Affective state of women following a prenatal diagnosis: predictors of a negative psychological outcome.

OBJECTIVE: The benefits of prenatal diagnostic procedures are well documented. However, the investigation of psychological consequences related to these procedures has remained a surprisingly neglected area of research. The main aim of the present study was to investigate the potential relationship between psychological outcome and associated (socio-demographic, psychological and obstetric) variables in women attending a tertiary referral center for prenatal diagnosis and therapy for ultrasound scanning (due to the suspicion of a fetal malformation raised by the gynecologist in private practice), amniocentesis or chorionic villus sampling. METHODS: Affective state was assessed by means of standardized measures of anxiety and depression (State-Trait Anxiety Inventory; Mood Scale) in 77 consecutive, unselected women. A follow-up investigation, including an additional assessment of coping mechanisms, took place 6 months after the first contact. Given the considerable number of intervening and correlating factors, a path analysis was undertaken. RESULTS: We found that all women in our sample experienced acute distress, not only those with proven fetal malformations, genetic disorders or intrauterine fetal death, but also those with the diagnosis of a sonographic sign. At baseline (i.e. immediately after the diagnostic procedure), mood and anxiety scores in our sample were found to be comparable to those of patients with a major depressive episode. A high trait anxiety level, implementation of negative coping strategies and loss of the child during pregnancy were found to be predictive of a negative psychological outcome at follow-up. Socio-demographic variables did not have a significant predictive function for the psychological outcome. CONCLUSIONS: We assume that a considerable number of women undergoing prenatal diagnostic procedures experience psychological distress, which may be underestimated by workers in prenatal care. Establishment of interdisciplinary treatment settings, in which access to psychological support is facilitated, may be extremely beneficial for women following a prenatal diagnosis.

Experiences with a psychological help service for women following a prenatal diagnosis: results of a follow-up study.

The aim of this study is to provide a description of a psychological help service for women following a prenatal diagnosis at the Division of Prenatal Diagnosis and Therapy at Vienna University Hospital. The investigation group consisted of 77 psychologically treated women. The follow-up took place six months after the first contact. For baseline evaluation the State-Trait Anxiety Inventory, a mood scale and a documentation instrument were used. In the follow-up patients were again investigated by the test inventory and the Freiburger Coping Behavior Scale and a special follow-up instrument. The women showed extreme high scores of general mood scale and state anxiety compared with a normal population. After six months the scores had decreased significantly. Approximately 56% of the patients showed former prenatal incidents in their case histories. A significant correlation was found between the use of negative coping strategies and the development of somatic problems and changes in the private life in the follow-up period. In total 97% of the women quoted the psychological treatment as very important for coping with the prenatal incident and 100% of the women stressed the implementation of a permanent psychological help service. In conclusion, psychological treatment should be available in the event of a prenatal diagnosis, if necessary with the partner. Special attention should be given to women traumatized by a former prenatal incident.