When a woman miscarries, it’s typically far more hurtful than helpful to say something like, “At least you have other children.” Now, new research backs that up and goes a step further, finding that even women who go on to welcome a child after a miscarriage or stillbirth report prolonged depression and anxiety surrounding their loss.
“We kind of assumed in the academic world that if you have a healthy baby, everything would be fine,” says Emma Robertson Blackmore, the lead researcher and an assistant professor of psychiatry at the University of Rochester Medical Center.
Each year, about 1 million U.S. women endure a miscarriage or stillbirth. Up to 80% of those women get pregnant again, but researchers found that nearly 13% of women who had a miscarriage or stillbirth before delivering a healthy baby still had symptoms of depression 33 months after the birth. Of those with two previous losses, almost 19% of new mothers had symptoms of depression within that same time span, according to the study published online this month in the British Journal of Psychiatry. (More on Time.com: Study: Secondhand Smoke Increases Risk of Stillbirth, Birth Defects)
The researchers tracked 13,133 pregnant women in the United Kingdom who were participating in the Avon Longitudinal Study of Parents and Children. They were screened for depression and anxiety throughout their pregnancy and after giving birth. Most reported no miscarriages, but 21% said they had experienced at least one.
The findings are significant for clinical care. Typically, women are flagged for potential postpartum mental problems based on a previous history of depression or a lack of social support. “But we never thought of flagging women who’ve lost a pregnancy,” says Robertson Blackmore. (More on Time.com: Pediatricians Should Start Screening for Postpartum Depression)
It’s expected that women who’ve suffered a loss might be more anxious in subsequent pregnancies, especially up until the point at which they lost the pregnancy. “Say you had a miscarriage at 15 weeks,” says Robertson Blackmore. “You can imagine until you get to that point, you think, Oh, my God, is everything going to be okay?
“After that point, we really expected symptoms of depression to decrease,” she says, “but they didn’t.”
In fact, multiple losses only compounded feelings of despair. Women who lost two or more pregnancies experienced depression more frequently than those who’d lost one; of those who’d lost four pregnancies, 22% reported experiencing depression three years later. (More on Time.com: Diagnosing Postpartum Depression with a Brain Scan)
Some of the depression may stem from the inept way in which others can react to miscarriage. People say well-intentioned but insensitive things, or they worry about saying the wrong thing, so they say nothing at all.
“With advancing medical knowledge, everyone assumes pregnancy is going to go well,” says Robertson Blackmore. “When that doesn’t happen, it strikes fear in a lot of people. It’s so common, but people don’t know what to say.”