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Banerjee J, Kaur C, Ramaiah S, Roy R, Aladangady N. Factors influencing the uptake of neonatal bereavement support services - Findings from two tertiary neonatal centres in the UK. BMC Palliat Care 2016; 15:54. [PMID: 27357123 PMCID: PMC4928251 DOI: 10.1186/s12904-016-0126-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 06/20/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research on perinatal bereavement services is limited. The aim of the study was to compare the uptake of bereavement support services between two tertiary neonatal units (NNU), and to investigate influencing factors. METHOD The medical and bereavement records of all neonatal deaths were studied from January 2006 to December 2011. Data collected included parent and baby characteristics, mode of death, consent for autopsy and bereavement follow-up. The categorical data were compared by chi-square or Fisher's exact test and continuous data by Wilcoxon signed-rank test; a multivariable regression analysis was performed using STATA 12.0. RESULTS The neonatal deaths of 297 babies (182 in NNU1 and 115 in NNU2) with full datasets were analysed. Baby characteristics were similar between units except for lower median gestational age in NNU1 (p = 0.03). Significantly more NNU1 parents were non-Caucasian (p < 0.01), from lower socio-economic status (p = 0.01) and had previous stillbirth/miscarriage (p = 0.03). More babies had care withdrawn in NNU2 (p < 0.01). A significantly higher proportion of parents from NNU1 (61 %) attended bereavement follow-up compared to NNU2 (34 %; p < 0.01). On multivariable analysis, significantly more parents who were married or co-habiting (p = 0.02) and consented for an autopsy (p = 0.01) attended bereavement services. CONCLUSION Uptake of bereavement services varied between the two NNUs, which could be due to differences in the ethnic and socio-economic mix of the population. Significantly more parents who were married or co-habiting, or consented for autopsy, attended bereavement follow up services.
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Affiliation(s)
- Jayanta Banerjee
- Neonatal Unit, Homerton University Hospital NHS Foundation Trust, Homerton Row, London, E9 6SR, United Kingdom.,Centre for Paediatrics, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Neonatal Unit, Imperial College Healthcare NHS Trust, London, UK
| | - Charanjit Kaur
- Neonatal Unit, Homerton University Hospital NHS Foundation Trust, Homerton Row, London, E9 6SR, United Kingdom
| | - Sridhar Ramaiah
- Neonatal Unit, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Rahul Roy
- Neonatal Unit, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Narendra Aladangady
- Neonatal Unit, Homerton University Hospital NHS Foundation Trust, Homerton Row, London, E9 6SR, United Kingdom. .,Centre for Paediatrics, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK. .,Department of Paediatrics, SDM Medical College and Hospitals, Dharwad, India.
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Gravensteen IK, Helgadóttir LB, Jacobsen EM, Rådestad I, Sandset PM, Ekeberg Ø. Women's experiences in relation to stillbirth and risk factors for long-term post-traumatic stress symptoms: a retrospective study. BMJ Open 2013; 3:e003323. [PMID: 24154514 PMCID: PMC3808779 DOI: 10.1136/bmjopen-2013-003323] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES (1) To investigate the experiences of women with a previous stillbirth and their appraisal of the care they received at the hospital. (2) To assess the long-term level of post-traumatic stress symptoms (PTSS) in this group and identify risk factors for this outcome. DESIGN A retrospective study. SETTING Two university hospitals. PARTICIPANTS The study population comprised 379 women with a verified diagnosis of stillbirth (≥23 gestational weeks or birth weight ≥500 g) in a singleton or twin pregnancy 5-18 years previously. 101 women completed a comprehensive questionnaire in two parts. PRIMARY AND SECONDARY OUTCOME MEASURES The women's experiences and appraisal of the care provided by healthcare professionals before, during and after stillbirth. PTSS at follow-up was assessed using the Impact of Event Scale (IES). RESULTS The great majority saw (98%) and held (82%) their baby. Most women felt that healthcare professionals were supportive during the delivery (85.6%) and showed respect towards their baby (94.9%). The majority (91.1%) had received some form of short-term follow-up. One-third showed clinically significant long-term PTSS (IES ≥ 20). Independent risk factors were younger age (OR 6.60, 95% CI 1.99 to 21.83), induced abortion prior to stillbirth (OR 5.78, 95% CI 1.56 to 21.38) and higher parity (OR 3.46, 95% CI 1.19 to 10.07) at the time of stillbirth. Having held the baby (OR 0.17, 95% CI 0.05 to 0.56) was associated with less PTSS. CONCLUSIONS The great majority saw and held their baby and were satisfied with the support from healthcare professionals. One in three women presented with a clinically significant level of PTSS 5-18 years after stillbirth. Having held the baby was protective, whereas prior induced abortion was a risk factor for a high level of PTSS. TRIAL REGISTRATION The study was registered at http://www.clinicaltrials.gov, with registration number NCT 00856076.
