Miscarriage and mental disorders

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Miscarriage and mental disorders
Specialty Psychiatry

Mental disorders can be a consequence of miscarriage or early pregnancy loss. [1] [2] Even though women can develop long-term psychiatric symptoms after a miscarriage, acknowledging the potential of mental illness is not usually considered. [3] A mental illness can develop in women who have experienced one or more miscarriages after the event or even years later. [4] [1] Some data suggest that men and women can be affected up to 15 years after the loss. [5] Though recognized as a public health problem, studies investigating the mental health status of women following miscarriage are still lacking. [5] Posttraumatic stress disorder (PTSD) can develop in women who have experienced a miscarriage. [6] [5] [7] Risks for developing PTSD after miscarriage include emotional pain, expressions of emotion, and low levels of social support. [5] Even if relatively low levels of stress occur after the miscarriage, symptoms of PTSD including flashbacks, intrusive thoughts, dissociation and hyperarousal can later develop. [8] Clinical depression also is associated with miscarriage. [9] Past responses by clinicians have been to prescribe sedatives. [10]

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Recurring miscarriage may increase the incidence of intrusive thoughts in women and their partners. [5]

Miscarriage has an emotional effect and can also lead to psychological disorders. One disorder that can develop is primary maternal preoccupation. This psychological trauma can develop as a response to early pregnancy loss. Anxiety can also develop as a result of a miscarriage. [9] Women describe the medical treatment that they receive contributed their distress. [5]

Intrusive thoughts can develop after the loss. [3] [8] Panic disorder and obsessive thoughts may also develop as a response to a miscarriage. [11] Men may experience pain and psychological effects but react by adopting "compensatory behaviours" such as increasing consumption of alcohol. Because men can consider their role to be supportive, they may not have their loss recognized. [12]

Posttraumatic stress disorder

Women who have had clinical depression before the miscarriage are more likely to develop PTSD. [3] Posttraumatic stress disorder is associated with miscarriage along with other traumatic events associated with pregnancy. [3] [13] [7] [14] [11] Those who experience recurrent miscarriage (>3) have a greater risk of developing PTSD than those who have experienced miscarriage once. [3] An association between the gender of the infant lost through miscarriage exists whereby there is an increased chance of developing PTSD if the infant was a male. Knowing the cause of the miscarriage does not reduce the risk of developing PTSD. Finding a 'meaning' for the loss reduces the risk of developing PTSD. A negative outlook regarding the world in general is correlated with increased levels of PTSD. Poor self-esteem is also related to developing PTSD after the loss. If memories of the loss are considered intense, risk for PTSD is increased. There are concerns that PTSD in mothers may have a negative impact on children born after the event. [3]

Though the development of PTSD in women and families after the loss has been identified, the presence of PTSD in a woman who is pregnant is detrimental. Women with PTSD are thought to be at a higher risk of prenatal loss, perinatal loss, pregnancy complications, ectopic pregnancy, preterm birth and growth abnormalities in the fetus. [3]

PTSD in a mother is suspected to increase the risk of autism, hypertension, cardiovascular diseases, and type 2 diabetes in a child. [3]

Depression and anxiety

43% of women who miscarry are found to have depression, anxiety disorders, and obsessive-compulsive disorder. [2] [11]

Complicated grief is an atypical response to a miscarriage. It differs from the more common form of grief that occurs after a miscarriage. The grieving process associated with other events such as the loss of a spouse or parent is expected to decline in a predictable and steady rate. This not true for those experiencing grief after a miscarriage because only 41% follow the expected decline in grief while most (59%) do not fit this pattern. [7] [15]

Cognitive behavior therapy has been found to be helpful if it is begun immediately after the loss. [3]

Epidemiology

A woman who miscarries has a 2.5 times greater risk for depression than those who have not. [11] In the US, estimates of PTSD related to miscarriage are thought to be 150,000–200,000 acute and 24,000–32,000 chronic PTSD cases. PTSD in fathers may be significant but remains unaddressed. [3]

Related Research Articles

<span class="mw-page-title-main">Post-traumatic stress disorder</span> Mental disorder associated with trauma

Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that develops from experiencing a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on a person's life or well-being. Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in the way a person thinks and feels, and an increase in the fight-or-flight response. These symptoms last for more than a month after the event and can include triggers such as misophonia. Young children are less likely to show distress, but instead may express their memories through play. A person with PTSD is at a higher risk of suicide and intentional self-harm.

