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.