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Affiliation(s)
- Ida Kathrine Gravensteen
- Department of Haematology, Oslo University Hospital, Oslo, Norway
- Department of Behavioural Sciences in Medicine, University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Linda Björk Helgadóttir
- Department of Haematology, Oslo University Hospital, Oslo, Norway
- Department of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Eva-Marie Jacobsen
- Department of Haematology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Per Morten Sandset
- Department of Haematology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Øivind Ekeberg
- Department of Behavioural Sciences in Medicine, University of Oslo, Oslo, Norway
- Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
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Abstract
To date, investigators have not demonstrated a clear relationship between a parent's history of prior perinatal losses and intensity of grief response following a subsequent perinatal loss. Examining this relationship for low-income, African-American parents is important because they are a vulnerable population due to the high incidence of perinatal mortality in Blacks and their other life stressors that can impact on grief response and caring needs. The purpose of this case study was to examine the impact of recurrent perinatal loss on a low-income African-American parent. The research design for this study was case report, using interview data collected from a mother who had recently experienced her fourth perinatal loss, which occurred at twenty-five weeks of gestation. Transcripts from two open-ended interviews were analyzed. The theoretical framework used to guide analysis of this case study was Lazarus and Folkman's stress and coping theory. Results demonstrated that the prior perinatal losses did not appear as critical components of the way the mother responded to her most recent loss. Instead, perception of the care she received from healthcare providers and how that care related to her experiences with her one living child who was born at the same gestational age was an important determinant in how she responded to her loss. The results of this case study demonstrate the importance assessing a person's perception of their experience and those factors which contribute to the way they respond.
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Elklit A, Björk Gudmundsdottir D. Assessment of guidelines for good psychosocial practice for parents who have lost an infant through perinatal or postnatal death. NORDIC PSYCHOLOGY 2012. [DOI: 10.1027/1901-2276.58.4.315] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Cunningham KA. Holding a stillborn baby: does the existing evidence help us provide guidance? Med J Aust 2012; 196:558-60. [DOI: 10.5694/mja11.11417] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Jind L, Elklit A, Christiansen D. Cognitive schemata and processing among parents bereaved by infant death. J Clin Psychol Med Settings 2011; 17:366-77. [PMID: 21110073 DOI: 10.1007/s10880-010-9216-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The present prospective study examined cognitive schemata and processing among 93 parents bereaved by infant death. The Trauma Constellation Identification Scale (TCIS) was used to assess maladaptive cognitive schemata associated with the loss. The impact of pre-, peri-, and post-trauma factors on the TCIS scores was assessed. Compared to parents who had not lost an infant, bereaved parents displayed significantly higher TCIS scores. High TCIS scores were significantly associated with PTSD as well as general symptomatology. Although interesting gender differences were found, the variables most strongly related to TCIS scores were posttraumatic emotional coping and cognitive processing.
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Affiliation(s)
- Lise Jind
- Department of Psychiatry, Aarhus University Hospital, Aarhus, Denmark
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Gaudet C, Séjourné N, Camborieux L, Rogers R, Chabrol H. Pregnancy after perinatal loss: association of grief, anxiety and attachment. J Reprod Infant Psychol 2010. [DOI: 10.1080/02646830903487342] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Sham AKH, Yiu MGC, Ho WYB. Psychiatric morbidity following miscarriage in Hong Kong. Gen Hosp Psychiatry 2010; 32:284-93. [PMID: 20430232 DOI: 10.1016/j.genhosppsych.2009.12.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2008] [Revised: 12/02/2009] [Accepted: 12/02/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of this study is to examine the pattern of psychiatric morbidity up to 3 months following miscarriage and to identify the risk factors of post-miscarriage depressive disorder among Chinese women in Hong Kong. METHOD This is a longitudinal cohort study. Women were interviewed immediately after miscarriage to collect psychiatric and sociodemographic data. Three months later, 161 subjects (89%) were assessed by a 12-item General Health Questionnaire (GHQ-12) and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID) as screening and diagnostic instruments, respectively. RESULTS Three months after miscarriage, 10% of subjects suffered depressive disorder, 1.2% were diagnosed with anxiety disorder not otherwise specified, and another two subjects each suffered obsessive compulsive disorder (0.6%) and posttraumatic stress disorder (0.6%), respectively. Risk factors of post-miscarriage depression included younger age, history of infertility and past history of depression. CONCLUSIONS Given the local annual figure of more than 7000 first-trimester miscarriages, about 900 local women suffer post-miscarriage psychiatric disorder each year. This finding may prompt general hospitals in Hong Kong to screen for post-miscarriage psychiatric disorders, particularly depression.
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Forhan M. Doing, Being, and Becoming: A Family’s Journey Through Perinatal Loss. Am J Occup Ther 2010; 64:142-51. [DOI: 10.5014/ajot.64.1.142] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Occupational therapists are encouraged to reflect on doing, being, and becoming not only as it relates to the development of their profession but also in their own lives (Wilcock 1999). This article is a description of that process for me and my family in our journey through perinatal loss. This autoethnography uses a personally situated account of perinatal death. This article is a form of self-narrative that places me and my family in social context through the lens of an occupational therapist. This article aims to convey the meanings attached to the experience of grief and loss in the context of participation in everyday occupations. By sharing a perspective on the lived experience and connecting it to the literature on grief and occupation, readers will be able to decide if the connection holds as valid from a theoretical and clinical perspective.
