Skip to main content
PMC home page
American Journal of Public Health logoLink to American Journal of Public Health
. 1992 Oct;82(10):1332–1339. doi: 10.2105/ajph.82.10.1332

Determinants of depressive symptoms in the early weeks after miscarriage.

R Neugebauer 1, J Kline 1, P O'Connor 1, P Shrout 1, J Johnson 1, A Skodol 1, J Wicks 1, M Susser 1
PMCID: PMC1695859  PMID: 1415855

Abstract

OBJECTIVES. We tested whether and under what conditions miscarriage increases depressive symptoms in the early weeks following loss. METHODS. We interviewed 232 women within 4 weeks of miscarriage and 283 pregnant women and 318 community women who had not recently been pregnant. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression (CES-D) Scale. RESULTS. Among women who had miscarried, the proportion who were highly symptomatic on the CES-D was 3.4 times that of pregnant women and 4.3 times that of community women. Among childless women, the proportion of women who had miscarried who were highly symptomatic was 5.7 times that of pregnant women and 11.0 times that of community women. Women who had miscarried were equally depressed regardless of length of gestation; among pregnant women, depressive symptoms declined with length of gestation. Among women who had miscarried, symptom levels did not vary with attitude toward the pregnancy; among pregnant women, depressive symptoms were elevated in those with unwanted pregnancies. Prior reproductive loss and advanced maternal age (35+ years) were not associated with symptom levels in any cohort. CONCLUSIONS. Depressive symptoms are markedly increased in the early weeks following miscarriage. This effect is substantially modified by number of living children, length of gestation at loss, and attitude toward pregnancy.

