Reproducing is an ability that human beings are born with. Since the beginning of the process of reproduction, most of the human beings would celebrate with joy and would even been on cloud nine (Li et al, 2020). However, not every human being would be that fortunate enough to give birth successfully to the next generation, especially some women would encounter miscarriage, which is indeed a really painful experience to undergo with. Plus, miscarriage is indeed something not extraordinary, but quite common among pregnant women (Jones, 2015). This painful experience would indeed lead these miscarriage women to depressive symptoms and to the feeling of grief and bereavement, while these presenting symptoms would sustain for at least 6 months (deMontigny, Verdon, Meunier & Dubeau, 2017), and result in Major Depressive Disorder (Johnson et al, 2016).
In order to fully understand the association between miscarriage and major depressive disorder, the bio-psycho-social approach can be applied, as this model is used to assist in the conceptualization of the presenting problem, and to have a better understanding towards the complexities and development of human beings and problems (Renn & Feliciano, 2017). By which in the bio-psycho-social approach, it can be divided into 3 parts respectively: the biological factor; the psychological factor and the social factor.
The application of the bio-psycho-social approach to miscarriage
The biological factor
The biological factor stands for the “bio” in the bio-psycho-social approach. By which, it refers to physiological impacts that affect the psychological and physical health (Renn & Feliciano, 2017). In the situation of miscarriage, miscarriage women may have a higher opportunity resulting in major depressive disorder with two reasons which are belonged to the biological factor that influence the occurrence of the major depressive disorder: higher risk of women having depressive disorders and the hormonal change in women during their pregnancy.
Higher risk of women having depressive disorders
According to the journal article, Society and ‘good woman’: A critical review of gender difference in depression (Maji, 2018), it stated that women have higher risk in having depressive disorders, which is twice likely to have depressive disorders than men. This is due to the biological structure of women, and therefore there is no such explanation of why women suffer from depressive disorders more significantly than men.
The hormonal change in women during their pregnancy
According to the same journal article mentioned above (Maji, 2018), it stated that during pregnancy, estrogen and progesterone, which are hormones of women, would record a sudden and dramatic increase. Which helps in nurturing the fetus and for the betterment of the growth of the fetus while transforming the body to a suitable shape in order to gear up for the labour. In which this would cause the pregnant women becoming more emotional while encounter more mood swings. This would cause miscarriage women to become vulnerable and emotional before encountering the saddening incident, being miscarriage.
By which, these two reasons would be subjected to the cause of the biological factor, as these two reasons have brought physiological impacts and have affect both psychological and physical health.
The psychological factor
The psychological factor stands for the “psycho” in the bio-psycho-social approach. By which, it refers to the mental and behavioural processes lead to different symptoms and bring negative influence to health (Renn & Feliciano, 2017). In the situation of miscarriage, miscarriage women may have a higher opportunity resulting in major depressive disorder as miscarriage women often present neuroticism after encounter the grief of miscarriage, and would eventually develop into certain negative symptoms, especially depressive episodes (Maji, 2018), and these would lead to neuroticism or fluctuation in emotions (Li et al, 2020), and eventually developed into major depressive disorder (Allington & Pepper, 2017).
Neuroticism occurred after miscarriage
After miscarriage, miscarriage women would present symptoms of feeling guilt and empty, feeling the loss and grief for their baby as well as their role as a mother, feeling abandoned and unsupported by people in their lives, and feeling out of control, these symptoms and feelings that miscarriage women started to develop would eventually elicit the negative belief of perceiving themselves as failure and as well as the situation, in which would started to develop depressive episodes (Maji, 2018). By which would directly affect their psychological well-being (Mcgee, PettyJohn, & Gallus, 2018). These negative feelings and thoughts would indeed be vulnerable leading to mood instability and indeed showing frequent shifts and fluctuation between emotions, and eventually present as neuroticism, low self-esteem and life stress (Li et al, 2020).
