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Maryam H, Liaqat R, Rowther AA, Atiq M, Nazir H, Malik A, Rahman A, Surkan PJ, Atif N. "If it has happened once, it can happen again". The impact of previous pregnancy loss on anxious women's ongoing pregnancies: A qualitative study from Pakistan. Midwifery 2024; 137:104087. [PMID: 39003932 DOI: 10.1016/j.midw.2024.104087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 06/20/2024] [Accepted: 06/28/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Pregnancy loss that includes both miscarriage and stillbirth cause significant psychological distress for women including anxiety, depression, and grief that persist long after physical recovery. This study focuses on the experiences of women in Pakistan, where pregnancy loss rates are high. OBJECTIVE To explore how pregnant women with anxiety symptoms and a history of pregnancy loss perceive their past experiences with the loss and how it affects overall well-being in their current pregnancy. DESIGN Qualitative methods were used to explore the impact of previous pregnancy loss on the well-being of pregnant women. SETTING This qualitative research was embedded within a randomized control trial conducted in a tertiary care facility in Rawalpindi, Pakistan. PARTICIPANTS Data were collected through in-depth interviews with 18 pregnant women who had experienced pregnancy loss. Data was analyzed using Framework Analysis. FINDINGS The findings revealed several factors influencing participants' well-being during pregnancies that resulted in a loss, such as unsupportive and abusive environments, unintended pregnancies, certain superstitious beliefs, poor health, and lack of access to quality healthcare. The study also highlighted the adverse impact of previous pregnancy loss on the ongoing pregnancy, including deterioration of physical and mental health and aversion of healthcare services. However, some participants reported positive changes in medical and self-care practices and an enhanced faith and reliance on destiny in their subsequent pregnancies. CONCLUSION Our study highlights the lasting impact of past pregnancy loss on subsequent pregnancies, affecting overall wellbeing and leading to healthcare avoidance. We identified persistent anxiety along with positive outcomes like enhanced medical practices and strengthened faith. Results suggest the need for culturally responsive interventions to support the overall well-being of anxious pregnant women with a history of pregnancy loss in resource-constrained settings.
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Affiliation(s)
- Hadia Maryam
- Human Development Research Foundation, Gujar Khan, Pakistan
| | | | - Armaan A Rowther
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States; Department of Psychiatry, Harbor-UCLA Medical Center, Los Angeles, CA, United States; Programme in Islamic Psychology, Cambridge Muslim College, Cambridge, United Kingdom
| | - Maria Atiq
- Human Development Research Foundation, Gujar Khan, Pakistan
| | - Huma Nazir
- Human Development Research Foundation, Gujar Khan, Pakistan
| | - Abid Malik
- Human Development Research Foundation, Gujar Khan, Pakistan; Public Mental Health Department, Health Services Academy, Islamabad, Pakistan
| | - Atif Rahman
- Human Development Research Foundation, Gujar Khan, Pakistan; Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Pamela J Surkan
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Najia Atif
- Human Development Research Foundation, Gujar Khan, Pakistan.
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Roberts LR, Nick JM, Sarpy NL, Peters J, Tamares S. Bereavement care guidelines used in health care facilities immediately following perinatal loss: a scoping review. JBI Evid Synth 2024:02174543-990000000-00324. [PMID: 38932508 DOI: 10.11124/jbies-23-00149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
OBJECTIVE The objective of the scoping review was to explore the evidence and describe what is known about perinatal bereavement care guidelines provided within health care facilities prior to discharge. Additionally, the review sought to identify what is known about parents' mental health outcomes, and map these outcomes to the characteristics of the bereavement care guidelines. INTRODUCTION Perinatal loss poses a serious risk of emotional trauma and mental health sequelae. Conflicting evidence for international bereavement care guidelines and inconsistent implementation, a lack of experimental studies, and older syntheses with a limited focus or population made synthesis complex. Therefore, a scoping review was undertaken to determine the breadth and depth of the existing literature on this topic. INCLUSION CRITERIA Sources pertaining to bereavement care guidelines used in health care facilities immediately after perinatal loss (miscarriage, stillbirth, or neonatal death) and parents' mental health outcomes were included. Sources pertaining to family members other than parents, perinatal loss occurring outside of a health care facility, and physical care guidelines were excluded. METHODS The review was conducted using JBI methodology for scoping reviews. The team considered quantitative and qualitative studies, practice guidelines, case reports, expert opinions, systematic reviews, professional organization websites, and gray literature. CINAHL (EBSCOhost), PsycINFO (EBSCOhost), SocINDEX (EBSCOhost), Cochrane Library, JBI Evidence-based Practice Database (Ovid), Embase, PubMed (NLM), ProQuest Dissertations and Theses A&I (ProQuest), Web of Science Core Collection, and Epistemonikos were the major databases searched. OpenGrey, Google Scholar, and organizational websites were also searched. The earliest empirical study publication found (1976) served as the starting date limit. After pilot-testing the screening process, data were extracted, collated, and presented in narrative form as well as in tables and figures. The search was first conducted in September and October 2021, and an updated search was performed on February 9, 2023. RESULTS The results provide a broad view of bereavement care guidelines to support grieving parents' mental health. The included sources (n = 195) were comprised of 28 syntheses, 96 primary studies, and 71 literature review/text and opinion. From the studies that specified the number of participants, 33,834 participants were included. Key characteristics of bereavement care guidelines were categorized as i) making meaning/memories, ii) good communication, iii) shared decision-making, iv) effective emotional and social support, and v) organizational response. Parents' reported mental health outcomes included both negative outcomes, such as depression, anxiety, anger, and helplessness, and positive outcomes, including coping, healing, recovery, and well-being. CONCLUSIONS Conceptually the characteristics of published guidelines are fairly consistent across settings, with cultural variations in specific components of the guidelines. Despite the exponential increase in research pertaining to bereavement care after perinatal loss, there is a gap in research pertaining to certain characteristics of bereavement care guidelines accepted as best practice to support parents' mental health outcomes. This review provides support for future research given the trauma and mental health risks following perinatal loss. Policies ensuring consistent and appropriate implementation of bereavement care guidelines are essential to improve parents' mental health outcomes.
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Affiliation(s)
- Lisa R Roberts
- School of Nursing, Loma Linda University, Loma Linda, CA, USA
- LLUH Center for Evidence Synthesis: A JBI Affiliated Group, Loma Linda, CA, USA
| | - Jan M Nick
- School of Nursing, Loma Linda University, Loma Linda, CA, USA
- LLUH Center for Evidence Synthesis: A JBI Affiliated Group, Loma Linda, CA, USA
| | - Nancy L Sarpy
- School of Nursing, Loma Linda University, Loma Linda, CA, USA
| | - Judith Peters
- School of Nursing, Loma Linda University, Loma Linda, CA, USA
| | - Shanalee Tamares
- LLUH Center for Evidence Synthesis: A JBI Affiliated Group, Loma Linda, CA, USA
- Del Webb Library, Loma Linda University, Loma Linda, CA, USA
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Gemmill A, Margerison CE, Stuart EA, Bell SO. Infant Deaths After Texas' 2021 Ban on Abortion in Early Pregnancy. JAMA Pediatr 2024:2819785. [PMID: 38913344 PMCID: PMC11197445 DOI: 10.1001/jamapediatrics.2024.0885] [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] [Received: 10/10/2023] [Accepted: 03/01/2024] [Indexed: 06/25/2024]
Abstract
Importance Prior observational research has shown that infants born in states with more abortion restrictions are more likely to die during infancy. It is unclear how recent and more severe abortion bans in the US have impacted infant mortality. Objective To examine whether Texas Senate Bill 8 (SB8), which banned abortions after embryonic cardiac activity and did not allow exemptions for congenital anomalies, is associated with infant mortality in the state of Texas. Design, Setting, and Participants This population-based cohort study of all recorded infant deaths from the state of Texas and 28 comparison states used a comparative interrupted time series analysis with an augmented synthetic control approach and national birth certificate data from January 1, 2018, to December 31, 2022, to estimate the difference between the number of observed and expected infant and neonatal deaths and death rates among monthly cohorts exposed to Texas' SB8. Exposure Deaths in March 2022 were treated as the first cohort exposed to the Texas' SB8 abortion policy because these infants (if born full term) were approximately 10 to 14 weeks' gestation when SB8 went into effect on September 1, 2021. The exposure period was thus March through December 2022. Main Outcomes and Measures Our outcomes were monthly counts and rates of infant (aged <1 year) and neonatal (aged <28 days) deaths in the exposure period in Texas. In secondary analyses, annual changes in cause-specific infant deaths between 2021 and 2022 in Texas and the rest of the US were examined. Results Between 2018 and 2022, there were 102 391 infant deaths in the US, with 10 351 of these deaths occurring in the state of Texas. Between 2021 and 2022, infant deaths in Texas increased from 1985 to 2240, or 255 additional deaths. This corresponds to a 12.9% increase, whereas the rest of the US experienced a comparatively lower 1.8% increase. On the basis of the counterfactual analysis that used data from Texas and eligible comparison states, an excess of 216 infant deaths (95% CI, -122 to 554) was observed from March to December 2022, or a 12.7% increase above expectation. At the monthly level, significantly greater-than-expected counts were observed for 4 months between March and December 2022: April, July, September, and October. An analysis of neonatal deaths found somewhat similar patterns, with significantly greater-than-expected neonatal deaths in April and October 2022. Descriptive statistics by cause of death showed that infant deaths attributable to congenital anomalies in 2022 increased more for Texas (22.9% increase) but not the rest of the US (3.1% decrease). Conclusions and Relevance This study found that Texas' 2021 ban on abortion in early pregnancy was associated with unexpected increases in infant and neonatal deaths in Texas between 2021 and 2022. Congenital anomalies, which are the leading cause of infant death, also increased in Texas but not the rest of the US. Although replication and further analyses are needed to understand the mechanisms behind these findings, the results suggest that restrictive abortion policies may have important unintended consequences in terms of trauma to families and medical cost as a result of increases in infant mortality. These findings are particularly relevant given the recent Dobbs v Jackson Women's Health Organization US Supreme Court decision and subsequent rollbacks of reproductive rights in many US states.
