Background:Although the prevalence of physical abuse in childhood is well studied, the extent among infants-a period of high vulnerability-remains poorly characterized. We aimed to estimate the prevalence of physical abuse of infants (<24 months) by caregivers, using data from anonymous self-report studies. Methods:A systematic review and meta-analysis were conducted following the Cochrane Handbook. We searched MEDLINE, Embase, PsycINFO, CINAHL, and Web of Science (inception to Sep 3rd, 2025) for studies anonymously reporting the prevalence of physical abuse toward infants (0-24 months) by primary caregivers. Two reviewers independently screened studies and assessed risk of bias using the Joanna Briggs Critical Appraisal tool for prevalence studies. Prevalence estimates were aggregated using Bayesian multilevel logistic regression and heterogeneity quantified with 95% prediction intervals. The protocol was registered with PROSPERO (ID: CRD42023459469). Findings:We identified 20 relevant studies (>220,000 caregivers) with prevalence estimates spread across 16 types of abuse, spanning North America, Europe, and East Asia. The pooled prevalence of reporting at least one form of abuse in a typical sample was 4·8%, 95% CI [2·6%, 7·5%] or 3·9%, 95% CI [1·9%, 6·4%] excluding "lesser" forms of abuse (e.g., spanking)-but with notable heterogeneity, 95% prediction interval [0·6%, 11·9%]. Aggregate estimates ranged from <3% for severe forms of abuse (e.g., shaking, hitting) to 9·5% for spanking or 20·5%-21·0% for slapping on the wrist (which might be culturally sanctioned in some areas). Interpretation:Approximately one in twenty infants in a typical sample worldwide experience physical abuse by caregivers, though estimates vary and are likely underreported. Even in the first two years of life, many children face violent caregiving practices, pointing to an urgent need for prevention. The large gap between self-reports and official statistics highlights that most infant abuse remains hidden. Funding:No funding was received for this research.

Objectives: Unwanted and often distressing intrusive thoughts of infant-related harm are common during the perinatal period and are associated with poorer maternal mental health. The mechanisms linking perinatal intrusive thoughts to mental health remain poorly understood. One proposed avenue is through maladaptive appraisals, yet there currently are no measures capturing perinatal-specific appraisals. The aim of the current study was to develop and validate a novel Perinatal Intrusions Interpretation Index (PIII) to assess negative appraisals related to intrusions of infant-related harm. Methods: 439 people who were 1–6 months postpartum completed 12 items capturing appraisals and an adapted online version of the Postpartum Intrusions Interview. A second validation sample, N = 142 people ≤ 9 months postpartum, completed the final 10-item PIII. Results: Exploratory and confirmatory factor analyses indicated a three-factor structure of the PIII: 1) inflated responsibility, 2) importance of thoughts, and 3) need for control. The total PIII and subscales demonstrated good internal consistency. Higher negative appraisals on the PIII were significantly associated with more frequent and distressing accidental and intentional infant-related harm intrusive thoughts and maladaptive behavioural responses. Intrusion type (accidental versus intentional) moderated the relationship between negative appraisals and intrusion frequency and distress, and frequency of behavioural responses. Conclusions: The PIII is a reliable and valid scale to assess negative appraisals of infant-related harm intrusions. Negative appraisals may be a cognitive risk factor for perinatal intrusions to progress from normative to functionally impairing, offering a modifiable target for the prevention and treatment of perinatal anxiety disorders.

