Mothers at risk: maternal mental health outcomes after perinatal death.

INTRODUCTION: Stillbirth and infant death are traumatic events with profound and lasting effects on bereaved families. Mothers with perinatal loss are at high risk for poor mental health, although this has not been well-assessed in a representative epidemiologic cohort. There are also virtually no data on loss among African-American women.

METHODS: The Michigan Mother's Study is a 2-year longitudinal survey of all mothers with stillbirth and infant death, matched with live-birth controls. The study assessed mental, physical, and reproductive health outcomes and screened for depression, post-traumatic stress disorder (PTSD), panic disorder, social phobia, and obsessive compulsive disorder.

RESULTS: Three hundred seventy-eight bereaved and 232 live-birth mothers responded to the 6-month mailing (44% response rate). Nineteen percent of those bereaved were African-American compared with 8% of those with live birth. Bereaved mothers compared with live-birth mothers had dramatically higher rates of positive screens for depression (23% compared with 8%, P<.001), PTSD (41% compared with 12%, P<.001), general anxiety disorder (19% compared with 7%, P<.001), social phobia (19% compared with 6%, P<.001), and panic disorder (12% compared with 6%, P=.011). Rates were similar for mothers with stillbirth compared with infant death. Although African-American mothers showed similar levels of distress, they were significantly less likely than white mothers to have received treatment.

CONCLUSION: This is the first population-based study of mental health outcomes among perinatally bereaved mothers. Results show extraordinarily high rates of depression and anxiety and limited treatment, particularly among African-American mothers, who face the highest risk for adverse pregnancy outcomes in the United States.