Objective To identify the trajectories of anxiety and depression in women and in their partners over 13 months after miscarriage.Design A prospective study with follow up at 6 and 13 months after miscarriage.Setting Three Scottish Early Pregnancy Assessment Units.Sample Of the 1443 eligible individuals approached, 686 (48.3%) consented to participate (432 women; 254 men). Complete data were obtained from 273 women and 133 men at baseline, 6, and 13 months.Methods On completion of the management of the index miscarriage, eligible and consenting women and men underwent an initial assessment comprising a semi-structured interview and a standardised self-report questionnaire. The latter was readministered at the follow-up assessments.Main outcome measures The hospital anxiety and depression scale (HADS), a reliable and valid measure of general psychopathology for use in nonpsychiatric samples.Results Compared with depression, anxiety was overall the greater clinical burden. Over the 13-month period, women reported higher levels of anxiety and depression than men. Over time, a significantly greater level of adjustment was reported by women particularly with regards to the resolution of anxiety symptoms. The effect of time on HADS scores in either gender was similar between subgroups of socio-demographic and clinical factors.Conclusions These findings verify that early pregnancy loss represents a significant emotional burden for women, and to some extent for men, especially with regards to anxiety. For many, the detrimental effects of miscarriage are enduring and display a complex course of resolution. These findings are discussed in terms of their clinical implications for early identification and management.

Clinicians should routinely explain ACP to older people and ensure they fully understand it prior to an ACP discussion. If there is any concern about their understanding, further exploration and documentation of their capacity using the capacity assessment framework would be necessary. However, capacity assessment is a complex iterative process that does not easily lend itself to screening methodology and requires a high level of clinical judgment.

BackgroundPeople with dementia receive worse end of life care compared to those with cancer. The main barrier to undertaking advanced care planning (ACP) in people with dementia has been uncertainty about their capacity to engage in such discussions. Although a capacity screening tool specific to advance care planning could improve its uptake within this population, none as yet exist.AimThe primary aim of this study was to compare the ACP-CAV tool (Advance Care Planning – Capacity Assessment Vignette) to the assessment of capacity to engage in ACP using a semi-structured interview adapted from the MacArthur Competence Assessment Tool-Treatment (MacCAT-T). The secondary aim was to identify other variables that may predict whether a person has capacity to engage in ACP.Methods37 Participants (mean age = 83.9; mean MMSE = 26.5) were recruited from two large retirement villages with different levels of care. Participants completed the Mini Mental State Examination (MMSE), Trail Making Tests and Geriatric Depression Scale before undertaking the capacity assessments which were video recorded to enable further analysis by 4 independent old age psychiatrists.ResultsThe ACP-CAV correctly assessed the capacity of 65% of the cases when compared to the MacCAT-T method. MMSE was the only variable found to predict capacity.ConclusionCapacity assessment should be routinely conducted prior to discussing ACP with older people, in particularly those with cognitive impairment. However, it is a complex iterative process that does not easily lend itself to screening methodology and requires a high level of clinical judgement.