2019;250:218-225.