A Panel Network Analysis of Posttraumatic Stress Disorder and Obsessive-Compulsive Disorder Symptoms Across the Perinatal Period

The perinatal period is marked by a higher risk of experiencing depressive, anxiety, and/or trauma-related symptoms, a phenomenon that affects millions of individuals each year. Obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) symptoms commonly co-occur but have rarely been examined together beyond prevalence estimates in the perinatal period. Our study aimed to explore patterns of associations among OCD and PTSD symptoms to elucidate within- and between-person effects and how these effects may change over time. Participants (N = 270) were recruited during pregnancy from an academic medical center affiliated with a midwestern university. PTSD, OCD, and depressive symptoms were assessed at pregnancy, 4, 8, and 12 weeks postpartum. A panel graphical vector autoregression model was used to estimate networks. The temporal network provided information regarding directed predictive effects between symptoms, and hyperarousal, neutralizing, and ordering were the most stable and predictive symptoms across time. The contemporaneous network, which yields undirected partial correlations between symptoms at a given moment, indicated that there were positive associations between intrusions and avoidance, hyperarousal and negative alterations in cognitions and mood, as well as between hyperarousal and dysphoria. This study identified hyperarousal and neutralizing as the PTSD and OCD symptoms with the strongest stability, predictive power, and association with other symptoms. Clinically, this indicates that screening for hyperarousal and neutralizing symptoms may identify individuals who could maximally benefit from treatment in the perinatal period. This study elucidates the posttraumatic stress disorder and obsessive-compulsive disorder symptoms most important to assess during pregnancy and the postpartum period. Network analysis determined that negative alterations in cognitions and mood, obsessing, checking, and avoidance symptoms as the symptoms with the highest relative importance in the between-person network, while hyperarousal, neutralizing, and ordering symptoms were the most stable and predictive symptoms across time. Posttraumatic stress disorder and obsessive-compulsive disorder symptoms are not routinely assessed by health care professionals, yet results suggest identified symptoms warrant closer attention in clinical and obstetric settings.