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. 2005 Dec 12;3:18.
doi: 10.1186/1741-7015-3-18.

The Course of Mental Health After Miscarriage and Induced Abortion: A Longitudinal, Five-Year Follow-Up Study

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Free PMC article

The Course of Mental Health After Miscarriage and Induced Abortion: A Longitudinal, Five-Year Follow-Up Study

Anne Nordal Broen et al. BMC Med. .
Free PMC article

Abstract

Background: Miscarriage and induced abortion are life events that can potentially cause mental distress. The objective of this study was to determine whether there are differences in the patterns of normalization of mental health scores after these two pregnancy termination events.

Methods: Forty women who experienced miscarriages and 80 women who underwent abortions at the main hospital of Buskerud County in Norway were interviewed. All subjects completed the following questionnaires 10 days (T1), six months (T2), two years (T3) and five years (T4) after the pregnancy termination: Impact of Event Scale (IES), Quality of Life, Hospital Anxiety and Depression Scale (HADS), and another addressing their feelings about the pregnancy termination. Differential changes in mean scores were determined by analysis of covariance (ANCOVA) and inter-group differences were assessed by ordinary least squares methods.

Results: Women who had experienced a miscarriage had more mental distress at 10 days and six months after the pregnancy termination than women who had undergone an abortion. However, women who had had a miscarriage exhibited significantly quicker improvement on IES scores for avoidance, grief, loss, guilt and anger throughout the observation period. Women who experienced induced abortion had significantly greater IES scores for avoidance and for the feelings of guilt, shame and relief than the miscarriage group at two and five years after the pregnancy termination (IES avoidance means: 3.2 vs 9.3 at T3, respectively, p < 0.001; 1.5 vs 8.3 at T4, respectively, p < 0.001). Compared with the general population, women who had undergone induced abortion had significantly higher HADS anxiety scores at all four interviews (p < 0.01 to p < 0.001), while women who had had a miscarriage had significantly higher anxiety scores only at T1 (p < 0.01).

Conclusion: The course of psychological responses to miscarriage and abortion differed during the five-year period after the event. Women who had undergone an abortion exhibited higher scores during the follow-up period for some outcomes. The difference in the courses of responses may partly result from the different characteristics of the two pregnancy termination events.

Figures

Figure 3
Figure 3
Percentage of cases according to IES intrusion in each pregnancy termination group at all four interviews. IES intrusion is a psychological trauma test that measures the women's extent of intrusive thoughts, feelings and flashbacks about the pregnancy termination event. A high score (> 19 points) on this scale indicates a "case". Statistically significant differences between the groups: * p < 0.05, ** p < 0.01, *** p < 0.001.
Figure 4
Figure 4
Percentage of cases according to IES avoidance in each pregnancy termination group at all four interviews. IES avoidance is a psychological trauma test that measures how much the women avoid thinking, talking or feeling anything about the pregnancy termination event. A high score (> 19 points) on this scale indicates a "case". Statistically significant differences between the groups: * p < 0.05, ** p < 0.01, *** p < 0.001.
Figure 5
Figure 5
Mean Quality of Life scores in each pregnancy termination group at all four interviews. The Quality of Life test measures how satisfied subjects are with their own lives. The higher the score, the better the quality of life. Statistically significant differences between groups: * p < 0.05, ** p < 0.01, *** p < 0.001.
Figure 6
Figure 6
Mean HADS anxiety scores in each pregnancy termination group at all four interviews. The mean anxiety scores for the two pregnancy termination groups and the mean anxiety scores for women in a general population sample in Norway (HUNT) are shown. There were no statistically significant differences between the two pregnancy termination groups. Statistically significant differences between the scores of each pregnancy termination group and those of the general population sample (of women aged 30–35 years, n = 2,879): ¶ p < 0.05, ¶¶ p < 0.01, ¶¶¶ p < 0.001.
Figure 7
Figure 7
Mean HADS depression scores in each pregnancy termination group at all four interviews. The mean depression scores of the two pregnancy termination groups and the mean depression scores of women in a general population sample in Norway (HUNT) are shown. There were no statistically significant differences between the two pregnancy termination groups. Statistically significant differences between the scores of each pregnancy termination group and those of the general population sample (of women aged 30–35 years, n = 2,879): ¶ p < 0.05, ¶¶ p < 0.01, ¶¶¶ p < 0.001.
Figure 1
Figure 1
Mean IES intrusion scores in each pregnancy termination group at all four interviews. IES intrusion is a psychological trauma test that measures the extent of intrusive thoughts, feelings and flashbacks about the pregnancy termination event. Statistically significant differences between the groups: * p < 0.05, ** p < 0.01, *** p < 0.001.
Figure 2
Figure 2
Mean IES avoidance scores in each pregnancy termination group at all four interviews. IES avoidance is a psychological trauma test that measures how much women avoid thinking, talking or feeling anything about the pregnancy termination event. Statistically significant differences between the groups: * p < 0.05, ** p < 0.01, *** p < 0.001.
Figure 8
Figure 8
Mean scores for feeling relief in each pregnancy termination group at all four interviews. At each interview, the women were asked to indicate how much relief they felt when thinking about the pregnancy termination. The scores were: 1 (not at all), 2 (a little), 3 (a great deal), 4 (much) and 5 (very much). Statistically significant differences between the groups: * p < 0.05, ** p < 0.01, *** p < 0.001.
Figure 9
Figure 9
Mean scores for feeling grief in each pregnancy termination group at all four interviews. At each interview, the women were asked to indicate how much grief they felt when thinking about the pregnancy termination. The scores were: 1 (not at all), 2 (a little), 3 (a great deal), 4 (much) and 5 (very much). Statistically significant differences between the groups: * p < 0.05, ** p < 0.01, *** p < 0.001.
Figure 10
Figure 10
Mean scores for feeling loss in each pregnancy termination group at all four interviews. At each interview, the women were asked to indicate how much loss they felt when thinking about the pregnancy termination. The scores were: 1 (not at all), 2 (a little), 3 (a great deal), 4 (much) and 5 (very much). Statistically significant differences between the groups: * p < 0.05, ** p < 0.01, *** p < 0.001.
Figure 11
Figure 11
Mean scores for feeling guilt in each pregnancy termination group at all four interviews. At each interview, the women were asked to indicate how much guilt they felt when thinking about the pregnancy termination. The scores were: 1 (not at all), 2 (a little), 3 (a great deal), 4 (much) and 5 (very much). Statistically significant differences between the groups: * p < 0.05, ** p < 0.01, *** p < 0.001.
Figure 12
Figure 12
Mean scores for feeling shame in each pregnancy termination group at all four interviews. At each interview, the women were asked to indicate how much shame they felt when thinking about the pregnancy termination. The scores were: 1 (not at all), 2 (a little), 3 (a great deal), 4 (much) and 5 (very much). Statistically significant differences between the groups: * p < 0.05, ** p < 0.01, *** p < 0.001.
Figure 13
Figure 13
Mean scores for feeling anger in each pregnancy termination group at all four interviews. At each interview, the women were asked to indicate how much anger they felt when thinking about the pregnancy termination. The scores were: 1 (not at all), 2 (a little), 3 (a great deal), 4 (much) and 5 (very much). Statistically significant differences between the groups: * p < 0.05, ** p < 0.01, *** p < 0.001.

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