(248) Mind the Gap a Systematic Review of Depression, Barriers, and Facilitators to Mental Health Care After Miscarriage

Introduction Miscarriage, a common pregnancy complication, carries a significant psychological burden that is frequently overlooked in clinical practice. Nearly one in five women develop a depressive disorder following miscarriage, with studies showing a 1.53-fold increase in risk for mood and anxiety disorders in the year after the event. Despite this, emotional support is often absent, especially in low- and middle-income settings where less than 10% of facilities offer comprehensive post-abortion care. Miscarriage-related grief is commonly disenfranchised and stigmatized, exacerbating mental health outcomes. While prior research has established statistical risk, a gap remains in synthesizing clinical, systemic, and intervention-focused data, particularly comparing single versus recurrent losses. Objective The review aimed to synthesize evidence on the prevalence and correlates of depression and the barriers and facilitators to accessing mental health care after miscarriage. It also sought to explore how these outcomes differ between women with single versus recurrent pregnancy loss, in order to identify distinct psychological impacts and unmet care needs. Methods A systematic search was conducted in PubMed, Embase, Scopus, and the Cochrane Library (from inception to June 2025), following PRISMA guidelines and registered in PROSPERO. Eligible studies assessed depressive symptoms or barriers/facilitators to care after miscarriage. Data were categorized into single/mixed versus recurrent loss and synthesized thematically. Methodological quality was assessed using JBI, NOS, and CASP tools. Results Out of 1,140 records, 46 studies were included. Depression was prevalent post-miscarriage, with a clear dose-response pattern: risk increased with each additional loss. Other key risk factors included absence of living children, previous psychiatric illness, and low social support. Reported prevalence varied widely depending on timing and methodology, with self-report tools yielding higher rates than clinical interviews. While acute distress was common in the weeks after miscarriage, a substantial subset experienced persistent symptoms months or even years later. A pronounced “care gap” was found: although up to 48.8% of women exhibited significant depressive symptoms, only 16–33% received psychological support. Barriers included insensitive provider communication, stigma, financial limitations, and lack of follow-up. Facilitators included strong social support, empathetic healthcare interactions, and clear information about prognosis. Evidence for formal interventions was limited but promising. Structured therapies such as CBT and psychoeducation showed preliminary effectiveness in reducing depression scores, though accessibility was a major barrier. Less structured interventions like debriefing were perceived as helpful but did not significantly improve clinical outcomes. Conclusions Miscarriage is associated with a high and cumulative risk of depression, particularly among women with recurrent losses or psychosocial vulnerabilities. Despite this, healthcare systems often fail to address psychological needs, focusing narrowly on physical care. A universal stepped-care model is urgently needed, incorporating initial psychoeducation, formal distress screening, and access to structured therapy for those affected. Clinically effective support must be both empathetic and evidence-based. Policy-level integration of mental health services into standard obstetric care is essential. Future research should focus on rigorous trials and longitudinal studies to inform scalable interventions and tailored support for at-risk populations. Disclosure No