A systematic review of instruments measuring grief after perinatal loss and factors associated with grief reactions

"Translation, cultural adaptation, and validation of perinatal grief scale in Urdu: Addressing a gap in the research of perinatal loss in Pakistan-Cross-sectional validation study"

Background and Aims

Perinatal grief have a significant influence on maternal mental health, hence appropriate tools for assessment are necessary. In this study, we translated and validated the Perinatal Grief Scale in Urdu (PGS-Urdu) for use in Pakistan, therefore filling the gap in validated tools.

Methods

Data was collected from 165 women using consecutive sampling. Initially, "forward/backward" translation was used. For validity, content validity index and confirmatory factor analysis (CFA) were used respectively, and "Cronbach's-Alpha" for reliability. In the validity stage, items 8, 11, 23, and 32 of the original scale were eliminated based on feedback from the target groups and the expert panel. For data-analysis, SPSS 26 and Amos 26 were used.

Results

In analyzing the "Confirmatory factor analysis", the "all-fitness indicators" validated the three-factor structure of 29-item main scale. Cronbach alpha value was 0.83 for the entire scale The CFA results showed that all fitness indicators, with the exception of four, had loadings greater than 0.20, supporting the main scale's three-factor structure. With a Cronbach's Alpha value of 0.83 for overall reliability, and varied from 0.81 to 0.87 for the PGS-U variables. the PGS-U exhibits an acceptable level of internal consistency.

Conclusion

The PGS-U identifies women in perinatal grief for medical and social care. This research supports using the Urdu perinatal grief scale in obstetrics and bereavement counseling to reduce maternal mental health issues.

Taiwanese family members' bereavement experience following an expected death: a systematic review and narrative synthesis

BACKGROUND

Bereavement experience is shaped by cultural and social contexts. No systematically constructed reviews were identified to explore the bereavement experience for people who are influenced by Chinese culture valuing filial piety and mutual dependence. This review aimed to systematically review the bereavement experience of Taiwanese family members living in Taiwan following an expected death.

METHODS

MEDLINE, PsycINFO, CINAHL, China Academic Journal Database, and Chinese Electronic Periodical Services were searched with no date restrictions from inception to 20 October 2022. The methodological rigour of studies was assessed using Hawker's appraisal tool. A narrative synthesis approach using Popay's work was employed to synthesise the findings of the studies. Studies investigating Taiwanese family members' bereavement experiences were included. We excluded papers studying bereavement through the death of a child.

RESULTS

Searches retrieved 12,735 articles (after de-duplication), 17 of which met the inclusion criteria and were included for synthesis: English [9] and Chinese [8], published between 2006 and 2021. The studies varied in quality with scores ranging from 22 to 33 out of 36. The studies differed in the relationship between participants and the deceased, the bereaved time frames, and the definitions of bereavement. Most studies focussed on family members of cancer patients receiving specialist palliative care. Three bereavement theories and four tools were used. Risk factors of bereavement outcomes included family members feeling less prepared for death and deaths where palliative sedative therapy was used. Protective factors were higher caregiving burden and longer caregiving periods. Four themes regarding Taiwanese bereavement experience were generated: multiple impacts of death; problem-based coping strategies; importance of maintaining connections; influential religious beliefs and rituals.

CONCLUSION

Continuing the relationship with the deceased is a key element of Taiwanese bereavement experience and it is influenced by religious and cultural beliefs. Suppressing or hiding emotions during bereavement to connect with the deceased and maintain harmonious relationships needs to be acknowledged as culturally acceptable and encouraged by some religions in Taiwan. The findings could be potentially relevant for other Chinese populations, predominantly Buddhist countries or other East Asian societies. The role of preparing for death in bereavement outcomes is little understood and requires further research.

No Baby to Bring Home: Perinatal Loss, Infertility, and Mental Illness-Overview and Recommendations for Care

PURPOSE OF REVIEW

Update readers on the state of the research on mental health, perinatal loss, and infertility with a focus on providing a comprehensive overview to empower clinicians in treating this population.

RECENT FINDINGS

Rates of psychiatric illness are increased in people that experience perinatal loss and infertility. The research remains largely below the clear need for focused screening, prevention, and treatment. Clinicians and researchers need to remain attuned to the impact of perinatal loss and infertility on the mental health of patients and families. Screening, referral, and expanded therapeutic and psychiatric resources are imperative to improving the well-being of these patients and families.

The Integration of the Resolved Through Sharing Perinatal Bereavement Follow-up Model with Latinx Cultural Values: A Case Illustration

The Resolved Through Sharing (RTS) Perinatal bereavement model is an approach used for working with birthing people and their families who have experienced a perinatal loss. RTS is designed to help families cope with their grief and integrate the loss in their lives, meet the needs of the families during the initial crisis, and offer comprehensive care to each member of the family affected by the loss. This paper utilizes a case illustration to describe a year-long bereavement follow-up of an undocumented underinsured Latina woman who suffered a stillbirth during the beginning of the COVID-19 pandemic and the hostile anti-immigrant policy during the Trump presidency. The case illustration is based on a composite case of several Latina women who had pregnancy losses with similar outcomes, demonstrating how a perinatal palliative care (PPC) social worker provided ongoing bereavement support to a patient who experienced a stillbirth. The case illustrates how the PPC social worker utilized the RTS model, incorporated the patient’s cultural values, and acknowledged systemic challenges which resulted in the patient receiving comprehensive, holistic support that aided her emotional and spiritual recovery from her stillbirth. The author ends with a call to action for providers in the field of perinatal palliative care to incorporate practices that allow for greater access and equity for all birthing people.

