Research investigates post-traumatic stress in partners following miscarriage

One in 12 partners experience post-traumatic stress after miscarriage, suggests a new study.

The research, led by Imperial College London, surveyed over 100 couples who had experienced early stage pregnancy loss (miscarriage or ectopic pregnancy before 12 weeks).

The study, the first ever to investigate post-traumatic stress (PTS) in partners following miscarriage, follows previous research from the same team that found around one in five women experience long-term PTS following early pregnancy loss.

The current research, published in the journal Ultrasound in Obstetrics and Gynecology, found that one month after pregnancy loss, one in 14 (7 per cent) partners met the criteria for post-traumatic stress (PTS), rising to one in 12 (8 per cent) at three months, with one in 25 partners still suffering from PTS nine months after the pregnancy los.

The team behind the research, funded by theImperial Health Charityand theImperial National Institute of Health ResearchBiomedical Research Centre, call for improved psychological support for a woman and her partner following pregnancy loss.

Today (Friday 9th October) marks the start of UK Baby Loss Awareness Week.

There are around 250,000 miscarriages in the UK every year. Our previous research suggested women can be left deeply traumatised after a pregnancy loss, and this new study suggests partners also experience post-traumatic stress. Partners are often ignored when a woman experiences pregnancy loss.

Yet this research suggests that although partners do not suffer PTS as often as women, there still could be many thousands of partners living with post-traumatic stress, which is a serious condition that requires treatment."

Tom Bourne, Study Lead Author and Professor, Tommy's National Centre for Miscarriage Research, Imperial College London

One in four pregnancies ends in miscarriage - most often before or around 12 weeks. Ectopic pregnancies always result in pregnancy loss, as an embryo grows in an area outside of the womb and is unable to develop.
The women in the study attended the Early Pregnancy Assessment Units at three London hospitals -Queen Charlottes and Chelsea,St Mary's, and Chelsea and Westminster.

All couples in the study were asked to complete validated questionnaires about their emotions and behaviour one month after pregnancy loss, then again three and nine months later. In total 102 partners completed the survey one month after the pregnancy loss, dropping to 70 at nine months after the pregnancy loss.

The responses from the women were similar to those reported in a previous study, and revealed one month following pregnancy loss, a third of women (34 per cent) suffered post-traumatic stress while one in four (26 per cent) suffered PTS three months after the pregnancy loss, and one in five (21 per cent) at nine months.

The women and partners in the study who met the criteria for post-traumatic stress reported regularly re-experiencing the feelings associated with the pregnancy loss, and suffering intrusive or unwanted thoughts about the pregnancy loss. Both women and partners also reported having nightmares or flashbacks, while others avoided anything that might remind them of their loss.

The team add that although fewer partners met criteria for PTS than women, many of the partners experienced the individual symptoms of PTS, even if they did not meet full criteria for the condition. For instance, at one month, three and nine months after the pregnancy loss, over 80 per cent of all partners reported feeling helpless, and around a third of all partners reported feeling terrified. Around 70 per cent of all partners reported re-experiencing the event, and one in five reported their symptoms had affected relationships.

Dr Jessica Farren, first author of the research from Imperial, and Obstetrician and Gynaecologist, said: "This study demonstrates there is a sizeable proportion of partners who experience severe psychological symptoms after a pregnancy loss. Moreover, those partners who did not reach the threshold for diagnosis of post traumatic stress are still very likely to be experiencing symptoms the have an impact on their wellbeing.

Post-traumatic stress can have a toxic effect on all elements of a person's life - affecting work, home and relationships. Evidence suggests the risk of relationship breakdown increases after pregnancy loss, and our research shows the loss of a pregnancy can leave have a significant and lasting psychological impact on both a woman and her partner.

Hopefully an awareness of the results of this study will help couples navigate their different responses to these losses, and show each other the understanding that is needed to get through a very difficult period in their relationship."

Professor Tom Bourne added: "We have made significant progress in recent years in breaking the silence around mental health issues in pregnancy and postnatally, but early pregnancy losses are still shrouded in secrecy, with very little acknowledgement of how distressing and profound an event they are. This research suggests psychological support should be offered to both the woman and her partner, with couples given the option of attending therapy together."

The authors caution the study used a questionnaire for screening for post-traumatic stress, but formal diagnosis of post-traumatic stress disorder would require a clinical interview.
Ian Lush, Chief Executive of Imperial Health Charity, said: "As the dedicated charity for five London hospitals, we are committed to supporting pioneering research that leads to real improvements in patient care.

"This latest study shines a light on the serious psychological difficulties experienced by partners after a miscarriage and we look forward to seeing how this important research can be translated into better care for couples who face the unimaginable pain of losing a baby."

Tommy's chief executive Jane Brewin commented: "Baby loss can have a deep and lasting impact on both parents, and this study gives a voice to many who have suffered in silence, highlighting the profound consequences that can have for their mental health and wellbeing. The message is clear; partners are vulnerable to the same psychological problems as mothers, and specialist support must be made available to either or both bereaved parents.

"It's fitting that Tommy's National Centre for Miscarriage Research has raised this issue in Baby Loss Awareness Week, which this year focuses on the isolation that grieving families too often face - an issue that can be exacerbated for partners who feel they have to be strong and supportive, hiding their own heartbreak. Attitudes to baby loss must change so that anyone who wants to open up or ask for help feels able to do so."

Source:
Journal reference:

Farren, J., et al. (2020) Post-traumatic stress, anxiety and depression following miscarriage and ectopic pregnancy: a multi-center, prospective, cohort study. American Journal of Obstetrics and Gynecology. doi.org/10.1016/j.ajog.2019.10.102.

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