Depression and Stress in Women With Recurrent Pregnancy Loss
Study Question Is the prevalence of psychological stress and moderate/severe depression higher for women with recurrent pregnancy loss (RPL) than pregnancy planners trying to conceive naturally?
Summary Answer Both psychological stress and major depression are significantly more common among women with RPL than in those trying to conceive naturally.
What is Known Already RPL has a significant emotional impact on couples, especially the woman. Previous studies have shown inconclusive results.
Study Design, Size, Duration In this cross-sectional study, we compared the prevalence of stress and depression among 301 women with RPL and 1813 women attempting to conceive naturally. We defined RPL as three or more pregnancy losses before 12 weeks' gestation. RPL patients were enrolled from 2010 to 2013 and the comparison group from 2011 to 2014.
Participants/Materials, Setting, Methods RPL patients completed an online questionnaire before their first consultation at the Danish RPL Unit. In addition, we included data from a comparison group of 1813 women who participated in the Soon Parents Study (www.SnartForældre.dk). The Major Depression Index (MDI) was used to assess symptoms of depression, and Cohen's Perceived Stress Scale (PSS) was used to measure stress. Relevant demographic data were also retrieved.
Main Results and the Role of Chance: Of the RPL patients, 26 (8.6%) had a score on the MDI corresponding to moderate/severe depression, as did 40 (2.2%) of the women in Soon Parents Study (adjusted odds ratio (OR) 5.53 (95% confidence interval (CI): 2.09; 14.61)). A high stress level, defined as ≥19 on the PSS scale, was reported by 124 (41.2%) of the patients and 420 (23.2%) in the comparison group (adjusted OR 1.59 (95% CI 1.03; 2.44)).
Limitations, Reasons for Caution: We used online questionnaires, and have no interview data. We were unaware if any of the women in the comparison group suffer from RPL.
Wider Implications of the Findings: This study should entail a heightened awareness of mental distress among care providers for women with RPL.
Study Funding/Competing Interest(S): No specific funding was sought for this study. The Soon Parents Study is funded by National Institute of Child Health and Human Development (R01 HD060680-01A4). No authors have competing interests to declare.
Trial Registration Number: N/A.
The loss of a desired pregnancy is a significant negative life event associated with grief comparable to the grief experienced after a peri- or neonatal death (Stirtzinger and Robinson, 1989; Brier, 2008). Recurrent pregnancy loss (RPL) is a distinct disease entity defined by the repeated, unintentional demise of pregnancies (Christiansen et al., 2008). It affects 0.5–3% of women seeking to have children (Larsen et al., 2013). In the Danish Recurrent Pregnancy Loss Unit at Rigshospitalet, Denmark, RPL is defined as three or more consecutive pregnancy losses in accordance with current European guidelines (Jauniaux et al., 2006; Rai et al., 2011). Among women referred to a tertiary RPL unit, ~1/3 will not have a live birth afterwards (Lund et al., 2012).
Depression is the leading cause of disability worldwide (Marcus and Taghi Yasami, 2012), and it is associated with considerable personal and socio-economic burden. A Danish population-based study with 1205 respondents found a major depression prevalence of 3.3%, as defined by the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) (Olsen et al., 2004). In a subgroup of women aged 20–49 years, the prevalence of major depression was 3.8%. This study described a significant relationship between levels of self-reported stress measured on the Cohen Perceived stress scale (PSS) (Cohen et al., 1983) and depression measured on the Major Depression Inventory (MDI) (Bech et al., 2001).
Most studies on depression and RPL have been small, using a variety of scales and lacked an appropriate comparison group (Rowsell et al., 2001; Craig et al., 2002; Andalib et al., 2006; Kagami et al., 2012; Mevorach-Zussman et al., 2012; Sugiura-Ogasawara et al., 2013; Toffol et al., 2013). The reported prevalence of depression varies considerably across studies, ranging from <15% (Sugiura-Ogasawara et al., 2013) to 33% (Craig et al., 2002). Psychological stress and RPL has not been extensively studied, but one case–control study described a significantly higher PSS total score among 45 patients with unexplained RPL, compared with 40 controls (median score 20.5 (interquartile range (IQR): 17.0; 25.0) versus 17.0 (IQR: 14.0; 21.0), adjusted odds ratio (OR): 1.13 (1.03; 1.24)) (Li et al., 2012).
Based on a clinical observation of significant distress among patients in the Danish RPL Unit, we wanted to investigate the prevalence of moderate/severe depression according to International Classification of Disease, version 10 (ICD-10) and prevalence of self-reported stress. As a relevant comparison group we used baseline data on women from the Soon Parents Study (www.snartforaeldre.dk), an ongoing online cohort study designed to elucidate the impact of life style factors on fertility. Furthermore, we wanted to investigate if there was a correlation between scores on the PSS and the MDI.
