Explanatory models associated with psychological morbidity in first trimester spontaneous abortion: a generalist study in a specialist setting

Abstract

First trimester spontaneous abortion is a common condition which can be associated with significant psychological sequelae. Many women are unsatisfied with the emotional support and follow up they receive from health professionals. The task of detecting and managing these psychological sequelae often falls to the patient's general practitioner. This prospective cohort study investigated the explanatory models of miscarriage associated with psychological morbidity of patients in the Early Pregnancy Clinic of a north London teaching hospital. Consecutive patients at the Early Pregnancy Clinic were interviewed shortly after diagnosis using a validated interview schedule to elicit their explanatory model for the miscarriage. Social and demographic variables were recorded and the Brief Checklist of Life Events was used to record the presence of potentially confounding life events. A medical and obstetric history was taken and the 30 item GHQ was completed at initial interview. Follow up was carried out using a second 30 item GHQ posted to the patient's home address 6 weeks later. Sixty-three of the 80 women eligible to participate agreed to take part in the study and 29 (43%) of these were GHQ positive at baseline. Having a predominantly personalistic explanatory model characterized by the invocation of human agency and blame to explain the miscarriage was associated with GHQ caseness at baseline (p = 0.008). Thirty-seven percent of the 43 women who responded were GHQ positive at follow up but there was no significant association between explanatory model type and GHQ caseness at 6 weeks. Explanatory model type was associated with baseline GHQ status but not with any other independent variables. Psychological distress is associated with personalistic explanatory models of miscarriage but this association does not remain significant at 6 week follow up.

Acknowledgments

We would like to thank the patients who volunteered to be interviewed and the medical team in the US Dept at the Royal Free Hospital. We would like to thank Dr Sally Hull for her comments on an earlier draft of the manuscript.