Events after stillbirth in relation to maternal depressive symptoms: a brief report.
BACKGROUND
Actions taken after a stillbirth can affect long-term psychological morbidity. Our objective was to study how infant bonding and maternal actions after stillbirth are associated with ensuing depressive symptoms.


METHODS
Using the population-based Swedish Medical Birth Register, we identified all 380 Swedish-speaking women who gave birth to singleton stillborn infants in Sweden in 1991. Of these, 314 (83%) completed a postal questionnaire 3 years after the stillbirth. Items included actions taken to bond with the baby and demographics. The association between care-related factors and later maternal depressive symptoms was quantified using relative risks estimated using multivariable regression.


RESULTS
We observed an almost sevenfold increased risk of depressive symptoms for mothers who reported not being with their babies as long as they wished (adjusted risk ratio [RR] 6.9, 95% CI 2.4-19.8). Compared with women who became pregnant again within 6 months, those with no later pregnancy were at higher risk of depressive symptoms (adjusted RR 2.8, 95% CI 0.9-8.4). In addition, compared with women who experienced a stillbirth in their first pregnancy, stillbirth occurring with an infant who was third in the birth order was related to a twofold risk of elevated depressive symptoms (adjusted RR 2.2, 95% CI 0.8-6.4). Furthermore, stillbirth occurring in a fourth or later pregnancy was associated with an almost sevenfold risk of depressive symptomatology (adjusted RR 6.7, 95% CI 2.2-20.5). No evidence of an association was found between other care-related actions and subsequent maternal depressive symptoms.


CONCLUSIONS
Our results suggest that a mother being with the stillborn baby for as long as desired and the birth order of the stillbirth may influence her later depressive symptomatology. Compared with mothers who became pregnant again within 6 months, those who did not have a subsequent pregnancy were at higher risk of depressive symptoms at 3 years' follow-up.
Division of Clinical Cancer Epidemiology, Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden.
Pamela J
PJ
Surkan
Ingela
I
Rådestad
Sven
S
Cnattingius
Gunnar
G
Steineck
Paul W
PW
Dickman
D000328:Adult; D001722:Birth Order / Q000523:psychology*; D003863:Depression / Q000453:epidemiology / Q000473:pathology / Q000523:psychology*; D019052:Depression, Postpartum / Q000453:epidemiology / Q000473:pathology / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D009034:Mother-Child Relations; D009035:Mothers / Q000523:psychology*; D015999:Multivariate Analysis; D016017:Odds Ratio; D012307:Risk Factors; D012720:Severity of Illness Index; D050497:Stillbirth / Q000523:psychology*; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D013997:Time Factors