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Affiliation(s)
- Mary Forhan
- Mary Forhan, MHSc, OT Reg (Ont), is PhD candidate, McMaster University School of Rehabilitation Science, Faculty of Health Sciences, 1400 Main Street West-IAHS 402, Hamilton, ON L8S 1C7 Canada;
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Raingruber B, Milstein J. Searching for circles of meaning and using spiritual experiences to help parents of infants with life-threatening illness cope. J Holist Nurs 2007; 25:39-49; discussion 50-1. [PMID: 17325313 DOI: 10.1177/0898010106289859] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
One of the major challenges parents can face is learning that their child has a life-threatening illness. A phenomenological study was completed to identify which interactions with health care providers were and were not helpful. Parents discussed what it was like to have an infant with a life-threatening illness and what helped them to cope. Parents indicated that they benefited from identifying "circles of meaning," or ways in which their infant touched another life. Parents appreciated hearing from health care providers that they felt close to their infant. This sense of connection allowed parents to reconstruct a semblance of meaning in the midst of a life-altering event. Parents were also influenced by intuitive and spiritual experiences associated with their infant's illness. Parents should be encouraged to reflect on spiritual moments and to identify how their critically ill infant influenced the lives of other family members, friends, and health care professionals.
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Affiliation(s)
- Bonnie Raingruber
- California State University, Sacramento and University of California, Davis Medical Center, CA, USA
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Abstract
Emerging evidence has suggested that miscarriage could be associated with significant and possibly enduring psychological consequences. As many as 50% of miscarrying women suffer some form of psychological morbidity in the weeks and months after loss. About 40% of miscarrying women were found to be suffering from symptoms of grief shortly after miscarriage, and pathological grief can follow. Elevated anxiety and depressive symptoms are common, and major depressive disorder has been reported in 10-50% after miscarriage. Psychological symptoms could persist for 6 months to 1 year after miscarriage. The underlying risk factors predisposing a miscarrying woman to psychological morbidity include a history of psychiatric illness, childlessness, lack of social support or poor marital adjustment, prior pregnancy loss, and ambivalence toward the fetus. In addition, care-givers should be aware of the possible moderating effect of clinical practices such as surgical treatment and ultrasound findings on the psychological impact on a miscarrying woman. Unlike in postpartum depression, simple and effective screening measures of psychological morbidity in the context of miscarriage have not been well established. While studies have highlighted that psychological follow-up was highly desired by miscarrying women, and that psychological intervention was potentially beneficial, there is a substantial lack of randomized controlled intervention studies in this area.
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Affiliation(s)
- Ingrid H Lok
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
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12
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Abstract
After perinatal loss, parents experience painful grief. Fathers and mothers show the same pattern of symptoms, but generally mothers' distress is more intense. Grief should be sympathetically acknowledged by health professionals, and parents should be reassured that their feelings are normal and that recovery may take many months. Intense depression lasting more than 6 months may require psychological treatment. There is some evidence that delaying conception for a year may allow an easier pregnancy psychologically. The common practice of encouraging parents to have contact with a dead infant is not evidence-based and may have adverse effects, including inducing symptoms of post-traumatic stress disorder. A protocol of postnatal follow-up allows parents to get appropriate information about the loss, including possible problems and timing of another pregnancy. The subsequent pregnancy is stressful, and health professionals should recognize that parents may suffer significant anxiety.
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Affiliation(s)
- William Badenhorst
- Division of Mental Health Sciences, Jenner Wing, St George's University of London, Cranmer Terrace, London SW17 0RE, UK
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13
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Pantke R, Slade P. Remembered parenting style and psychological well-being in young adults whose parents had experienced early child loss. Psychol Psychother 2006; 79:69-81. [PMID: 16611422 DOI: 10.1348/147608305x52667] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Pre-, peri-, or postnatal childloss can have devastating consequences for bereaved families. This study explored the long-term sequelae of these experiences for the young adult siblings' psychological well-being and the perceived quality of parenting received during participants' first 16 years of life. METHODS A bereaved group of young adult siblings was compared to a non-bereaved group on the Parent Bonding Instrument, the Rosenberg Self-esteem Scale and the Mental Health Index-5. RESULTS The loss group reported their mothers, but not their fathers, to have been more protective/controlling than non-bereaved participants. No differences between the loss group and the comparison group were found for parental care, their own mental health or self-esteem. Those participants whose siblings died during the peri/post-natal period perceived their parents as more controlling than the miscarriage group as well as the non-bereaved group. Higher protection scores were evident among those born subsequent to the loss than those who were born before. Lower levels of protection were associated with better mental health across all groups. In the non-bereaved group lower levels of protection were associated with better self-esteem, but in the bereaved group a different even opposite pattern was shown. CONCLUSIONS Young adults who lost a sibling when they themselves were under 5 recall their mothers as more protective/controlling than non-bereaved groups, although they do not report less care nor differ in mental health nor self-esteem. Higher levels of parental protection/control were found where the child was born subsequent to loss and for peri/post-natal loss rather than miscarriage. While high protection was associated with poorer mental health regardless of loss this may not be necessarily disadvantageous to the child's self-esteem. Differences with regard to parent gender were found.
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Affiliation(s)
- Renate Pantke
- Sheffield Care Trust, UK, University of Sheffield, UK.
