Major depressive disorder in the 6 months after miscarriage

Richard Neugebauer, Jennie Kline, Patrick Shrout, Andrew Skodol, Patricia O'Connor, Pamela A. Geller, Zena Stein, Mervyn Susser

Research output: Contribution to journalArticle

Abstract

Objective. - To test a priori hypotheses that miscarrying women are at increased risk for a first or recurrent episode of major depressive disorder in the 6 months following loss and that this increased risk is greater for childless women, women with prior reproductive loss, and women aged 35 years or older; and to evaluate whether risk varies by time of gestation or by attitude toward the pregnancy. Design. - Cohort study. Setting. - The miscarriage cohort consisted of women attending a medical center for a spontaneous abortion (n=229); the comparison group was 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 gestation. 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 education. Participants constituted 60% of miscarrying women and 72% of community women who completed the first phase of this cohort study. Main Outcome Measure. - Major depressive disorder was measured using the Diagnostic Interview Schedule. Results. - Risk for an episode of major depressive 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% experienced an episode of major depressive disorder, compared with 4.3% of community women. The overall relative risk (RR) for an episode of major depressive disorder for miscarrying women was 2.5 (95% confidence interval [CI], 1,2-5.1) and was substantially higher for childless women (RR, 5.0; 95% CI, 1.7-14.4) than for women with children (RR, 1.3; 95% CI, 0.5-3.5) (P<.06). Among miscarrying women, 72% of cases of major depressive disorder began within the first month after loss; only 20% of community cases started during the comparable period. Among miscarrying women with a history of major depressive disorder, 54% experienced a recurrence. However, RR did not vary significantly by history of prior reproductive loss or by maternal age, nor did risk vary by time of gestation or attitude toward the pregnancy. Conclusions. - Physicians should monitor miscarrying women in the first weeks after reproductive 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.

Original languageEnglish (US)
Pages (from-to)383-388
Number of pages6
JournalJAMA - Journal of the American Medical Association
Volume277
Issue number5
StatePublished - Feb 5 1997

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Major Depressive Disorder
Spontaneous Abortion
Pregnancy
Confidence Intervals
Cohort Studies
Reproductive History
Maternal Age

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Neugebauer, R., Kline, J., Shrout, P., Skodol, A., O'Connor, P., Geller, P. A., ... Susser, M. (1997). Major depressive disorder in the 6 months after miscarriage. JAMA - Journal of the American Medical Association, 277(5), 383-388.

Major depressive disorder in the 6 months after miscarriage. / Neugebauer, Richard; Kline, Jennie; Shrout, Patrick; Skodol, Andrew; O'Connor, Patricia; Geller, Pamela A.; Stein, Zena; Susser, Mervyn.

In: JAMA - Journal of the American Medical Association, Vol. 277, No. 5, 05.02.1997, p. 383-388.

Research output: Contribution to journalArticle

Neugebauer, R, Kline, J, Shrout, P, Skodol, A, O'Connor, P, Geller, PA, Stein, Z & Susser, M 1997, 'Major depressive disorder in the 6 months after miscarriage', JAMA - Journal of the American Medical Association, vol. 277, no. 5, pp. 383-388.
Neugebauer R, Kline J, Shrout P, Skodol A, O'Connor P, Geller PA et al. Major depressive disorder in the 6 months after miscarriage. JAMA - Journal of the American Medical Association. 1997 Feb 5;277(5):383-388.
Neugebauer, Richard ; Kline, Jennie ; Shrout, Patrick ; Skodol, Andrew ; O'Connor, Patricia ; Geller, Pamela A. ; Stein, Zena ; Susser, Mervyn. / Major depressive disorder in the 6 months after miscarriage. In: JAMA - Journal of the American Medical Association. 1997 ; Vol. 277, No. 5. pp. 383-388.
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abstract = "Objective. - To test a priori hypotheses that miscarrying women are at increased risk for a first or recurrent episode of major depressive disorder in the 6 months following loss and that this increased risk is greater for childless women, women with prior reproductive loss, and women aged 35 years or older; and to evaluate whether risk varies by time of gestation or by attitude toward the pregnancy. Design. - Cohort study. Setting. - The miscarriage cohort consisted of women attending a medical center for a spontaneous abortion (n=229); the comparison group was 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 gestation. 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 education. Participants constituted 60{\%} of miscarrying women and 72{\%} of community women who completed the first phase of this cohort study. Main Outcome Measure. - Major depressive disorder was measured using the Diagnostic Interview Schedule. Results. - Risk for an episode of major depressive 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{\%} experienced an episode of major depressive disorder, compared with 4.3{\%} of community women. The overall relative risk (RR) for an episode of major depressive disorder for miscarrying women was 2.5 (95{\%} confidence interval [CI], 1,2-5.1) and was substantially higher for childless women (RR, 5.0; 95{\%} CI, 1.7-14.4) than for women with children (RR, 1.3; 95{\%} CI, 0.5-3.5) (P<.06). Among miscarrying women, 72{\%} of cases of major depressive disorder began within the first month after loss; only 20{\%} of community cases started during the comparable period. Among miscarrying women with a history of major depressive disorder, 54{\%} experienced a recurrence. However, RR did not vary significantly by history of prior reproductive loss or by maternal age, nor did risk vary by time of gestation or attitude toward the pregnancy. Conclusions. - Physicians should monitor miscarrying women in the first weeks after reproductive 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.",
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N2 - Objective. - To test a priori hypotheses that miscarrying women are at increased risk for a first or recurrent episode of major depressive disorder in the 6 months following loss and that this increased risk is greater for childless women, women with prior reproductive loss, and women aged 35 years or older; and to evaluate whether risk varies by time of gestation or by attitude toward the pregnancy. Design. - Cohort study. Setting. - The miscarriage cohort consisted of women attending a medical center for a spontaneous abortion (n=229); the comparison group was 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 gestation. 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 education. Participants constituted 60% of miscarrying women and 72% of community women who completed the first phase of this cohort study. Main Outcome Measure. - Major depressive disorder was measured using the Diagnostic Interview Schedule. Results. - Risk for an episode of major depressive 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% experienced an episode of major depressive disorder, compared with 4.3% of community women. The overall relative risk (RR) for an episode of major depressive disorder for miscarrying women was 2.5 (95% confidence interval [CI], 1,2-5.1) and was substantially higher for childless women (RR, 5.0; 95% CI, 1.7-14.4) than for women with children (RR, 1.3; 95% CI, 0.5-3.5) (P<.06). Among miscarrying women, 72% of cases of major depressive disorder began within the first month after loss; only 20% of community cases started during the comparable period. Among miscarrying women with a history of major depressive disorder, 54% experienced a recurrence. However, RR did not vary significantly by history of prior reproductive loss or by maternal age, nor did risk vary by time of gestation or attitude toward the pregnancy. Conclusions. - Physicians should monitor miscarrying women in the first weeks after reproductive 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.

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