Abstract and Introduction
Abstract
Study Question Is the prevalence of psychological stress and moderate/severe depression higher for women with recurrent pregnancy loss (RPL) than pregnancy planners trying to conceive naturally?
Summary Answer Both psychological stress and major depression are significantly more common among women with RPL than in those trying to conceive naturally.
What is Known Already RPL has a significant emotional impact on couples, especially the woman. Previous studies have shown inconclusive results.
Study Design, Size, Duration In this cross-sectional study, we compared the prevalence of stress and depression among 301 women with RPL and 1813 women attempting to conceive naturally. We defined RPL as three or more pregnancy losses before 12 weeks' gestation. RPL patients were enrolled from 2010 to 2013 and the comparison group from 2011 to 2014.
Participants/Materials, Setting, Methods RPL patients completed an online questionnaire before their first consultation at the Danish RPL Unit. In addition, we included data from a comparison group of 1813 women who participated in the Soon Parents Study (www.SnartForældre.dk). The Major Depression Index (MDI) was used to assess symptoms of depression, and Cohen's Perceived Stress Scale (PSS) was used to measure stress. Relevant demographic data were also retrieved.
Main Results and the Role of Chance: Of the RPL patients, 26 (8.6%) had a score on the MDI corresponding to moderate/severe depression, as did 40 (2.2%) of the women in Soon Parents Study (adjusted odds ratio (OR) 5.53 (95% confidence interval (CI): 2.09; 14.61)). A high stress level, defined as ≥19 on the PSS scale, was reported by 124 (41.2%) of the patients and 420 (23.2%) in the comparison group (adjusted OR 1.59 (95% CI 1.03; 2.44)).
Limitations, Reasons for Caution: We used online questionnaires, and have no interview data. We were unaware if any of the women in the comparison group suffer from RPL.
Wider Implications of the Findings: This study should entail a heightened awareness of mental distress among care providers for women with RPL.
Study Funding/Competing Interest(S): No specific funding was sought for this study. The Soon Parents Study is funded by National Institute of Child Health and Human Development (R01 HD060680-01A4). No authors have competing interests to declare.
Trial Registration Number: N/A.
Introduction
The loss of a desired pregnancy is a significant negative life event associated with grief comparable to the grief experienced after a peri- or neonatal death (Stirtzinger and Robinson, 1989; Brier, 2008). Recurrent pregnancy loss (RPL) is a distinct disease entity defined by the repeated, unintentional demise of pregnancies (Christiansen et al., 2008). It affects 0.5–3% of women seeking to have children (Larsen et al., 2013). In the Danish Recurrent Pregnancy Loss Unit at Rigshospitalet, Denmark, RPL is defined as three or more consecutive pregnancy losses in accordance with current European guidelines (Jauniaux et al., 2006; Rai et al., 2011). Among women referred to a tertiary RPL unit, ~1/3 will not have a live birth afterwards (Lund et al., 2012).
Depression is the leading cause of disability worldwide (Marcus and Taghi Yasami, 2012), and it is associated with considerable personal and socio-economic burden. A Danish population-based study with 1205 respondents found a major depression prevalence of 3.3%, as defined by the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) (Olsen et al., 2004). In a subgroup of women aged 20–49 years, the prevalence of major depression was 3.8%. This study described a significant relationship between levels of self-reported stress measured on the Cohen Perceived stress scale (PSS) (Cohen et al., 1983) and depression measured on the Major Depression Inventory (MDI) (Bech et al., 2001).
Most studies on depression and RPL have been small, using a variety of scales and lacked an appropriate comparison group (Rowsell et al., 2001; Craig et al., 2002; Andalib et al., 2006; Kagami et al., 2012; Mevorach-Zussman et al., 2012; Sugiura-Ogasawara et al., 2013; Toffol et al., 2013). The reported prevalence of depression varies considerably across studies, ranging from <15% (Sugiura-Ogasawara et al., 2013) to 33% (Craig et al., 2002). Psychological stress and RPL has not been extensively studied, but one case–control study described a significantly higher PSS total score among 45 patients with unexplained RPL, compared with 40 controls (median score 20.5 (interquartile range (IQR): 17.0; 25.0) versus 17.0 (IQR: 14.0; 21.0), adjusted odds ratio (OR): 1.13 (1.03; 1.24)) (Li et al., 2012).
Based on a clinical observation of significant distress among patients in the Danish RPL Unit, we wanted to investigate the prevalence of moderate/severe depression according to International Classification of Disease, version 10 (ICD-10) and prevalence of self-reported stress. As a relevant comparison group we used baseline data on women from the Soon Parents Study (www.snartforaeldre.dk), an ongoing online cohort study designed to elucidate the impact of life style factors on fertility. Furthermore, we wanted to investigate if there was a correlation between scores on the PSS and the MDI.
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