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Affiliation(s)
- Alison Gemmill
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Claire E. Margerison
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing
| | - Elizabeth A. Stuart
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Suzanne O. Bell
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
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Denhup C. Hurricane-Force Grief: A Mirror of Fathers' Love. OMEGA-JOURNAL OF DEATH AND DYING 2024:302228241260979. [PMID: 38870417 DOI: 10.1177/00302228241260979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
A child's death is a traumatic experience that profoundly impacts parents' psychological, physical, and social wellbeing. The literature describes gender differences in grief response associated with child loss, yet less is known about fathers' grief in comparison that of mothers due to fathers' underrepresentation in bereavement research. There is a need for scholarly exploration to advance understanding of fathers' grief. This article presents selected findings on fathers' grief responses that emerged from a larger qualitative study, which aimed to describe fathers' lived experience of bereavement after a child's death. Profound grief emerged as one essential theme of fathers' bereavement experience. Participants described the meaning of their grief, their multidimensional grief responses, their grief triggers, and their grief intensity. Findings deepen understanding of fathers' grief associated with child loss and advance the body of parental bereavement literature.
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Affiliation(s)
- Christine Denhup
- Fairfield University, Egan School of Nursing and Health Studies, Fairfield, CT, USA
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Denhup C. "Trying to Find North": Fathers Voice the Nature of Their Bereavement. OMEGA-JOURNAL OF DEATH AND DYING 2024:302228241238383. [PMID: 38445575 DOI: 10.1177/00302228241238383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Fathers' lived experience of bereavement is not well understood. This article presents findings from a Heidegerrian phenomenological study, which aimed to describe fathers' bereavement. Fathers' bereavement is a life-long journey along which a father navigates through devastating and traumatic loss with great strength; has profound grief that mirrors the profound love he has for his child; chooses to live life with intention and engages in meaningful activities that create purpose aimed at honoring his child, continuing his child's legacy, and using his own suffering for the good of others; is anchored by a continuing bond of love that fuels an ongoing relationship with his child; and needs a supportive community to sustain him as he travels down the healing road where it is possible to find faith, hope, and love while being forever transformed by loss. Findings amplify fathers' voice so nurses gain a deeper understanding of their experience.
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Affiliation(s)
- Christine Denhup
- The Marion Peckham Egan School of Nursing and Health Studies, Fairfield University, Fairfield, CT, USA
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Alexopoulos J, Tmej A, Naderer A, Grussmann M, Tordy K, Stammler-Safar M, Feichtinger K, Gipperich A, Leithner K. Men don't cry: The supporting role as necessary for women's well-being after termination of pregnancy. Int J Gynaecol Obstet 2024; 164:1205-1211. [PMID: 37922219 DOI: 10.1002/ijgo.15234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 10/13/2023] [Accepted: 10/17/2023] [Indexed: 11/05/2023]
Abstract
OBJECTIVES The present study investigated similarities and differences of grief between men and women as part of the parental couple 1 year after termination of pregnancy (TOP) following a diagnosis of fetal anomaly. METHODS We applied a method triangulation approach. We assessed several aspects of perinatal grief, depressive symptoms, posttraumatic stress, and anxiety as well as health-related quality of life. In addition, we conducted qualitative interviews with the men to explore the fathers' roles in the partnership during pregnancy, the time of the diagnosis, TOP, and afterwards. RESULTS Women showed a more elevated grief response compared with men. Qualitative data revealed that men in our sample were mainly concerned with their partners' well-being and concentrated on supporting their partners rather than on their own emotions. In addition, the supportive role of the male partner plays a central role in the well-being of women and the man's coping with the situation. CONCLUSION In clinical work, but also when developing new questionnaires, the specific role of the male partners needs to be considered more thoroughly. Particular attention should be paid to identify the men who find it difficult to assume the supporting role.
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Affiliation(s)
- Johanna Alexopoulos
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Anna Tmej
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Andrea Naderer
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Magdalena Grussmann
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Karin Tordy
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynaecology, Medical University of Vienna, Vienna, Austria
| | - Maria Stammler-Safar
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynaecology, Medical University of Vienna, Vienna, Austria
| | - Karin Feichtinger
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Andrea Gipperich
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Katharina Leithner
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
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Cevik A, Aksut Akcay E, Gozuyesil E, Avcibay Vurgec B, Gokyildiz Surucu S. Impact of trauma, support, and control perceptions during childbirth on post-traumatic stress disorder among Syrian immigrant adolescent pregnant women. Midwifery 2023; 127:103870. [PMID: 37931461 DOI: 10.1016/j.midw.2023.103870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 10/25/2023] [Accepted: 10/31/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVE The probability of experiencing mental health problems in the perinatal period is high for adolescent women. Immigration is a complicated phenomenon that increases the risk of encountering temporary or permanent psychological problems. This study aims to determine Syrian immigrant adolescent women's support and control perception levels during childbirth, birth trauma levels, and posttraumatic stress disorder incidence and affecting factors. METHODS This study used a prospective cohort design and was conducted in a hospital in Adana, a city in southern Turkey, between February and April 2022. It included 122 Syrian adolescent immigrant women, and data were collected in two interviews. While the first interview was conducted within the first 24 hours following birth, the second interview was conducted one month after birth. Data were collected through structured interviews using standardized questionnaires, including the Personal Information Form, the City Birth Trauma Scale, the Support and Control in Birth Scale, and the Post-traumatic Stress Disorder Checklist for DSM-5. FINDINGS The average age of participating women was 17.40±0.94. The participants' Perceived Support and Control in Birth Scale total score was 100.55±20.12, the City Birth Trauma Scale total score was 43.11±13.29, and the Post-traumatic Stress Disorder Checklist total score was 30.36±16.86. Of all the participating women, 26% were found to have post-traumatic stress disorder symptoms in the postpartum period. A relationship was found between support and control perceptions during childbirth and post-traumatic stress disorder symptoms. CONCLUSION This study found that immigrant adolescent women's support and control perceptions during childbirth were better than expected, and they had a high level of perceived trauma during childbirth. The presence of birth trauma emerged as a robust predictive factor for posttraumatic stress disorder, underscoring its critical role in maternal mental health. A positive childbirth experience, which is important for all women, has become an increasing need for immigrant women. There is a need for developing and sustaining health policies guaranteeing culturally sensitive care to prevent immigrant women from having a traumatic birth experience.
