Risk factors and interventions for psychological sequelae in women after miscarriage

Spontaneous abortion occurs in about one in five pregnancies, and for many women can lead to significant psychological sequelae. This article reviews the literature on the psychological morbidities after pregnancy loss, their risk factors, differences in partner's reactions, potential screening tools and interventions for physicians. The most common reactions women experienced after pregnancy loss were grief, depression, and anxiety, with rates cited of approximately 40%, 12-50%, and 22-41%, respectively. Risk factors for these reactions include having a past psychiatric history, poor social support, no living children, lack of knowledge about miscarriages, and having no explanation for the event. Women's partners also show grief reactions after pregnancy loss, but they grieve less intensely and for a briefer time than women. Men also tend to talk less about their feelings. Women consistently express a desire to have follow-up appointments after a miscarriage, and have a high (75%) show rate when physicians offer them follow-up appointments. The 30-item General Health Questionnaire has good sensitivity and specificity in detecting psychological morbidity after miscarriage. Based on our review we recommend that ob/gyns offer women a follow-up appointment two to three weeks after miscarriage. By using a screening tool such as the General Health Questionnaire and asking about potential risk factors, ob/gyns should be able to effectively identify and refer high risk women to a psychiatric consultant.