Mental health outcome and perceived care needs of women treated for a miscarriage in a low-resource setting

Abstract

Introduction: There have been many advances in the management of miscarriage in recent times including the introduction of expectant and medical management protocols. However, a study of the psychological impact of the condition and its management has not received similar attention. Aim: To determine the psychosocial consequences of miscarriages and perceived needs of the patients compared to the care provided by the hospital. Materials and Method: This was a prospective cohort study conducted between January 15, 2018 and April 30, 2019. Participants were recruited on admission and psychological morbidity was assessed at 1 week after a miscarriage in the gynecological clinics. They were screened for psychological morbidities using DASS 21 (Depression, Anxiety and Stress Scale). Results: Of 140 women that participated in the study, severe depression was reported in 8 (5.7%) whereas 12 (8.5%) participants reported symptoms of extremely severe depression. Moderate to severe anxiety was present in 23.5% while extremely severe anxiety was noted among 21.5% of the women. Stress was reported in over half of respondents and severe to extremely severe stress occurred in 19.9% of the participants. Factors significantly associated with psychological morbidities following miscarriage include age ≥35 years, no living child, subfertility, planned pregnancy, and assisted conception. Healthcare providers not listening to the patient's concern, non-participation in decision making, and dissatisfaction with care were associated with adverse psychological outcomes. Conclusion: Psychological morbidity following a miscarriage is common among participants in our study. The provision of the correct information and psychological debriefing may be useful in enabling women to adjust emotionally following miscarriage.