Anxiety Disorders Following Miscarriage

Background: Several previous studies haveestablished that miscarriage is a risk factor for depressivesymptoms and disorder. By contrast, research on miscarriage as apossible risk factor for anxiety symptoms is inconclusive, andfor anxiety disorders, sparse and uninformative. The currentstudy examines the incidence of and relative risk for 3 DSM-IIIanxiety disorders (obsessive-compulsive disorder [OCD], panicdisorder, and phobic disorders) within the 6 months followingmiscarriage. Adequate diagnostic data on other anxiety disorderswere not available.

Method: Using a cohort design, we tested whetherwomen who miscarry are at increased risk for a first or recurrentepisode of an anxiety disorder in the 6 months following loss.The miscarriage cohort consisted of women attending a medicalcenter for spontaneous abortion (N = 229); the comparison groupwas a population-based cohort of women drawn from the community(N = 230).

Results: Among miscarrying women, 3.5%experienced a recurrent episode of OCD, compared with 0.4% ofcommunity women (relative risk [RR] = 8.0; 95% confidenceinterval [CI] = 1.0 to 63.7). The relative risk for noncomorbidpanic disorder was substantial (RR = 3.6), albeit notstatistically significant (95% CI = 0.8 to 17.2). There was nostrong evidence for increased risk for phobic disorders oragoraphobia, combined or considered separately, in the 6 monthsfollowing loss. Relative risk for all 3 disorders combined was1.5 (95% CI = 0.9 to 2.3).

Conclusion: In this first miscarriage cohortstudy using a concurrent frequency-matched comparison group,miscarriage was a substantial risk factor for an initial orrecurrent episode of OCD. Given statistical power limitations ofthis investigation, the current findings do not preclude apossible contribution of miscarriage to risk for other anxietydisorders.