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Post-traumatic stress, anxiety and depression following miscarriage or ectopic pregnancy: a prospective cohort study
  1. Jessica Farren1,
  2. Maria Jalmbrant2,
  3. Lieveke Ameye3,
  4. Karen Joash1,
  5. Nicola Mitchell-Jones4,
  6. Sophie Tapp1,
  7. Dirk Timmerman3,5,
  8. Tom Bourne1,3,5
  1. 1Tommy's National Centre for Miscarriage Research, Queen Charlottes and Chelsea Hospital, Imperial College, London, UK
  2. 2South London and Maudsley NHS Foundation Trust, London, UK
  3. 3Department of Development and Regeneration, KU Leuven, Leuven, Belgium
  4. 4Chelsea and Westminster NHS Trust, London, UK
  5. 5Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
  1. Correspondence to Professor Tom Bourne; t.bourne{at}imperial.ac.uk

Abstract

Objectives This is a pilot study to investigate the type and severity of emotional distress in women after early pregnancy loss (EPL), compared with a control group with ongoing pregnancies. The secondary aim was to assess whether miscarriage or ectopic pregnancy impacted differently on the type and severity of psychological morbidity.

Design This was a prospective survey study. Consecutive women were recruited between January 2012 and July 2013. We emailed women a link to a survey 1, 3 and 9 months after a diagnosis of EPL, and 1 month after the diagnosis of a viable ongoing pregnancy.

Setting The Early Pregnancy Assessment Unit (EPAU) of a central London teaching hospital.

Participants We recruited 186 women. 128 had a diagnosis of EPL, and 58 of ongoing pregnancies. 11 withdrew consent, and 11 provided an illegible or invalid email address.

Main outcome measures Post-traumatic stress disorder (PTSD) was measured using the Post-traumatic Diagnostic Scale (PDS), and anxiety and depression using the Hospital Anxiety and Depression Scale (HADS).

Results Response rates were 69/114 at 1 month and 44/68 at 3 months in the EPL group, and 20/50 in controls. Psychological morbidity was higher in the EPL group with 28% meeting the criteria for probable PTSD, 32% for anxiety and 16% for depression at 1 month and 38%, 20% and 5%, respectively, at 3 months. In the control group, no women met criteria for PTSD and 10% met criteria for anxiety and depression. There was little difference in type or severity of distress following ectopic pregnancy or miscarriage.

Conclusions We have shown a large number of women having experienced a miscarriage or ectopic pregnancy fulfil the diagnostic criteria for probable PTSD. Many suffer from moderate-to-severe anxiety, and a lesser number depression. Psychological morbidity, and in particular PTSD symptoms, persists at least 3 months following pregnancy loss.

  • post-traumatic stress disorder
  • miscarriage
  • ectopic pregnancy

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Twitter Follow Tom Bourne at @proftombourne

  • Contributors TB, MJ and KJ devised the original study protocol. JF recruited patients for the study. JF and LA were responsible for statistical analysis of the results. TB, JF and MJ wrote the first draft of the manuscript that was then critically reviewed and revised by the other co-authors. DT, NM-J and ST commented on the drafts of the paper. All authors approved the final version of the manuscript for submission. All authors had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. TB is the guarantor, and affirms that the manuscript is an honest, accurate and transparent account of the study being reported; and that any discrepancies from the study as planned have been explained.

  • Funding JF was supported by Imperial College Healthcare Charity grant number 141517. TB is supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Imperial College Healthcare NHS Trust and Imperial College London. The early pregnancy unit at Queen Charlottes and Chelsea Hospital is supported by the Tommy's charity. DT is Senior Clinical Investigator of FWO (Research Foundation—Flanders).

  • Disclaimer The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests None declared.

  • Ethics approval This was a prospective cohort study, with ethical approval of the study protocol granted by the NRES committee of South-West Exeter, reference 11/SW/0052.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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