Mind the gap: a systematic review of depression, barriers, and facilitators to mental health care after miscarriage.

PURPOSE: This systematic review synthesizes evidence on depressive symptoms and access to mental health care following miscarriage. It examines differences between women in general care settings and those with recurrent pregnancy loss to explore differential psychological vulnerability and care gaps.

METHODS

A search of four databases (inception-June 2025) followed PRISMA guidelines. Studies reporting depressive symptoms or barriers and facilitators to care were included. Given methodological heterogeneity, findings were synthesized narratively using a SWiM framework, stratifying populations by miscarriage history and assessing quality with risk-of-bias tools.

RESULTS

Of 1,140 records, 46 were included. Depressive symptoms were common, though prevalence varied by timing, tools, and characteristics. Evidence suggests a possible graded association between recurrent loss and symptoms, although this was inconsistent and often attenuated in acute assessments. Key correlates included childlessness, prior psychiatric history, repeated loss, and low social support. Barriers included insensitive communication, lack of follow-up, and financial constraints. Facilitators included empathetic interactions, clear information, and supportive networks.

CONCLUSIONS

Miscarriage is frequently associated with significant distress, yet evidence certainty varies regarding recurrence and intervention effectiveness. Findings highlight a persistent gap between women's mental health needs and healthcare responses.