GRIEF AND DEPRESSION AFTER MISCARRIAGE - THEIR SEPARATION, ANTECEDENTS, AND COURSE

Bereavement is a major risk factor for physical illness, grief, depres sion, and anxiety. In contrast to recent tendencies in the psychiatric literature to equate grief and depression, we propose that a careful discrimination between the two must be made for diagnostic, therapeuti c, and investigative purposes. We report the results of a longitudinal study of a frequent but neglected event, miscarriage early in pregnan cy, to make this point. Clinical criteria for differentiating grief an d depressive reactions were developed based on phenomenological criter ia and theoretical considerations. We hypothesized that the detrimenta l psychological and physical consequences occur only when the miscarri age was not mourned and resulted in a depressive reaction, but not in a grief reaction. In a controlled, representative study, 125 consecuti ve women were assessed shortly after their miscarriage (before the 20t h week of gestation) and 6 months (N = 94) and 12 months (N = 90) late r. Assessments included standardized questionnaires for life events, d epression, physical complaints, anxiety, and a specific, multidimensio nal grief scale (Munich Grief Scale) that we had developed previously. Immediately after the miscarriage, the average anxiety and depression scores were elevated when compared with 80 pregnant and 125 age-match ed community controls. Twenty percent of the patients who had miscarri ed showed a grief reaction, 12% showed a depressive reaction, and 20% responded with a combined depressive and grief reaction. The remaining women (48%) reported no changes in their emotional reactions. As pred icted, longer-lasting psychological, social, and health status changes followed the initial depressive, but not the grief reactions. Depress ive reactions were predicted by a history of previous depression, a la ck of social resources, and an ambivalent attitude to the lost fetus. The grief measures were reliable and made it possible to discriminate between grief and depression.