Anxiety disorders following miscarriage.
BACKGROUND
Several previous studies have established that miscarriage is a risk factor for depressive symptoms and disorder. By contrast, research on miscarriage as a possible risk factor for anxiety symptoms is inconclusive, and for anxiety disorders, sparse and uninformative. The current study examines the incidence of and relative risk for 3 DSM-III anxiety disorders (obsessive-compulsive disorder [OCD], panic disorder, and phobic disorders) within the 6 months following miscarriage. Adequate diagnostic data on other anxiety disorders were not available.


METHODS
Using a cohort design, we tested whether women who miscarry are at increased risk for a first or recurrent episode of an anxiety disorder in the 6 months following loss. The miscarriage cohort consisted of women attending a medical center for spontaneous abortion (N = 229); the comparison group was a population-based cohort of women drawn from the community (N = 230).


RESULTS
Among miscarrying women, 3.5% experienced a recurrent episode of OCD, compared with 0.4% of community women (relative risk [RR] = 8.0; 95% confidence interval [CI] = 1.0 to 63.7). The relative risk for noncomorbid panic disorder was substantial (RR = 3.6), albeit not statistically significant (95% CI = 0.8 to 17.2). There was no strong evidence for increased risk for phobic disorders or agoraphobia, combined or considered separately, in the 6 months following loss. Relative risk for all 3 disorders combined was 1.5 (95% CI = 0.9 to 2.3).


CONCLUSIONS
In this first miscarriage cohort study using a concurrent frequency-matched comparison group, miscarriage was a substantial risk factor for an initial or recurrent episode of OCD. Given statistical power limitations of this investigation, the current findings do not preclude a possible contribution of miscarriage to risk for other anxiety disorders.
Geller
P A
PA
Department of Clinical and Health Psychology, MCP Hahnemann University, Philadelphia, PA 19102, USA.
Klier
C M
CM
Neugebauer
R
R
D000022:Abortion, Spontaneous / Q000150:complications* / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D000379:Agoraphobia / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008016:Life Change Events; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D016584:Panic Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D010698:Phobic Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D011247:Pregnancy; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012008:Recurrence; D012306:Risk; D012307:Risk Factors