Background The purpose of this investigation was to assess postpartum associations between adult attachment (anxiety and avoidance), and symptoms of obsessive-compulsive disorder (OCD) and separation anxiety disorder (SAD). We predicted strong, significant associations between SAD, OCD and attachment (especially attachment anxiety), and that these relationships would be stronger for symptoms focused on the infant compared to symptoms excluding the infant. We also predicted that SAD would mediate the relationship between attachment and OCD. Methods Participants were birthing parents (N = 322) of infants aged 0–12 months, and residing in Canada, the United States, the United Kingdom, Australia, or New Zealand. Data was collected via an online self-report survey. We assessed symptoms of SAD and OCD separately for symptoms focused on the infant and those excluding the infant. Predictions were assessed via correlation analysis, path analysis and structural equation modeling. Results Predictions were partially supported by the data. Attachment anxiety was significantly and positively correlated with infant- and non-infant SAD (r = 0.26, and 0.28) and OCD (r = 0.17 and 0.16). Attachment avoidance correlated weakly with SAD and OCD. Infant- and non-infant SAD and OCD were strongly associated (range: r = .44 to .59). Concordant (i.e., infant with infant and adult with adult) associations did not differ from non-concordant ones. Path analysis showed significant associations between SAD and OCD with concordant pathways (.43 and .45) stronger than non-concordant pathways (.27 and .16). SAD mediated the relationship between attachment anxiety and OCD for all associations other than infant-related SAD with adult-related OCD. Conclusions Findings suggest a strong association between symptoms of SAD and OCD, and that SAD is a key mechanism linking attachment anxiety and OCD among new parents. This study is the first to empirically demonstrate these pathways in the postpartum context.

Objectives: Unwanted intrusive thoughts (UITs) of intentional infant-related harm are common among birthing parents. Evidence to date has failed to find any association with physical aggression toward the infant. However, the relationship between UITs of infant-related sexual harm and sexual behaviors toward the infant has yet to be assessed. This is the purpose of the current study. Methods: Data were collected from February 9, 2014, to February 14, 2017, via a prospective, province-wide, unselected cohort of N = 763 Englishspeaking birthing parents, n= 502 of whom provided data for the current analysis. Interview assessments of UITs of infant-related sexual harm were administered at approximately 7 weeks postpartum and 4 months postpartum. Sexual harming behaviors toward the infant were assessed via an anonymized questionnaire at the end of the study. Results: UITs of infant-related sexual harm were reported by 9.2% (n =38; 95% CI, 6.6-1 2.4) of participants. We found no evidence of an association between UITs ofthis nature and sexual behaviortoward one's infant (Fisher exact, P = 1.00). Only 1 participant reported engaging in sexual behavior toward their infant, and they did not report any UITs of infant-related sexual harm. Conclusions: Study findings add to growing evidence that UITs of infant-related harm are common, and when these thoughts are unwanted and intrusive, they are not associated with an increased risk of actually harming one's infant. Although findings suggest that this is also true for UITs of infant-related sexual harm and sexual behavior, due to the small sample employed in this research, replication with a larger sample is needed.

Background: Because pregnancy is a predictable life event and perinatally-occurring OCD is highly prevalent, the perinatal period is an excellent time to investigate OCD development. The cognitive-behavioural (CBT) model of OCD development posits that negative beliefs about unwanted, intrusive thoughts (UITs) increase the likelihood of OCD development. Previously published studies provide support for this model but key knowledge gaps remain.Objectives: To assess prenatal beliefs about thoughts as predictors of postpartum OCS and test the bidirectional relationship between beliefs about thoughts and OCS.Methods: Participants were an unselected sample of pregnant people in British Columbia (N = 760). Assessments occurred in late pregnancy and twice postpartum and included self-report measures of OCD (DOCS) and obsessive beliefs (OBQ-44). Random intercept cross-lagged panel models tested bidirectional associations between beliefs about thoughts and OCS over the perinatal period, controlling for prior symptoms and covariates.Results: Prenatal OBQ-44 scores predicted both early and later postpartum DOCS scores. OBQ-44 scores better predicted later postpartum OCS, compared with early postpartum OCS. The relationship between beliefs about thoughts and OCS was found to be largely independent of depressed mood. Prenatal OBQ-44 scores better predicted both early and later postpartum DOCS scores than did prenatal DOCS scores predicting postpartum OBQ-44. Findings related to DOCS subscales partially supported study hypotheses.Conclusions: Findings provide further support for the CBT model of OCD and suggest that negative beliefs about thoughts (rather than OCS) represent an important mechanism in postpartum OCS severity. Study findings have implications for prevention and treatment.