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Affiliation(s)
- Ayseren Cevik
- Department of Midwifery, Cukurova University Faculty of Health Sciences, Adana, Turkey.
| | - Emine Aksut Akcay
- Midwifery Department, Kahramanmaras Sütcü Imam University Faculty of Health Sciences, Kahramanmaraş, Turkey
| | - Ebru Gozuyesil
- Department of Midwifery, Cukurova University Faculty of Health Sciences, Adana, Turkey
| | - Burcu Avcibay Vurgec
- Department of Midwifery, Cukurova University Faculty of Health Sciences, Adana, Turkey
| | - Sule Gokyildiz Surucu
- Department of Midwifery, Cukurova University Faculty of Health Sciences, Adana, Turkey
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Hollins Martin CJ, Reid K. A scoping review of therapies used to treat psychological trauma post perinatal bereavement. J Reprod Infant Psychol 2023; 41:582-598. [PMID: 34989287 DOI: 10.1080/02646838.2021.2021477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/30/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Up to 39% of women who experience perinatal bereavement proceed to develop Post-Traumatic-Stress-Disorder (PTSD), with this large proportion meriting treatment. Before setting-up a treatment service for postnatal women who are experiencing psychological trauma, it is important to identify what therapies have been used in-the-past to address this problem. AIM To scope for research that has implemented therapies to treat psychological trauma post perinatal bereavement, for potential inclusion in a flexible treatment package. METHOD A scoping review mapped coverage, range, and type of research that has reported on prior therapies used to treat psychological trauma post perinatal bereavement. FINDINGS Due to the dearth of papers that directly addressed perinatal bereavement, we widened the scope of the review to view what treatments had been used to treat psychological trauma post-childbirth. Out of 23 studies that report on effectiveness of therapies used to treat psychological trauma post-childbirth, only 4-focused upon treating PTSD post perinatal bereavement (3 effective/1 ineffective). Successful treatments were reported by Kersting et al. (2013), who found CBT effective at reducing PTSD symptoms post-miscarriage, termination for medical reasons, and stillbirth (n = 33 & n = 115), and Navidian et al. (2s017)) found that 4-sessions of grief-counselling reduced trauma symptoms post-stillbirth in (n = 50) women. One study by Huberty et al. (2020found on-line yoga to be ineffective at reducing PTSD symptoms post-stillbirth. CONCLUSIONS A dearth of research has explored effectiveness of therapies for treating psychological trauma post perinatal bereavement and post-childbirth, with need to develop and test a research informed flexible counselling package.
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Affiliation(s)
- Caroline J Hollins Martin
- School of Nursing, Midwifery and Social Care, Edinburgh Napier University (Enu), Edinburgh, Scotland, UK
| | - Katrina Reid
- School of Nursing, Midwifery and Social Care, Edinburgh Napier University (Enu), Edinburgh, Scotland, UK
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Sun S, Sun Y, Qian J, Tian Y, Wang F, Yu Q, Yu X. Parents' experiences and need for social support after pregnancy termination for fetal anomaly: a qualitative study in China. BMJ Open 2023; 13:e070288. [PMID: 37734885 PMCID: PMC10514653 DOI: 10.1136/bmjopen-2022-070288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 08/29/2023] [Indexed: 09/23/2023] Open
Abstract
OBJECTIVE The aim of this study was to explore the experiences and need for social support of Chinese parents after termination of pregnancy for fetal anomalies. DESIGN A qualitative study using semistructured, in-depth interviews combined with observations. Data were analysed by Claizzi's phenomenological procedure. SETTING A large, tertiary obstetrics and gynaecology hospital in China. PARTICIPANTS Using purposive sampling approach, we interviewed 12 couples and three additional women (whose spouses were not present). RESULTS Four themes were identified from the experiences of parents: the shock of facing reality, concerns surrounding termination of pregnancy, the embarrassment of the two-child policy and the urgent need for social support. CONCLUSION Parents experienced complicated and intense emotional reactions, had concerns surrounding the termination of pregnancy and an urgent need for social support. Paternal psychological reactions were often neglected by healthcare providers and the fathers, themselves. These findings suggest that both mothers and fathers should receive appropriate support from family, medical staff and peers to promote their physical and psychological rehabilitation.
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Affiliation(s)
- Shiwen Sun
- Department of Obstetrics, Zhejiang University School of Medicine, Women's Hospital, Hangzhou, China
| | - Yaping Sun
- Zhejiang University School of Medicine, Hangzhou, China
| | - Jialu Qian
- Zhejiang University School of Medicine, Hangzhou, China
| | - Yanping Tian
- Department of Obstetrics, Zhejiang University School of Medicine, Women's Hospital, Hangzhou, China
| | - Fang Wang
- Nursing Department, Zhejiang University School of Medicine, Women's Hospital, Hangzhou, China
| | - Qing Yu
- Department of Obstetrics, Zhejiang University School of Medicine, Women's Hospital, Hangzhou, China
| | - Xiaoyan Yu
- Department of Obstetrics, Zhejiang University School of Medicine, Women's Hospital, Hangzhou, China
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Burgess A, Murray C, Clancy A. Fathers' Relational Experiences of Stillbirth: Pre-natal Attachment, Loss and Continuing Bonds Through Use of Objects. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231162736. [PMID: 36927236 DOI: 10.1177/00302228231162736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
This study aimed to investigate fathers' lived experiences of stillbirth through the lens of continuing bonds and use of objects. Semi-structured interviews were conducted with six fathers who had experienced stillbirth from 20 weeks gestation. Interpretative phenomenological analysis revealed five themes: loss and continued bonds in a mother-mediated dynamic, objects as manifestations of relational and meaningful memories, exerting existence and continued connection to others, continued bond through physical presence and evolving expressions of love and fatherhood. Findings offer a novel understanding of the relationship between objects and continued bonds, where objects are seen to facilitate this bond through varying means, including physical manifestation of the deceased and representation of the father-infant relationship. The study places importance on fathers' involvement in creating objects permeated with meaning and memories, and of validating fathers' experiences of loss rather than considering these men merely as partners of a mother who lost their own baby.
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Affiliation(s)
- Amy Burgess
- Doctorate in Clinical Psychology, Lancaster University, UK
| | - Craig Murray
- Doctorate in Clinical Psychology, Lancaster University, UK
| | - Anna Clancy
- Doctorate in Clinical Psychology, Lancaster University, UK
- Aching Arms, Brentwood, UK
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Qian J, Chen S, Jevitt C, Sun S, Wang M, Yu X. Experiences of obstetric nurses and midwives receiving a perinatal bereavement care training programme: A qualitative study. Front Med (Lausanne) 2023; 10:1122472. [PMID: 37007785 PMCID: PMC10056219 DOI: 10.3389/fmed.2023.1122472] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/01/2023] [Indexed: 03/17/2023] Open
Abstract
AimTo explore obstetric nurses and midwifery professionals’ experiences with the Perinatal Bereavement Care Training Programme (PBCTP) after implementation.DesignA qualitative descriptive design was used.MethodThis qualitative study was conducted at a tertiary level maternity hospital in China. The PBCTP was implemented at Women’s Hospital School of Medicine, Zhejiang University from March to May 2022. A total of 127 nurses and 44 midwives were invited to participate in the training. Obstetric nurses and midwives studied a 5-module training programme comprised of eight online theoretical courses and submitted a reflective journal after each session. Semi-structured interviews were conducted with 12 obstetric nurses and four midwives from May to July 2022 as a post-intervention evaluation. Thematic analysis was used in data analysis.FindingsA total of 16 participants in this study ranged in age from 23 to 40 years [mean age (SD), 30 (4) years]. Six main themes within participants’ experiences of PBCTP intervention were identified: participants’ aims of undertaking the training; personal growth and practice changes after training; the most valuable training content; suggestions for training improvement; directions for practice improvement; influencing factors of practice optimization.ConclusionNursing and midwifery professionals described the PBCTP as satisfying their learning and skills enhancement needs and supporting positive changes in their care providing for bereaved families. The optimized training programme should be widely applied in the future. More efforts from the hospitals, managers, obstetric nurses, and midwives are needed to jointly contribute to forming a uniform care pathway and promoting a supportive perinatal bereavement care practice.