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Kavanaugh K, Trier D, Korzec M. Social support following perinatal loss. JOURNAL OF FAMILY NURSING 2004; 10:70-92. [PMID: 17426820 PMCID: PMC1850574 DOI: 10.1177/1074840703260905] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The purpose of this project was to examine parents' descriptions of the ways family and friends supported them after they had experienced a perinatal loss. For this project, a secondary analysis of data from two phenomenological studies on perinatal loss was performed. A combined total of 62 interview transcripts from 22 mothers and 9 fathers were examined. Data analysis included identifying all statements in the interview transcripts that pertained to the ways that family and friends supported parents. The modes of supportive behavior (emotional, advice/feedback, practical, financial, and socializing) in Vaux's theory of social support served as a useful framework for presenting the findings. Parents received emotional support most frequently. Findings from the current study provide data for health care professionals to use to provide guidance to family and friends of bereaved parents.
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Affiliation(s)
- Karen Kavanaugh
- University of Illinois at Chicago College of Nursing, Chicago, IL 60612-7350, USA.
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Neugebauer R. Depressive symptoms at two months after miscarriage: interpreting study findings from an epidemiological versus clinical perspective. Depress Anxiety 2003; 17:152-61. [PMID: 12768649 DOI: 10.1002/da.10019] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
We identify two study designs used to investigate psychiatric symptoms following reproductive loss. One design examines psychiatric outcomes in a single cohort of bereaved women; the other compares psychiatric outcomes in bereaved and non-bereaved cohorts. We employ the findings from one study of depressive symptoms following miscarriage to exemplify these designs and inferential differences in causal inferences that can be drawn. We interviewed a cohort of 114 women at 6-8 weeks after miscarriage and a cohort of 318 community women not recently pregnant. Depressive symptoms were assessed with the Center for Epidemiologic Studies Depression (CES-D) Scale. Among miscarrying women, the mean level of depressive symptoms was substantially elevated above that in the community cohort (adjusted difference in means between cohorts, 4.9, 95% confidence interval [CI] 2.3-7.4). Among miscarrying women, 20.2% were highly symptomatic (CES-D 30+), as compared with 10.1% among community women (adjusted odds ratio [OR] 2.8, 95% CI 1.4-5.6). However, in contrast to findings from the same study concerning depressive reactions at 2 weeks after loss, the impact of miscarriage on depressive symptoms at 6-8 weeks was markedly greater for younger women and possibly for women with a history of prior reproductive loss, but otherwise did not vary with number of living children, marital status, ethnicity or educational level. We conclude that miscarrying women first seen at their 6- to 8-week post miscarriage gynecologic visit are likely to be more depressed on average than otherwise comparable women who have not experienced a recent reproductive loss. Factors that moderate the impact of miscarriage may vary with time since loss. Enhanced recognition of the implications of study design for research inferences may help bring greater clarify and uniformity to findings from future investigations in this field.
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Affiliation(s)
- Richard Neugebauer
- Epidemiology of Developmental Brain Disorders Department, New York State Psychiatric Institute, New York, NY 10032, USA.
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Abstract
PURPOSE OF REVIEW Parents are attached to their unborn children, and loss around the time of birth is a serious trauma. Parental grief is a normal response, and may last for many months. Clinicians have always sought to implement practices that will help recovery, and for a generation, have advocated that parents have contact with the body of their dead infant, believing that this will facilitate mourning. Review of the literature shows that no previous systematic evidence has ever been offered to support this practice. RECENT FINDINGS Recent research throws doubt on the therapeutic value of the practice of encouraging contact with the dead infant. These findings are outlined and discussed. SUMMARY Following an outline of what is already known about the psychological effects of perinatal loss, the paper focuses on the evidence that aspects of psychosocial management are associated with better outcomes. It goes on to describe the cultural context in which psychosocial management changed and parents were first encouraged to see and handle their dead infant, and explores the distinction between the medical and cultural models which may frame this behaviour in very different ways. Finally, it briefly discusses the ethical position of staff who advise parents about their choice to see or not see their infant's body.
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Affiliation(s)
- Patricia Hughes
- Department of Psychiatry, St George's Hospital Medical School, London, UK.
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Vance JC, Boyle FM, Najman JM, Thearle MJ. Couple distress after sudden infant or perinatal death: a 30-month follow up. J Paediatr Child Health 2002; 38:368-72. [PMID: 12173998 DOI: 10.1046/j.1440-1754.2002.00008.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To examine, using a 30-month prospective study, patterns of anxiety, depression and alcohol use in couples following stillbirth, neonatal death or sudden infant death syndrome. METHODOLOGY One hundred and thirty-eight bereaved and 156 non-bereaved couples completed standardized interviews at 2, 8, 15 and 30 months post-loss. RESULTS At all interviews, bereaved couples were significantly more likely than non-bereaved couples to have at least one distressed partner. Rarely were both partners distressed in either group. For bereaved couples, 'mother only' distress declined from 21% to 10% during the study. 'Father only' distress ranged from 7% to 15%, peaking at 30 months. Bereaved mothers who were distressed at 2 months reported significantly lower marital satisfaction at 30 months. CONCLUSIONS At the couple level, the experience of a baby's death is multifaceted. Gender differences are common and partners' needs may change over time. Early recognition of these differences may facilitate longer-term adjustment for both partners.
