Effect of individualized psychological interventions on the psychological state and pregnancy outcomes of patients with recurrent spontaneous abortion

TL;DR

This study shows that personalized psychological support helps reduce anxiety and depression in women with repeated miscarriages and improves their chances of a successful pregnancy.

Contribution

The study demonstrates that individualized psychological interventions significantly improve mental health and pregnancy outcomes in patients with recurrent spontaneous abortion.

Findings

The intervention group had significantly lower anxiety and depression scores compared to the control group.

The intervention group had a lower miscarriage recurrence rate and higher newborn Apgar scores.

Patients in the intervention group reported higher satisfaction with their care.

Abstract

To investigate the effects of individualized psychological interventions on the psychological state and pregnancy outcomes of patients experiencing recurrent spontaneous abortion (RSA).

This was a retrospective study. Eighty-eight patients with RSA treated at Langfang TCM Hospital from December 2022 to December 2023 were selected as study subjects. They were randomly divided into a control group, which received standard nursing care, and an intervention group, which underwent individualized psychological interventions. The psychological states and pregnancy outcomes of patients in both groups were compared through assessments of anxiety and depression scores, quality of life, recurrence rate of miscarriage, newborn Apgar scores, and patient satisfaction.

Before the intervention, no significant difference was observed in the baseline characteristics between the two groups(P>0.05). After the intervention, the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) scores in the intervention group were significantly lower than those in the control group, respectively. The quality of life scores were all higher in the intervention group than in the control group. The recurrence rate of miscarriage in the intervention group (4.55%) was significantly lower than that in the control group (18.18%). The Apgar scores of newborns at birth, one minute after birth, and five minutes after birth were all higher in the intervention group. The satisfaction rate of the intervention group was significantly higher than that of the control group, with all differences being statistically significant(P<0.05).

Individualized psychological interventions can effectively improve the psychological state and pregnancy outcomes of patients with recurrent spontaneous abortion.

Tables

Table-I. Comparison of SAS and SDS scores (N=44,`χ±s, points).

Group	SAS score		SDS
	Pre-intervention	Post-intervention	Pre-intervention	Post-intervention
Control group	57.80±3.67	46.91±3.67	56.57±4.44	48.20±4.73
Intervention group	57.39±3.29	39.27±6.31	57.59±4.22	31.43±6.89
t	0.550	6.938	-1.108	13.311
P	0.584	1.7137E-9	0.271	1.4484E-21

Table-II. Comparison of quality of life (N=44, χ̅±S, points).

Quality of life	Control group		Intervention group
	Before treatment	After treatment	Before treatment	After treatment
Physical functioning	74.36±4.21	76.86±2.48	74.32±4.12	79.34±3.09a
Role physical	58.84±3.76	63.82±3.87	58.77±3.87	70.02±3.06a
Social functioning	54.48±3.02	59.86±3.23	53.64±3.50	72.25±5.02a
Emotional role	46.64±5.49	52.20±6.64	46.45±5.72	64.57±4.75a
Mental health	43.86±6.46	49.70±4.05	43.91±6.82	60.70±5.47a
Vitality	43.82±6.47	52.66±3.17	43.32±6.71	61.39±4.33a
Bodily pain	61.73±4.57	63.77±3.05	60.95±3.99	72.80±3.45a

Table-III. Comparison of recurrence rate of miscarriage (N=44, cases).

Miscarriage status	Control Group	Combined Group
Miscarriage	8	2
No miscarriage	36	42
Recurrence rate of miscarriage/%	18.18	4.55

Table-IV. Comparison of newborn Apgar scores (N=44, χ̅±S, points).

Group	At birth	one minute after birth	five minutes after birth
Control group	5.57±1.66	7.11±1.35	8.91±0.86
Intervention group	7.05±2.17	9.16±1.08	9.84±0.37
t	-3.588	-7.854	-6.617
P	0.000570	1.0417E-11	1.2457E-8

Table-V. Comparison of patient satisfaction (N=44, cases/%).

Complications	Dissatisfied	General	Satisfied	Satisfaction (%)
Control group	4/9.09	8/18.18	32/72.73	90.91
Intervention group	13/29.55	11/25.00	20/45.45	70.45

Full text

INTRODUCTION

Recurrent spontaneous abortion (RSA), commonly delineated as the occurrence of three or more consecutive miscarriages before the 20th week of gestation with the same partner1,2, represents a prevalent pregnancy complication. It affects 1%-5% of women of reproductive age3,4, with its incidence rate gradually increasing.5 The etiology of RSA remains multifaceted, with no identifiable cause in 50% of cases.6 Most patients with recurrent miscarriage endure considerable personal, familial, and societal stress, often leading to anxiety and depression.7 Anxiety and depression are recognized as significant risk factors for miscarriage.