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Affiliation(s)
- Jialu Qian
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
- Division of Midwifery, Department of Family Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Shuyi Chen
- Department of Thyroid and Breast Surgery, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Cecilia Jevitt
- Division of Midwifery, Department of Family Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Shiwen Sun
- Department of Obstetrics, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Man Wang
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoyan Yu
- Department of Obstetrics, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- *Correspondence: Xiaoyan Yu,
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Kothari A, Bruxner G, Dulhunty JM, Ballard E, Callaway L. Dads in Distress: symptoms of depression and traumatic stress in fathers following poor fetal, neonatal, and maternal outcomes. BMC Pregnancy Childbirth 2022; 22:956. [PMID: 36550457 PMCID: PMC9773585 DOI: 10.1186/s12884-022-05288-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND This study aims to explore the prevalence of symptoms of depression and traumatic stress in fathers in the setting of poor fetal, neonatal, and maternal outcomes. METHODS A prospective mixed-methods study was conducted at an outer metropolitan public teaching hospital in Brisbane, Australia, with quantitative results presented here. Subjects included 28 fathers whose male partners had experienced pregnancy or childbirth complicated by a significant congenital abnormality or aneuploidy, termination of pregnancy, fetal death in-utero, stillbirth, admission to the neonatal intensive care unit or special care nursery or significant maternal morbidity, such as a postpartum haemorrhage or an emergency postpartum hysterectomy. These experiences were classified into two groups: anticipatory (time to prepare) and sudden (no warning). The fathers were screened using the Edinburgh Postnatal Depression Scale (EPDS) and the Impact of Events Scale-Revised (IES-R) to assess subjective distress at 2-3 weeks (timepoint 1) and 3-4 months (timepoint 2) after the event. RESULTS Data for both the EPDS and IES-R scales was available for 26 fathers (92.9%) at timepoint 1 and for 15 fathers (53.6%) at timepoint 2. High overall EPDS scores (≥10) were noted in 16/27 (59.3%) fathers at timepoint 1 and 6/15 fathers (40.0%) at timepoint 2. High overall IES-R scores ≥33 were noted in 12/26 (46.2%) fathers at timepoint 1 and 4/15 fathers (26.7%) at timepoint 2. A higher percentage of fathers who experienced anticipatory events had EPDS and IES-R score above these cut-offs at timepoint 1 (8/13 or 61.5%) compared to those experiencing sudden events (8/14 or 57.1%), however, percentages were similar between groups at time point 2 (2/7 or 28.6%% and 4/8 or 50.0%, respectively). More fathers who experienced anticipatory events had IES-R scores ≥33 at timepoint 1 (7/13 or 53.8%) compared to those experiencing sudden events (5/14 or 38.0%). CONCLUSION Our study indicates high rates of distress in fathers exposed to poor fetal, neonatal, and maternal outcomes, which can persist for months after the event. Increased support for fathers in this setting may be required to prevent poor mental health. Further research on the long-term effects of these adverse events is warranted.
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Affiliation(s)
- A. Kothari
- grid.490424.f0000000406258387Redcliffe Hospital, Anzac Avenue, Redcliffe, Queensland 4020 Australia ,grid.1003.20000 0000 9320 7537The University of Queensland, Brisbane, Queensland Australia
| | - G. Bruxner
- grid.490424.f0000000406258387Redcliffe Hospital, Anzac Avenue, Redcliffe, Queensland 4020 Australia ,grid.1003.20000 0000 9320 7537The University of Queensland, Brisbane, Queensland Australia
| | - J. M. Dulhunty
- grid.490424.f0000000406258387Redcliffe Hospital, Anzac Avenue, Redcliffe, Queensland 4020 Australia ,grid.1003.20000 0000 9320 7537The University of Queensland, Brisbane, Queensland Australia
| | - E. Ballard
- grid.1049.c0000 0001 2294 1395QIMR Berghofer Medical Research Institute, Brisbane, Queensland Australia
| | - L. Callaway
- grid.1003.20000 0000 9320 7537The University of Queensland, Brisbane, Queensland Australia ,grid.416100.20000 0001 0688 4634The Royal Brisbane and Women’s Hospital, Brisbane, Queensland Australia
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13
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Posttraumatic Stress Disorder Symptoms and Related Factors in Women with Early Pregnancy Loss. JOURNAL OF CONTEMPORARY MEDICINE 2022. [DOI: 10.16899/jcm.1165862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Aim: Women may experience emotions such as fear, anxiety, stress, anger or guilt after pregnancy loss, and it can lead to posttraumatic stress disorder if the women cannot cope with these emotions. This study aimed to identify posttraumatic stress disorder symptoms and related factors in women with early pregnancy loss.
Material and Methods: The sample of this descriptive study consisted of 132 women hospitalised with early pregnancy loss in an Obstetrics and Gynecology service of a state hospital (
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14
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Levy S, Avitsur R. Gender Differences in the Development of Posttraumatic Stress Symptoms Following Pregnancy Loss: Social Support and Causal Attributes. PSYCHOLOGICAL STUDIES 2022. [DOI: 10.1007/s12646-022-00691-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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15
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Sun S, Qian J, Sun Y, Wu M, Liu L, Yu X. Factors influencing parental posttraumatic stress disorder in cases of fetal abnormality requiring pregnancy termination in China. Perspect Psychiatr Care 2022; 58:2774-2781. [PMID: 35644010 DOI: 10.1111/ppc.13119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/11/2022] [Accepted: 05/10/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To estimate the prevalence of posttraumatic stress disorder (PTSD) among parents in cases of fetal abnormalities and associated factors. DESIGN AND METHODS A cross-sectional study. The study sample comprised 169 couples who experienced fetal abnormalities. FINDINGS We observed a high prevalence of PTSD. Fathers had similar levels of PTSD to those of mothers. Social support was an important protective factor against parental PTSD. In addition, a negative psychological reaction to the loss of a child in either the father or the mother affects the other spouse. PRACTICE IMPLICATIONS This study emphasizes recognizing the importance of social support and of psychological interactions between mothers and fathers in PTSD intervention for parents.
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Affiliation(s)
- Shiwen Sun
- Department of Nursing, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jialu Qian
- Department of Nursing, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Department of Nursing, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yaping Sun
- Department of Nursing, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Department of Nursing, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Mengwei Wu
- Department of Nursing, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Lu Liu
- Department of Nursing, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Department of Nursing, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xiaoyan Yu
- Department of Nursing, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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16
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Robinson M, Robinson Esq CD. The silent cry: A psychiatric-mental health nurse's guide for fathers experiencing perinatal loss. J Psychiatr Ment Health Nurs 2022; 29:619-623. [PMID: 35661485 PMCID: PMC9544921 DOI: 10.1111/jpm.12849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/10/2022] [Accepted: 03/24/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The effects of grief on fathers that have experienced perinatal loss merit further exploration. AIM The purpose of this paper is to draw attention to the experience of grief felt by fathers when facing perinatal loss. A father's grief and loss are frequently unrecognized and underappreciated by healthcare professionals who customarily attend only to the needs of mothers. RESULTS Data for this study were based on a couple's lived experience. This is a co-authored piece by a husband and wife. This literature suggests that the lack of resources for fathers might result in unresolved grief which if prolonged could be expressed in potential losses during subsequent pregnancies. IMPLICATIONS FOR PRACTICE Content from a review of the literature provides evidence helpful in addressing the recognition and management of grief in fathers experiencing perinatal losses. The grief and any related trauma due to prenatal losses can be managed in fathers with different methods, including support services, counselling, and if needed psychotherapy and pharmacotherapy. Psychiatric-mental health nurses can play an important role in the recognition and management of grief and planning interventions to support grieving fathers.
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Affiliation(s)
- Mamilda Robinson
- Rutgers University School of Nursing, Rutgers the State University of New Jersey, Newark, New Jersey, USA
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17
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Evans NM, Hsu YL, Kabasele CM, Kirkland C, Pantuso D, Hicks S. A Qualitative Exploration of Stressors: Voices of African American Women who have Experienced Each Type of Fetal/Infant Loss: Miscarriage, Stillbirth, and Infant Mortality. JOURNAL OF BLACK PSYCHOLOGY 2022. [DOI: 10.1177/00957984221127833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Historically, African American women have experienced racial disparities in miscarriage, stillbirth, and infant mortality rates. Yet, little attention has been given to stressors that African American women may experience prior to, during, and after experiencing fetal/infant loss. This study provided an opportunity for African American women to describe their lived experiences of stressors prior to, during, and after experiencing each type of fetal/infant loss. Semi-structured interviews were conducted with seven African American women. Each participant experienced miscarriage, stillbirth, and infant mortality and were 18 years of age or older. Recruitment occurred in 2019 in a county in Northeast Ohio and data were analyzed using descriptive coding and thematic analysis. Four themes identified how these African American women navigated stressors prior to, during, and after experiencing each type of fetal/infant loss: (a) social support, (b) grief, (c) internal conflict, and (d) pregnancy, delivery, and death of child. Our findings expand the literature by being an innovative study may bring awareness and influence programs that assist African American women during their experience with fetal/infant loss.
