Maternal Mental Health After Stillbirth: Associations With Autopsy Decisions, Cause of Death Knowledge, and Psychosocial Risk Factors.

PURPOSE: Stillbirth is a traumatic event with potentially lifelong effects on maternal mental health, but there are few clinical guidelines or resources for supporting families. Additionally, the effects of parental autopsy decision-making and knowledge of cause of death effect on maternal mental health is unclear. METHODS: We evaluated associations between autopsy decision, cause of death determination, and maternal mental health in data from the multi-center, five region Stillbirth Collaborative Research Network (2006-2008). Secondarily, we examined psychosocial risk factors associated with adverse MMH outcomes. Maternal mental health was assessed at single time point within 6-36 months after stillbirth delivery. Exposures included autopsy decision (none, partial, full) and knowledge of cause of death (known, unknown). Adverse maternal mental health was defined as abnormal scores on one or more validated instruments assessing depression, grief, distress, post-traumatic growth, and change in substance use. Psychosocial risk factors included childhood trauma and perceptions of support or blame. Logistic regression identified associations with maternal mental health outcomes. RESULTS: Among 272 participants (44% response rate), 54% reported one adverse maternal mental health outcome 6-36 months postpartum. Autopsy decision and knowledge of cause of death did not impact maternal mental health. Knowledge of cause of death was associated with less feeling of blame (OR 2.02, 95% CI 1.05-3.88). Childhood trauma (OR 4.10, 95% CI 1.60-10.70) and low income (OR 2.32, 95% CI 1.34-4.02) were associated with poorer maternal mental health. CONCLUSIONS: Despite the impact of stillbirth on maternal health, our understanding of factors impacting mental health is limited, and the clinical guidelines for providing psychological care are limited. In the current study, autopsy decision and knowledge of cause of death did not impact mental health outcomes 6-36 months postpartum, while childhood trauma, feeling blamed for the loss, and socioeconomic disadvantage were significantly associated with adverse mental health. This important, early data from the Stillbirth Collaborative Research Network may help inform screening for psychosocial risk factors and updating guidelines for providing trauma-informed support following stillbirth.