Major depressive disorder in the 6 months after miscarriage
R. Neugebauer, J. Kline, P. Shrout, A. Skodol, P. O'Connor, P. A. Geller, Z. Stein and M. Susser
Epidemiology of Developmental Brain Disorders Department, New York State Psychiatric Institute, New York, NY 10032, USA.
OBJECTIVE: To test a priori hypotheses that miscarrying women are at
increased risk for a first or recurrent episode of major depressive
disorder in the 6 months following loss and that this increased risk is
greater for childless women, women with prior reproductive loss, and women
aged 35 years or older; and to evaluate whether risk varies by time of
gestation or by attitude toward the pregnancy. DESIGN: Cohort study.
SETTING: The miscarriage cohort consisted of women attending a medical
center for a spontaneous abortion (n=229); the comparison group was a
population-based cohort of women drawn from the community (n=230).
PARTICIPANTS: Miscarriage was defined as the involuntary termination of a
nonviable intrauterine pregnancy before 28 completed weeks of gestation.
Half of all participants were between 25 and 34 years of age; 40% were
white and 35% Hispanic; 55% had more than a high school education.
Participants constituted 60% of miscarrying women and 72% of community
women who completed the first phase of this cohort study. MAIN OUTCOME
MEASURE: Major depressive disorder was measured using the Diagnostic
Interview Schedule. RESULTS: Risk for an episode of major depressive
disorder among miscarrying women in the 6 months following loss was
compared with the 6-month risk among community women who had not been
pregnant in the preceding year. Among miscarrying women, 10.9% experienced
an episode of major depressive disorder, compared with 4.3% of community
women. The overall relative risk (RR) for an episode of major depressive
disorder for miscarrying women was 2.5 (95% confidence interval [CI],
1.2-5.1) and was substantially higher for childless women (RR, 5.0; 95% CI,
1.7-14.4) than for women with children (RR, 1.3; 95% CI, 0.5-3.5)
(P<.06). Among miscarrying women, 72% of cases of major depressive
disorder began within the first month after loss; only 20% of community
cases started during the comparable period. Among miscarrying women with a
history of major depressive disorder, 54% experienced a recurrence.
However, RR did not vary significantly by history of prior reproductive
loss or by maternal age, nor did risk vary by time of gestation or attitude
toward the pregnancy. CONCLUSIONS: Physicians should monitor miscarrying
women in the first weeks after reproductive loss, particularly women who
are childless or who have a history of major depressive disorder. Where
appropriate, supportive counseling or psychopharmacologic treatment should
be considered.
