title: Depressive disorder and grief following spontaneous abortion.
abstract: BACKGROUND
  Abortion is associated with moderate to high risk of psychological problems such as depression, use of alcohol or marijuana, anxiety, depression and suicidal behaviours. The increased risk of depression after spontaneous abortion in Asian populations has not been clearly established. Only a few studies have explored the relationship between grief and depression after abortion.
  
  
  METHODS
  A study was conducted to assess the prevalence and risk factors of depressive disorder and complicated grief among women 6-10 weeks after spontaneous abortion and compare the risk of depression with pregnant women attending an antenatal clinic. Spontaneous abortion group consisted of women diagnosed with spontaneous abortion by a Consultant Obstetrician. Women with confirmed or suspected induced abortion were excluded. The comparison group consisted of randomly selected pregnant, females attending the antenatal clinics of the two hospitals. Diagnosis of depressive disorder was made according to ICD-10 clinical criteria based on a structured clinical interview. This assessment was conducted in both groups. The severity of depressive symptoms were assessed using the Patients Health Questionnaire (PHQ-9). Grief was assessed using the Perinatal Grief Scale which was administered to the women who had experienced spontaneous abortion.
  
  
  RESULTS
  The sample consisted of 137 women in each group. The spontaneous abortion group (mean age 30.39 years (SD = 6.38) were significantly older than the comparison group (mean age 28.79 years (SD = 6.26)). There were more females with ≥10 years of education in the spontaneous abortion group (n = 54; SD = 39.4) compared to the comparison group (n = 37; SD = 27.0). The prevalence of depression in the spontaneous abortion group was 18.6 % (95 CI, 11.51-25.77). The prevalence of depression in the comparison group was 9.5 % (95 CI, 4.52-14.46). Of the 64 women fulfilling criteria for grief, 17 (26.6 %) also fulfilled criteria for a depressive episode. The relative risk of developing a depressive episode after spontaneous abortion was significantly higher than in females with a viable pregnancy (RR = 2.19, 95 % CI, 1.05 to 4.56). After adjustment for age and period of amenorrhoea, the difference was not significant. Prevalence of complicated grief was 54.74 % (95 % CI, 46.3-63.18).
  
  
  CONCLUSIONS
  The relative risk of developing a depressive episode after spontaneous abortion was not significantly higher compared to pregnant women after taking into account age and period of amenorrhoea (POA). Almost half the women developed complicated grief after spontaneous abortion. Of these, a significant proportion also had features of depressive disorder.
authors.affiliation: University Psychiatry Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka.
authors.forename: Susil
authors.initials: S
authors.lastname: Kulathilaka
authors.affiliation: Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
authors.forename: Raveen
authors.initials: R
authors.lastname: Hanwella
authors.affiliation: Faculty of Medicine, University of Colombo, Colombo, Sri Lanka. varunidesilva2@yahoo.co.uk.
authors.forename: Varuni A
authors.initials: VA
authors.lastname: de Silva
mesh_terms: D000022:Abortion, Spontaneous / Q000453:epidemiology* / Q000523:psychology*; D000328:Adult; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D005260:Female; D006117:Grief; D006801:Humans; D011247:Pregnancy; D012307:Risk Factors; D013188:Sri Lanka / Q000453:epidemiology