Moreover, providers are in a position to assess the patient’s response to the spontaneous abortion, provide an appropriate intervention, and make a referral to a behavioral health professional when necessary.
Methods and Results
Methods
Participants and procedure
This study was approved by the appropriate institutional human subject review committee. Participants were recruited through the Tripler Army Medical Center Department of Obstetrics and Gynecology. Approximately 75% of participants approached agreed to participate, resulting in a sample of 25 females in the initial phase of this study (Time 1) and 19 women at Time 2.
Following a scheduled appointment with their physician (approximately 1 week post-spontaneous abortion), patients were asked by a member of the nursing staff if they would be willing to participate in the study. Confidentiality was assured to all participants and informed consent was obtained. Each participant completed a questionnaire assessing demographic characteristics and the Stanford Acute Stress Reaction Questionnaire (SASRQ).
Approximately 30 days after the initial questionnaires were administered, participants returned to clinic to complete a follow-up questionnaire assessing demographic characteristics and the Posttraumatic Stress Diagnostic Scale (PSD).
TABLE 4 summarizes demographic information. There were no notable demographic differences between the groups at Time 1 and Time 2. Due to the small sample size and to ensure satisfactory statistical power, a significance level of 0.10 was used, and all tests were one-tailed.
Measures
Demographic information. The following demographic information was obtained for each participant: age, education, marital status, employment status, and ethnicity. Additionally, participants ranked a list of individuals (eg, significant other, friend, physician) who provided them with support after their miscarriage and answered questions specifically related to the spontaneous abortion that have been examined in prior literature.9-13
Acute stress disorder. The Stanford Acute Stress Reaction Questionnaire (SASRQ),2,12-14 was used to measure acute stress disorder symptoms experienced in reaction to the spontaneous abortion. Previous research has supported the reliability, validity, and internal consistency of this measure.15
Posttraumatic stress disorder. The Posttraumatic Stress Diagnostic Scale (PDS) scale was used to assess the presence and symptom severity of postraumatic stress disorder. This instrument offers good content validity, as the items correspond to the 17 symptom criteria identified in the DSM-IV. This measure also has been shown to have good convergent validity and satisfactory internal consistency and test-retest reliability.16
Results
TABLE 3 lists variables related to miscarriage/pregnancy and perceived support. Seven women (28%) were identified as meeting criteria for acute stress disorder at Time 1. (TABLE 2 shows variables’ relationships to acute stress disorder.) At Time 2, 7 women (39%) met criteria for a diagnosis of postraumatic stress disorder.
Women who presented with acute stress disorder at Time 1 were significantly more likely to meet criteria for postraumatic stress disorder at Time 2. Of the 7 women who met criteria for acute stress disorder at Time 1, 4 (57%) completed follow-up assessments at Time 2. Notably, all 4 met criteria for postraumatic stress disorder at Time 2. Additionally, 3 women who did not meet criteria for an acute stress disorder diagnosis at Time 1 did meet criteria for postraumatic stress disorder at Time 2.
TABLE 3
Variables related to pregnancy and miscarriage
| TIME 1 (N=25), TIME 2 (N=19) | ||
|---|---|---|
| N | % | |
| Pregnancy | ||
| Planned pregnancy | 16 | 64.0 |
| Pregnancy wanted | 23 | 92.0 |
| Support after miscarriage (Time 1) | ||
| Spouse | 23 | 92.0 |
| Physician | 14 | 56.0 |
| Nurse | 7 | 28.0 |
| Support after miscarriage (Time 2) | ||
| Spouse | 19 | 100.0 |
| Physician | 11 | 58.0 |
| Nurse | 7 | 37.0 |
TABLE 4
Demographic characteristics of the sample
| TOTAL SAMPLE (N=25) | ||
|---|---|---|
| M (SD)/N | % | |
| Age | 26.2 (6.24) | |
| Ethnic background | ||
| African American | 3 | 12.0 |
| Asian American | 1 | 4.0 |
| Caucasian | 15 | 60.0 |
| Hispanic | 2 | 8.0 |
| Pacific Islander | 3 | 12.0 |
| Other | 1 | 4.0 |
| Education | ||
| High school degree/GED | 17 | 68.0 |
| Associate degree | 7 | 28.0 |
| ≥Bachelor’s degree | 1 | 4.0 |
| Employment | ||
| Not employed | 10 | 40.0 |
| Full-time employed | 10 | 40.0 |
| Part-time employed | 1 | 4.0 |
| Other | 4 | 16.0 |
| Marital status | ||
| Married | 24 | 96.0 |
| Single | 1 | 4.0 |
Limitations
This study’s limitations should be considered in interpreting its results. The sample size was relatively small, so results should be interpreted with circumspection. Also, acute stress disorder and posttraumatic stress disorder diagnoses were derived from patient self-report rather than by a clinical interview. Despite these limitations, the results suggest a number of risk factors for the provider to examine with patients who have experienced a spontaneous abortion.
Future research with larger sample sizes and more diverse populations is warranted to replicate these findings. Additionally, researchers should examine a broader range of variables to determine if there are additional risk factors for developing acute stress disorder (eg, history of prior spontaneous abortions). It also will be important to develop empirically supported treatments.
It should be noted that the majority of women who miscarried did not experience traumatic stress. Researching this group of women may identify markers of resilience that lead to a positive resolution of the miscarriage, which can then guide development of prevention and treatment interventions.
The opinion expressed in this article reflect the views of the authors and do not reflect the opinion of the Department of the Army, the Department of Defense or the United States Government.