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18
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Late fetal demise, a risk factor for post-traumatic stress disorder. Sci Rep 2022; 12:12364. [PMID: 35859001 PMCID: PMC9300686 DOI: 10.1038/s41598-022-16683-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/13/2022] [Indexed: 11/09/2022] Open
Abstract
Late-term fetal demise including fetal death in utero, late miscarriage and late termination of pregnancy are relatively frequent occurrences. Post-traumatic stress disorder (PTSD) is a pathology that finds its roots in exposure to a life-threatening event or an event related to death. Exposure to fetal death during a late-term fetal demise is, therefore, a situation at risk of trauma. The objective of this study was to assess the prevalence of PTSD symptoms in the short term among patients faced with late fetal demise, and to identify potential risk factors. All women were assessed at 15 days, one month, and three months after late fetal demise using the Impact of Event Scale-Revised (IES-R) and the Peritraumatic Dissociative Experiences Questionnaire (PDEQ). At 15 days, 44.2% of patients presented a pathological score on the IES-R (≥ 33). At one month and three months, this figure was 34.1% and 9.1% respectively. Factor associated with PTSD symptoms were: peritraumatic dissociation (p = 0.014), seeing the fetus during hospitalization (p = 0.035), holding the fetus in one's arms (p = 0.046), and the organization of a funeral service (p = 0.025). Patients experiencing late fetal demise are at significant risk of trauma. Care providers should remain vigilant to identify high-risk situations to offer appropriate care.Clinical trials registration number: NCT03433989.
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Wesselmann ED, Parris L. Miscarriage, Perceived Ostracism, and Trauma: A Preliminary Investigation. Front Psychol 2022; 12:747860. [PMID: 35153890 PMCID: PMC8828504 DOI: 10.3389/fpsyg.2021.747860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 12/23/2021] [Indexed: 11/28/2022] Open
Abstract
Miscarriage often is a traumatic experience with serious mental health implications. Friends and family members are often uncomfortable with and avoid discussing the topic with bereaved individuals, potentially making them feel ostracized (i.e., being ignored and excluded), contributing to their mental health concerns. We investigated the correlation between posttraumatic stress symptoms, perceived ostracism, and recalled grief intensity measures in a sample of cisgender women (N = 97) who have had a miscarriage. These participants were recruited using Qualtrics’s Panel Recruitment Services. Women’s perceived ostracism correlated positively with posttraumatic stress symptoms and negatively with grief congruence (i.e., the degree to which they felt that their miscarriage process was as satisfactory as possible, given they had to experience it). Perceived ostracism also explained additional variance in posttraumatic stress symptoms when considered alongside grief intensity measures (e.g., congruence).
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Affiliation(s)
- Eric D Wesselmann
- Department of Psychology, Illinois State University, Normal, IL, United States
| | - Leandra Parris
- College of William & Mary, Williamsburg, VA, United States
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20
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Hackett J, Heavey E, Beresford B. 'It was like an airbag, it cushioned the blow': A multi-site qualitative study of bereaved parents' experiences of using cooling facilities. Palliat Med 2022; 36:365-374. [PMID: 35049399 PMCID: PMC8894949 DOI: 10.1177/02692163211059345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Evidence on the benefits to parents of spending time with their child in the hours after their death means this is now routine practice. UK children's hospices offer parents the opportunity to extend this period by using cooling facilities (i.e. cooled 'bedrooms'; cooling blankets/mattresses) to slow deterioration. AIM To explore parents' experiences of using cooling facilities and beliefs about how it shaped experiences of the very early days of bereavement, and on-going grieving processes. METHODS Multi-site study involving in-depth interviews with parents bereaved in the previous 3 years. Grief theories informed data analysis, which employed narrative and thematic approaches. Eight hospices supported recruitment. RESULTS Twenty-two mothers and eight fathers were recruited, representing 25% of families approached. Duration of use of a cooling facility varied, as did the amount of time spent with the child. All parents treasured this period, valuing the way it eased separation from their child and gave some control over when this happened. They believed all bereaved parents should have the opportunity to use a cooling facility. Using a cooling facility supported parents' engagement with grief tasks including acceptance of loss, processing emotional pain and facing changes to their lives brought about by their child's death. Memories and mementoes created during this period served to support on-going connections with the child. Parents who used a cooling facility at a hospice reported benefits of the setting itself. CONCLUSIONS As well as easing the very early days of loss, use of cooling facilities may influence longer-term bereavement outcomes.
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Affiliation(s)
- Julia Hackett
- Martin House Research Centre, University of York, York, UK
| | - Emily Heavey
- Department of Behavioural and Social Sciences, University of Huddersfield, Huddersfield, UK
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21
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The mental health impact of perinatal loss: A systematic review and meta-analysis. J Affect Disord 2022; 297:118-129. [PMID: 34678403 DOI: 10.1016/j.jad.2021.10.026] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 01/23/2023]
Abstract
Perinatal loss can pose a significant risk to maternal mental health. There is limited data on the strength of association between perinatal loss and subsequent common mental health disorders (CMHD) such as anxiety, depression and post-traumatic symptoms (PTS). A systematic review and meta-analysis identified studies with control groups, published between January 1995 and March 2020 reporting validated mental health outcomes following perinatal loss. We identified 29 studies from 17 countries, representing a perinatal loss sample (n = 31,072) and a control group of women not experiencing loss (n = 1,261,517). We compared the likelihood of increased CMHD in both groups. Random-effects modelling on suggested that compared to controls, perinatal loss was associated with increased risk of depressive (RR = 2.14, 95% CI = 1.73-2.66, p < 0.001, k = 22) and anxiety disorders (RR = 1.75, 95% CI = 1.27-2.42, p < 0.001, k = 9). Compared to controls, Perinatal loss was also associated with increased depression (SMD = 0.34, 95% CI = 0.20-0.48, p < 0.001, k = 12) and anxiety scores (SMD = 0.35, 95% CI = 0.12-0.58, p < 0.003, k = 10). There were no significant effects for post-traumatic stress (PTS) outcomes (k = 3). Our findings confirm that anxiety and depression levels following perinatal loss are significantly elevated compared to "no loss" controls (live-births, non pregnant from community, or difficult live births). Elevated depression and anxiety rates were also reported for those who experienced loss during later stages of pregnancy. Assessing mental health following loss is a maternal health priority.
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22
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Ferrajão P. Worldviews about the self mediate the impact of immature and mature defense styles on posttraumatic symptoms in bereaved parents. DEATH STUDIES 2021; 46:1390-1400. [PMID: 34514966 DOI: 10.1080/07481187.2021.1975176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The present study analyzed the mediating role of assumptive worldviews on the effect of defense mechanisms on post-traumatic stress symptoms (PTS) in bereaved parents. Sample included a convenience sample of 153 bereaved parents and a control group of 157 nonbereaved parents. Structural equation modeling was conducted to examine our hypotheses. Bereaved parents presented higher levels of PTS and more negative assumptions compared to nonbereaved participants. Worthiness of the self mediated the effect of both immature and mature defense styles on PTS levels, and neurotic defense style directly predicted PTS levels.
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Affiliation(s)
- Paulo Ferrajão
- Faculdade de Ciências da Saúde e do Desporto, Universidade Europeia, Lisbon, Portugal
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23
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Alston M, Thomas D, Jambulingam M, Hunt A, Grover R, Bronner L, Bronner Y. Examining the Relationship Between Sleep-Related Infant Deaths and Social Determinants of Health in Urban Communities. J Racial Ethn Health Disparities 2021; 9:779-785. [PMID: 34133008 DOI: 10.1007/s40615-021-01016-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 02/27/2021] [Accepted: 02/28/2021] [Indexed: 11/24/2022]
Abstract
In 2017, sleep-related infant deaths (SRID) accounted for about 3600 deaths in the USA. The SRID rate for African American infants (186. 41 per 100,000 live births) is more than twice that of Caucasian American infants (85. 43 per 100,000 live births) (Centers for Disease and Prevention, July 2020). PURPOSE The purpose of this article is to develop a case for considering the relationship between racial disparities in SRID and social determinants of health (SDOH) in impoverished communities. The later has been related to chronic stress impacting biological and psychological functioning. The authors advocate that undesirable SDOH be regarded when developing safe sleep strategies for at risk communities, since chronic stress can impact psychological and biologic functioning, possibly manifesting in inconsistent safe sleep practices by caregivers. METHODS An adapted environmental scan (AES), using SRID and SDOH data from impoverished communities, was used to illustrate the comparison of SRID and SDOH in contrasting Baltimore neighborhoods. RESULTS The AES revealed a match between disparities in SRID and SDOH (e.g., educational achievement, unemployment, poverty, poor housing, and violence). The comparison between the SDOH and SRID increases together for named impoverished neighborhoods, as compared to those with low SRID rates in Baltimore. CONCLUSION Rather than limit safe sleep interventions to crib and infant sleeper give-aways, for example, hazardous SDOH seen in impoverished communities should be addressed. We posit that these results will stimulate discussion for well-placed and financed programs, along with policies that focus on decreasing SRID by improving poor SDOH.
