Predicting depressive symptoms after miscarriage: a path analysis based on the Lazarus paradigm.

Twenty percent of all pregnancies end in miscarriage. Findings are mixed about who is most at risk for a depressive response. The purpose of this study was to develop and test a theory-based path model that would enable prediction of the intensity of women's depressive symptoms at 4 months and at 1 year after miscarriage. The model is based on Lazarus's theory of emotions and adaptation. Model constructs examined included stage I contextual variables (gestational age, number of miscarriages, number of children, maternal age, perceived provider caring at the time of loss, and family income), stage II interceding variables (perceived social support, emotional strength, and subsequent pregnancy/birth), stage III primary appraisal of meaning (personal significance of miscarrying), stage IV secondary appraisal (active or passive coping), and stage V emotional response (depressive symptoms). Path analysis employing a series of stepwise, multiple regression equations was used to test the hypothesized model. The sample consisted of 174 women whose pregnancies ended prior to 20 weeks gestation (mean = 10.51, SD = 3.32). The model accounted for 63% of the variance in women's depressive symptoms at 4 months and 54% at 1 year. Findings support the utility of the Lazarus model and confirm that women most at risk for increased depressive symptoms after miscarriage are those who attribute high personal significance to miscarriage, lack social support, have lower emotional strength, use passive coping strategies, have lower incomes, and do not conceive or give birth by 1 year after loss.