Understanding miscarriage grief: how shame, guilt, and meaning making influence recovery

Several studies have highlighted the significant negative impact of miscarriage on women's mental health, which can be experienced as a traumatic event, associated with symptoms such as depression, anxiety and PTSD. However, little research has explored the psychological factors that explain this impact, which involve women's emotional processes, meaning-making processes, and relationships. Women who have experienced miscarriage rarely share their experiences because of social stigma and prejudice, which can lead to feelings of isolation and unresolved grief. To inform tailored supportive psychological interventions, this study aimed to examine the predominant emotions related to miscarriage, specifically distinguishing between guilt and shame, and other related key psychological factors such as role of self disclosure, couple support, and meaning making ability. Through an online survey, we collected data from 98 Italian women with a miscarriage in their lives, investigating their emotional responses, cultural meanings and values, and disclosure behaviors related to miscarriage. A set of self-report measures on guilt and shame (TOSCA-4, PFQ2), dyadic coping strategies (DCI), perinatal grief and distress (PGS-33, PHQ-4), and meaning making (ISLES, CBI) were administered. Results showed that shame, rather than guilt, emerged as the predominant emotional response among women who experienced miscarriage and was strongly associated with reluctance to share their experiences. Greater self-disclosure was linked to lower levels of grief severity. Shame was also found to intensify grief, mainly through its role in mediating difficulties in make sense to the miscarriage event. Dyadic coping, on the other hand, was found to be a protective factor against psychological distress; in particular, supportive dyadic coping and reciprocal stress communication were significantly associated with reduced psychological distress and lower severity of perinatal bereavement. The findings highlight the complex psychological consequences of miscarriage and underscore the need for targeted psychological interventions aimed to reduce feelings of shame through emotional validation and recognition, engage partners to strengthen shared coping strategies, and facilitate meaning-making processes both individually and in couple relationships.