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Affiliation(s)
- J C Vance
- Department of Paediatrics and Child Health, University of Queensland, St Lucia, Queensland, Australia
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Ritsher JB, Neugebauer R. Perinatal Bereavement Grief Scale: distinguishing grief from depression following miscarriage. Assessment 2002; 9:31-40. [PMID: 11911232 DOI: 10.1177/1073191102009001005] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The study evaluated the Perinatal Bereavement Grief Scale (PBGS), the first scale designed to measure grieffollowing reproductive loss in terms of yearning for the lost pregnancy and lost baby. Participants included 304 women interviewed by telephone I to 3 times within 6 months aftermiscarriage. The PBGS had high internal consistency and test-retest reliability. It showed convergent validity with measures of attachment and investment in the child and divergent validity against measures of social desirability and depressive symptoms, supporting the conceptual distinction between grief and depression. Cross-cultural validity was acceptable whether tested by language (Spanish vs. English) or ethnicity (Hispanic vs. other). This measure of yearning enables study of the epidemiology and prognostic value of this key feature of mourning.
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Wing DG, Burge-Callaway K, Rose Clance P, Armistead L. Understanding gender differences in bereavement following the death of an infant: Implications of or treatment. ACTA ACUST UNITED AC 2001. [DOI: 10.1037/0033-3204.38.1.60] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
Existing interventions to assist mothers following newborn death are implemented once manifestations of distress are present. Preventive measures could be instituted if predictors of grief were defined. The objective of this study was to investigate the value of perceived support, relationship satisfaction, emotion-focused coping, problem-focused coping, and mixed coping in predicting maternal grief in the year after a newborn death. The sample consisted of seventy-five bereaved mothers. Measures used included the Perinatal Grief Scale, Short Version; the Ways of Coping Scale, Revised; the Personal Resources Questionnaire 85, Part II; the Relationship Satisfaction Questionnaire; and the Demographic Data Sheet. Perceived support and emotion-focused coping accounted for a significant proportion of variance in total grief (43 percent), demonstrating that these two variables together can predict maternal grief. Programs to help bereaved mothers mobilize perceived support and use different ways of coping could be beneficial following the death of a newborn.
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Murray JA, Terry DJ, Vance JC, Battistutta D, Connolly Y. Effects of a program of intervention on parental distress following infant death. DEATH STUDIES 2000; 24:275-305. [PMID: 11010730 DOI: 10.1080/074811800200469] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
A longitudinal study of 144 parents (65 fathers, 79 mothers) was conducted to evaluate the effectiveness of a program of intervention in relieving the psychological distress of parents affected by infant death. Participants were assessed in terms of their psychiatric disturbance, depression, anxiety, physical symptoms, dyadic adjustment, and coping strategies. The experimental group (n = 84) was offered an intervention program comprising the use of specially designed resources and contact with a trained grief worker. A control group (n = 60) was given routine community care. Parental reactions were assessed at four to six weeks postloss (prior to the implementation of the intervention program), at six months postloss, and at 15 months postloss. A series of multivariate analyses of variance revealed that the intervention was effective in reducing the distress of parents, particularly those assessed prior to the intervention as being at high-risk of developing mourning difficulties. Effects of the intervention were noted in terms of parents' overall psychiatric disturbance, marital quality, and paternal coping strategies.
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Dyregrov A, Dyregrov K. Long-term impact of sudden infant death: a 12- to 15-year follow-up. DEATH STUDIES 1999; 23:635-661. [PMID: 10915455 DOI: 10.1080/074811899200812] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
To understand parents' subjective feelings, experiences, and understanding connected to the loss of a child over time, the authors chose semi-structured, in-depth interviews as the method of examination in a study of 26 parents who lost a child to sudden infant death syndrome (SIDS) between 1981 and 1984. In addition, parents were asked to complete different inventories to compare their present responses (1996) with their responses to the same inventories in 1981-1984. Most parents still viewed the death of their child as affecting their daily life in important ways. Inventory data show that gender differences have diminished 12-15 years after the loss, and few parents are psychologically at risk in 1996. The study clearly shows the benefit of method triangulation in providing a total picture of the parent's experiences.
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Affiliation(s)
- A Dyregrov
- Center for Crisis Psychology, Bergen, Norway
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Rådestad I, Steineck G, Nordin C, Sjögren B. Psychological complications after stillbirth--influence of memories and immediate management: population based study. BMJ (CLINICAL RESEARCH ED.) 1996; 312:1505-8. [PMID: 8646141 PMCID: PMC2351280 DOI: 10.1136/bmj.312.7045.1505] [Citation(s) in RCA: 145] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To identify factors that may predict long term psychological complications among women who have had a stillborn child. DESIGN Nationwide population based study using epidemiological methods. SUBJECTS 380 subjects and 379 controls who had had a stillborn or non-deformed live child in Sweden in 1991. RESULTS Information was provided by 636 (84%) women. The ratio (95% confidence interval) of proportions of women with symptoms related to anxiety above the 90th centile for women who had had a stillborn child compared with those who had not was 2.1 (1.2 to 3.9). An interval of 25 hours or more from the diagnosis of death in utero to the start of delivery gave a ratio of 4.8 (1.5 to 15.9). The ratio was 2.3 (1.1 to 5.3) for not seeing the child as long as the mother had wished and 3.1 (1.6 to 6.0) for no possession of a token of remembrance. CONCLUSION It is advisable to induce the delivery as soon as feasible after the diagnosis of death in utero. A calm environment for the woman to spend as much time as she wants with her stillborn child is beneficial, and tokens of remembrance should be collected.
