Understanding Paranoia and Hallucinations in the Antenatal and Postnatal Period

Postpartum psychosis (PPP) is a serious mental health condition, which can occur in those without previous mental health difficulties. To understand risk factors for PPP, there is emerging literature on psychotic-like experiences (PLEs). Two of the most common PLEs are paranoia and hallucinations. Psychological theories suggest that worry and insomnia may be important mechanisms underpinning paranoia/hallucinations. There is little research on this in the perinatal period. The aim of this longitudinal study was to investigate the presence of paranoia/hallucinations in pregnancy (antenatal) and after birth (postnatal). The second aim was to identify whether insomnia, worry, and risk factors for common mental health difficulties were associated with and predicted paranoia/hallucinations. A community sample of pregnant women/birthing people were recruited through social media and perinatal organisations. They completed online questionnaires during pregnancy (T1, N=253) and 0-3 months postnatally (T2, N=91). The online questionnaires included measures of paranoia, hallucinations, risk factors, insomnia, and worry. Overall, there were higher levels of paranoia and hallucinations at T1. TI insomnia and T1 worry predicted T1 paranoia and hallucinations. Longitudinally, T1 insomnia, T1 worry, and T1 risk factors for common mental health difficulties did not predict T2 paranoia/hallucinations. T2 insomnia and T2 worry also did not predict T2 paranoia/hallucinations. The results suggest that insomnia and worry may be important mechanisms that underpin paranoia/hallucinations in the antenatal period only. A limitation is that we did not control for postnatal depression (PND) which has been associated with insomnia. Therefore, future longitudinal studies should control for PND, investigate other possible risk factors for paranoia/hallucinations, and gather data at more timepoints to identify any temporal associations in the antenatal and postnatal period.