<span class="mw-page-title-main">Postpartum depression</span> Mood disorder experienced after childbirth

Postpartum depression (PPD), also called postnatal depression, is a mood disorder experienced after childbirth, which can affect men and women. Symptoms may include extreme sadness, low energy, anxiety, crying episodes, irritability, and changes in sleeping or eating patterns. PPD can also negatively affect the newborn child.

Psychological trauma is an emotional response caused by severe distressing events that are outside the normal range of human experiences. It must be understood by the affected person as directly threatening the affected person or their loved ones generally with death, severe bodily injury, or sexual violence; indirect exposure, such as from watching television news, may be extremely distressing and can produce an involuntary and possibly overwhelming physiological stress response, but does not produce trauma per se. Examples of distressing events include violence, rape, or a terrorist attack.

Eye movement desensitization and reprocessing (EMDR) is a form of psychotherapy that is a recommended treatment for post-traumatic stress disorder (PTSD), but remains controversial within the psychological community. It was devised by Francine Shapiro in 1987 and originally designed to alleviate the distress associated with traumatic memories such as PTSD.

Recurrent miscarriage or recurrent pregnancy loss (RPL) is the spontaneous loss of 2-3 pregnancies that is estimated to affect up to 5% of women. The exact number of pregnancy losses and gestational weeks used to define RPL differs among medical societies. In the majority of cases, the exact cause of pregnancy loss is unexplained despite genetic testing and a thorough evaluation. When a cause for RPL is identified, almost half are attributed to a chromosomal abnormality. RPL has been associated with several risk factors including parental and genetic factors, congenital and acquired anatomical conditions, lifestyle factors, endocrine disorders, thrombophila, immunological factors, and infections. The American Society of Reproductive Medicine recommends a thorough evaluation after 2 consecutive pregnancy losses; however, this can differ from recommendations by other medical societies. RPL evaluation can be evaluated by numerous tests and imaging studies depending on the risk factors. These range from cytogenetic studies, blood tests for clotting disorders, hormone levels, diabetes screening, thyroid function tests, sperm analysis, antibody testing, and imaging studies. Treatment is typically tailored to the relevant risk factors and test findings. RPL can have a significant impact on the psychological well-being of couples and has been associated with higher levels of depression, anxiety, and stress. Therefore, it is recommended that appropriate screening and management be considered by medical providers.  

<span class="mw-page-title-main">Complex post-traumatic stress disorder</span> Psychological disorder

Complex post-traumatic stress disorder is a stress-related mental disorder generally occurring in response to complex traumas, i.e., commonly prolonged or repetitive exposures to a series of traumatic events, within which individuals perceive little or no chance to escape.

Sex is correlated with the prevalence of certain mental disorders, including depression, anxiety and somatic complaints. For example, women are more likely to be diagnosed with major depression, while men are more likely to be diagnosed with substance abuse and antisocial personality disorder. There are no marked gender differences in the diagnosis rates of disorders like schizophrenia and bipolar disorder. Men are at risk to suffer from post-traumatic stress disorder (PTSD) due to past violent experiences such as accidents, wars and witnessing death, and women are diagnosed with PTSD at higher rates due to experiences with sexual assault, rape and child sexual abuse. Nonbinary or genderqueer identification describes people who do not identify as either male or female. People who identify as nonbinary or gender queer show increased risk for depression, anxiety and post-traumatic stress disorder. People who identify as transgender demonstrate increased risk for depression, anxiety, and post-traumatic stress disorder.

<span class="mw-page-title-main">Grief counseling</span> Therapy for responses to loss

Grief counseling is a form of psychotherapy that aims to help people cope with the physical, emotional, social, spiritual, and cognitive responses to loss. These experiences are commonly thought to be brought on by a loved person's death, but may more broadly be understood as shaped by any significant life-altering loss.

Prolonged exposure therapy (PE) is a form of behavior therapy and cognitive behavioral therapy designed to treat post-traumatic stress disorder. It is characterized by two main treatment procedures – imaginal and in vivo exposures. Imaginal exposure is repeated 'on-purpose' retelling of the trauma memory. In vivo exposure is gradually confronting situations, places, and things that are reminders of the trauma or feel dangerous. Additional procedures include processing of the trauma memory and breathing retraining.

As defined by the United States Department of Veterans Affairs, military sexual trauma (MST) are experiences of sexual assault, or repeated threatening sexual harassment that occurred while a person was in the United States Armed Forces.

Memory and trauma is the deleterious effects that physical or psychological trauma has on memory.

