Sait ERBEY, Mehmet Alican SAPMAZ, Murat POLAT, Talat SARIKAVAK, Çağanay SOYSAL
Anatolian Journal of Obstetrics and Gynecology Research - 2026;3(2):139-148
Purpose: This study examined associations of treatment modality, perceived social support, and childbearing motivation with depression, anxiety, and stress in women in their first pregnancy after ectopic pregnancy loss. Methods: Women in their first pregnancy with ectopic pregnancy were included. Psychological assessments were administered mostly on post-treatment days 2-3 (all within 1 week) using the [depression anxiety stress scale-21 (DASS-21); standard 0-42 metric], multidimensional scale of perceived social support, childbearing motivation scale, and pregnancy psychosocial health assessment scale. Group comparisons, Pearson correlations, and hierarchical multivariable regression analyses were conducted. Results: A total of 146 women were included (methotrexate, n=83; salpingectomy, n=63). Surgical management was associated with higher depression (20.63+/-6.17 vs. 6.82+/-4.90, p<0.001, d=2.52), anxiety (d=1.88), and stress scores (d=1.94), and lower perceived social support (d=2.14). According to standard DASS-21 cut-offs, 54.0% of surgically managed women fell into the severe or extremely severe depression category, compared with 2.4% in the medical group. Social support was negatively correlated with distress in bivariate analyses (r between -0.49 and -0.53, all p<0.001). In the hierarchical model for depression, surgical treatment (beta=0.75), anxiety (beta=0.18), and, after adjustment, social support (beta=0.17) were positively associated with depressive symptoms, whereas childbearing motivation was negatively associated (beta=-0.10). The final model explained 64.5% of the variance (adjusted R2=0.645). Conclusion: Ectopic pregnancy loss was associated with substantial psychological burden, particularly after surgical management. However, because treatment was clinically indicated rather than randomized, these associations should not be interpreted as causal. Surgically managed women also had markedly greater clinical severity (higher beta human chorionic gonadotropin and frequent tubal rupture) so these associations are best regarded as exploratory and hypothesis-generating rather than as evidence of a causal effect of surgical treatment itself. Findings support integrating psychosocial assessment into routine care after ectopic pregnancy loss, especially when it is a first pregnancy.