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Affiliation(s)
- I Rådestad
- Centre for Caring Sciences North, Karolinska Institute, Stockholm, Sweden
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Janssen HJEM, Cuisinier MCJ, Hoogduin KAL. A Critical Review of the Concept of Pathological Grief following Pregnancy Loss. OMEGA-JOURNAL OF DEATH AND DYING 1996. [DOI: 10.2190/yll0-mwv4-wg7h-kbr3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
It has often been suggested in the literature on pregnancy loss, that parents run a high risk of complicated or pathological grief as a result of the specific characteristics of such loss. What confuses the issue is that pathological grief has been defined in various ways. In the interest of improving professional care, it is important to ascertain how pathological grief manifests itself and which parents are most likely to have problems coping with pregnancy loss and therefore develop pathological grief reactions. Given the lack of clarity regarding the concept of pathological grief following pregnancy loss, this article reviews empirical studies on pathological grief following pregnancy loss according to four subtypes derived from general bereavement literature: chronic grief, delayed grief, masked grief, and exaggerated grief. It can be concluded that in the first six months following pregnancy loss, psychological complaints, behavioral changes, and somatic complaints are fairly common responses. Approximately 10-to-15 percent of the women develop a psychiatric disorder during the first two years following such loss, and less than 10 percent seek specific psychiatric care. Parents often mourn the loss of their baby for more than a year; one in five women is unable to accept pregnancy loss after approximately two years. A delayed grief reaction occurs in about 4 percent of parents and seems to occur most often in men. It is suggested that developing pathological grief following pregnancy loss may be more uncommon than had previously been thought, and the long-held idea that parents run a higher risk of pathological grief following pregnancy loss seems partly to result from flaws in the empirical studies in this field. A large majority of women seem to be able to recover from pregnancy loss in due time, drawing on their own strength.
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Lang A, Gottlieb LN, Amsel R. Predictors of husbands' and wives' grief reactions following infant death: the role of marital intimacy. DEATH STUDIES 1996; 20:33-57. [PMID: 10160531 DOI: 10.1080/07481189608253410] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This follow-up study examined how bereaved couples' grief reactions change over time and how the quality of the marriage can predict these reactions for men and women. A group of 31 bereaved couples who 2 to 4 years earlier had lost an infant ( greater than 20 weeks gestation and less than 1 year of age) were revisited in their home 24 months after the initial home visit. With the exception of somatization, couples' grief reactions were less intense at follow-up than at the initial visit. Overall, husbands experienced less guilt, meaninglessness, yearning, and morbid fear than wives. Both husbands and wives who reported lower levels of marital intimacy soon after the loss experienced more intense grief at follow-up. Finally, couples continued to be vulnerable to a resurgence of grief even years later.
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Affiliation(s)
- A Lang
- Center for Nursing Research, Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada
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Abstract
New reproductive technologies, such as advanced infertility treatments, may have significant implications for women's psychological experience of pregnancy and motherhood. This paper examines some of the psychodynamic implications of multifetal pregnancy reduction, a medical procedure in which some of the fetuses in a multiple pregnancy are aborted while other fetuses are carried to term. Forty-four women who had undergone pregnancy reductions were interviewed about their emotional experience of this medical intervention and their subsequent pregnancies. A qualitative analysis of their experience was conducted from five psychoanalytically-informed vantage points: drive theory, ego psychology, object relations theory, self psychology and a developmental perspective. Women experienced having to abort some of their fetuses as a stressful and distressing life event, and a fourth of the women experienced bereavement reactions which impaired their functioning for at least two weeks. Conscious and unconscious responses to the procedure included ambivalence, guilt, and a sense of narcissistic injury, increasing the complexity of their attachment to the remaining babies. However, the achievement of the developmental goal of parenting healthy birth children helped most women feel that they had made the right decision for themselves and their families. Further research is indicated, including interviews before the reduction and long-term follow-up of mothers and surviving children.
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Affiliation(s)
- M K McKinney
- University of Michigan Psychological Clinic, Ann Arbor, USA
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Hunfeld JA, Wladimiroff JW, Verhage F, Passchier J. Previous stress and acute psychological defence as predictors of perinatal grief--an exploratory study. Soc Sci Med 1995; 40:829-35. [PMID: 7747218 DOI: 10.1016/0277-9536(94)e0118-c] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We evaluated whether the emotional reactions of women at 2-6 weeks after the prenatal diagnosis of a lethal anomaly and at 3 months after perinatal loss might be predicted by previous stress and acute psychological defence reactions to the diagnosis. Previous stress was defined objectively as a history of major life event(s) and having received professional mental health treatment in the past, and subjectively as the disposition for feelings of inadequacy and anxiety. Forty-one women were interviewed and completed measures on their history of major life events, whether they had received professional mental health treatment in the past, inadequacy, acute psychological defence reactions and perinatal grief. Regression analyses showed that inadequacy was the most strongly positive predictor of perinatal grief shortly after receiving the unfavourable diagnosis and three months after perinatal loss. In addition to inadequacy, having received professional mental health treatment in the past led to significantly more intense grief, but only shortly after receiving the unfavourable diagnosis. Previous life events intensified grief three months after perinatal death. The grieving process was significantly moderated by the defence of 'principalization' while it was significantly intensified by 'turning aggression against oneself', but only shortly after receiving the unfavourable diagnosis. These effects were not contaminated by relationships with pregnancy-related variables. Our findings imply that psychological support for women with perinatal loss should particularly be offered to those who have been identified as generally anxious, who have reported previous major life events and have received professional mental health treatment in the past.
