Depression in Women with Recurrent Miscarriages – an Exploratory Study

Abstract

Objective To assess depression, domestic violence and the use of substances in women with recurrent miscarriages.

Methods The Abuse Assessment Screen (AAS), the Edinburgh Postnatal Depression Scale (EPDS) and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) were used to assess violence, depression and the use of substances among women with recurrent miscarriages. The population corresponded to patients receiving prenatal care from June to August 2014. Multiple logistic regression was used to assess the multivariable relationship between depression and sociodemographic, psychosocial and medical characteristics (p < 0,10).

Results The prevalence of depression was of 41.3% (95% confidence interval [CI] = 28.3–55.7%). One third of the pregnant women (32.6%) reported emotional or physical violence, and 13% were classified as abusing or addicted to tobacco according to ASSIST. History of psychiatric diseases was associated with depression (p = 0.005). Violence during life demonstrated a modest association (p = 0.073) with depression, as well as the number of miscarriages (p = 0.071).

Conclusion Depression is a frequent disease among pregnant women with recurrent miscarriages. The results of this investigation suggest that a systematic assessment of depression and its associated conditions, such as domestic violence and the use of substances, should be part of the prenatal follow-up visits for women with recurrent miscarriages.

Resumo

Objetivo Avaliar a presença de depressão, violência doméstica e uso de substâncias em gestantes com história de perdas gestacionais de repetição.

Métodos Foram utilizados os instrumentos: Edinburgh Postnatal Depression Scale (EPDS), Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), Abuse Assessment Screen (AAS), além de um questionário com dados sociodemográficos e clínicos elaborado pelos investigadores. As variáveis que apresentaram associação com depressão na análise bivariada (p < 0,10), tais como número de abortos e violência durante a vida, entraram no modelo de regressão logística.

Resultados Foram entrevistadas 46 pacientes, sendo encontrada uma prevalência de depressão de 41,3% (intervalo de confiança [IC] de 95% = 28,3–55,7%). Com relação à violência contra a mulher, um terço das gestantes (32,6%) foi vítima de violência emocional ou física pelo seu parceiro ou por alguém próximo a elas. O abuso e/ou dependência de tabaco estava presente em 13% das gestantes, segundo o ASSIST. Na análise bivariada, observou-se uma associação significativa entre histórico de doença psiquiátrica e depressão em mulheres com abortamento de repetição (p = 0,005). Observamos também uma tendência de associação entre depressão, número de abortos (p = 0,071) e histórico de violência durante a vida (p = 0,073).

Conclusão Depressão é uma doença frequente entre as gestantes com abortamento de repetição. A sobreposição entre depressão, violência doméstica e uso de substâncias aponta para a necessidade do rastreio sistemático dessas condições no pré-natal de gestantes com perdas gestacionais de repetição.

Keywords

habitual abortion - post partum depression - violence against women - mental health - smoking

Palavras-chave

aborto habitual - depressão pós-parto - violência contra a mulher - saúde mental - hábito de fumar

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