Exploring the Psychological Impact of Miscarriage: Shame and coping strategy

Introduction. Multiple studies highlighted the psychological effects of miscarriage, which can be experienced as a traumatic event like a loss, exiting in depression, anxiety, and PTSD. However, limited research has delved into its psychological effects on women's life and relationships. Women experienced miscarriage rarely share their experiences for various reasons, including biases about its frequency, leading to a tendency to grieve alone. For these reasons, it is important to offer specific and customized support treatments. For guidance on how to set up these treatments this study aims to explore the predominant emotions associated with miscarriage, particularly differentiating between guilt and shame, the relationship between lack of disclosure and subsequent emotional distress, and the role of meaning-making capability and couple support as protective factors. Methods. Through a web-based survey we collected data from fifty-six Italian women who had experienced miscarriage, recruited via social media, investigating on emotional responses, cultural significance, and disclosure behavior about miscarriage. Self-report measures on guilt, shame, coping strategies, grief, psychological well-being, and meaning making were also administered. In addition, thirty participants were administered a narrative projection test, the Thurston Cradock Test of Shame, and a semi-structured interview to qualitatively explore the women's experiences. The responses were coded using interpretive phenomenological analysis. Results. Women with miscarriage experiences often felt a sense of shame rather than guilt. Shame was closely associated to the fear of social judgment and the stigma surrounding miscarriage, resulting in reluctance to share their experience. This heightened emotional distress. The analyses indicated that women with lower ability of making sense of their loss and lower satisfaction from their couple relationship or weaker dyadic coping strategies tended to exhibit more distress symptoms. Discussion. The results showed specific psychological impact of miscarriage and emphasizes the need for tailored support interventions which should promote the validation and transformation of shame, engage the women’s partners to enhance shared coping strategies, provide opportunities to activate individually and with significant others functional meaning making processes.