History Taking · Intermediate · Psychiatry

Low Mood Following Loss

Practise this PLAB 2 history taking station on Depression (Post-Miscarriage). 8-minute voice AI simulation with feedback on all 3 marking domains.

Clinical scenario

You are an FY2 doctor in general practice. Phoebe Wood, a 31-year-old woman, has attended with low mood following a recent miscarriage. She is in a same-sex relationship with her partner Sarah. Please take a sensitive psychiatric history, assess risk, and discuss management.

Background notes: PMH: Nil significant

What this station tests

  • Distinguishing depression from normal grief: persistent unrelenting low mood for 3 months with functional impairment
  • IVF context: the miscarriage represents loss of the path to parenthood, not just a pregnancy
  • PHQ-9 framework for depression assessment: systematic screening of all core and associated symptoms
  • SSRI choice for women planning pregnancy: sertraline preferred if pharmacotherapy needed
  • Including the partner: Sarah is also grieving and couple counselling may help

How to use your 8 minutes

  • 0-1 min — Introduction: Introduce yourself, confirm identity, open question. 'What's brought you in today?'
  • 1-4 min — Systematic History: Presenting complaint detail (SOCRATES for pain, timeline, severity). Systems review. PMH, medications, allergies.
  • 4-6 min — Context and ICE: Social history (smoking, alcohol, occupation, living situation). Family history. Ideas, Concerns, Expectations.
  • 6-7 min — Summary and Plan: Summarise findings back to patient. Share differential/working diagnosis. Outline investigation and management plan.
  • 7-8 min — Closing: Safety netting with specific red flags. Arrange follow-up. Check for questions.

Consultation approach

The opening

Depression following miscarriage in a same-sex couple requires sensitivity to the pregnancy journey (which may have involved IVF, donor insemination, and significant emotional investment). Phoebe is 31, married to Sarah, with low mood after a miscarriage 3 months ago. Open with: 'Phoebe, I am sorry about your loss. Tell me how you have been feeling.'

Core approach

Assess depression using PHQ-9 framework. Duration: 3 months of persistent low mood (beyond normal grief trajectory). Core symptoms: low mood most of the day nearly every day, anhedonia (lost interest in things she previously enjoyed). Associated: poor sleep, reduced appetite, fatigue, poor concentration, guilt ('it was my body that failed'), hopelessness about trying again. Screen for suicidal ideation.

Context matters. The pregnancy was through IVF (emotional, physical, and financial investment). The miscarriage feels like losing more than a pregnancy: it feels like losing the path to parenthood. She may feel her body 'failed.' Sarah is also grieving but is being strong, creating an imbalance.

Distinguish depression from normal grief. Grief: waves of sadness with good days between. Depression: persistent, unrelenting low mood affecting function. After 3 months with worsening symptoms and functional impairment, this is depression requiring treatment.

Closing and safety netting

Treatment: per NICE stepped care. Moderate depression: offer talking therapy (CBT or counselling, specifically bereavement or perinatal loss counselling) AND consider SSRI if moderate-severe. She may prefer counselling first. If SSRI: discuss implications for future pregnancy attempts (some SSRIs are safer in pregnancy than others, sertraline is preferred).

Acknowledge the relationship dimension: 'How is Sarah coping? Would couple counselling be helpful?' Miscarriage Association for specialist support. Safety net: if mood worsens, suicidal thoughts develop, or she feels unable to cope, come back urgently or contact crisis services. Follow-up in 2 weeks.

How examiners mark this station

Examiners will focus on the thoroughness and structure of your history taking for depression. Domain 1 (Data Gathering) carries the most weight: expect marks for systematic coverage of presenting complaint, red flags, PMH, medications, social and family history. Domain 2 (Clinical Management) requires a clear differential, appropriate investigations, and a safe management plan with safety netting. Domain 3 (Interpersonal Skills) is assessed throughout: genuine exploration of ICE, active listening, empathic responses, and clear communication without jargon.

Domain 1 (Primary focus)

Scores well: PHQ-9 assessment. Grief versus depression distinguished. Suicidal ideation screened. IVF context understood. Partner's wellbeing asked.

Costs marks: Not assessing depression systematically. Dismissing as grief. Not screening suicidality.

Domain 2 (Primary focus)

Scores well: Stepped care applied. Talking therapy offered. SSRI discussed with pregnancy safety. Miscarriage Association. Couple counselling offered.

Costs marks: No treatment plan. Wrong SSRI choice. Not considering future pregnancy.

Domain 3 (Primary focus)

Scores well: Empathic about the loss. Acknowledging the IVF journey. Including Sarah. Not pathologising grief while treating depression.

Costs marks: Dismissive. Not acknowledging IVF context. Excluding Sarah. Being clinical about loss.

Common examiner feedback (and how to fix it)

Did not gather sufficient information to make an adequate assessment of the patient's condition

Fix: Use a consistent framework for every history. After covering the presenting complaint, systematically move through PMH, drug history, social history, family history, and ICE. Keep a mental checklist.

Did not identify the patient's problems and/or did not develop a management plan adequately

Fix: Reserve the final 2 minutes to summarise your findings, share your working diagnosis with the patient, and outline your investigation and management plan including safety netting.

Common mistakes in this station

  1. Dismissing as normal grief: 3 months of worsening mood with functional impairment is depression
  2. Not acknowledging the IVF journey: the emotional and financial investment makes the loss more complex
  3. Not including Sarah: she is grieving too and the relationship needs support

Resitting PLAB 2?

If you have previously struggled with history taking stations, focus on building a consistent systematic framework that you apply to every case. Practise structuring your history into clear phases (presenting complaint, systems review, PMH, social, ICE) so that even under pressure, you cover all domains. Many resitters lose marks not on knowledge but on organisation and time management.

Example opening

Good morning/afternoon, my name is Dr [Name], I'm one of the doctors here today. Could I confirm your name and date of birth please? Thank you. So, what's brought you in to see me today?

Frequently asked questions

How do I approach the consultation in this depression (Post-Miscarriage) station?

Depression following miscarriage in a same-sex couple requires sensitivity to the pregnancy journey (which may have involved IVF, donor insemination, and significant emotional investment). Phoebe is 31, married to Sarah, with low mood after a miscarriage 3 months ago.

What does a strong performance look like to the examiner in this station?

Strong performances show: PHQ-9 assessment. Grief versus depression distinguished. Suicidal ideation screened. IVF context understood. Partner's wellbeing asked. Weak performances: Not assessing depression systematically. Dismissing as grief. Not screening suicidality.

What is the biggest pitfall in this depression (Post-Miscarriage) station?

Dismissing as normal grief: 3 months of worsening mood with functional impairment is depression. Another frequent error: Not acknowledging the IVF journey: the emotional and financial investment makes the loss more complex.

How should I prepare for depression (Post-Miscarriage) if I have never seen it in practice?

This station rewards process over personal experience. The skill being assessed: IVF context: the miscarriage represents loss of the path to parenthood, not just a pregnancy. Use the domain breakdown on this page to target your preparation, then practise the station aloud so your structure survives exam pressure.

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