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Affiliation(s)
- Margaret Alston
- School of Community Health and Policy, Morgan State University, Portage Hall: 4530 Portage Ave./Room 302K, Baltimore, MD, 21239, USA.
| | - David Thomas
- School of Community Health and Policy, Morgan State University, Portage Hall: 4530 Portage Ave./Room 302K, Baltimore, MD, 21239, USA
| | - Malliga Jambulingam
- School of Community Health and Policy, Morgan State University, Portage Hall: 4530 Portage Ave./Room 302K, Baltimore, MD, 21239, USA
| | - Ariel Hunt
- School of Community Health and Policy, Morgan State University, Portage Hall: 4530 Portage Ave./Room 302K, Baltimore, MD, 21239, USA
| | - Raneitra Grover
- School of Community Health and Policy, Morgan State University, Portage Hall: 4530 Portage Ave./Room 302K, Baltimore, MD, 21239, USA
| | - Leslie Bronner
- Department of Psychiatry, Duke Regional Medical Center, 3643 North Roxboro Road, Durham, NC, 27704, USA
| | - Yvonne Bronner
- School of Community Health and Policy, Morgan State University, Portage Hall: 4530 Portage Ave./Room 302K, Baltimore, MD, 21239, USA
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Abstract
Importance Psychological reactions to perinatal loss, although often self-limited, may lead to significant psychological morbidities. Obstetrician-gynecologists and other maternal health providers play a key role in recognizing the range of psychological responses to perinatal loss and providing education, support, and treatment options to their patients. Objective This review aims to define psychological reactions associated with perinatal loss, examine psychotherapy and psychopharmacologic treatments for psychiatric morbidities, discuss interpregnancy interval following perinatal loss, and highlight brief, psychological interventions that can be implemented by maternal health providers. Evidence Acquisition Search terms "perinatal loss psychology," "reproductive loss grief," "perinatal psychopharmacology," "psychopharmacology grief," and "interpregnancy interval" were utilized to search PubMed, Google Scholar, and PsycINFO. Results Grief is an expected, normal response to perinatal loss. Psychological morbidities, including major depressive disorder, generalized anxiety disorder, and posttraumatic stress disorder, are also associated with perinatal loss. Risk factors for these conditions include history of a psychiatric illness, childlessness, unknown cause of perinatal loss, limited social support, and marital/relationship discord. Careful interviewing and brief screening measures can help identify patients who may suffer from depressive or anxiety disorders following reproductive loss. Patients with perinatal loss can benefit from psychological and possibly pharmacologic treatments. Recommended interpregnancy interval after perinatal loss should be customized by gestational age and cause of loss. Conclusions and Relevance Patients with perinatal loss emotionally benefit from their reproductive health care providers acknowledging the psychological aspects of reproductive loss, inquiring about their emotional needs, and providing information regarding grief and mental health referrals.
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McNeil MJ, Baker JN, Snyder I, Rosenberg AR, Kaye EC. Grief and Bereavement in Fathers After the Death of a Child: A Systematic Review. Pediatrics 2021; 147:peds.2020-040386. [PMID: 33648950 DOI: 10.1542/peds.2020-040386] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/22/2020] [Indexed: 11/24/2022] Open
Abstract
CONTEXT The death of a child is devastating, and complicated grief adversely impacts parental physical and psychosocial well-being. Most research currently is centered on bereaved mothers, and the experiences of fathers remains underexplored. OBJECTIVE We systematically reviewed the literature to characterize the grief and bereavement experiences of fathers after the death of a child. DATA SOURCES We searched Medline, PsycInfo, Embase, and Cumulative Index to Nursing and Allied Health Literature using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. STUDY SELECTION Inclusion criteria encompassed English language articles published between 2007 and 2019 that evaluated the grief and bereavement experiences of fathers after the death of their child. We excluded studies describing paternal bereavement after the death of a child aged older than 21 years, stillbirth, miscarriage, or studies that did not specify age of death. DATA EXTRACTION Extracted domains included study design, demographics, findings, and quality assessment. RESULTS We screened 1848 deduplicated titles and abstracts and 139 full articles, yielding 21 articles for inclusion in this analysis. Fathers often avoided discussing their grief with others, returned to work earlier, and used goal-oriented tasks as coping strategies. Intense grief reactions and posttraumatic psychological sequelae diminished over time in mothers yet persisted in fathers. LIMITATIONS Included studies were primarily descriptive in nature, without ability to ascertain causality. Limited paternal data exists in the literature compared with maternal data. CONCLUSIONS Despite evolving gender roles, many fathers navigate loss through stoicism, self-isolation, and hard work. For some fathers, these coping mechanisms may be inadequate for navigating grief.
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Affiliation(s)
- Michael J McNeil
- Division of Quality and Life and Palliative Care, Department of Oncology St. Jude Children's Research Hospital, Memphis, Tennessee;
| | - Justin N Baker
- Division of Quality and Life and Palliative Care, Department of Oncology St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Ian Snyder
- University of Tennessee Health Science Center, Memphis, Tennessee
| | - Abby R Rosenberg
- Palliative Care and Resilience Laboratory, Seattle Children's Research Institute, Seattle, Washington; and.,Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington
| | - Erica C Kaye
- Division of Quality and Life and Palliative Care, Department of Oncology St. Jude Children's Research Hospital, Memphis, Tennessee
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Martin CJH, Patterson J, Paterson C, Welsh N, Dougall N, Karatzias T, Williams B. ICD-11 complex Post Traumatic Stress Disorder (CPTSD) in parents with perinatal bereavement: Implications for treatment and care. Midwifery 2021; 96:102947. [PMID: 33610906 DOI: 10.1016/j.midw.2021.102947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 12/21/2020] [Accepted: 02/09/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The 11th revision of the WHO International Classification of Diseases (ICD-11) has identified Complex PTSD (CPTSD) as a new condition. AIM To explore whether the new diagnosis of CPTSD (ICD11) is relevant to women who have experienced perinatal bereavement and to advance knowledge about the acceptability, feasibility and perceived impact of delivering an innovative flexible Compassionate Focused Therapy (CFT) informed treatment package to alleviate symptoms of this condition. METHODS A mixed methods study using survey and interviews was conducted. Participants first completed the International Trauma Questionnaire (ITQ) to assess if they met the criteria for PTSD or CPTSD (n=72), and subsequent semi-structured interviews (n=12) identified participants' views about different treatment approaches. PARTICIPANTS A convenience sample of women who had experienced perinatal bereavement were recruited from one geographical region in Scotland. DATA COLLECTION Information was gathered about trauma experiences related to perinatal bereavement; participants' levels of PTSD or CPTSD using the ITQ; and views regarding the features of treatment options. In-depth interviews with women (n=12) and a focus group with staff (n=5) were also conducted. FINDINGS Of 74 participants (n=74) who fully completed the ITQ, 10.8% (n=8) met the criteria for PTSD and 29.7% (n=22) for CPTSD, equating to a total of 40.5% of participants experiencing traumatic stress. Results suggest that CPTSD is a more common condition than PTSD in people with perinatal bereavement, with qualitative data suggesting that CFT and EMDR can be useful and acceptable interventions for this population group. CONCLUSION A feasibility study is recommended next to evaluate acceptability of trial processes in preparation for a definitive randomised controlled trial of a new flexible CFT informed treatment package to address PTSD and CPTSD in people with perinatal bereavement. RECOMMENDATIONS FOR PRACTICE Routine assessment of ICD-11 CPTSD is recommended in this population group.
