Traumatic stress disorders following first-trimester spontaneous abortion

This study was approved by the appropriate institutional human subject review committee. Participants were recruited through the Tripler Army Medical Center Department of Obstetrics and Gynecology. Approximately 75% of participants approached agreed to participate, resulting in a sample of 25 females in the initial phase of this study (Time 1) and 19 women at Time 2.

Following a scheduled appointment with their physician (approximately 1 week post-spontaneous abortion), patients were asked by a member of the nursing staff if they would be willing to participate in the study. Confidentiality was assured to all participants and informed consent was obtained. Each participant completed a questionnaire assessing demographic characteristics and the Stanford Acute Stress Reaction Questionnaire (SASRQ).

Approximately 30 days after the initial questionnaires were administered, participants returned to clinic to complete a follow-up questionnaire assessing demographic characteristics and the Posttraumatic Stress Diagnostic Scale (PSD).

TABLE 4 summarizes demographic information. There were no notable demographic differences between the groups at Time 1 and Time 2. Due to the small sample size and to ensure satisfactory statistical power, a significance level of 0.10 was used, and all tests were one-tailed.

Measures

Demographic information. The following demographic information was obtained for each participant: age, education, marital status, employment status, and ethnicity. Additionally, participants ranked a list of individuals (eg, significant other, friend, physician) who provided them with support after their miscarriage and answered questions specifically related to the spontaneous abortion that have been examined in prior literature.^9-13

Acute stress disorder. The Stanford Acute Stress Reaction Questionnaire (SASRQ),^2,12-14 was used to measure acute stress disorder symptoms experienced in reaction to the spontaneous abortion. Previous research has supported the reliability, validity, and internal consistency of this measure.¹⁵

Posttraumatic stress disorder. The Posttraumatic Stress Diagnostic Scale (PDS) scale was used to assess the presence and symptom severity of postraumatic stress disorder. This instrument offers good content validity, as the items correspond to the 17 symptom criteria identified in the DSM-IV. This measure also has been shown to have good convergent validity and satisfactory internal consistency and test-retest reliability.¹⁶

Results

TABLE 3 lists variables related to miscarriage/pregnancy and perceived support. Seven women (28%) were identified as meeting criteria for acute stress disorder at Time 1. (TABLE 2 shows variables’ relationships to acute stress disorder.) At Time 2, 7 women (39%) met criteria for a diagnosis of postraumatic stress disorder.

Women who presented with acute stress disorder at Time 1 were significantly more likely to meet criteria for postraumatic stress disorder at Time 2. Of the 7 women who met criteria for acute stress disorder at Time 1, 4 (57%) completed follow-up assessments at Time 2. Notably, all 4 met criteria for postraumatic stress disorder at Time 2. Additionally, 3 women who did not meet criteria for an acute stress disorder diagnosis at Time 1 did meet criteria for postraumatic stress disorder at Time 2.