BACKGROUND:Fear of childbirth (FoB) is a common experience during pregnancy which can cause clinically significant distress and impairment. To date, a number of investigations of FoB have assumed that clinically significant FoB is best understood as a type of specific phobia. However, preliminary evidence suggests that specific phobia may not be the only diagnostic category under which clinically significant symptoms of FoB are best described. AIM:The current study is the first to investigate which DSM-5 diagnostic categories best describe clinically significant symptoms of FoB. METHOD:Pregnant people reporting high levels of FoB (n=18) were administered diagnostic interviews related to their experience of FoB. RESULTS:Participants (n=18) were predominantly nulliparous (73.3%), cisgender women (83.3%). Of these, 14 (77.8%) met criteria for one or more DSM-5 anxiety-related disorders. Preliminary findings suggest that primary FoB may align with specific phobia criteria, whereas secondary FoB (following a traumatic birth) may be better classified under post-traumatic stress disorder (PTSD). FoB also featured in other anxiety-related disorders but was not the primary focus (e.g. obsessive-compulsive disorder). Four participants did not meet criteria for any DSM-5 disorder. CONCLUSIONS:Findings provide preliminary evidence that clinically significant FoB fits within existing DSM-5 categories, in particular specific phobia and PTSD. Although FoB-related concerns appears in other anxiety-related disorder categories, it does not appear as the primary focus. Although informative, due to the small sample employed in this research, replication in larger and more diverse samples is needed.

Background The Canadian Network for Mood and Anxiety Treatments (CANMAT) publishes clinical practice guidelines for mood and anxiety disorders. This CANMAT guideline aims to provide comprehensive clinical guidance for the pregnancy and postpartum (perinatal) management of mood, anxiety and related disorders. Methods CANMAT convened a core editorial group of interdisciplinary academic clinicians and persons with lived experience (PWLE), and 3 advisory panels of PWLE and perinatal health and perinatal mental health clinicians. We searched for systematic reviews of prevention and treatment interventions for perinatal depressive, bipolar, anxiety, obsessive–compulsive and post-traumatic stress disorders (January 2013–October 2023). We prioritized evidence from reviews of randomized controlled trials (RCTs), except for the perinatal safety of medications where reviews of large high-quality observational studies were prioritized due to the absence of RCT data. Targeted searches for individual studies were conducted when systematic reviews were limited or absent. Recommendations were organized by lines of treatment based on CANMAT-defined levels of evidence quality, supplemented by editorial group consensus to balance efficacy, safety, tolerability and feasibility considerations. Results The guideline covers 10 clinical sections in a question-and-answer format that maps onto the patient care journey: case identification; organization and delivery of care; non-pharmacological (lifestyle, psychosocial, psychological), pharmacological, neuromodulation and complementary and alternative medicine interventions; high-risk clinical situations; and mental health of the father or co-parent. Equity, diversity and inclusion considerations are provided. Conclusions This guideline's detailed evidence-based recommendations provide clinicians with key information to promote the delivery of effective and safe perinatal mental healthcare. It is hoped that the guideline will serve as a valuable tool for clinicians in Canada and around the world to help optimize clinical outcomes in the area of perinatal mental health.

Anxiety and anxiety-related disorders are, as a group, the most common mental health conditions and are more common among women compared with among men. It is now evident that these disorders affect one in five pregnant and postpartum people and are more common than depression. For some disorders (e.g., obsessive-compulsive disorder), there is also evidence of an elevated risk for their development and exacerbation during perinatal periods. In this article, we review the literature pertaining to anxiety and anxiety-related disorders during the perinatal period. We also provide information related to pregnancy-specific anxiety and fear of childbirth constructs that exist outside of diagnostic classification but are particularly important in the perinatal context. We review the scope, prevalence, and etiology of these disorders as well as comorbidity, screening, assessment, and treatment. We conclude with an overview of some of the key gaps in knowledge and recommendations for future research.