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Affiliation(s)
- J A Hunfeld
- Department of Obstetrics and Gynaecology, University Hospital Dijkzigt, Rotterdam, The Netherlands
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Cuisinier MC, Kuijpers JC, Hoogduin CA, de Graauw CP, Janssen HJ. Miscarriage and stillbirth: time since the loss, grief intensity and satisfaction with care. Eur J Obstet Gynecol Reprod Biol 1993; 52:163-8. [PMID: 8163030 DOI: 10.1016/0028-2243(93)90066-l] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
In this paper we discuss the results of a study, conducted in the Netherlands, involving 143 women who experienced a miscarriage or stillbirth (response of 69%). The main questions were: how women with a fetal loss before the 20th week (miscarriage) versus women with a loss later in pregnancy (stillbirth) coped with the death of their baby; how the lapse of time since the loss related to grief intensity; and how satisfied women were with the professional care and support. The relationship between some other variables and grief intensity was also examined. It was found that grief intensity was greater and there was more satisfaction with professional care when gestational age was longer. With regard to the care, we concluded that some aspects needed improvement, especially the professional support for women who miscarry and the coordination of care for all women after discharge from hospital.
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Affiliation(s)
- M C Cuisinier
- Department of Clinical Psychology, University of Nijmegen, Netherlands
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Forrest GC. Preterm labour and delivery: psychological sequelae. BAILLIERE'S CLINICAL OBSTETRICS AND GYNAECOLOGY 1993; 7:653-68. [PMID: 8252820 DOI: 10.1016/s0950-3552(05)80453-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The psychological care of preterm babies and their families is challenging and at least as demanding for staff as the technical aspects of care. There is growing evidence for the effectiveness of therapeutic interventions in this area, thus ensuring the optimum outcome for the baby, the family and the staff.
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Affiliation(s)
- G C Forrest
- Park Hospital for Children, Headington, Oxford, UK
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31
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Hunfeld JA, Wladimiroff JW, Passchier J, Venema-Van Uden MU, Frets PG, Verhage F. Emotional reactions in women in late pregnancy (24 weeks or longer) following the ultrasound diagnosis of a severe or lethal fetal malformation. Prenat Diagn 1993; 13:603-12. [PMID: 8415426 DOI: 10.1002/pd.1970130711] [Citation(s) in RCA: 57] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
We studied the emotional reactions of 41 women in late pregnancy shortly after they had been informed of the diagnosis of 'severe or lethal fetal malformations' and 3 months after delivery. In addition, situational variables were explored as determinants of grieving. While grief did not diminish during the study period, psychological instability was less pronounced at 3 months after delivery. More grief reactions were evoked by self-reported easily versus self-reported not easily initiated pregnancy, gestational age between 24 and 34 weeks versus beyond 34 weeks, multiparity versus primiparity, and viewing versus not viewing the baby.
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Affiliation(s)
- J A Hunfeld
- Department of Obstetrics and Gynaecology, University Hospital, Dijkzigt, Rotterdam, The Netherlands
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Maternal views of the management of foetal remains following early miscarriage. Ir J Psychol Med 1993. [DOI: 10.1017/s0790966700012945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjective:Recommendations for the sensitive management of perinatal and late pregnancy deaths are now widely applied. This study assessed management experiences and preferences of women who had an early miscarriage to ascertain if current practices are acceptable to these women.Method:Women who had experienced a first trimester miscarriage in the previous year and had attended hospital were identified from hospital and GP records. They were interviewed using a semi-structural format (N=27) and asked about their own experiences and opinions regarding viewing the foetus following miscarriage and making burial arrangements.Results:Most women did not see their miscarried foetus (85%) or know what burial arrangements had been made for the foetus (92%). Preferences regarding these issues were varied but all women felt that parents should be consulted.Conclusions:Recommendations on specific arrangements for the viewing of and disposal of remains following early miscarriage may be secondary to the provision of choice for the parents involved.
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Neugebauer R, Kline J, O'Connor P, Shrout P, Johnson J, Skodol A, Wicks J, Susser M. Determinants of depressive symptoms in the early weeks after miscarriage. Am J Public Health 1992; 82:1332-9. [PMID: 1415855 PMCID: PMC1695859 DOI: 10.2105/ajph.82.10.1332] [Citation(s) in RCA: 85] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES We tested whether and under what conditions miscarriage increases depressive symptoms in the early weeks following loss. METHODS We interviewed 232 women within 4 weeks of miscarriage and 283 pregnant women and 318 community women who had not recently been pregnant. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression (CES-D) Scale. RESULTS Among women who had miscarried, the proportion who were highly symptomatic on the CES-D was 3.4 times that of pregnant women and 4.3 times that of community women. Among childless women, the proportion of women who had miscarried who were highly symptomatic was 5.7 times that of pregnant women and 11.0 times that of community women. Women who had miscarried were equally depressed regardless of length of gestation; among pregnant women, depressive symptoms declined with length of gestation. Among women who had miscarried, symptom levels did not vary with attitude toward the pregnancy; among pregnant women, depressive symptoms were elevated in those with unwanted pregnancies. Prior reproductive loss and advanced maternal age (35+ years) were not associated with symptom levels in any cohort. CONCLUSIONS Depressive symptoms are markedly increased in the early weeks following miscarriage. This effect is substantially modified by number of living children, length of gestation at loss, and attitude toward pregnancy.
