Abstract
BackgroundMiscarriage and induced abortion are life events that can potentially cause mental distress. The objective of this study was to determine whether there are differences in the patterns of normalization of mental health scores after these two pregnancy termination events.MethodsForty women who experienced miscarriages and 80 women who underwent abortions at the main hospital of Buskerud County in Norway were interviewed. All subjects completed the following questionnaires 10 days (T1), six months (T2), two years (T3) and five years (T4) after the pregnancy termination: Impact of Event Scale (IES), Quality of Life, Hospital Anxiety and Depression Scale (HADS), and another addressing their feelings about the pregnancy termination. Differential changes in mean scores were determined by analysis of covariance (ANCOVA) and inter-group differences were assessed by ordinary least squares methods.ResultsWomen who had experienced a miscarriage had more mental distress at 10 days and six months after the pregnancy termination than women who had undergone an abortion. However, women who had had a miscarriage exhibited significantly quicker improvement on IES scores for avoidance, grief, loss, guilt and anger throughout the observation period. Women who experienced induced abortion had significantly greater IES scores for avoidance and for the feelings of guilt, shame and relief than the miscarriage group at two and five years after the pregnancy termination (IES avoidance means: 3.2 vs 9.3 at T3, respectively, p < 0.001; 1.5 vs 8.3 at T4, respectively, p < 0.001). Compared with the general population, women who had undergone induced abortion had significantly higher HADS anxiety scores at all four interviews (p < 0.01 to p < 0.001), while women who had had a miscarriage had significantly higher anxiety scores only at T1 (p < 0.01).ConclusionThe course of psychological responses to miscarriage and abortion differed during the five-year period after the event. Women who had undergone an abortion exhibited higher scores during the follow-up period for some outcomes. The difference in the courses of responses may partly result from the different characteristics of the two pregnancy termination events.
Highlights
Miscarriage and induced abortion are life events that can potentially cause mental distress
One study reported that 1% of participants suffered from post-traumatic stress disorder (PTSD) two years after the event [12], and another reported that 10% of women were traumatized six months after the induced abortion [14]
All women who had an induced abortion were less than 13 weeks pregnant, and no terminations were due to fetal anomalies
Summary
Miscarriage and induced abortion are life events that can potentially cause mental distress. Miscarriage is regarded as a difficult and distressing life event for a woman [1,2,3] It can cause anxiety [4,5] and depression [6], and can be experienced as a traumatic life event [7,8]. One study reported that 1% of participants suffered from post-traumatic stress disorder (PTSD) two years after the event [12], and another reported that 10% of women were traumatized (according to a high Impact of Events Scale [IES] score) six months after the induced abortion [14]. In a previous study [15] in which the subjects were the same as those evaluated in this study, we found that 18.1% of women were classed as "cases" (> 19 points on one or both of the IES subscales) two years after an induced abortion
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