Q&A: Mental health needs after miscarriage require ‘open line of communication’

Miscarriage is more than a physical event, often requiring mental health care beyond the OB/GYN office. Yet multiple factors may discourage women from seeking the help they need and finding hope beyond their loss.

Tulsie Patel, MD, a board-certified psychiatrist with Talkiatry in New York City, has experience in medication management, individual and group therapy and transcranial magnetic stimulation. Healio spoke with her to find out more.

Healio: How common is miscarriage?

Tulsie Patel

Patel: According to the Mayo Clinic, 10% to 20% of pregnancies end in miscarriage. However, the Mayo Clinic explains that this value is associated with clinically identified pregnancies, so the actual number may be higher due to loss very early in pregnancy.

Healio: What are the common mental health impacts of miscarriage?

Patel: Miscarriage can be incredibly traumatic for a woman. As such, it is likely that many women will experience severe distress, grief and even symptoms of depression and anxiety. It is important to note that their symptoms may persist or worsen and develop into a diagnosis of major depressive disorder, PTSD or anxiety disorder.

Of note, research by University of Rochester Medical Center professor Emma Robertson Blackmore, PhD, shows that mental health issues may be identified even after a future successful pregnancy.

Research also shows that individuals who have previously had a miscarriage, who have a history of infertility, who have no living children and who have limited support are more prone to developing mental health issues after a miscarriage.

Healio: What does treatment for these issues ideally look like?

Patel: Treatment will depend on the symptoms experienced by the patient. It may range from listening and offering support to therapy or even medication management.

The first step is creating an open line of communication between patients and providers. This will allow for providers to appropriately assess what a woman is experiencing during and after a miscarriage.

It is important for a provider to continually check up on a woman, as symptoms may not develop immediately or may persist beyond the days or weeks after the event. Additionally, it is important for providers to offer support and resources early on, but also to maintain that open line of communication, especially if the woman plans to become pregnant again.

Healio: What are the primary barriers to patients getting this treatment?

Patel: As with all mental health conditions, access to appropriate and timely care may be a barrier. In addition, women and providers may often underestimate the long-term mental health implications of a miscarriage, as the initial focus is centered on any necessary medical interventions.

Women may also experience societal pressures that limit their willingness to seek help and create a larger barrier to treatment. Women often suffer through miscarriages silently and therefore may not know who or how to ask for help. They may also experience loneliness as a result of limited support. In some cases, women may be blamed by others or by themselves for causing a miscarriage, so sharing their experience may be difficult.

Another concern that is often overlooked is the mental health implications of miscarriage on a woman’s partner, as they too have invested in the lost pregnancy and may experience some of the same symptoms surrounding grief, loss, anxiety and depression as the woman who suffered a miscarriage.

Healio: How can mental health providers help patients overcome these various barriers?

Patel: Mental health providers are vital in treating patients who develop worsening grief or symptoms consistent with a mood disorder such as anxiety, PTSD or depression. Mental health care providers can help patients understand their condition and provide treatment, including but not limited to therapy and medication management.

Healio: How can other providers such as primary care physicians and OB/GYNs help patients in this care?

Patel: PCPs and OB/GYNs are most often the first providers to see patients experiencing a miscarriage. As such, it is important for them to create that initial safe space to discuss a woman’s reproductive health, goals and fears so that the patient feels comfortable sharing their experiences.

In addition, they must educate their patients about the possibility and implications of miscarriage, especially for individuals who would like to become pregnant again in the future.

It is also important for PCPs and OB/GYNs to be educated about mental health conditions and treatments so they can assess their patients for mental health treatment need, if appropriate. Often, they are the providers who begin or even manage treatment for many mental health conditions.

Healio: What kinds of signs and symptoms should PCPs and OB/GYNs look for in women who may be experiencing mental health problems stemming from miscarriages but not sharing them?

Patel: It is vital that PCPs and OB/GYNs create a safe environment for their patients to feel comfortable sharing their thoughts and feelings. If patients are unable or unwilling to share on their own, it is important for the provider to screen for symptoms of grief, anxiety, depression and PTSD during their visits with patients.

All of these conditions may present with overlapping symptoms. Some of these include worry, fear, difficulty sleeping, changes in energy, changes in appetite, difficulty focusing or vague physical complaints. In serious cases, patients may also exhibit thoughts of self-harm or harm to others. It is important for providers to identify these symptoms so that the appropriate treatment plan can be determined.

Healio: What resources are available for patients with mental health needs following a miscarriage?

Patel: A woman’s providers are always a great resource, as they will ideally have access to current literature and community resources, such as support groups, that may be helpful for a woman. There are also resources available online including the Ammon-Pinizzotto Center for Women’s Mental Health at MGH.

References:

• Blackmore ER, et al. Br J Psychiatry. 2011;doi:10.1192/bjp.bp.110.083105.
• Nynas J, et al. Prim Care Companion CNN Disord. 2015;doi:10.4088/PCC.14r01721.