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Affiliation(s)
- R Neugebauer
- New York State Psychiatric Institute, Epidemiology of Developmental Brain Disorders Department, NY 10032
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Abstract
Dramatic improvements in the hospital management of perinatal loss have taken place in the past 20 years. However, there has been no critical examination of current approaches. Four possible hazards of current hospital practice are described: 1) Institutionalization of bereavement: Instead of offering parents an empathic awareness of the unique dimensions of their perinatal loss, caregivers often interact according to detailed behavioral protocols. 2) Idealization of contact with the dead baby: This approach may equate actual physical contact with the dead child with the more complicated and variable process of mourning. 3) Homogenization of grief: Counselors tend to denigrate different grief responses by focusing on a preconceived grief reaction. Thus, they may mistakenly label many such reactions pathologic if they deviate from the rigidly prescribed "norm." 4) Lecturing the bereaved: Telling parents the "right" thing to do may deprive them of a crucial aspect of the process that empowers parents after they experience the helplessness associated with perinatal loss--that of making their own decisions. These problems are illustrated by a clinical vignette, and alternative approaches are explored.
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Affiliation(s)
- I G Leon
- Department of Psychiatry, Child and Adolescent Psychiatric Hospital, Ann Arbor, MI 48109-0390
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35
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Neugebauer R, Kline J, O'Connor P, Shrout P, Johnson J, Skodol A, Wicks J, Susser M. Depressive symptoms in women in the six months after miscarriage. Am J Obstet Gynecol 1992; 166:104-9. [PMID: 1733177 DOI: 10.1016/0002-9378(92)91839-3] [Citation(s) in RCA: 125] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This study, the first systematic investigation of the psychiatric impact of miscarriage, tests whether miscarriage markedly increases depressive symptoms in the 6 months after loss. We interviewed 382 miscarrying women entering the study at 2 weeks, 6 weeks, or 6 months after loss and, for comparison, 283 pregnant women and 318 community women not recently pregnant. Among women interviewed 2 weeks after miscarriage the proportion highly symptomatic on the Center for Epidemiologic Studies-Depression scale was 3.4 times that of pregnant women (95% confidence limits 2.0 and 5.0) and 4.3 times that of community women (95% confidence limits 3.0 and 5.8). Among women first interviewed 6 weeks and 6 months after miscarriage the proportion highly symptomatic was three times that of the community women. Women reinterviewed at 6 weeks and 6 months did not have elevated symptom levels, a result attributed to the unintended therapeutic and test effects of study interviews. Interviews were fully structured, readily administered by telephone by nonmedical personnel. The possibility that such interviews afford miscarrying women substantial psychologic benefits merits future investigation.
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Affiliation(s)
- R Neugebauer
- Epidemiology of Developmental Brain Disorders Department, New York State Psychiatric Institute, New York
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Abstract
This article examines methodological problems, and describes and evaluates commonly explored variables regarding research on the effect of an infant's death on the family. The components of parents' and siblings' grief reactions, and the similarities and differences in parental grief are reviewed. The research shows marked differences between mothers' and fathers' reactions--the grief reactions in mothers being stronger and more prolonged. Different explanations for this are put forward. The effect of different types of loss as well as the effect of the child's life span before death are also reviewed and discussed. Further knowledge is needed to single out the influence of these factors' on the families' reactions. It is concluded that the death of an infant makes the family prone to develop short-term and/or long-term problems in their adaptation to the loss. An integrated effort by health professionals is needed to develop systematic ways of helping families to cope with the death of a child.
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Affiliation(s)
- A Dyregrov
- Department of Pediatrics, University of Bergen, Norway
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37
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Oglethorpe RJL. Parenting after perinatal bereavement - a review of the literature. J Reprod Infant Psychol 1989. [DOI: 10.1080/02646838908403597] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
Parental adaptation following perinatal loss has received increasing attention in the past 20 years. From early anecdotal accounts to recent more rigorous investigations, it is clear that perinatal loss in the developed world is a significant psychological trauma for parents. Major immediate consequences are likely for virtually all affected families, and long-term sequelae are likely for some. Despite widespread attention to the experience of families who lose a stillborn or newborn infant, including major changes in hospital practices regarding management of these families, many important questions remain unanswered. We know little, for instance, about which parents are at greatest risk for disordered mourning or what additional measures might minimize their psychological morbidity. In fact, because of a tendency to focus exclusively on affective symptomatology following the loss, other important features of the process of mourning have been overlooked or examined unsystematically. Suggestions for specific and general directions for further research are discussed.
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