Full text

PDF
1336

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aneshensel C. S., Frerichs R. R., Clark V. A., Yokopenic P. A. Measuring depression in the community: a comparison of telephone and personal interviews. Public Opin Q. 1982 Spring;46(1):110–121. doi: 10.1086/268703. [DOI] [PubMed] [Google Scholar]
  2. Benfield D. G., Leib S. A., Vollman J. H. Grief response of parents to neonatal death and parent participation in deciding care. Pediatrics. 1978 Aug;62(2):171–177. [PubMed] [Google Scholar]
  3. Boyd J. H., Weissman M. M., Thompson W. D., Myers J. K. Screening for depression in a community sample. Understanding the discrepancies between depression symptom and diagnostic scales. Arch Gen Psychiatry. 1982 Oct;39(10):1195–1200. doi: 10.1001/archpsyc.1982.04290100059010. [DOI] [PubMed] [Google Scholar]
  4. Elliott B. A., Hein H. A. Neonatal death: reflections for physicians. Pediatrics. 1978 Jul;62(1):96–100. [PubMed] [Google Scholar]
  5. Folstein M. F., Luria R. Reliability, validity, and clinical application of the Visual Analogue Mood Scale. Psychol Med. 1973 Nov;3(4):479–486. doi: 10.1017/s0033291700054283. [DOI] [PubMed] [Google Scholar]
  6. Forrest G. C., Standish E., Baum J. D. Support after perinatal death: a study of support and counselling after perinatal bereavement. Br Med J (Clin Res Ed) 1982 Nov 20;285(6353):1475–1479. doi: 10.1136/bmj.285.6353.1475. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Friedman T., Gath D. The psychiatric consequences of spontaneous abortion. Br J Psychiatry. 1989 Dec;155:810–813. doi: 10.1192/bjp.155.6.810. [DOI] [PubMed] [Google Scholar]
  8. Graham M. A., Thompson S. C., Estrada M., Yonekura M. L. Factors affecting psychological adjustment to a fetal death. Am J Obstet Gynecol. 1987 Aug;157(2):254–257. doi: 10.1016/s0002-9378(87)80145-x. [DOI] [PubMed] [Google Scholar]
  9. Kennell J. H., Slyter H., Klaus M. H. The mourning response of parents to the death of a newborn infant. N Engl J Med. 1970 Aug 13;283(7):344–349. doi: 10.1056/NEJM197008132830706. [DOI] [PubMed] [Google Scholar]
  10. Kline J., Hutzler M., Levin B., Stein Z., Susser M., Warburton D. Marijuana and spontaneous abortion of known karyotype. Paediatr Perinat Epidemiol. 1991 Jul;5(3):320–332. doi: 10.1111/j.1365-3016.1991.tb00717.x. [DOI] [PubMed] [Google Scholar]
  11. Kline J., Stein Z., Susser M., Warburton D. Induced abortion and the chromosomal characteristics of subsequent miscarriages (spontaneous abortions). Am J Epidemiol. 1986 Jun;123(6):1066–1079. doi: 10.1093/oxfordjournals.aje.a114335. [DOI] [PubMed] [Google Scholar]
  12. LaRoche C., Lalinec-Michaud M., Engelsmann F., Fuller N., Copp M., McQuade-Soldatos L., Azima R. Grief reactions to perinatal death--a follow-up study. Can J Psychiatry. 1984 Feb;29(1):14–19. doi: 10.1177/070674378402900104. [DOI] [PubMed] [Google Scholar]
  13. Leinbach R. M. Alternatives to the face-to-face interview for collecting gerontological needs assessment data. Gerontologist. 1982 Feb;22(1):78–82. doi: 10.1093/geront/22.1.78. [DOI] [PubMed] [Google Scholar]
  14. Leppert P. C., Pahlka B. S. Grieving characteristics after spontaneous abortion: a management approach. Obstet Gynecol. 1984 Jul;64(1):119–122. [PubMed] [Google Scholar]
  15. Lewis E. The management of stillbirth: coping with an unreality. Lancet. 1976 Sep 18;2(7986):619–620. doi: 10.1016/s0140-6736(76)90680-2. [DOI] [PubMed] [Google Scholar]
  16. Myers J. K., Weissman M. M. Use of a self-report symptom scale to detect depression in a community sample. Am J Psychiatry. 1980 Sep;137(9):1081–1084. doi: 10.1176/ajp.137.9.1081. [DOI] [PubMed] [Google Scholar]
  17. Neugebauer R., Kline J., O'Connor P., Shrout P., Johnson J., Skodol A., Wicks J., Susser M. Depressive symptoms in women in the six months after miscarriage. Am J Obstet Gynecol. 1992 Jan;166(1 Pt 1):104–109. doi: 10.1016/0002-9378(92)91839-3. [DOI] [PubMed] [Google Scholar]
  18. Nicol M. T., Tompkins J. R., Campbell N. A., Syme G. J. Maternal grieving response after perinatal death. Med J Aust. 1986 Mar 17;144(6):287–289. doi: 10.5694/j.1326-5377.1986.tb128375.x. [DOI] [PubMed] [Google Scholar]
  19. Peppers L. G., Knapp R. J. Maternal reactions to involuntary fetal/infant death. Psychiatry. 1980 May;43(2):155–159. doi: 10.1080/00332747.1980.11024061. [DOI] [PubMed] [Google Scholar]
  20. Rowe J., Clyman R., Green C., Mikkelsen C., Haight J., Ataide L. Follow-up families who experience a perinatal death. Pediatrics. 1978 Aug;62(2):166–170. [PubMed] [Google Scholar]
  21. Seibel M., Graves W. L. The psychological implications of spontaneous abortions. J Reprod Med. 1980 Oct;25(4):161–165. [PubMed] [Google Scholar]
  22. Toedter L. J., Lasker J. N., Alhadeff J. M. The Perinatal Grief Scale: development and initial validation. Am J Orthopsychiatry. 1988 Jul;58(3):435–449. doi: 10.1111/j.1939-0025.1988.tb01604.x. [DOI] [PubMed] [Google Scholar]
  23. Tudehope D. I., Iredell J., Rodgers D., Gunn A. Neonatal death: grieving families. Med J Aust. 1986 Mar 17;144(6):290–292. doi: 10.5694/j.1326-5377.1986.tb128376.x. [DOI] [PubMed] [Google Scholar]
  24. Weissman M. M., Sholomskas D., Pottenger M., Prusoff B. A., Locke B. Z. Assessing depressive symptoms in five psychiatric populations: a validation study. Am J Epidemiol. 1977 Sep;106(3):203–214. doi: 10.1093/oxfordjournals.aje.a112455. [DOI] [PubMed] [Google Scholar]
  25. Zeanah C. H. Adaptation following perinatal loss: a critical review. J Am Acad Child Adolesc Psychiatry. 1989 Jul;28(4):467–480. doi: 10.1097/00004583-198907000-00001. [DOI] [PubMed] [Google Scholar]
  26. Zuckerman B., Amaro H., Bauchner H., Cabral H. Depressive symptoms during pregnancy: relationship to poor health behaviors. Am J Obstet Gynecol. 1989 May;160(5 Pt 1):1107–1111. doi: 10.1016/0002-9378(89)90170-1. [DOI] [PubMed] [Google Scholar]

Articles from American Journal of Public Health are provided here courtesy of American Public Health Association

RESOURCES