Repetitive Negative Thinking and Its Role in Perinatal Mental Health

Abstract

Background: There is evidence that anxiety is common, perhaps even more prevalent than depression, in the post-partum period. In this review we propose adopting a transdiagnostic approach to perinatal mental health: to delineate psychopathology and identify potential underlying cognitive mechanisms such as repetitive negative thinking (RNT). Sampling and Methods: We provide an overview of key studies of RNT in perinatal mental health and suggest directions for future work. We propose the value of examining post-partum depression and anxiety, and their co-occurrence, and of testing whether the psychological mechanisms that predict and maintain depression and anxiety also play a role in these conditions in the post-partum period. Further, given that psychological distress often first emerges in the antenatal phase, we make a case for investigating RNT across the perinatal period – i.e., in antenatal and postnatal women. Results and Conclusions: RNT may be a modifiable risk factor which can be targeted in pregnancy to prevent depression and anxiety in new mothers.

Perceived social support and prenatal wellbeing; The mediating effects of loneliness and repetitive negative thinking on anxiety and depression during the COVID-19 pandemic

“…Pregnant women's tendency to engage in RNT could be readily assessed during routine prenatal care (e.g., by administration of a brief selfreport measure in the context of routine antenatal appointments with midwives). Such a simple assessment approach has the potential to identify a key psychological vulnerability, and in turn prompt a referral to relevant mental health care provider, which may circumvent fears of disclosure which reduce help seeking behaviours during the perinatal period [14,69], and help identify women at-risk of developing clinical symptoms (see Moulds et al [34]).…”

“…There is growing evidence that RNT predicts perinatal anxiety and depression [33,34]. For example, Schmidt et al [35] found that RNT in the first trimester predicted depression levels in the third trimester, while Barnum et al [36] reported that RNT in the third trimester predicted changes in depression symptoms from the third trimester to eight weeks postpartum.…”

Measuring repetitive negative thinking: Development and validation of the Persistent and Intrusive Negative Thoughts Scale (PINTS).

“…Within the internalizing disorders literature, there is extensive evidence that RNT shares common rather than unique associations with depression and anxiety disorders, as well as being one of the underlying dimensions in the comorbidity between them (Drost, Van der Does, van Hemert, Penninx, & Spinhoven, 2014;McEvoy et al, 2018McEvoy et al, , 2019McEvoy, Watson, Watkins, & Nathan, 2013). Although much of the RNT research has focused on depression and anxiety, RNT has also been found to be significantly associated with sleep disturbance (Cox, Cole, Kramer, & Olatunji, 2018;Lin, Xie, Yan, Chen, & Yan, 2017), perinatal mental health (Egan, Kane, Winton, Eliot, & McEvoy, 2017;Moulds, Black, Newby, & Hirsch, 2018), mania (McEvoy et al, 2018), maladaptive perfectionism (Macedo et al, 2015), lower levels of happiness and life satisfaction (Eldelekliog ˘lu, 2015), and a reduced sense of belonging and social support (Turner & McLaren, 2011). Collectively, this body of research suggests that RNT has possible relevance for the etiology, maintenance, and recurrence of a wide range of interpersonal problems, mental disorders, and comorbidities.…”

Content and Themes of Repetitive Thinking in Postnatal First-Time Mothers

“…Both of these types of RT are well-established predictors of the onset and maintenance of depression and anxiety, respectively. To date, the nature, role and consequences of RT have been minimally studied in the context of perinatal psychological adjustment (see DeJong et al, 2016 for review; also, Moulds et al, 2018), although there is growing evidence that RT predicts depression in the perinatal period (DeJong et al, 2016). For example, worry in the first trimester predicts depression in the third trimester (Schmidt et al, 2016), and rumination predicts increases in depression symptoms from the third trimester to 8 weeks postpartum (an association that is not moderated by level of depression in the third trimester; Barnum et al, 2013).…”

“…Whilst we note studies in which investigators have examined the content of worry (one specific type of RT) in perinatal populations (e.g., Moran et al, 2014), as well as perinatal women with generalized anxiety disorder (GAD; Goldfinger et al, 2020), to our knowledge, no research to date has investigated the themes of RT (as defined more broadly here) in the context of postnatal anxiety. Indeed, the absence of such work reflects the relative neglect of anxiety in this literature (Moulds et al, 2018), despite the documented prevalence of anxiety across the perinatal period (e.g., Dennis et al, 2017;Fairbrother et al, 2017;Viswasam et al, 2019). Accordingly, as a first step, there is a need to develop our understanding of the themes and experiences that are commonly the focus of RT in the postnatal period, in order to determine the types of thoughts that new mothers typically return to repeatedly.…”