THE TRIPLE –R MODEL: RISK

I had mentioned in an earlier post that I had developed a model based on existing evidence that may help to predict how well a woman will deal with the effects of a pregnancy loss. The following are risk factors that have been identified that may influence one’s ability to cope.

·         Nature of spousal support and/or social support: the receipt of poor social support is a very strong predictor for low emotional strength, intense emotional feelings and high risk of depression in the woman (1). A study also found that dissatisfaction with the spouse’s caring after a miscarriage was significantly raised in women who had a depression reaction to the miscarriage as opposed to those who simply had a grief reaction (2).

Simply put, the husband is vital to the woman’s healing  and grieving process.

·         Pre-existing vulnerability to anxiety/depression: The physical manifestation of a miscarriage usually causes anxiety during and after the event (3) and women who have miscarried have an increased risk of anxiety and depression that could last for years compared to women who never miscarried (4). A past history of depression could trigger a depressive reaction to the miscarriage (2). Some women may also possess a temperamental vulnerability to anxiety (5) and this may make her more prone to an anxiety response to the loss. The tendency to go beyond the normal grief response to a miscarriage and exhibit a pathological inability to cope and/or a state of despair is exacerbated by poor social support (2).

Simply put, if the woman is naturally anxious and easily worried or has suffered depression in the past, she is more likely to find it more difficult to cope after the pregnancy loss

·         Gestational age at the time of the loss: As early as 10weeks gestation, there is a real emotional connection to the pregnancy (2). When the gestational age is less than 20weeks, then the age of the foetus at the time of the loss does not make a difference in the strength or the duration of the grief, anxiety or depression (4). For pregnancies older than 20weeks, there is a longer grieving duration and a greater chance of depression, impacting negatively on close relationships (1) (4).

Simply put, a loss at 10weeks can be just as painful as a loss at 16weeks but a loss at 20+ weeks is potentially more devastating.

REFERENCES

1.       Swanson K M, Karmali Z A, Powell S, Pulvermakher F. Miscarriage effects on couples' interpersonal and sexual relationships during hte first year after loss: women's perceptions. Psychosomatic Medicine, Vol. 65, pp902-910, 2003.

2.       Beutel M, Deckhardt R, von Rad M, Weiner H. Grief and Depression after miscarriage: their separation, antecedents and course. Psychosomatic Medicine, Vol. 57(6) pp517-526, 1995.

3.       Swanson K M, Connor S, Jolley S N, Pettinato M, Wang T. Contexts and Evolution of Women's responses to miscarriage during the first year after loss. Research in Nursing and Health, Vol. 30. pp2-16, 2007.

4.       Swanson K M. Research-based practice with women who have had miscarriages. Journal of Nursing Scholarship, Vol. 31(4) pp339-345, 1999.

5.       S, Rachman. Anxiety. UK : Psychology Press Ltd, 2004.