The absence of effective psychological interventions exacerbates the physical and mental strain on the patient, potentially culminating in unfavorable pregnancy outcomes.8,9 Psychological interventions have gained widespread recognition and application in developed countries in Europe and America.10-12 The psychological states of different patients or the same patient at different stages vary significantly. This study endeavorsed to tailor psychological intervention strategies to the unique psychological profile of each patient, aimed to ameliorate their psychological state and achieve optimal pregnancy outcomes.

METHODS

This was a retrospective study. Eighty-eight patients with recurrent spontaneous abortion (RSA) admitted to Langfang TCM Hospital from December 2022 to December 2023 were selected as study subjects by the principle of random sampling. Based on the nursing approach, patients were divided into a control group and an intervention group, with 44 individuals in each group.

Ethical Approval:

The study was approved by the Institutional Ethics Committee of Langfang TCM Hospital (No.: 2023-123; date: December 1^st^, 2023), and written informed consent was obtained from all participants.

Inclusion criteria:

• Patients diagnosed with RPL based on medical history and relevant examinations after admission.
• Those with ability to communicate normally.
• Those with miscarriage gestational weeks <20 weeks.
• Those who have volunteered themselves and their families to participate in the research project and have signed the relevant documents.
• Those with no other pregnancy diseases, cardiopulmonary diseases, or leukemia, etc.

Exclusion criteria:

• Patients with mental illness or unable to communicate normally.
• Those with severe diseases such as malignant tumors.
• Those in the pre-pregnancy, pregnancy, or lactation period.
• Those who allergic to the drugs used in this study.

The ages ranged from 20 to 37 years, with three to five pregnancies on average. The average age in the control group was 28.43±5.66 years, with an average of 3.73±0.82 pregnancies; the intervention group consisted of 27 males and females each, with an average age of 28.80±5.33 years and an average of 3.75±0.81 pregnancies. No statistically significant difference was observed in the general data between the two groups of patients with recurrent miscarriages (P>0.05).

Methods Control Group:

Standard nursing care interventions were applied.

The gestational status and uterine contractions of the patients were meticulously documented, followed by vigilant monitoring throughout the subsequent treatment process to ensure the timely implementation of appropriate therapeutic interventions.

In response to the patients’ various diagnostic indicators, interventions were made in their dietary habits, daily routines, and occupational activities to mitigate excessive fatigue, thereby reducing the risk of recurrent miscarriage.

Patients were educated on the fundamental knowledge of recurrent miscarriage, and their inquiries were addressed, enhancing their understanding and awareness of the condition.

Intervention Group:

On top of standard nursing care interventions, an individualized psychological intervention plan was developed for patients.

Before the treatment started, the intervention group patients were scored for anxiety (SAS) and depression (SDS), and an individualized psychological intervention plan was formulated based on the scores;

Patients and their partners were educated on recurrent miscarriage to enhance their and their families’ awareness of recurrent spontaneous abortion (RSA), emphasizing the adverse impact of psychological stress on pregnancy outcomes, strengthening the partner’s role in psychological counseling in daily life, creating a relaxed family atmosphere, and reducing the patient’s stress from self and family environment;

One-on-one psychological counseling was provided for patients based on their psychological state, once to twice a week; (4) A WeChat group was established to answer common questions daily, enhance patient communication, and eliminate negative emotions. The two groups of patients were followed up for six months.

Observation indicators:

Comparison of anxiety and depression scores.

The Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) were employed to score the anxiety and depression levels of both groups.13 SAS scores below 50 and SDS scores below 53 are considered normal, indicating no anxiety. Scores were rated before and after treatment for both groups, with higher scores indicating more severe anxiety or depression.

Comparison of quality of life:

A quality-of-life questionnaire for patients with recurrent miscarriage was devised by the medical team, covering seven dimensions: physical functioning, role physical, social functioning, emotional role, mental health, vitality, and bodily pain, with each dimension scored from 0 to 100. Higher scores indicate better quality of life.

Comparison of the recurrence rate of miscarriage:

The number of patients experiencing recurrent miscarriages in both groups was statistically analyzed.

Comparison of newborn Apgar scores:

The Apgar scores of newborns at birth, one minute after birth, and five minutes after birth were compared between the two groups, scoring newborns’ skin color, heart rate, respiration, muscle tone, and response to stimuli on a scale of 0, 1, or 2, for a total of 10 points. Higher scores indicate better newborn conditions.14

Patient satisfaction:

A satisfaction questionnaire was customized by the medical team based on relevant literature from CNKI, covering treatment plan satisfaction, nursing communication skills, responsibility, timeliness, and effectiveness of problem-solving, among other aspects. The total score is out of 100, with scores below 60 indicating dissatisfaction, 60 to 79 indicating general satisfaction, and 80 or above indicating satisfaction. All the questionnaire was simply handed over to the participants to fill themselves, for patients under 18 years of age, satisfaction was jointly completed by the patient and their family.