A postpartum disorder or puerperal disorder is a disease or condition which presents primarily during the days and weeks after childbirth called the postpartum period. The postpartum period can be divided into three distinct stages: the initial or acute phase, 6–12 hours after childbirth; subacute postpartum period, which lasts two to six weeks, and the delayed postpartum period, which can last up to six months. In the subacute postpartum period, 87% to 94% of women report at least one health problem. Long term health problems are reported by 31% of women.

PTSD or post-traumatic stress disorder, is a psychiatric disorder characterised by intrusive thoughts and memories, dreams or flashbacks of the event; avoidance of people, places and activities that remind the individual of the event; ongoing negative beliefs about oneself or the world, mood changes and persistent feelings of anger, guilt or fear; alterations in arousal such as increased irritability, angry outbursts, being hypervigilant, or having difficulty with concentration and sleep.

Childbirth-related post-traumatic stress disorder is a psychological disorder that can develop in women who have recently given birth. This disorder can also affect men or partners who have observed a difficult birth. Its symptoms are not distinct from post-traumatic stress disorder (PTSD). It may also be called post-traumatic stress disorder following childbirth (PTSD-FC).

Antenatal depression, also known as prenatal or perinatal depression, is a form of clinical depression that can affect a woman during pregnancy, and can be a precursor to postpartum depression if not properly treated. It is estimated that 7% to 20% of pregnant women are affected by this condition. Any form of prenatal stress felt by the mother can have negative effects on various aspects of fetal development, which can cause harm to the mother and child. Even after birth, a child born from a depressed or stressed mother feels the affects. The child is less active and can also experience emotional distress. Antenatal depression can be caused by the stress and worry that pregnancy can bring, but at a more severe level. Other triggers include unplanned pregnancy, difficulty becoming pregnant, history of abuse, and economic or family situations.

Women's reproductive health in the United States refers to the set of physical, mental, and social issues related to the health of women in the United States. It includes the rights of women in the United States to adequate sexual health, available contraception methods, and treatment for sexually transmitted diseases. The prevalence of women's health issues in American culture is inspired by second-wave feminism in the United States. As a result of this movement, women of the United States began to question the largely male-dominated health care system and demanded a right to information on issues regarding their physiology and anatomy. The U.S. government has made significant strides to propose solutions, like creating the Women's Health Initiative through the Office of Research on Women's Health in 1991. However, many issues still exist related to the accessibility of reproductive healthcare as well as the stigma and controversy attached to sexual health, contraception, and sexually transmitted diseases.

<span class="mw-page-title-main">Miscarriage and grief</span>

Miscarriage and grief are both an event and subsequent process of grieving that develops in response to a miscarriage. Almost all those experiencing a miscarriage experience grief. This event is often considered to be identical to the death of a child and has been described as traumatic. "Devastation" is another descriptor of miscarriage. Grief is a profound, intensely personal sadness stemming from irreplaceable loss, often associated with sorrow, heartache, anguish, and heartbreak. Sadness is an emotion along with grief, on the other hand, is a response to the loss of the bond or affection was formed and is a process rather than one single emotional response. Grief is not equivalent to depression. Grief also has physical, cognitive, behavioral, social, cultural, and philosophical dimensions. Bereavement and mourning refer to the ongoing state of loss, and grief is the reaction to that loss. Emotional responses may be bitterness, anxiety, anger, surprise, fear, and disgust and blaming others; these responses may persist for months. Self-esteem can be diminished as another response to miscarriage. Not only does miscarriage tend to be a traumatic event, women describe their treatment afterwards to be worse than the miscarriage itself.

<span class="mw-page-title-main">Emily A. Holmes</span> Clinical psychologist and neuroscientist

Emily A. Holmes is a clinical psychologist and neuroscientist known for her research on mental imagery in relation to psychological treatments for post traumatic stress disorder (PTSD), bipolar disorder, and depression. Holmes is Professor at the department of Women's and Children's Health at Uppsala University. She also holds an appointment as Honorary Professor of Clinical Psychology at the University of Oxford.

<span class="mw-page-title-main">Dual representation theory</span>

Dual representation theory (DRT) is a psychological theory of post-traumatic stress disorder (PTSD) developed by Chris Brewin, Tim Dalgleish, and Stephen Joseph in 1996. This theory proposes that certain symptoms of PTSD - such as nightmares, flashbacks, and emotional disturbance - may be attributed to memory processes that occur after exposure to a traumatic event. DRT proposes the existence of two separate memory systems that run in parallel during memory formation: the verbally accessible memory system (VAM) and situationally accessible memory system (SAM). The VAM system contains information that was consciously processed and thus can be voluntarily recalled or described. In contrast, the SAM system contains unconsciously processed sensory information that cannot be voluntarily recalled. This theory suggests that the VAM system is impaired during a traumatic event because conscious attention is narrowly drawn to threat-related information. Therefore, memory of the trauma is heavily focused on fear, which affects information processing. This gives rise to PTSD symptoms such as trauma-related cognitions, appraisals, and emotions. The SAM system captures vivid sensory information during the traumatic event, which is automatically recalled through exposure to trauma-related triggers. This system is thought to be responsible for the presence of flashbacks and nightmares in PTSD symptomatology.

