This study looked at which factors may independently impact on the positive screen for depression after a miscarriage. This analysis revealed that only 2 factors could be independent variables to this. They are education level (
p = 0.039) and mode of conception (
p = 0.005). Mode of conception has been shown to be a factor influencing occurrence of depression after a miscarriage [
6]. Women who have had difficulty in conceiving and hence had assisted conception have been shown to have a predisposition towards developing depression after a miscarriage [
6]. This has been majorly attributed to the fact that women who have assisted conception and experience a miscarriage, tend to have feelings of grief, profound aloneness and are concerned on whether they will conceive again [
13]. The present study found that education level was associated with occurrence of positive depression screen after a miscarriage meaning the higher the education level the less the chance of a positive depression screen. No studies have looked at the relationship between education level and depression after a miscarriage. However, we can posit that the reason for this may be that if a woman is more educated, she is better placed to understand the cause and clinical outcomes after a miscarriage and hence cope with a miscarriage better than one who is less educated. The other possible reason is that the societal role of a woman changes with education. In that, a woman may be geared towards professional ambitions as opposed to her major role as a parent as she gets more educated. This in turn may lead to a less adverse depressive reaction to a miscarriage. These may explain the lower prevalence among more educated women. The other factors did not seem to independently affect the depression screen after a miscarriage. A few of these factors have been shown to affect positive depression screen after a miscarriage including a younger age at miscarriage [
6,
10]. Being single at the time of miscarriage has also been associated with a higher risk of depression but this wasn’t the case in the present study [
11]. Finally poor social support has also been associated with depression after a miscarriage [
11] but the present study did not delineate that association. These factors ought to have had an impact on depression after a miscarriage. However, their lack of independent impact on depression in the present study can be explained by the fact that the study wasn’t designed and powered to examine these associations therefore the lack of relationship may be an apparent one rather than a true one.
Multivariate analysis was done to delineate potential relationships between the dependent variable of depression screen and the independent variables while taking into other variables as confounders. This was done through logistic regression analysis which revealed that more variables impacted on depression screen in multivariate analysis that did not in Univariate analysis. These included age (
p = 0.09), education level (
p = 0.01), gestation at miscarriage (
p = 0.04), marital status (
p = 0.043), prior miscarriage (
p = 0.011) and mode of conception (
p = 0.03). Some of these factors have been previously associated as risk factors for developing depression after a miscarriage. Age of the woman at miscarriage seemed to impact on the depression screen. This finding has been reported before in multiple studies [
6,
11] with a younger age at miscarriage being shown to increase the likelihood of developing depression afterwards. This has been linked to associated social factors such as a younger woman is more likely to be single, live alone and be less educated and hence the miscarriage may a have a heavier bearing with regards to psychiatric morbidity as opposed to an older woman [
17]. More so, young age has also been shown to be a risk factor for depressive illness in the general population [
18]. Education level has not been studied as a risk factor for depressive illness after a miscarriage but as we discussed earlier, this may impact on the woman’s understanding on the cause and subsequent implications of a miscarriage and hence influence the psychological reaction to it. Gestational age at miscarriage was found to impact on the occurrence of a positive depression screen, in that the older the pregnancy the more the likelihood of depressive symptoms. This has previously been shown in other studies with a gestational age of more than 8 weeks being shown to predispose one to depression as opposed to a gestational age before 8 weeks [
19]. This has been attributed to factors such as the couple having formed less attachment to the pregnancy before 8 weeks and there is also less likelihood of undergoing additional treatment procedures such as dilatation and curettage prior to this gestational age which may impact on their psychological reaction after the loss [
20,
21]. Marital status seemed to impact on the occurrence of positive depression screen after a miscarriage in the present study. This has been observed before with being single at the time of a miscarriage impacting on the occurrence of depression afterwards [
11,
17]. This was further attributed to the social support one has a after a miscarriage which may impact on the occurrence of depression as discussed previously. The presence of a prior miscarriage also seemed to be a factor determining the occurrence of positive depression screen in our study. This was shown previously with women who had a previous miscarriage being shown to be predisposed to depression after a miscarriage [
7]. This was further shown to increase with the number of prior miscarriages and was attributed to the growing anxiety and concern about having a miscarriage in a current pregnancy from prior experience [
7]. Mode of conception was also shown to impact on occurrence of positive depression screen after a miscarriage in the multivariate analysis. This was also true in the Univariate analysis, a factor explained earlier, as the impact of mode of conception on the reaction after a miscarriage [
13]. The other factors that still didn’t seem to impact on the occurrence of a miscarriage were pregnancy planning, social support, others being aware of the pregnancy and prior pregnancy outcome and their prior impact of lack of had been discussed earlier. Although these trends may seem apparent in the present study, it is important to note that this study wasn’t powered to investigate them but may point out on potential associations that may warrant further investigation in our population. However, it is reassuring to note that the factors identified to be associated with a positive depression screen in our study are similar to those identified in other studies.