Postnatal Depression and Post-Traumatic Stress Risk Following Miscarriage
Citation
Kukulskiene, M.; Žemaitiene, N. Postnatal Depression and Post-Traumatic Stress Risk Following Miscarriage. Int. J. Environ. Res. Public Health 2022, 19, 6515.
Academic Editors: Magdalena Piegza and Paweł Dębsk.
Received: 30 April 2022
Accepted: 25 May 2022
Published: 27 May 2022
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Abstract
Miscarriage prevalence: Affects approximately 10–25% of pregnancies.
Research focus: Extensive on physical consequences but less on psychological sequelae.
Women's experiences: Many women feel pressured to stay silent and face challenges alone following miscarriage.
**Psychological disorders associated: ** Complicated grief, anxiety, depression, post-traumatic stress, suicidal risk, psychosomatic disorders, sexual health disorders, etc.
Study aim: Assess risks of postnatal depression and post-traumatic stress following miscarriage using a questionnaire on 839 women.
Findings:
59.1% at increased risk of postnatal depression.
48.9% at high risk of postnatal depression.
44.7% at increased risk of post-traumatic stress.
Key predictors: Impaired relationships with body and feelings of childlessness.
1. Introduction
Definitions of pregnancy loss: Inconsistencies in terminology; "miscarriage" versus "spontaneous abortion".
WHO distinction:
Miscarriage = loss before 28 weeks.
Stillbirth = loss at or after 28 weeks, although these definitions can be contradictory.
Impact of miscarriage: Significant at a population level and affecting many aspects of women’s health, as well as their partners and families.
Stigmatization: Miscarriage remains a taboo subject, impacting women's physical and mental health significantly.
Research gaps: Need for deeper understanding of psychological morbidity details, including vulnerability and resilience factors post-miscarriage.
2. Literature Review
Numerous studies link miscarriage to physical and mental health disorders:
Complicated grief, anxiety, depression, post-traumatic stress disorder (PTSD).
Suicidal risks and psychosomatic disorders noted.
Prevalence of symptoms post-miscarriage:
29% show PTSD symptoms one month post-loss.
24% moderate to severe anxiety; 11% moderate to severe depression.
Long-term studies report:
Symptoms persist at clinically important levels nine months after miscarriage.
Risk of PTSD generally reported as 25–29%.
It's noted that partners can also experience anxiety, depression, and PTSD, albeit at lower rates.
Importance of early symptom detection: Early identification of postnatal depression is crucial to prevent long-lasting effects.
3. Methodology
Study design: Cross-sectional to assess women's wellbeing in relation to previous miscarriages.
Ethics approval: Procedures approved by the Kaunas Regional Biomedical Research Ethics Committee.
Data collection: Conducted from December 2021 to February 2022 through online surveys, with invitations circulated in social networks focused on pregnancy and reproductive health.
Participants: 839 women with singleton or recurrent miscarriages, aged 19–55 (Mean age: 33.34 ± 5.46).
Questionnaire structure:
Demographic data, emotional and physical wellbeing, EPDS, IES-R scales, coping mechanisms, support needs.
Utilized validated Lithuanian versions of EPDS (Edinburgh Postnatal Depression Scale) and IES-R (Impact of Events Scale-Revised).
4. Results
Study found high levels of psychological distress:
Postnatal depression risk: 59.1% increased risk, with means on EPDS of 11.69 (Min: 0, Max: 29).
Post-traumatic stress risk: 44.7% identified at risk (IES-R mean: 31.30, Min: 0, Max: 88).
Logistic regression findings on postnatal depression risk:
**Key predictors: **
Impaired body relationship (OR = 2.48).
Younger age and lower education are associated with a higher risk.
Emotional and physical well-being directly post-miscarriage impact.
5. Discussion
Majority of participants reported high levels of distress; 15.4% had self-harm thoughts and 14.2% had suicidal thoughts.
Body-image correlation: Impaired relationships with one's body are predictive of high postnatal depression and PTSD risks.
Discussion factors include age, emotional health pre and post-miscarriage, and social support.
Found that childlessness significantly predicts PTSD risk but is not correlated with depression.
6. Conclusion
Persistent postnatal depression and PTSD symptoms following miscarriage highlight a need for targeted psychological support.
Emphasis on embodiment and support, particularly among women without children.
Need to improve the understanding of women’s experiences post-miscarriage, focusing on evidence-based healthcare practices.
7. Limitations and Future Directions
Limitations include potential recall bias, non-representative sampling, and reliance on retrospective data.
Recommendations for longitudinal studies to capture changes over time and further exploration of support needs post-miscarriage.
Future work could assess the experiences of male partners and the broader implications on family health post-miscarriage.
The study was conducted using a cross-sectional design to assess women's well-being concerning previous miscarriages. Data collection took place from December 2021 to February 2022 through online surveys circulated in social networks focused on pregnancy and reproductive health. The participants included 839 women, aged 19–55 (mean age: ), who had experienced singleton or recurrent miscarriages. The questionnaire used covered demographic data, emotional and physical well-being, and utilized validated Lithuanian versions of the EPDS (Edinburgh Postnatal Depression Scale) and IES-R (Impact of Events Scale-Revised) scales, along with questions on coping mechanisms and support needs. Ethical approval was obtained from the Kaunas Regional Biomedical Research Ethics Committee.