February 5, 1997

Major Depressive Disorder in the 6 Months After Miscarriage

Author Affiliations

From the Epidemiology of Developmental Brain Disorders Department, New York State Psychiatric Institute, New York (Drs Neugebauer, Kline, Stein, and Susser); Gertrude H. Sergievsky Center, Faculty of Medicine, Columbia University, New York, NY (Drs Neugebauer, Kline, Stein, and Susser); Department of Psychology, New York University, New York (Dr Shrout); Department of Psychiatry, Faculty of Medicine (Dr Skodol), and Division of Epidemiology, School of Public Health (Dr Geller), Columbia University, New York, NY; and Department of Psychology, Russell Sage College, Troy, NY (Dr O'Connor).

JAMA. 1997;277(5):383-388. doi:10.1001/jama.1997.03540290035029

Objective.  —To test a priori hypotheses that miscarrying women are at increased risk for a first or recurrent episode of major depressive disorder in the 6 months following loss and that this increased risk is greater for childless women, women with prior reproductive loss, and women aged 35 years or older; and to evaluate whether risk varies by time of gestation or by attitude toward the pregnancy.

Design.  —Cohort study.

Setting.  —The miscarriage cohort consisted of women attending a medical center for a spontaneous abortion (n=229); the comparison group was a populationbased cohort of women drawn from the community (n=230).

Participants.  —Miscarriage was defined as the involuntary termination of a nonviable intrauterine pregnancy before 28 completed weeks of gestation. Half of all participants were between 25 and 34 years of age; 40% were white and 35% Hispanic; 55% had more than a high school education. Participants constituted 60% of miscarrying women and 72% of community women who completed the first phase of this cohort study.

Main Outcome Measure.  —Major depressive disorder was measured using the Diagnostic Interview Schedule.

Results.  —Risk for an episode of major depressive disorder among miscarrying women in the 6 months following loss was compared with the 6-month risk among community women who had not been pregnant in the preceding year. Among miscarrying women, 10.9% experienced an episode of major depressive disorder, compared with 4.3% of community women. The overall relative risk (RR) for an episode of major depressive disorder for miscarrying women was 2.5 (95% confidence interval [CI], 1.2-5.1) and was substantially higher for childless women (RR, 5.0; 95% CI, 1.7-14.4) than for women with children (RR, 1.3; 95% CI, 0.5-3.5) (P<.06). Among miscarrying women, 72% of cases of major depressive disorder began within the first month after loss; only 20% of community cases started during the comparable period. Among miscarrying women with a history of major depressive disorder, 54% experienced a recurrence. However, RR did not vary significantly by history of prior reproductive loss or by maternal age, nor did risk vary by time of gestation or attitude toward the pregnancy.

Conclusions.  —Physicians should monitor miscarrying women in the first weeks after reproductive loss, particularly women who are childless or who have a history of major depressive disorder. Where appropriate, supportive counseling or psychopharmacologic treatment should be considered.