Grief and Depression After Miscarriage

Abstract

Bereavement is a major risk factor for physical illness, grief, depression, and anxiety. In contrast to recent tendencies in the psychiatric literature to equate grief and depression, we propose that a careful discrimination between the two must be made for diagnostic, therapeutic, and investigative purposes. We report the results of a longitudinal study of a frequent but neglected event, miscarriage early in pregnancy, to make this point. Clinical criteria for differentiating grief and depressive reactions were developed based on phenomenological criteria and theoretical considerations. We hypothesized that the detrimental psychological and physical consequences occur only when the miscarriage was not mourned and resulted in a depressive reaction, but not in a grief reaction. In a controlled, representative study, 125 consecutive women were assessed shortly after their miscarriage (before the 20th week of gestation) and 6 months (N = 94) and 12 months (N = 90) later. Assessments included standardized questionnaires for life events, depression, physical complaints, anxiety, and a specific, multidimensional grief scale (Munich Grief Scale) that we had developed previously. Immediately after the miscarriage, the average anxiety and depression scores were elevated when compared with 80 pregnant and 125 age-matched community controls. Twenty percent of the patients who had miscarried showed a grief reaction, 12% showed a depressive reaction, and 20% responded with a combined depressive and grief reaction. The remaining women (48%) reported no changes in their emotional reactions. As predicted, longer-lasting psychological, social, and health status changes followed the initial depressive, but not the grief reactions. Depressive reactions were predicted by a history of previous depression, a lack of social resources, and an ambivalent attitude to the lost fetus. The grief measures were reliable and made it possible to discriminate between grief and depression.

Previous prenatal loss as a predictor of perinatal depression and anxiety

“…Previous studies had documented that women who had experienced miscarriage or stillbirth had significantly higher levels of anxiety and depression in a subsequent pregnancy. 5,9,6,27 The current study extends this work by showing that the impact persists well past the subsequent pregnancy and despite the birth of a healthy child (indexed here by birth weight and gestational age of the subsequent child).…”

“…It may be that a more recent loss is associated with higher levels of affective symptoms that continue in the postpartum period, perhaps as a function of bereavement. 6,14 …”

Shared or Discordant Grief in Couples 2–6 Years After the Death of Their Premature Baby: Effects on Suffering and Posttraumatic Growth

“…Table 1 Instruments Parental grief was assessed using the Münchner Trauerskala (MTS) 23 , developed from the short form of the Perinatal Grief Scale (PGS) 24 . The MTS is the best validated German questionnaire for assessment of perinatal grief.…”

Applying Heidegger’s interpretive phenomenology to women’s miscarriage experience

“…The miscarriage experience, although not uncommon, is an unwelcome event and can be traumatic for a woman 4. Many women describe the experience of miscarriage as if they had actually lost a baby5 or a part of themselves 6–8.…”

“…Many women describe the experience of miscarriage as if they had actually lost a baby5 or a part of themselves 6–8. Women who experience a miscarriage acknowledge that it is a source of increased stress and they describe the experience in terms of sorrow,9–17 depression and anxiety,4,11–14,18–23 and self blame and guilt 7,8,25. Between 25% and 50% of the women who have experienced a miscarriage have been determined to have posttraumatic stress symptoms 10…”