MAJOR DEPRESSIVE DISORDER IN THE 6 MONTHS AFTER MISCARRIAGE

Objective.-To test a priori hypotheses that miscarrying women are at i ncreased risk for a first or recurrent episode of major depressive dis order in the 6 months following loss and that this increased risk is g reater for childless women, women with prior reproductive loss, and wo men aged 35 years or older; and to evaluate whether risk varies by tim e of gestation or by attitude toward the pregnancy. Design.-Cohort stu dy. Setting.-The miscarriage cohort consisted of women attending a med ical center for a spontaneous abortion (n=229); the comparison group w as a population-based 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 ge station. 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 educ ation. Participants constituted 60% of miscarrying women and 72% of co mmunity women who completed the first phase of this cohort study. Main Outcome Measure.-Major depressive disorder was measured using the Dia gnostic Interview Schedule. Results.-Risk for an episode of major depr essive 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% ex perienced an episode of major depressive disorder, compared with 4.3% of community women. The overall relative risk (RR) for an episode of m ajor depressive disorder for miscarrying women was 2.5 (95% confidence interval [Cl], 1.2-5.1) and was substantially higher for childless wo men (RR, 5.0; 95% Cl, 1.7-14.4) than for women with children (RR, 1.3; 95% Cl, 0.5-3.5) (P<.06). Among miscarrying women, 72% of cases of ma jor depressive disorder began within the first month after loss; only 20% of community cases started during the comparable period. Among mis carrying women with a history of major depressive disorder, 54% experi enced a recurrence. However, RR did not vary significantly by history of prior reproductive loss or by maternal age, nor did risk vary by ti me of gestation or attitude toward the pregnancy. Conclusions.-Physici ans should monitor miscarrying women in the first weeks after reproduc tive 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.