Probable post-traumatic stress disorder after miscarriage: psychological, social, and healthcare-related factors in a mixed-methods study

Abstract Background: Miscarriage is commonly managed as a short-term obstetric condition, yet its psychological consequences may extend beyond physical recovery. This study aimed to estimate the prevalence of probable post-traumatic stress disorder (PTSD) after miscarriage and to examine psychological, social, and healthcare-related factors shaping PTSD symptom severity and recovery experiences. Methods: A theory-informed sequential mixed-methods study was conducted at the Post Abortion Care clinic of a tertiary Grade-A women’s and children’s hospital in Sichuan Province, China. In the quantitative phase, 293 women who had experienced miscarriage before 20 completed weeks of gestation completed a digital survey assessing PTSD symptoms, psychological resilience, perceived social support, rumination, coping style, distress disclosure, self-efficacy, anxiety, depression, and post-traumatic growth. Probable PTSD was defined as a Post-traumatic Stress Disorder Checklist–Civilian Version score of 38 or higher. Between-group comparisons, Spearman correlations, and hierarchical multivariable linear regression models were used. In the qualitative phase, nine women participated in semi-structured interviews, which were analyzed thematically and integrated with quantitative findings. Results: The mean PCL-C score was 33.5 ± 12.1, and 95 women (32.4%) screened positive for probable PTSD. Women with probable PTSD had lower psychological resilience than those without probable PTSD (55.4 ± 12.7 vs. 66.4 ± 16.4) and lower perceived social support (59.3 ± 14.0 vs. 66.3 ± 13.8). Higher resilience and perceived social support were associated with lower PTSD symptom severity, while intrusive rumination showed the strongest positive association. Hierarchical regression showed that sociodemographic and reproductive variables alone explained little variance in PTSD symptom severity (adjusted R² = 0.007), whereas adding healthcare-related, psychosocial, and psychological process variables increased explanatory power (adjusted R² = 0.161 and 0.538). Qualitative interviews identified four themes: self-regulation after miscarriage, partner and family support, social safety and stigma, and healthcare communication and care-process burden. These findings contextualized the quantitative associations and highlighted modifiable family, social, and health-service factors. Conclusions: Probable PTSD was common after miscarriage and was shaped by more than individual psychological vulnerability. Post-miscarriage care should move beyond procedure-centered management toward trauma-informed, partner- and family-sensitive, and patient-centered support that includes psychological screening, clear communication, stigma reduction, and attention to care-process burden.