Statistical analysis:

All data were statistically analyzed using the SPSS 22.0 software(SPSS Inc., Chicago, IL, USA). Measurement data were expressed as (χ̅±S), and t test was used for comparison between groups. Enumeration data were expressed as percentage (%), and the chi-squared test (χ^2^) was used for data analysis. A P-value <0.05 was considered a statistically significant difference.

RESULTS

No statistically significant difference in the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) scores between the two groups before intervention (P>0.05). Table-I. Utilizing different psychological intervention methods, both groups showed a decrease in SAS and SDS scores, with the intervention group exhibiting significantly lower scores than the control group, with a statistically significant difference (P<0.01). This suggests that individualized psychological intervention can effectively improve the psychological state of patients with recurrent spontaneous abortion.

After psychological intervention, the intervention group’s scores in physical functioning, role physical, social functioning, emotional role, mental health, vitality, and bodily pain were all significantly higher than those of the control group (P<0.01) indicating that individualized psychological intervention can effectively enhance the quality of life for patients with recurrent spontaneous abortion. Table-II.

The recurrence rate of miscarriage within six months in the intervention group was significantly lower than that in the control group, with a statistically significant difference (P<0.05).Table-III.

The Apgar scores of newborns at birth, one minute after birth, and five minutes after birth in the intervention group were significantly higher than those in the control group, with a statistically significant difference (P<0.01). Table-IV The satisfaction rate in the intervention group (90.91%) was significantly higher than that in the control group (70.45%), with a statistically significant difference (P<0.05). Table-V.

DISCUSSION

Before the intervention, baseline comparisons revealed no significant disparities in the indicators assessed between the two groups (P>0.05). Subsequent to the tailored interventions, the intervention group demonstrated a marked improvement in mental health, as evidenced by lower Self-Rating Anxiety Scale (SAS) scores (39.27±6.31) and Self-Rating Depression Scale (SDS) scores (31.43±6.89) compared to the control group (46.91±3.67, 48.20±4.73). This suggests a better psychological state. Additionally, the quality of life scores in the intervention group, including physical functioning, role physical, social functioning, emotional role, mental health, vitality, and bodily pain, were all higher than those in the control group.

The recurrence rate of miscarriage in the intervention group (4.55%) was significantly lower than that in the control group (18.18%). The Apgar scores of newborns at birth, one minute after birth, and five minutes after birth were all higher in the intervention group, indicating better pregnancy outcomes compared to the control group. Patient satisfaction within the intervention group (90.91%) also significantly exceeded that of the control group (70.45%), with all observed differences achieving statistical significance (P<0.05). Pregnancy loss, a significant concern in clinical practice, affects 15-25% of all pregnancies, with the majority of sporadic losses being attributed to random numerical chromosomal errors, particularly trisomies.15 Less than 5% of women will experience two consecutive miscarriages, and only 1% will suffer three or more, representing one of the unresolved challenges in reproductive medicine.16 Women with recurrent spontaneous abortion are prone to feelings of depression, anxiety, guilt, and anger, with the incidence of depression being approximately five times higher among these women, further impacting their pregnancy outcomes.17,18 Hence, effective psychological intervention is necessary for treatment.

To date, much of the literature has focused on the experiences of women, neglecting the significance of the male partner’s experience in miscarriage and the interaction between partners. This field is gradually shifting towards a couple-based approach, emphasizing the value of psychological counseling for the couple as a whole.19-21 Building upon standard care, this study incorporated knowledge dissemination and psychological interventions for partners, enhancing the involvement of patients’ partners in the treatment process. Individualized psychological intervention treatment plans were developed based on the specific circumstances of different patients and their partners, aiming to reduce anxiety and depression in partners and strengthen mutual support among couples. Addressing patients’ psychological health issues comprehensively in a clinical setting improves pregnancy outcomes.

Limitations:

However, a small number of samples was the shortcoming of this study. In view of this, more samples should be included in future studies to further validate the findings of this study.

CONCLUSIONS

Individualized psychological interventions can effectively improve the psychological state and pregnancy outcomes of patients with recurrent spontaneous abortion. The study highlights the profound psychological impact of recurrent spontaneous abortion on both men and women, pointing to the distinct experiences and the lack of adequate societal support and scholarly attention. This underscores an urgent need for expanded research into psychological health interventions, particularly for men affected by recurrent spontaneous abortion.

Authors’ Contributions:

YY and JS: Carried out the studies, participated in collecting data, and drafted the manuscript, and are responsible and accountable for the accuracy or integrity of the work.

CL, NH, GW and WZ: Performed the statistical analysis and participated in its design. Critical Review.

All authors read and approved the final manuscript.