It is recommended that perinatal mental health screening for depression and anxiety occur at least once during pregnancy and at least once during the 12 months postpartum.
This should include screening for intrusive thoughts / perinatal OCD when:
- The General Anxiety Disorder (GAD 3 or 7) is positive,
- When a mother discloses recurring unwanted or scary thoughts, and/or
- When a provider suspects psychosis (in order to “rule-out” OCD)
The following three tools are easily accessible and validated for detecting OCD in the perinatal period:
Obsessive Compulsive Inventory 4 (OCI-4)*
The OCI-4 is an ultra-brief 4-item version of a widely used self-report measure, the Obsessive-Compulsive Inventory-Revised (OCI-R), which may be employed as a routine screener for OCD. OCI-4 shows promise as an ultra-brief screening tool for identifying likely OCD in settings where in-depth assessment is impractical (Abramovitch, Abramowitz, & McKay, 2021).
Obsessive Compulsive Inventory 12 (OCI-12)*
The OCI-12 is a syndromally valid 12-item self-report scale based on the OCI-R. It does not include hoarding and neutralizing items. The OCI-12 demonstrates good to excellent psychometric properties, including sensitivity to treatment (Abramovitch, Abramowitz, & McKay, 2021).
The PASS screens for a broad range of anxiety symptoms during pregnancy and the postpartum period. This 31-item questionnaire is easy to complete and score, is sensitive to how anxiety presents in perinatal women and may be used in a variety of settings. This scale assesses four categories of anxiety: (1) acute anxiety and adjustment, (2) general worry and specific fears, (3) perfectionism, control and trauma and (4) social anxiety (MGH Center for Women's Mental Health, 2015).
- This screener is validated in the perinatal population to detect anxiety disorders and includes questions about obsessions/compulsions (in factor 3).
- At the optimal cutoff score (26) the PASS identified 68 % of women with a diagnosed anxiety disorder. This was compared to the EPDS anxiety subscale which detected 36 % of anxiety disorders. The PASS is an acceptable, valid and useful screening tool for the identification of risk of significant anxiety in women in the perinatal period.
- Analyses revealed that the optimal cutoff PASS score for detecting anxiety was 26, which yielded an AUC of 0.7 (standard error=0.04) with a sensitivity and specificity of 0.7 and 0.3, respectively
*These tools are not specific to the perinatal period. Though no studies specific to the perinatal population have been conducted, these screeners are still strong options for the perinatal population. It should also be noted that one of the developers, Dr. Jon Abramowitz, is a leader of the perinatal OCD research subgroup.