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Affiliation(s)
- Caroline J Hollins Martin
- Maternal Health, School of Health and Social Care, Edinburgh Napier University (ENU), Sighthill Campus, Edinburgh, Scotland, UK, EH11 4BN.
| | - Jenny Patterson
- School of Health and Social Care, Sighthill Campus, Edinburgh Napier University, 9 Sighthill Court, UK, EH11 4BN.
| | | | - Nicola Welsh
- 'Held in Our Hearts', 177, Colinton Road, Edinburgh, EH14 1BZ, UK.
| | - Nadine Dougall
- School of Health and Social Care, Sighthill Campus, Edinburgh Napier University, 9 Sighthill Court, UK, EH11 4BN, UK.
| | - Thanos Karatzias
- School of Health and Social Care, Sighthill Campus, Edinburgh Napier University, 9 Sighthill Court, UK, EH11 4BN.
| | - Brian Williams
- School of Health and Social Care, 4B06, Sighthill Campus, Edinburgh Napier University, 9 Sighthill Court, UK, EH11 4BN.
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Bayrı Bingöl F, Bal MD, Dişsiz M, Sormageç MT, Yildiz PD. Validity and reliability of the Turkish version of the City Birth Trauma Scale (CityBiTS). J OBSTET GYNAECOL 2020; 41:1023-1031. [PMID: 33263267 DOI: 10.1080/01443615.2020.1821354] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The City Birth Trauma Scale (CityBiTS) was developed to be consistent with the current Diagnostic and Statistical Manual of Mental Disorders-DSM-5. It has been used as a complementary instrument that measures the psychological trauma related to childbirth. The aim of this study was to investigate the validity and reliability of the Turkish version of the CityBiTS. This research is a methodological study. This study was conducted with 315 women who had 6-month-old infants from August to October 2018. The CityBiTS is a 29-item instrument that was developed according to DSM-5 criteria to assess childbirth-related Post-Traumatic Stress Disorder. Test-retest measurements were performed at two-week intervals to evaluate the invariance of the scale over time. Cronbach's alpha coefficient of reliability was used to analyse internal consistency of scale. Cronbach's alpha coefficients were .76 for re-experiencing symptoms, .57 for avoidance symptoms, .77 for negative cognitions and mood, .83 for hyperarousal and .82 for dissociative symptoms. In conclusion, The Turkish version of the CityBiTS, as an instrument developed to be consistent with DSM-5 criteria in assessing childbirth-related trauma symptoms, is a valid and reliable tool.Impact statementWhat is already known on this subject? One of the possible barriers for this is the lack of validated questionnaires that measure the postpartum PTSD.What do the results of this study add? The aim of this study was to investigate the validity and reliability of the Turkish version of the CityBiTS. The City Birth Trauma Scale has good psychometric properties and the two symptom clusters identified are consistent with previous research on symptoms of postpartum PTSD.What are the implications of these findings for clinical practice and/or further research? The City Birth Trauma Scale provides with a measure of birth-related PTSD foruse in research and clinical practice.
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Affiliation(s)
- Fadime Bayrı Bingöl
- Midwifery Department, Marmara University, Health Sciences Faculty, Istanbul, Turkey
| | - Meltem Demirgöz Bal
- Midwifery Department, Marmara University, Health Sciences Faculty, Istanbul, Turkey
| | - Melike Dişsiz
- Hamidiye Faculty of Nursing, University of Health Science, Uskudar, Istanbul, Turkey
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Bayri Bingol F, Demirgoz Bal M. The risk factors for postpartum posttraumatic stress disorder and depression. Perspect Psychiatr Care 2020; 56:851-857. [PMID: 32175591 DOI: 10.1111/ppc.12501] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/22/2020] [Accepted: 03/07/2020] [Indexed: 11/28/2022] Open
Abstract
PURPOSE In this study, we examined the association between specific birth-related variables and postpartum posttraumatic stress disorder (PTSD) and depressive symptoms. DESIGN AND METHODS In this descriptive study, data were collected using a personal information form, the City Birth Trauma Scale, and the Edinburgh Postpartum Depression Scale. FINDINGS The findings revealed that 8.5% of participants met all the diagnostic criteria for PTSD. The risk of developing depression was 9.7 times higher among women who met all the criteria for PTSD than among those who did not meet all the criteria. PRACTICE IMPLICATIONS During the postpartum period, at-risk mothers should be followed and screened for PTSD and depressive symptoms.
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Affiliation(s)
- Fadime Bayri Bingol
- Department of Midwifery, Health Sciences Faculty, Marmara University, Istanbul, Maltepe, Turkey
| | - Meltem Demirgoz Bal
- Department of Midwifery, Health Sciences Faculty, Marmara University, Istanbul, Maltepe, Turkey
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Eli B, Zhou Y, Liang Y, Fu L, Zheng H, Liu Z. A profile analysis of post-traumatic stress disorder and depressive symptoms among Chinese Shidu parents. Eur J Psychotraumatol 2020; 11:1766770. [PMID: 33029310 PMCID: PMC7472999 DOI: 10.1080/20008198.2020.1766770] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 04/21/2020] [Accepted: 05/01/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Due to the one-child policy implemented in China, most families have only one child. When parents experience the death of their only child, these parents receive the label 'Shidu parents'. Shidu is a major public health issue in China. However, the patterns of post-traumatic stress disorder (PTSD) and depressive symptoms that are present in this population remain unclear. OBJECTIVE This study aims to identify profiles of PTSD and depressive symptoms among Shidu parents and to explore the predictors of profile membership. METHODS A total of 363 participants (M age = 61.5 years, SD = 7.5) were asked to complete questionnaires assessing PTSD, depressive symptoms, perceived social support, and demographic information. Latent profile analyses and multivariate logistic regressions were used. RESULTS Three distinct profiles were identified: low (39.4%), moderate (32.8%), and high symptoms (27.8%). Parents who were younger and perceived lower levels of support from family and significant others were more likely to experience higher levels of PTSD and depressive symptoms. CONCLUSIONS These results indicate that the severity of PTSD and depressive symptoms tightly cohere, providing evidence for the co-occurrence of PTSD and depressive symptoms after bereavement. The findings provide valuable information for the development of tailored professional interventions for bereaved parents.
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Affiliation(s)
- Buzohre Eli
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yueyue Zhou
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yiming Liang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Lin Fu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Hao Zheng
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Zhengkui Liu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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Davis SL, Harmon CM, Baker Urquhart B, Moore B, Sprague R. Women and Infants in the Deep South Receiving Perinatal and Neonatal Palliative and Supportive Care Services. Adv Neonatal Care 2020; 20:216-222. [PMID: 31922972 DOI: 10.1097/anc.0000000000000706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND While women in the Deep South area of the United States have higher rates of maternal and infant mortality, palliative and supportive care programs are lacking. Additionally, few studies have detailed referral triggers that are specific to the mother, infant, or pregnancy for inclusion in perinatal and neonatal palliative and supportive care programs. PURPOSE The purpose of this retrospective, descriptive study was to examine the sociodemographic factors and referral triggers for perinatal-neonatal palliative and supportive care services for women enrolled in a newly developed perinatal-neonatal palliative and supportive care program. METHODS Data were collected from medical records of 135 women enrolled in the program. Triggers for referral to the program were classified as fetal, maternal, or prenatal complications. RESULTS A diverse sample of women were enrolled in the program. Most infants survived to birth and discharge from the hospital. Two-thirds of referrals were related to infant complications and 34% were for multiple complications (fetal, maternal, and/or prenatal). Triggers for referral to the program were not related to sociodemographic characteristics of women. IMPLICATIONS FOR PRACTICE A comprehensive list of triggers that include maternal and prenatal complications, in addition to infant complications, may ensure at-risk women and infants, are enrolled in perinatal-neonatal palliative and supportive care programs early in pregnancy, regardless of sociodemographic factors. IMPLICATIONS FOR RESEARCH Prospective research on the effectiveness of perinatal-neonatal palliative and supportive care programs in diverse populations of women is needed. This includes the examination of family health outcomes and provider perspectives.
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Jones K, Robb M, Murphy S, Davies A. New understandings of fathers’ experiences of grief and loss following stillbirth and neonatal death: A scoping review. Midwifery 2019; 79:102531. [DOI: 10.1016/j.midw.2019.102531] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 08/16/2019] [Accepted: 08/21/2019] [Indexed: 10/26/2022]
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Potentially Traumatic Events and Job Satisfaction: A Prospective Population-Based Comparative Study. J Occup Environ Med 2019; 60:e126-e133. [PMID: 29200186 DOI: 10.1097/jom.0000000000001237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to examine the effects of potentially traumatic events (PTEs), posttraumatic stress symptoms (PTSS), and coping self-efficacy (CSE) on post-event job satisfaction. METHODS Repeated analysis of variance (ANOVA) was used to assess differences in the course of job satisfaction during 1 year between population-based samples of affected and nonaffected workers. Multivariate regression analyses were conducted with pre-event health, job satisfaction and insecurity, and postevent PTSS and CSE as predictors. RESULTS About 16% of the affected workers had probable PTSD. The course of job satisfaction between affected (n = 123) and nonaffected workers (n = 644) did not differ significantly. PTSS and CSE did not independently predict post-event satisfaction, in contrast to pre-event job satisfaction. CONCLUSION Findings suggest that when needed social support is provided, concerns about the negative effects of potentially traumatic events on job satisfaction could be somewhat relaxed.
