Post-traumatic stress, anxiety and depression following miscarriage or ectopic pregnancy: a prospective cohort study

Jessica Farren, Maria Jalmbrant, Lieveke Ameye, Karen Joash, Nicola Mitchell-Jones, Sophie Tapp, Dirk Timmerman, Tom Bourne, Jessica Farren, Maria Jalmbrant, Lieveke Ameye, Karen Joash, Nicola Mitchell-Jones, Sophie Tapp, Dirk Timmerman, Tom Bourne

Abstract

Objectives: This is a pilot study to investigate the type and severity of emotional distress in women after early pregnancy loss (EPL), compared with a control group with ongoing pregnancies. The secondary aim was to assess whether miscarriage or ectopic pregnancy impacted differently on the type and severity of psychological morbidity.

Design: This was a prospective survey study. Consecutive women were recruited between January 2012 and July 2013. We emailed women a link to a survey 1, 3 and 9 months after a diagnosis of EPL, and 1 month after the diagnosis of a viable ongoing pregnancy.

Setting: The Early Pregnancy Assessment Unit (EPAU) of a central London teaching hospital.

Participants: We recruited 186 women. 128 had a diagnosis of EPL, and 58 of ongoing pregnancies. 11 withdrew consent, and 11 provided an illegible or invalid email address.

Main outcome measures: Post-traumatic stress disorder (PTSD) was measured using the Post-traumatic Diagnostic Scale (PDS), and anxiety and depression using the Hospital Anxiety and Depression Scale (HADS).

Results: Response rates were 69/114 at 1 month and 44/68 at 3 months in the EPL group, and 20/50 in controls. Psychological morbidity was higher in the EPL group with 28% meeting the criteria for probable PTSD, 32% for anxiety and 16% for depression at 1 month and 38%, 20% and 5%, respectively, at 3 months. In the control group, no women met criteria for PTSD and 10% met criteria for anxiety and depression. There was little difference in type or severity of distress following ectopic pregnancy or miscarriage.

Conclusions: We have shown a large number of women having experienced a miscarriage or ectopic pregnancy fulfil the diagnostic criteria for probable PTSD. Many suffer from moderate-to-severe anxiety, and a lesser number depression. Psychological morbidity, and in particular PTSD symptoms, persists at least 3 months following pregnancy loss.

Keywords: ectopic pregnancy; miscarriage; post-traumatic stress disorder.

Conflict of interest statement

Conflicts of Interest: None declared.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Figures

Figure 1
Figure 1
Flow chart showing number of women invited to participate, reasons for withdrawal and response rates to 1-month and 3-month questionnaires.
Figure 2
Figure 2
Bar chart illustrating proportion of women meeting criteria for moderate or severe anxiety/depression, according to HADS, with 95% confidence limits. EPL, early pregnancy loss; HADS, Hospital Anxiety and Depression Scale.