According to the sage encyclopedia of abnormal and clinical psychology, it stated that neuroticism is associated with other psychological factors, and a person who has neuroticism would pay extra attention on negative information, in memorizing negative and traumatic events, and worry about possible negative outcomes and would result in becoming having the strongest association with the development of psychopathology, and leading oneself and becoming more vulnerable in the result of having depressive disorders, especially major depressive disorders (Allington & Pepper, 2017).
The social factor
The social factor stands for the “social” in the bio-psycho-social approach. By which, it refers to the psychological and physiological functioning occurs in interpersonal relationships, social values, cultural norms, and community institutions, as human beings are social beings and the connection is close-knitted with the context (Renn & Feliciano, 2017). In the situation of miscarriage, the lack of social support and the insufficient support from family and friends are vital in contributing the social factor.
The lack of social support
Nowadays, Miscarriage is still seen as a cultural taboo to discuss or to encounter (Martel, 2014). The society and even the medical world would keep silent when encounter women suffer from miscarriage, showing denial towards this topic. These miscarriage women even find professionals such as medical professionals, coworkers, and the society in general would neglect and invalidate their grief received from miscarriage, and in return in perpetuating silence, and giving the miscarriage women to have an impression of being isolated and abandoned (Randolph, Hruby & Sharif, 2015). Plus, these miscarriage women would even need to face a socially sanctioned expectation, which has expected them to just overcome such grief and loss of their baby (Martel, 2014), while having a hard time facing the lack of empathy received from the society and medical professionals (Geller, Psaros & Kornfield, 2010).
The insufficient support from family and friends
Other than the lack of social support, the family and friends of miscarriage women had also present insufficient as well. As mentioned above, miscarriage is seen as a cultural taboo and the society would avoid discuss it transparently, plus ambiguous loss from miscarriage and death was with the lack of publicity and transparency, as well as discussion on such topic. By which, friends and the grieving family members around miscarriage women would tend to behave apathetically towards the discussion and would avoid the grief within (Randolph, Hruby & Sharif, 2015).
On the other hand, the male partner of miscarriage women would also at the same time feel the same amount of pain, guilt, anger, shame and isolation that miscarriage women are facing (Fredenburg, 2017). However, the society usually only focused on the effects on miscarriage women, ignored the effects on their male partners, in which the depressive symptoms are also as prevalent as those on miscarriage women (Williams, et al, 2020). By which, the grief on their male partners would negatively affect them to perform well and act as a support for their partners. Plus, the fact is there are only few resources that are available for them to tackle the problem (Fredenburg, 2017).
By which, leading the result of miscarriage women not getting the social support and the support family and friends that she should have, and making them to the exacerbation of the grief received from miscarriage, suffering from depressive symptoms and several negative emotions, and result in Major depressive disorder (Johnson et al, 2016).
To sum up, the grief received from miscarriage is massive, and it is indeed a combination of grief and depressive reaction (Toffol, Kopone & Partonen, 2013), while the bio-psycho-social approach showed that how biological factor, psychological factor and social factor influence the development of the Major depressive disorder, and the correlation within, such as Neuroticism in psychological factor is result due to the poor coping from the social environment and had indeed elicit the psychological and physiological stressors and make it more vulnerable (Goetter et al, 2019).
It is a vital issue for the society to stay alert on how to gradually show more acceptance and less avoidance on miscarriage and death, and showing more social support towards miscarriage women, letting them and giving them the space and time to heal from the grief, in order to help in the betterment of the mental health and decreasing the rate of miscarriage women to result in major depressive disorder, as such grief received from miscarriage is indeed so complex and massive (Jones, 2015). And with the lack of social support and time and space for these miscarriage women to heal their grief, would indeed result in incomplete grief, and leading to have potential result in psychiatric disorders and major depressive disorder (Boelen & Smid, 2017; Johnson et al, 2016).
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