title: When mixed methods produce mixed results: integrating disparate findings about miscarriage and women's wellbeing.
abstract: OBJECTIVE
  To discuss an example of mixed methods in health psychology, involving separate quantitative and qualitative studies of women's mental health in relation to miscarriage, in which the two methods produced different but complementary results, and to consider ways in which the findings can be integrated.
  
  
  METHODS
  We describe two quantitative projects involving statistical analysis of data from 998 young women who had had miscarriages, and 8,083 who had not, across three waves of the Australian Longitudinal Study on Women's Health. We also describe a qualitative project involving thematic analysis of interviews with nine Australian women who had had miscarriages.
  
  
  RESULTS
  The quantitative analyses indicate that the main differences between young women who do and do not experience miscarriage relate to social disadvantage (and thus likelihood of relatively early pregnancy) and to a lifestyle that makes pregnancy likely: Once these factors are accounted for, there are no differences in mental health. Further, longitudinal modelling demonstrates that women who have had miscarriages show a gradual increase in mental health over time, with the exception of women with prior diagnoses of anxiety, depression, or both. By contrast, qualitative analysis of the interviews indicates that women who have had miscarriages experience deep emotional responses and a long and difficult process of coming to terms with their loss.
  
  
  CONCLUSIONS
  A contextual model of resilience provides a possible framework for understanding these apparently disparate results. Considering positive mental health as including the ability to deal constructively with negative life events, and consequent emotional distress, offers a model that distinguishes between poor mental health and the processes of coping with major life events. In the context of miscarriage, women's efforts to struggle with difficult emotions, and search for meaning, can be viewed as pathways to resilience rather than to psychological distress. Statement of contribution What is already known on this subject? Quantitative research shows that women who miscarry usually experience moderate depression and anxiety, which persists for around 6 months. Qualitative research shows that women who miscarry frequently experience deep grief, which can last for years. What does this study add? We consider ways in which these disparate findings might triangulate. The results suggest a need to distinguish between poor mental health and the experience of loss and grief. Adjusting to miscarriage is often emotionally challenging but not always associated with poor mental health.
authors.affiliation: School of Psychology, University of Queensland, St Lucia, Queensland, Australia.
authors.forename: Christina
authors.initials: C
authors.lastname: Lee
authors.forename: Ingrid J
authors.initials: IJ
authors.lastname: Rowlands
mesh_terms: D000022:Abortion, Spontaneous / Q000523:psychology*; D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D001315:Australia; D005260:Female; D005500:Follow-Up Studies; D006117:Grief; D006801:Humans; D008137:Longitudinal Studies; D008603:Mental Health; D011247:Pregnancy; D036301:Qualitative Research; D012107:Research Design; D055500:Resilience, Psychological; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: mental health; miscarriage; mixed methods