Emotional consequences following early miscarriage and the influence of psychological follow-up intervention.

This thesis consists of a literature review, a research report and a critical
appraisal of the process of research. A fifth of pregnancies end in
miscarriage, and anxiety and depression are observed for several months
after the event. Workers have attempted to discover predictive factors of
emotional adjustment, but have found conflicting results. Grief has been
identified as a common feature following miscarriage, but the traumatic nature
of the miscarriage experience has largely been ignored. Despite the
recognised psychological impact, there is no routine follow-up care for
women following early miscarriage. Anecdotal evidence suggests beneficial
effects, but no controlled intervention studies have yet been carried out. Such
a study, therefore, was conducted, and is described in the research report.
Anxiety, depression, intrusion and avoidance levels were assessed at one
week and four months post-miscarriage. Half the women also received a
session of psychological debriefing at two weeks post-miscarriage, an
intervention chosen to take account of the whole experience of miscarriage.
Intrusion and avoidance scores were initially as high as those of post-trauma
victims, but had significantly decreased by four months. Although depression
was not detected, anxiety was significantly higher than community sample
estimates at both time points, and psychological debriefing did not influence
emotional adaptation. A variety of hypotheses to explain these results are
discussed. Outcome scores at one week significantly predicted outcome at
four months. Thus, early assessment would be important in determining
which women should be offered intervention. Finally, in the critique section of
the thesis, the origins of the project, timescale and progress, and aids and
barriers to progress are discussed.