Exploratory analysis of intrusive thoughts in a community sample of mothers with young infants

3 CHAPTER 1: INTRODUCTION Overview of Introduction 4 Pregnancy and Mood Disorders Pregnancy and anxiety 5 Pregnancy and Obsessive-compulsive disorder 11 Post Natal Depression and Obsessive Symptoms 17 Predicting postnatal depression 21 Intrusions and post-traumatic stress disorder in childbirth 26 Intrusive Thoughts in non clinical populations Prevalence 29 Phenomenology of intrusive thoughts 31 Relationship with mood disturbance 35 Summary 46 Aims and hypotheses 51 CHAPTER 2: METHODOLOGY Ethics Approval 53 Design 53 Recruitment 54 Participants 55 Measures Maudsley Obsessional Compulsive Inventory 56 The Edinburgh Postnatal Depression Scale 58 State-trait Anxiety Inventory 59 Assessment of intrusive thoughts 60 Procedure Statistical Analysis 66 67 CHAPTER 3: RESULTS Overview of results section 69 Participants characteristics 70 Intrusive thoughts interview Scale analysis for frequency, intensity and dismissability items 71 Descriptive statistics for intrusive thought form and content 72 Concordance of pre and postnatal intrusive thoughts 74 Emotional content of the intrusion 75 Descriptive analysis of responses to thoughts 76 Hypothesis I: High emotional content of the thoughts will be positively correlated with the frequency, intensity and reduced dismissability of the thoughts. 77 Hypothesis II: Those participants who experience intrusive thoughts and respond to them will experience higher levels of negative emotion, depression, anxiety and obsessionality, than those participants who have intrusive thoughts but do not respond to them. 79 Hypothesis III: Those participants who experience intrusive thoughts and respond to them will experience them more frequently, intensely and find them more difficult to dismiss than those who experience intrusive thoughts but do not respond to them. 80 Standardised measures Tests of normality 83 Pre and postnatal scores and their comparison to other samples 85 Longitudinal examination of the standardised Measures 86 Hypothesis IV: Previous negative pregnancy experience and young maternal age will predict higher levels of postnatal anxiety and depressive symptoms. 86 Hypothesis V: The levels of depression, anxiety and obsessionality prenatally will be correlated and predict the levels of these emotions postnatally. 88 Hypothesis VI: Levels of depression, anxiety and obsessionality will be higher in the postnatal period. 90 Hypothesis VII: The scores on the EPDS, STAI, MOCI and negative emotion will be positively correlated with each other. 91 Hypothesis VIII: There will be a positive correlation between the scores on the EPDS, MOCI and STAI and the frequency, intensity and reduced dismissability of the intrusive thoughts. 94 Hypothesis IX: Those participants who experience intrusive thoughts will have higher levels of depression, anxiety and obsessionality than those participants who do not experience intrusive thoughts. 99 Summary of results 101 CHAPTER 4: DISCUSSION Intrusive thoughts Incidence and content 103 Frequency, intensity and dismissability 108 Response to thought 109 Emotional Content 113 Intrusive thoughts and their association with the EPDS, MOCI and STAI 114 Longitudinal results Depression 122 Anxiety 125 Obsessional symptoms 128 Strengths and weaknesses of the study 132 Clinical implications 137 Future research 137