Obsessions and compulsions in women with postpartum depression

Objective: The quantity, content, and intensity of the obsessions and compu lsions of women with postpartum onset major depressive disorder were compar ed with those of women with major depressive disorder with non-postpartum o nset. Method: Sequential cases of women with postpartum onset major depression (N = 37) and major depression (N = 28) who presented to our Women's Mood Diso rders program were included. Psychiatric examination using DSM-IV criteria and the Inventory to Diagnose Depression established the diagnosis of major depression. Obsessive thoughts and compulsions were reported on the Yale-B rown Obsessive Compulsive, Scale and reviewed during the psychiatric examin ation. Comparisons between groups were performed with chi-square statistics , Fisher exact test and its extensions, and Mann-Whitney U test. Results: Although more women with postpartum onset major depression (N = 21 , 57%) than major depression (N = 10, 36%) reported obsessional thoughts, t he difference between the groups was not significant (p = .13). However, fo r women who endorsed obsessions, those with postpartum onset had a higher m edian number (median = 7) than women without postpartum onset (median = 2, p = .00). Most of the difference in frequency of thoughts was owing to more women with postpartum onset major depression having aggressive thoughts (N = 20, 95%) than women with major depression (N = 6, 60%, Fisher exact p = .03). The most frequent content of the aggressive thoughts for women with p ostpartum onset major depression was causing harm to their newborns or infa nts. The presence or number of obsessional thoughts or compulsions was not related to severity of the depressive episode. Conclusion: Childbearing-aged women commonly experience obsessional thought s or compulsions in the context of major depressive episodes. Women with po stpartum onset major depression experience disturbing aggressive obsessiona l thoughts more frequently than women with non-postpartum major depression.