Perinatal bereavement or perinatal grief refers to the emotions of the family following a perinatal death, defined as the demise of a fetus or newborn infant. Perinatal loss affects one in every ten women across the globe with the worldwide perinatal death rate at approximately 2.7 million deaths per year. Perinatal death is recognized as a traumatic life event as it is often sudden, unexpected, and devastating to parents who have had little to no direct life experiences with their child before their death.

References

  1. 1 2 BMJ Best Practice. "Miscarriage". us.bestpractice.bmj.com. Ida Muslim, Jothi Doraiswamy, Acknowledgements. Retrieved 2017-10-08.
  2. 1 2 Randolph, Amber L.; Hruby, Brittaney T.; Sharif, Shaakira (4 April 2015). "Counseling Women Who Have Experienced Pregnancy Loss: A Review of the Literature". Adultspan Journal. 14 (1): 2–10. doi:10.1002/j.2161-0029.2015.00032.x.
  3. 1 2 3 4 5 6 7 8 9 10 Christiansen, DM (February 2017). "Posttraumatic stress disorder in parents following infant death: A systematic review". Clinical Psychology Review. 51: 60–74. doi:10.1016/j.cpr.2016.10.007. PMID   27838460.
  4. ↑ Seftel 2006.
  5. 1 2 3 4 5 6 Daugirdaitė, Viltė; Akker, Olga van den; Purewal, Satvinder (2015). "Posttraumatic Stress and Posttraumatic Stress Disorder after Termination of Pregnancy and Reproductive Loss: A Systematic Review". Journal of Pregnancy. 2015: 646345. doi: 10.1155/2015/646345 . ISSN   2090-2727. PMC   4334933 . PMID   25734016.
  6. ↑ International Federation of Gynecology and Obstetrics. "What is the psychological impact of miscarriage? | FIGO" . Retrieved 2017-09-23.
  7. 1 2 3 Kersting, Anette; Wagner, Birgit (June 2012). "Complicated grief after perinatal loss". Dialogues in Clinical Neuroscience. 14 (2): 187–194. doi:10.31887/DCNS.2012.14.2/akersting. PMC   3384447 . PMID   22754291.
  8. 1 2 Seftel 2006, p. 60.
  9. 1 2 Scheidt, CE (2007). "Trauerverarbeitung nach Prä- und Perinatalverlust (Mourning processing after pre-and perinatal loss)". Psychother Psych Med. 57 (1): 4–11. doi:10.1055/s-2006-951906. PMID   17357028. S2CID   77050200.
  10. ↑ Quagliata, Emanuela (2013). Becoming Parents and Overcoming Obstacles : Understanding the Experience of Miscarriage, Premature Births, Infertility, and Postnatal Depression. City: Karnac Books. ISBN   9781782200185.
  11. 1 2 3 4 Barnes, Diana Lynn (2014-05-30). Women's reproductive mental health across the lifespan. Lynn-Barnes, Diana. Cham. ISBN   9783319051161. OCLC   880941778(online text, no page numbers){{cite book}}: CS1 maint: location missing publisher (link) CS1 maint: postscript (link)
  12. ↑ Due, Clemence; Chiarolli, Stephanie; Riggs, Damien W. (2017-11-15). "The impact of pregnancy loss on men's health and wellbeing: a systematic review". BMC Pregnancy and Childbirth. 17 (1): 380. doi: 10.1186/s12884-017-1560-9 . ISSN   1471-2393. PMC   5688642 . PMID   29141591.
  13. ↑ Martin 2012, p. 26.
  14. ↑ Daugirdaitė, V; van den Akker, O; Purewal, S (2015). "Posttraumatic stress and posttraumatic stress disorder after termination of pregnancy and reproductive loss: a systematic review". Journal of Pregnancy. 2015: 646345. doi: 10.1155/2015/646345 . PMC   4334933 . PMID   25734016.
  15. ↑ "Miscarriage and loss". American Psychological Association. 2017. Retrieved 2017-09-23.

Bibliography

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