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Pohlkamp L, Kreicbergs U, Sveen J. Bereaved mothers' and fathers' prolonged grief and psychological health 1 to 5 years after loss—A nationwide study. Psychooncology 2019; 28:1530-1536. [DOI: 10.1002/pon.5112] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 05/06/2019] [Accepted: 05/13/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Lilian Pohlkamp
- Department of Health Care Sciences, Palliative Research CentreErsta Sköndal Bräcke University College Stockholm Sweden
| | - Ulrika Kreicbergs
- Department of Health Care Sciences, Palliative Research CentreErsta Sköndal Bräcke University College Stockholm Sweden
- Department of Women's and Children's HealthKarolinska Institutet Stockholm Sweden
| | - Josefin Sveen
- Department of Health Care Sciences, Palliative Research CentreErsta Sköndal Bräcke University College Stockholm Sweden
- Department of Neuroscience, PsychiatryUppsala University Uppsala Sweden
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Watson J, Simmonds A, La Fontaine M, Fockler ME. Pregnancy and infant loss: a survey of families' experiences in Ontario Canada. BMC Pregnancy Childbirth 2019; 19:129. [PMID: 30991981 PMCID: PMC6469137 DOI: 10.1186/s12884-019-2270-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 03/27/2019] [Indexed: 11/29/2022] Open
Abstract
Background Pregnancy and infant loss has a pervasive impact on families, health systems, and communities. During and after loss, compassionate, individualized, and skilled support from professionals and organizations is important, but often lacking. Historically, little has been known about how families in Ontario access existing care and supports around the time of their loss and their experiences of receiving such care. Methods An online cross-sectional survey, including both closed-ended multiple choice questions and one open-ended question, was completed by 596 people in Ontario, Canada relating to their experiences of care and support following pregnancy loss and infant death. Quantitative data were analyzed descriptively using frequency distributions. Responses to the one open-ended question were thematically analyzed using a qualitative inductive approach. Results The majority of families told us that around the time of their loss, they felt they were not adequately informed, supported and cared for by healthcare professionals, and that their healthcare provider lacked the skills needed to care for them. Almost half of respondents reported experiencing stigma from providers, exacerbating their experience of loss. Positive encounters with care providers were marked by timely, individualized, and compassionate care. Families indicated that improvements in care could be made by providing information and explanations, discharge and follow-up instructions, and through discussions about available supports. Conclusions Healthcare professionals can make a positive difference in how loss is experienced and in overall well-being by recognizing the impact of the loss, minimizing uncertainty and isolation, and by thoughtfully working within physical environments often not designed for the experience of loss. Ongoing supports are needed and should be tailored to parents’ changing needs. Prioritizing access to specialized education for professionals providing services and care to this population may help to reduce the stigma experienced by bereaved families.
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Affiliation(s)
- Jo Watson
- Pregnancy and Infant Loss (PAIL) Network, Women and Babies Program, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, Canada. .,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
| | - Anne Simmonds
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Michelle La Fontaine
- Pregnancy and Infant Loss (PAIL) Network, Women and Babies Program, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, Canada
| | - Megan E Fockler
- Pregnancy and Infant Loss (PAIL) Network, Women and Babies Program, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Troisi A. Psychotraumatology: What researchers and clinicians can learn from an evolutionary perspective. Semin Cell Dev Biol 2018; 77:153-160. [DOI: 10.1016/j.semcdb.2017.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/22/2017] [Accepted: 09/05/2017] [Indexed: 12/11/2022]
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van der Velden PG, Pijnappel B, van der Meulen E. Potentially traumatic events have negative and positive effects on loneliness, depending on PTSD-symptom levels: evidence from a population-based prospective comparative study. Soc Psychiatry Psychiatr Epidemiol 2018; 53:195-206. [PMID: 29288318 PMCID: PMC5816097 DOI: 10.1007/s00127-017-1476-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 12/17/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE Examine to what extent adults affected by recent potentially traumatic events (PTE) with different PTSD-symptom levels are more at risk for post-event loneliness than non-affected adults are in the same study period. METHODS We extracted data from the Dutch longitudinal LISS panel to measure pre-event loneliness (2011) and post-event loneliness (2013 and 2014), pre-event mental health problems (2011), PTE and PTSD symptoms (2012). This panel is based on a traditional random sample drawn from the population register by Statistics Netherlands. RESULTS Results of the multinomial logistic regression analyses showed that affected adults with high levels of PTSD symptoms were more at risk for high levels of post-event loneliness than affected adults with very low PTSD-symptom levels and non-affected adults, while controlling for pre-event loneliness, pre-event mental health problems and demographics. However, affected adults with very low levels of PTSD symptoms compared to non-affected adults were less at risk for medium and high levels of post-event loneliness while controlling for the same variables. Yet, pre-event loneliness appeared to be the strongest independent predictor of loneliness at later stages: more than 80% with high pre-event levels had high post-event levels at both follow-ups. CONCLUSIONS Remarkably, potentially traumatic events have depending on PTSD-symptom levels both negative and positive effects on post-event loneliness in favor of affected adults with very low PTSD symptoms levels. However, post-event levels at later stages are predominantly determined by pre-event loneliness levels.
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Affiliation(s)
| | | | - Erik van der Meulen
- INTERVICT, Tilburg University, PO Box 90153, 5000 LE, Tilburg, The Netherlands
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Ayers S, Wright DB, Thornton A. Development of a Measure of Postpartum PTSD: The City Birth Trauma Scale. Front Psychiatry 2018; 9:409. [PMID: 30279664 PMCID: PMC6153962 DOI: 10.3389/fpsyt.2018.00409] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 08/13/2018] [Indexed: 11/29/2022] Open
Abstract
Post-traumatic stress disorder (PTSD) affects 4% of women after birth yet there are very few questionnaire measures of postpartum PTSD that have been validated in this population. In addition, none of the available questionnaires assess postpartum PTSD in accordance with criteria specified in the latest edition of the Diagnostic and Statistical Manual [DSM-5, (1)]. The City Birth Trauma Scale is a 29-item questionnaire developed to measure birth-related PTSD according to DSM-5 criteria of: stressor criteria (A), symptoms of re-experiencing (B), avoidance (C), negative cognitions and mood (D), and hyperarousal (E), as well as duration of symptoms (F), significant distress or impairment (E), and exclusion criteria or other causes (H). Two additional items from DSM-IV were also included on the basis of evidence suggesting they might be important in this population. The first was criterion A2 that women responded to events during birth with intense fear, helplessness or horror. The second was symptoms of emotional numbing. Items were first reviewed by researchers (n = 9) and postpartum women (n = 8) and revised accordingly. The questionnaire was then completed by 950 women recruited online. Results showed the City Birth Trauma Scale had excellent reliability (Cronbach's α = 0.92) and is easy to understand (Flesch reading score 64.17). Exploratory factor analysis found two factors which together accounted for 56% of the variance: (i) Birth-related symptoms (40.8% variance) and (ii) General symptoms (15.5% variance). PTSD symptoms were highly associated with distress, impaired functioning, and women reporting they wanted treatment (r = 0.50-0.61). Removing DSM-IV A2 criteria only increased births classified as traumatic by 2%. Adding the item on emotional numbing did not change the psychometric properties of the scale. These items were therefore removed. The City Birth Trauma Scale has good psychometric properties and the two symptom clusters identified are consistent with previous research on symptoms of postpartum PTSD. This scale therefore provides a promising measure of PTSD following childbirth that can be used in research and clinical practice. Future research should examine the scale's predictive validity using clinical interviews.
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Affiliation(s)
- Susan Ayers
- Centre for Maternal and Child Health Research, City, University of London, London, United Kingdom
| | - Daniel B Wright
- Alder Graduate School of Education, Redwood City, CA, United States
| | - Alexandra Thornton
- Centre for Maternal and Child Health Research, City, University of London, London, United Kingdom
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