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[Relation between neuroticism and low educational level and the risk of post-traumatic stress disorder in women after miscarriage or stillbirth].

OBJECTIVE
To determine whether neuroticism and educational level are predictive variables for post-traumatic stress disorder (PTSD) in women following an unsuccessful pregnancy.


DESIGN
Prospective.


METHOD
In the period June-September 1999, via advertisements in national newspapers, pregnant women with a gestation period shorter than 12 weeks were asked to participate in a study into their perception of the pregnancy. After they had agreed to participate they were given the 'Eysenck personality questionnaire' (EPQ) for neuroticism and other questionnaires, including a scale to determine their highest attained level. Every other month during the pregnancy and one month after the expected date of birth the participants were given brief questionnaires about the pregnancy, in which they were also asked to report miscarriage or stillbirth if such had occurred. Participants in whom the pregnancy had in fact ended unsuccessfully were contacted by telephone and asked to participate in a follow-up study with the 'Post-traumatic symptom scale' (PSS), among others.


RESULTS
Of the 1339 women studied, 126 (9%) experienced an unsuccessful pregnancy; 8 of these dropped out of the study (response rate: 94%); one had not indicated her educational level. The remaining 117 women filled out the PSS after about one month. The average age was 31 years (SD: 4). The average duration of gestation at the moment of loss was 12 weeks (SD: 6; range 5-40). The average EPQ-score was 7.3 (SD: 4.6) and the average PSS-score was 18.1 (SD: 9.1). On the basis of the DSM IV, 31 women (26%) fulfilled the criteria for PTSS and 86 women did not. The average PSS-score was 28.2 (SD: 7.0) for the group with PTSS and 14.7 (SD: 6.7) for the group without PTSS. Logistic regression analysis revealed that a later diagnosis of PTSS was significantly associated with a higher score for neuroticism (RR = 4.49; p = 0.004; 95% CI: 1.60-12.60), a lower educational level (RR = 0.65; p = 0.009; 95% CI: 0.48-0.90) and a longer duration of gestation (RR = 2.48; p = 0.001; 95% CI: 1.45-4.25).


CONCLUSION
In patients with a high educational level and a low score for neuroticism the risk of developing PTSS was negligible, while with a low educational level and a high score for neuroticism the estimated risk was about 70%. Care and guidance should be concentrated primarily on this group.