Network analysis and comparison of psychological distress among women with miscarriage experience

As many as 15.3% of pregnancies do not end in a live birth meaning miscarriage is among the most common pregnancy complications. This experience is robustly evidenced to be associated with adverse health and well-being outcomes for mothers, however, much existing evidence focuses on psychopathology outcomes such as depression and anxiety disorders. Adopting a holistic approach inclusive of more nuanced mental health outcomes of pregnancy loss, this study sought to assess and compare distress among women experiencing miscarriage at home or in hospital. The current study applied Network Analysis to examine associations between indicators of psychological distress (e.g. feelings of loss, isolation, and devastation) in a sample of 839 women. Networks were assessed to identify the most influential indicators for the total sample of women who experienced miscarriage in the previous 5 years (N = 839), and for subsamples who reported experiencing management of their miscarriage at home (n = 493), or in hospital (n = 273). Results highlighted the most influential distress indicators in the network to be: 'feelings of a person lost', 'destroyed zest for life', and 'feelings of isolation'. Comparison between subgroups, those who experienced miscarriage at home and in hospital, revealed similar network structures. Those who experienced miscarriage at home displayed greater global association between nodes in the network, i.e. stronger connections between distress indicators suggesting these have greater influence on each other a potentially exacerbate distress. The most influential distress indicators are highlighted as important targets for screening psychological distress, and as potentially viable intervention targets to promote greater well-being among women experiencing miscarriage, regardless of setting. These findings provide a novel understanding of psychological distress following miscarriage as a system of connected symptoms, further research is called for to examine broader influences of the impact of miscarriage network.