Coping with miscarriage: Australian women's experiences

This thesis combines quantitative and qualitative methods to examine both women’s psychological wellbeing after miscarriage and the specific coping strategies that are associated with coping well with this event. Chapter 1 reviews the ways in which miscarriage has been defined and its estimated prevalence. As definitions of miscarriage tend to vary across Western countries, the research implications of this are discussed. Chapter 2 reviews the literature related to women’s psychological responses following miscarriage, discussing the main outcomes which have been examined, including depression, anxiety, stress and grief. As the literature is relatively small, and current research is limited by small and non-representative samples, Chapter 3 takes an epidemiological approach by cross-sectionally investigating the psychological correlates, and relevant sociodemographic, reproductive and health-related variables associated with miscarriage using a large population sample of young Australian women. Sociodemographic and reproductive variables most strongly predicted membership of the Miscarriage and No Miscarriage groups, while psychological wellbeing did not distinguish the two groups in the stepwise logistic regression. Using the same data but applying longitudinal methods, Chapter 4 examined whether trajectories of Mental Health, Stress and Optimism varied over time and according to women’s miscarriage status. Relevant sociodemographic and reproductive variables identified in Chapter 3 as possible confounding variables were controlled in these analyses. Miscarriage was found to affect trajectories of Mental Health, Stress and Optimism, with poorer outcomes on all variables for women reporting miscarriage by comparison to women who had never miscarried over a seven-year period. Because miscarriage has significant effects on women’s mental health and wellbeing, the next part of the thesis was dedicated to examining the predictors of, and coping strategies related to, coping well after miscarriage. Since the term coping well is not easily defined, Chapter 5 is a critical review of the theoretical frameworks of coping, with an emphasis on identifying the conceptualisation and measurement problems which have limited advancements in the field. Chapter 6 is a review of the psychological, reproductive and sociodemographic predictors of adjustment to miscarriage, highlighting the conflicting evidence and the need for multivariate methods when analysing these relationships. Using the Australian Longitudinal Study on Women’s Health data, Chapter 7 uses longitudinal methods to investigate predictors of Mental Health among young women reporting miscarriage. Optimism, social support and the number of miscarriages were strong predictors of Mental Health among women reporting miscarriage. Chapter 8 is a review of the research which has examined the coping styles and strategies that women use to cope with miscarriage. The majority of this research tends to be of a qualitative nature, and therefore the next step was to complete interviews with nine women to gain a more in-depth understanding of the specific coping strategies related to positive outcomes after miscarriage. Social support was reported as facilitating adjustment to miscarriage, consistent with the quantitative analyses. Acknowledgement and support from health professionals was also described as facilitating adjustment. While the quantitative analyses had also initially suggested that satisfaction with the general practitioner was an important predictor of adjustment, this variable did not reach significance when other reproductive and psychological variables were controlled for. Taking all the results into consideration, it appears that changes to social norms and attitudes regarding miscarriage may help women to cope with this challenging and distressing experience. Interventions to help women cope with miscarriage need to be grounded in an understanding of women’s need for social and family support, and understanding from health professionals. However, it is essential that interventions should be comprehensively evaluated, and future research in this area is warranted