Paternal Experiences of Perinatal Loss-A Scoping Review

BACKGROUND

Perinatal grief is one of the most complex and devastating types of mourning for both mothers and fathers; however, there is still little research on the psychological impact on men who experience it. Therefore, the objective of this study was to summarize and synthetize the existing literature on the way men's grief is experienced.

METHODS

A search was carried out to examine three databases for articles published in the last four years; 56 articles were obtained, and 12 were retained for analysis.

RESULTS

Four common themes were found: the men's experience of grief, their role as fathers, the impact of the death, and their needs regarding grief and how to face it.

CONCLUSIONS

There is also a need for discussion of the importance of validating perinatal grief in men and studies that examine it without social gender stigmas in order to provide them with effective emotional support.

Multicountry study protocol of COCOON: COntinuing Care in COVID-19 Outbreak global survey of New, expectant, and bereaved parent experiences

INTRODUCTION

Globally, the COVID-19 pandemic has significantly disrupted the provision of healthcare and efficiency of healthcare systems and is likely to have profound implications for pregnant and postpartum women and their families including those who experience the tragedy of stillbirth or neonatal death. This study aims to understand the psychosocial impact of COVID-19 and the experiences of parents who have accessed maternity, neonatal and bereavement care services during this time.

METHODS AND ANALYSIS

An international, cross-sectional, online and/or telephone-based/face-to-face survey is being administered across 15 countries and available in 11 languages. New, expectant and bereaved parents during the COVID-19 pandemic will be recruited. Validated psychometric scales will be used to measure psychosocial well-being. Data will be analysed descriptively and by assessing multivariable associations of the outcomes with explanatory factors. In seven of these countries, bereaved parents will be recruited to a nested, qualitative interview study. The data will be analysed using a grounded theory analysis (for each country) and thematic framework analysis (for intercountry comparison) to gain further insights into their experiences.

ETHICS AND DISSEMINATION

Ethics approval for the multicountry online survey, COCOON, has been granted by the Mater Misericordiae Human Research Ethics Committee in Australia (reference number: AM/MML/63526). Ethics approval for the nested qualitative interview study, PUDDLES, has been granted by the King's College London Biomedical & Health Sciences, Dentistry, Medicine and Natural & Mathematical Sciences Research Ethics Subcommittee (reference number: HR-19/20-19455) in the UK. Local ethics committee approvals were granted in participating countries where required. Results of the study will be published in international peer-reviewed journals and through parent support organisations. Findings will contribute to our understanding of delivering maternity care services, particularly bereavement care, in high-income, lower middle-income and low-income countries during this or future health crises.

Living with Loss: study protocol for a randomized controlled trial evaluating an internet-based perinatal bereavement program for parents following stillbirth and neonatal death

BACKGROUND

Stillbirth and neonatal death are devastating pregnancy outcomes with long-lasting psychosocial consequences for parents and families, and wide-ranging economic impacts on health systems and society. It is essential that parents and families have access to appropriate support, yet services are often limited. Internet-based programs may provide another option of psychosocial support for parents following the death of a baby. We aim to evaluate the efficacy and acceptability of a self-guided internet-based perinatal bereavement support program "Living with Loss" (LWL) in reducing psychological distress and improving the wellbeing of parents following stillbirth or neonatal death.

METHODS

This trial is a two-arm parallel group randomized controlled trial comparing the intervention arm (LWL) with a care as usual control arm (CAU). We anticipate recruiting 150 women and men across Australia who have experienced a stillbirth or neonatal death in the past 2 years. Participants randomized to the LWL group will receive the six-module internet-based program over 8 weeks including automated email notifications and reminders. Baseline, post-intervention, and 3-month follow-up assessments will be conducted to assess primary and secondary outcomes for both arms. The primary outcome will be the change in Kessler Psychological Distress Scale (K10) scores from baseline to 3-month follow-up. Secondary outcomes include perinatal grief, anxiety, depression, quality of life, program satisfaction and acceptability, and cost-effectiveness. Analysis will use intention-to-treat linear mixed models to examine psychological distress symptom scores at 3-month follow-up. Subgroup analyses by severity of symptoms at baseline will be undertaken.

DISCUSSION

The LWL program aims to provide an evidence-based accessible and flexible support option for bereaved parents following stillbirth or neonatal death. This may be particularly useful for parents and healthcare professionals residing in rural regions where services and supports are limited. This RCT seeks to provide evidence of the efficacy, acceptability, and cost-effectiveness of the LWL program and contribute to our understanding of the role digital services may play in addressing the gap in the availability of specific bereavement support resources for parents following the death of a baby, particularly for men.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry, ACTRN12621000631808 . Registered prospectively on 27 May 2021.

Miscarriage, Perceived Ostracism, and Trauma: A Preliminary Investigation

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).