Medical and psychological interventions after miscarriage and women's distress: a controlled study

Purpose: To examine the impact of medical and psychological interventions on women‘s distress after early pregnancy loss. Methods: A case-control study design. Women diagnosed with a missed miscarriage during the ultrasound examination at 10 to 14 weeks of pregnancy; one group received routine care (n=61); one group (n=66) had medical investigations to ascertain the cause of the miscarriage and, at five weeks post-loss, a medical consultation to discuss the results of the investigations; one group received a single session of psychological counselling. The control group was matched to the intervention groups on all relevant socio-demographic and obstetric variables. Measures included the Hospital Anxiety and Depression Scale, Texas Grief Inventory (adjusted for miscarriage), self-blame, and worry about future pregnancy. Assessment was at four weeks after loss, two weeks after the counselling and at four months post-miscarriage. Repeated measures analyses were employed. Results: In all three groups, the scores on all outcome variables decreased significantly from four weeks to four months post-miscarriage. There was a significantly greater decrease in the levels of grief, self-blame and worry, over time in women who received both medical and psychological counselling as compared to the control group. No significant differences were identified between the controls and the group who had medical investigations and a consultation, the exception being the self-blame measure. Conclusions: Psychological counselling, in addition to the medical investigations and a consultation, is likely to be beneficial in reducing women‘s distress after miscarriage.