Postnatal Depression and Post-Traumatic Stress Risk Following Miscarriage

Abstract

The experience of miscarriage is an important population-level problem that affects approximately 10–25% of pregnancies. The physical consequences of miscarriage have been researched extensively, but psychological sequelae less so. First-person accounts show that women who have experienced miscarriage feel pressured to stay silent, to grieve, and to fight intense physical and psychological challenges alone. There is ample scientific evidence on the links between miscarriage and physical and mental health disorders, such as complicated grief, anxiety, depression, post-traumatic stress, suicidal risk, psychosomatic disorders, sexual health disorders, etc. However, there is a lack of deeper understanding of the specifics of psychological morbidity after miscarriage, as well as of the information on vulnerability and resilience factors. This study aims to assess the risk of postnatal depression and post-traumatic stress following miscarriage. A total of 839 Lithuanian women who had one or more miscarriages were asked to complete an online questionnaire, including the Edinburgh Postnatal Depression Scale (EPDS) and the Impact of Events Scale-Revised (IES-R). Of the women, 59.1% were found to be at increased risk of postnatal depression and 48.9% at high risk of postnatal depression; 44.7% of the women were considered to be at increased risk of post-traumatic stress. An impaired relationship with one’s body and childlessness has been the strongest predictors of psychological morbidity risk.

Direct and indirect predictors of postpartum depression symptoms among indigenous Bedouin mothers in Israel

“…Another notable finding is the high number of miscarriages in our sample, as more than a third (33.8%) of women reported at least one prior miscarriage (range 0–7). This allowed us to examine the number of miscarriages as a continuous variable in path analyses, not a dichotomous or ordinal variable as in most prior research (e.g., Kukulskienė & Žemaitienė, 2022). Number of prior miscarriages was found to directly predict PPD.…”

Mean comparisons of trauma symptoms between a reproductive trauma sample and a normative sample: Toward a trauma-informed practice.

“…Some qualitative studies exist which describe trauma symptomology within the context of adverse reproductive events, yet these also remain few. In their qualitative study, Kukulskienė & Žemaitienė (2022) noted that seven women reported themes of trauma after miscarriage. Grauerholz et al (2021) indicated that a review of website blogs from female participants detailed symptoms of PTSD, relationship problems, and depression.…”

“…Every adverse reproductive event is indeed a form of reproductive trauma, though each brings its own form of disenfranchised grief and emotional pain (Gozuyesil et al, 2020; Grauerholz et al, 2021; Volgsten et al, 2008). Though there are many forms of reproductive trauma, the most prevalent forms within the current literature include Infertility (Brigance et al, 2021; Jaffe, 2017), miscarriage (Kukulskienė & Žemaitienė, 2022), stillbirth (Gravensteen et al, 2013), fetal distress during delivery (Jotzo & Poets, 2005), fetal distress during pregnancy (Grauerholz et al, 2021), and premature birth (Gallus & Shreffler, 2009).…”

“…Chen et al (2004) indicated that a staggering 40% of women who have experienced infertility may meet the criteria for a psychological disorder. Kukulskienė & Žemaitienė (2022) indicated that individuals who have experienced miscarriage and stillbirth often experience intense grief. However, that grief is often left unprocessed due to a lack of general societal awareness of reproductive trauma as a form of loss, especially for miscarriage (Diamond & Diamond, 2016).…”

CBT for post-traumatic stress disorder and depression in the context of pregnancy loss: a case study reflection

“…Unlike other losses, there are no standardised rituals to manage this grief, and there is often no physical manifestation of the loss to mourn (Fredenburg, 2017). Societal factors which discourage or make it difficult to openly acknowledge or publicly grieve pregnancy loss may leave women facing emotional and physical challenges alone (Kukulskienė and Žemaitienė, 2022; Rowlands and Lee, 2010). Stigma and misconceptions regarding pregnancy loss not only silence and obscure grief from others (Berry, 2022), but may also contribute to the maintenance of PTSD as the trauma memory is not updated, nor are negative beliefs challenged.…”