Objectives: The purpose of this research was to assess the timing and characteristics of the onset of perinatally occurring obsessive-compulsive disorder (OCD). OCD is a potentially disabling anxiety-related mental health condition for which the perinatal period represents a time of increased risk for onset, recurrence, and exacerbation. Methods: This was a prospective cohort study conducted in British Columbia, Canada. Recruitment took place from January 23, 2014, to September 9, 2016. Participants provided information on reproductive and demographic questionnaires and diagnostic interviews (using the Structured Clinical Interview for DSM-5) in late pregnancy and at 2 postpartum time points. Only participants who reported symptoms meeting full criteria for OCD during their current perinatal period were included in this report of findings (N= 97). Analyses were primarily descriptive in nature, with chi(2) tests employed to test differences in onset (pregnancy vs postpartum) and perinatal OCD development based on age first symptom onset (childhood/ adolescence vs adulthood). Results: Over two-thirds (71%) of participants whose symptoms met full criteria for OCD at some point in their most recent perinatal period reported perinatal disorder onset. The majority of these (74%) reported onset during their first perinatal period. Perinatal disorder onset was much more likely to occur in the postpartum (83%), compared with in pregnancy (17%), chi(2) (1 N= 69) = 29.3, P< .001. Symptom exacerbations were more likely to occur in the postpartum (77%) compared with prenatally (35%). Further, the lag time from symptom onset to disorder onset was shorter among participants who experienced a perinatal compared with a nonperinatal onset of their OCD. Conclusion: Findings contribute to our understanding of perinatal OCD onset, emphasize the vulnerability to OCD during the perinatal period, and provide one of the first assessments in which symptom onset is distinguished from disorder onset. This work underscores the importance of recognizing the distinct nature of perinatal OCD.

Objective: The purpose of this study was to identify the views of a cohort of Canadian university students related to maternity care provider preferences and the reasons for these preferences. Relationships between care provider preferences, childbirth attitudes, and desire for epidural anesthesia and cesarean section (CS) were also examined. Methods: This was a large cross-sectional survey (N = 3,680) of male and female university students at the University of British Columbia (male, 991; female, 2,676). Students were invited to participate via an electronic letter of invitation containing a link to this online survey.Results: Approximately half of all participants (51.8% for women and 43.7% for men) selected an obstetrician as one of their preferred care providers; somewhat fewer selected a family physician (40.1% for women and 32.8% for men), and even fewer selected a registered midwife (30.1% for women and 18.0% for men). Among the 11 reasons for these preferences (coded from open-ended responses), the most common were expert/specialist, safety, and quality of relationship with care provider. Attitudes toward vaginal birth as well as mode of delivery and pain management preferences were found to relate to caregiver preferences.Conclusion: Provider preferences among university students are largely driven by perceived risk, level of confidence in birth, and attitudes toward obstetric interventions. These preferences, in combination with the current shortage of maternity providers in Canada, indicate a need for restructuring maternity care human resources.

The debate between professional groups in Canada about the advisability of planned home birth continues. The Canadian Birth Place Study examines Canadian registered midwives', family physicians', and obstetricians' experiences with and attitudes towards planned home birth, as well as factors associated with in those attitudes. Evidence based strategies were applied to the development, validity testing, and implementation of a cross-sectional questionnaire to a multi-disciplinary sample of maternity care providers.The survey questions and attitude scale items were adapted from a previously validated questionnaire and reviewed by two discipline-specific expert panels. Experts provided qualitative comments and rated each socio-demographic and attitude item on three 4-point Likert-type scales to evaluate importance, clarity, and relevance. Aggregated scores (content validity indices) demonstrated strong content validity of items. The questionnaire construction and administration plan incorporated best practices for increasing response rates among healthcare providers, as well as participation from multiple perspectives on a controversial topic across study populations.

