Stress and anxiety-depression levels following first-trimester miscarriage: a comparison between women who conceived naturally and women who conceived with assisted reproduction

Abstract

Objective: To compare the psychological impact following early miscarriage between women who conceived naturally and women who conceived following assisted reproduction.

Design: Prospective cohort study.

Setting: Assisted reproduction clinic and general gynaecological unit in a university-affiliated, tertiary referral hospital.

Population: A cohort of 150 women (75 after natural conception; 75 after assisted reproduction).

Methods: Completed semi-structured interviews using two standard questionnaires [the 12-item General Health Questionnaire (GHQ-12) and the 22-item Revised Impact of Events Scale (IES-R)], at 1, 4, and 12 weeks after a diagnosis of first-trimester miscarriage.

Main outcome measures: The GHQ-12 and IES-R scores for the two groups of women.

Results: The GHQ-12 and IES-R scores were significantly higher in the assisted reproduction group than the scores in the natural conception group, at 4 weeks and 12 weeks after miscarriage. Further breakdown of the scores revealed significantly higher hyperarousal symptoms at 4 and 12 weeks in the assisted reproduction group, indicating the traumatic effect of miscarriage to these women.

Conclusions: Following first-trimester miscarriage, subfertile women who conceived after assisted reproduction had higher stress and anxiety-depression levels, and experienced more traumatic impact from the event, than those after natural conception. A timely support and psychological intervention would be beneficial in the management of this group of women.

Keywords: Anxiety; assisted reproduction; depression; miscarriage; subfertility.