Post-traumatic stress, anxiety and depression following miscarriage or ectopic pregnancy: a prospective cohort study.
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.



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.



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



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.



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).



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.



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.
Tommy's National Centre for Miscarriage Research, Queen Charlottes and Chelsea Hospital, Imperial College, London, UK.
Jessica
J
Farren
South London and Maudsley NHS Foundation Trust, London, UK.
Maria
M
Jalmbrant
Department of Development and Regeneration, KU Leuven, Leuven, Belgium.
Lieveke
L
Ameye
Tommy's National Centre for Miscarriage Research, Queen Charlottes and Chelsea Hospital, Imperial College, London, UK.
Karen
K
Joash
Chelsea and Westminster NHS Trust, London, UK.
Nicola
N
Mitchell-Jones
Tommy's National Centre for Miscarriage Research, Queen Charlottes and Chelsea Hospital, Imperial College, London, UK.
Sophie
S
Tapp
Department of Development and Regeneration, KU Leuven, Leuven, Belgium.|Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium.
Dirk
D
Timmerman
Tommy's National Centre for Miscarriage Research, Queen Charlottes and Chelsea Hospital, Imperial College, London, UK.|Department of Development and Regeneration, KU Leuven, Leuven, Belgium.|Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium.
Tom
T
Bourne
D000022:Abortion, Spontaneous / Q000523:psychology*; D000328:Adult; D001007:Anxiety / Q000453:epidemiology*; D003863:Depression / Q000453:epidemiology*; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D008131:London; D010865:Pilot Projects; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000523:psychology*; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*; D011795:Surveys and Questionnaires
ectopic pregnancy; miscarriage; post-traumatic stress disorder