In this research letter, we discuss the challenges, implications and opportunities for action when assessing and reporting perinatal mental health conditions, in particular anxiety disorders (ADs). We present a case study from British Columbia (BC) to explore the challenges and potential inaccuracies that can arise when mental health difficulties are recorded inconsistently on perinatal records and in perinatal databases, rather than systematically using valid and reliable measures.

Objective: Unwanted, intrusive thoughts (UITs) of infant-related harm are a common postpartum phenomenon and can be classified into thoughts of accidental harm (TAHs) and thoughts of intentional harm (TIHs). Our study's objective was to complete a comprehensive, comparative analysis of TAHs and TIHs by commenting on their prevalence, course, characteristics (time, distress, and impairment) and most intense period. Methods: A total of 763 English-speaking pregnant women across British Columbia were recruited to participate in a prospective cohort study. Study data were collected between February 2014 and February 2017. UITs were assessed by semistructured interviews twice during the postpartum period. Results: The prevalence of TAHs and TIHs in the postpartum period was 95.8% and 53.9%, respectively. The most common TAHs included thoughts of the baby suffocating or dying from sudden infant death syndrome; the most common TIHs included thoughts of neglect. On average, TAHs are more prevalent, time-consuming, and result in greater interference compared to TIHs. The most intense period for TAHs (5.74 weeks postpartum) and TIHs (within first 8 weeks postpartum) was identified. During this period, over 40% of participants reported moderate or extreme distress related to UITs. For most, UITs decreased in frequency or completely resolved by 6 months postpartum, and most participants did not report clinically significant symptoms. Conclusion: UITs are a normative and typically self-resolving occurrence in the postpartum period. UITs' most intense period signifies a time of heightened vulnerability. Increased education is necessary to normalize and reduce distress associated with UITs.

In this cross-sectional study performed in Canada, we evaluated the frustration levels of prepartum and postpartum mother and father couple-pairs. Our goal was to determine if there were differences in frustration levels between mothers and fathers while listening to prolonged infant crying, and further, how frustration levels might differ between prepartum and postpartum samples. Using two discrete groups, prepartum (Sample 1; N = 48) and postpartum (Sample 2; N = 44) mother and father couple-pairs completed 600 s of listening to audio-recorded infant cry sounds. Participants continuously reported their subjective frustration using a computerized Continuous Visual Analog Scale (CVAS). There was no significant difference in frustration responses between mothers and fathers across both prepartum and postpartum samples. Postpartum mothers and fathers experienced greater frustration than their prepartum counterparts, and frustration increased faster in postpartum couples compared to prepartum couples. Informing first-time parents of the universal experiences of frustration to prolonged crying bouts that are characteristic of their infant's early weeks of life may lead to greater understanding towards their infant, and perhaps decreased instances of harmful responses.

Background: The anxiety and their related disorders (AD) are the most common of all mental health conditions, and affect approximately 20% of pregnant and postpartum people. They are associated with significant distress and life interference for sufferers, as well as negative consequences for fetal and infant development. At present, little if any routine screening for prenatal AD is being conducted and data regarding the most effective tools to screen for these disorders is lacking. The majority of screening studies suffer from methodological difficulties which undermine the confidence needed to recommend measures for population distribution. The primary purpose of this research is to identify the most accurate self-report tool(s) to screen for perinatal AD. Methods: A large, prospective cohort of pregnant people (N=1,000) is being recruited proportionally across health service delivery regions in British Columbia (BC). The screening accuracy of a broad range of perinatal AD self-report measures are being assessed using gold standard methodology. Consenting individuals are administered online questionnaires followed by a semi-structured diagnostic interview between 16- and 36-weeks’ gestation, and again between 6 and 20 weeks postpartum. Questionnaires include all screening measures, measures of sleep and unpaid family work, and questions pertaining to demographic and reproductive history, COVID-19, gender role burden, and mental health treatment utilization. Interviews assess all current anxiety disorders, as well as obsessive-compulsive disorder, and posttraumatic stress disorder. Discussion: This research is in response to an urgent demand for accurate perinatal AD screening tools based on high quality evidence. AD among perinatal people often go unidentified and untreated, resulting in continued suffering and life impairment. Findings from this research will inform healthcare providers, policymakers, and scientists, about the most effective approach to screening for anxiety and related disorders in pregnancy in the postpartum period.

