It is still unclear whether social support can moderate the high risk of depression and anxiety due to spontaneous miscarriage. This study prospectively investigated the associations of spontaneous miscarriage with risks of depression and anxiety, and evaluated the interactions between spontaneous miscarriage and the degree of social support in relation to depression and anxiety risks. A total of 179,000 participants from the UK Biobank with pregnancy experience and without depression or anxiety at baseline were included. Spontaneous miscarriage was defined by self-report from participants at enrollment or by International Classification of Diseases codes. The degree of social support was defined as the number of social support factors including living with a spouse or partner, participation in social activities, and confiding. Cox proportional hazards models were used to evaluate the joint association of spontaneous miscarriage and social support with the risks of depression and anxiety. During a median follow-up of 12.3 years, 4939 depression incidents and 5742 anxiety incidents were documented. For participants with 1, 2, and 3 spontaneous miscarriages, hazard ratios (95% confidence intervals) for depression were 1.10 (1.02–1.19), 1.31 (1.14–1.50), and 1.40 (1.18–1.67), respectively ( trend <.001), compared with participants without a history of spontaneous miscarriage, after adjustment for covariates. For anxiety, the hazard ratios (95% confidence intervals) were 1.07 (1.00–1.15), 1.04 (0.90–1.19), and 1.21 (1.02–1.44), respectively ( trend=.01). Moreover, we found that the risk of depression associated with a combination of spontaneous miscarriage and low degree of social support in later life was greater than the sum of the risks associated with each individual factor, indicating significant interactions on an additive scale ( interaction=.03). Spontaneous miscarriage is associated with higher risks of depression and anxiety, and the risk of depression is further increased when there is also low degree of social support.

中文翻译：

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自然流产和社会支持在预测抑郁和焦虑风险中的作用：英国生物银行的一项队列研究

目前尚不清楚社会支持是否可以降低自然流产导致的抑郁和焦虑的高风险。本研究前瞻性地调查了自然流产与抑郁和焦虑风险的关联，并评估了自然流产与抑郁和焦虑风险相关的社会支持程度之间的相互作用。英国生物银行总共纳入了 179,000 名有怀孕经历且基线时没有抑郁或焦虑的参与者。自然流产是根据参与者在登记时的自我报告或国际疾病分类代码来定义的。社会支持程度定义为社会支持因素的数量，包括与配偶或伴侣同居、参与社会活动和倾诉。 Cox比例风险模型用于评估自然流产和社会支持与抑郁和焦虑风险的联合关联。在中位随访 12.3 年期间，记录了 4939 起抑郁事件和 5742 起焦虑事件。对于 1、2 和 3 次自然流产的参与者，抑郁症的风险比（95% 置信区间）分别为 1.10 (1.02–1.19)、1.31 (1.14–1.50) 和 1.40 (1.18–1.67)（趋势 <. 001），在调整协变量后与没有自然流产史的参与者进行比较。对于焦虑，风险比（95% 置信区间）分别为 1.07 (1.00–1.15)、1.04 (0.90–1.19) 和 1.21 (1.02–1.44)（趋势=.01）。此外，我们发现，与自然流产和晚年社会支持程度低相关的抑郁风险大于与每个单独因素相关的风险总和，表明在加性尺度上存在显着的相互作用（相互作用=. 03）。自然流产与抑郁和焦虑的较高风险相关，当社会支持程度较低时，抑郁的风险会进一步增加。