Multiple and multifactorial evaluation of distal and proximal risk factors for mental health in adolescents hospitalized for a spontaneous or missed abortion or stillbirth

BACKGROUND. Examination of possible risk factors (mental disorders, obstetric and psychosocial conditions), in adolescents hospitalized in Lombardy for a first spontaneous abortion, which were identified during pregnancy, at outcome or in the obstetric and psychiatric history and may contribute to the onset of subsequent mental disorders. METHODS. The study examines data contained in the hospital discharge records (SDO) of adolescents hospitalized for first spontaneous abortion (n. 4597), comparing them with those detected in women with induced abortion (n. 19991) or normal delivery (n. 22342). Diagnosis of mental disorders have been isolated using ICD 9CM codes. The measures used were: number of evaluated patients per ten thousand (ptt), Crude age-specific index, Odds Ratio with 95% CI, Fischer's test. RESULTS. At hospital discharge a lower frequency of mental disorders emerged in the spontaneous abortion group (2.18 ptt) compared to the normal delivery (2.24) or the induced abortion group (4.05), with a large prevalence of women without any diagnosis of mental disorders. In the three groups, at pregnancy outcome, a higher occurrence of mental disorders was detected compared to the occurrence in pregnancy or psychiatric history. In women of 15-19 years a higher frequency of mental disorders was detected compared to ranges 20-24 and 10-14 as well as a higher probability of an outcome consisting in spontaneous or induced abortion. The SDO have provided more information on obstetric history than on mental disorders or family and psychosocial context as supplied by women. CONCLUSIONS. The results suggest the need for a transverse and multifactorial evaluation of the risks present in the different stages of pregnancy as well as the support provided to the adolescents in evolutionary tasks such as the procreative competence, which is deemed significant by the woman and her family.