References

    1. Blohm F, Fridén B, Milsom I. A prospective longitudinal population-based study of clinical miscarriage in an urban Swedish population. BJOG 2008;115:176–82. discussion 83 10.1111/j.1471-0528.2007.01426.x
    1. NICE. Ectopic pregnancy and miscarriage: diagnosis and initial management. Clinical guideline (CG154). Published date: December 2012. last accessed 10th October 2016.
    1. Lok IH, Yip AS, Lee DT et al. . A 1-year longitudinal study of psychological morbidity after miscarriage. Fertil Steril 2010;93:1966–75. 10.1016/j.fertnstert.2008.12.048
    1. Cumming GP, Klein S, Bolsover D et al. . The emotional burden of miscarriage for women and their partners: trajectories of anxiety and depression over 13 months. BJOG 2007;114:1138–45. 10.1111/j.1471-0528.2007.01452.x
    1. Prettyman RJ, Cordle CJ, Cook GD. A three-month follow-up of psychological morbidity after early miscarriage. Br J Med Psychol 1993;66:363–72. 10.1111/j.2044-8341.1993.tb01762.x
    1. Janssen HJ, Cuisinier MC, Hoogduin KA et al. . Controlled prospective study on the mental health of women following pregnancy loss. Am J Psychiatry 1996;153:226–30. 10.1176/ajp.153.2.226
    1. Thapar AK, Thapar A. Psychological sequelae of miscarriage: a controlled study using the general health questionnaire and the hospital anxiety and depression scale. Br J Gen Pract 1992;42:94–6.
    1. Nikcevic AV, Tunkel SA, Nicolaides KH. Psychological outcomes following missed abortions and provision of follow-up care. Ultrasound Obstet Gynecol 1998;11:123–8. 10.1046/j.1469-0705.1998.11020123.x
    1. Hamama L, Rauch SA, Sperlich M et al. . Previous experience of spontaneous or elective abortion and risk for posttraumatic stress and depression during subsequent pregnancy. Depress Anxiety 2010;27:699–707. 10.1002/da.20714
    1. Engelhard IM, van den Hout MA, Arntz A. Posttraumatic stress disorder after pregnancy loss. Gen Hosp Psychiatry 2001;23:62–6. 10.1016/S0163-8343(01)00124-4
    1. Farhi J, Ben-Rafael Z, Dicker D. Suicide after ectopic pregnancy. N Engl J Med 1994;330:714 10.1056/NEJM199403103301013
    1. Foa EB, Riggs DS, Dancu CV et al. . Reliability and validity of a brief instrument for assessing post-traumatic stress disorder. J Trauma Stress 1993;6:459–73. 10.1002/jts.2490060405
    1. Foa E, Cashman L, Jaycox L et al. . The validation of a self-report measure of posttraumatic stress disorder: the Posttraumatic Diagnostic Scale. Psychological Assessment 1997;9:445–51. 10.1037/1040-3590.9.4.445
    1. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983;67:361–70. 10.1111/j.1600-0447.1983.tb09716.x
    1. Bjelland I, Dahl AA, Haug TT et al. . The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res 2002;52:69–77. 10.1016/S0022-3999(01)00296-3
    1. Neugebauer R, Kline J, O'Connor P et al. . Depressive symptoms in women in the six months after miscarriage. Am J Obstet Gynecol 1992;166:104–9. 10.1016/0002-9378(92)91839-3
    1. Kessler RC. Posttraumatic stress disorder: the burden to the individual and to society. J Clin Psychiatry 2000;61(Suppl 5):4–12; discussion 13–4.
    1. American Psychiatric A, American Psychiatric Association DSMTF. Diagnostic and statistical manual of mental disorders: DSM-5. London: American Psychiatric Association, 2013.
    1. Rapaport MH, Clary C, Fayyad R et al. . Quality-of-life impairment in depressive and anxiety disorders. Am J Psychiatry 2005;162:1171–8. 10.1176/appi.ajp.162.6.1171
    1. Rogal SS, Poschman K, Belanger K et al. . Effects of posttraumatic stress disorder on pregnancy outcomes. J Affect Disord 2007;102:137–43. 10.1016/j.jad.2007.01.003
    1. Dunkel Schetter C, Tanner L. Anxiety, depression and stress in pregnancy: implications for mothers, children, research, and practice. Curr Opin Psychiatry 2012;25:141–8. 10.1097/YCO.0b013e3283503680
    1. Klier CM, Geller PA, Ritsher JB. Affective disorders in the aftermath of miscarriage: a comprehensive review. Arch Womens Ment Health 2002;5:129–49. 10.1007/s00737-002-0146-2
    1. NICE. Post-traumatic stress disorder management. Clinical guideline (CG26). Published date: March 2006. last accessed 10th October 2016
    1. Murphy FA, Lipp A, Powles DL. Follow-up for improving psychological well being for women after a miscarriage. Cochrane Database Syst Rev 2012;(3):Cd008679 10.1002/14651858.CD008679.pub2

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다