Background: Fear of childbirth (FoB) is experienced to some degree by most pregnant people and can be intense enough to merit treatment. Despite significant research on the topic of FoB, studies investigating various forms of maltreatment and mental health symptoms in relation to FoB are very limited. In particular, studies including multiple forms of maltreatment along with mental health symptoms as predictors of FoB are extremely limited. We sought to fill this gap and clarify the relative contributions of these variables to the prediction of FoB. Methods: This was a secondary analysis of data from pregnant people in Canada. Participants (N = 881) provided demographic and reproductive history information, completed self-report measures of FoB, childhood maltreatment (multiple forms), adult sexual victimization, depressed mood and symptoms of posttraumatic stress disorder (PTSD). They were also administered a diagnostic interview to assess for specific phobia, FoB. Analyses included descriptive information, Wilcoxon rank sum tests, linear and logistic regression, and path analysis. Results: Most forms of maltreatment showed some association with increased FoB. However, when assessed together, only emotional maltreatment remained a significant predictor of FoB. Both depressed mood and symptoms of PTSD contributed more to FoB than maltreatment, and mediated the relationship of emotional maltreatment with FoB. The only direct effects of childhood emotional maltreatment on FoB were for fears of medical interventions and feelings of embarrassment during labour and delivery. Limitations: Study findings fill significant gaps in our understanding of the relationship between maltreatment, mental health symptoms and FoB. However, the study sample was limited to Canadian participants, most of whom were socio-economically advantaged, cis-gender women of European descent, thus limiting the generalizability of the findings. Further, as childhood maltreatment and sexual assault experiences in adulthood were reported retrospectively, study findings are also vulnerable to recall bias. Conclusions: Findings contribute to our understanding of the relationship between childhood maltreatment, adult sexual victimization, mental health and FoB. These findings can facilitate future research and improved care via a focus on depressed mood, symptoms of PTSD, emotional maltreatment and specific fears of medical interventions and social discomfort as significant contributors to one's experience of FoB.

Objective: Pregnancy-specific anxiety (PSA) is a distinct construct from general anxiety and depression. The purpose of this study was to develop, evaluate, and validate the Pregnancy-Specific Anxiety Tool (PSAT), to measure PSA and its severity.Methods: The study was carried out in 2 stages. Stage 1 involved item development and content and face validation. Stage 2 included psychometric evaluation to examine item distributions and correlational structure, dimensionality, internal consistency reliability, stability, and construct, convergent, and criterion validity, using 2 independent samples (initial sample N = 494, May-October 2018; validation sample N = 325, July 2019-May 2020).Results: Eighty-two items were evaluated for face validity and 41 items were considered in stage 2 based on feedback from participants and experts. Model fit from exploratory factor analysis and patterns of item-factor loadings suggested a 6-factor model with 33 items. The 6 factors included items pertaining to health and well-being of the baby, labor and the pregnant person's well-being, postpartum, support, career and finance, and indicators of severity. Confirmatory factor analysis carried out using the initial sample showed good fit with the validation sample. The area under the curve (AUC) for the diagnosis of adjustment disorders (AD) was 0.73 (95% CI, 0.67-0.79), and for AD/any anxiety disorders, the AUC was 0.80 (95% CI, 0.75-0.85).Conclusions: The PSAT can be useful for screening and monitoring of PSA, and pregnant people with scores higher than 10 should be considered for further assessment.