Resolution of depression and grief during the first year after miscarriage: a randomized controlled clinical trial of couples-focused interventions

The impact of midwife/nurse-led psychosocial interventions on parents experiencing perinatal bereavement: An integrative review

BACKGROUND

Perinatal loss is a traumatic event associated with a high risk of parents experiencing negative psychological outcomes. Despite most parents being in regular contact with midwives and nurses during the perinatal period, there is a lack of evidence which hampers these professionals from using effective psychosocial interventions with parents.

AIM

This study aims to synthesise the existing evidence on the types of psychosocial interventions delivered by midwives/nurses for parents with perinatal bereavement, their impacts on bereaved parents' mental health and the experiences of midwives and nurses in delivering psychosocial interventions for parents experiencing perinatal loss.

DESIGN

An integrative review of the literature.

METHODS

Whittemore and Knafl's five-stage integrative review framework guided this review. A systematic literature search of the Medline, PsycINFO, Embase, CINAHL and ASSIA, Cochrane Library and ProQuest databases was conducted from inception to January 2023, with no language or geographical limiters set due to the paucity of research published in this subject area. Two researchers independently screened and reviewed each study's data extraction and methodological quality using the Joanna Briggs Institute and Mixed Method Appraisal Tool. Results were analysed and synthesised using narrative synthesis.

RESULTS

A total of 21 studies met the inclusion criteria. From these, we identified nine types of psychosocial interventions for perinatal bereavement that can be delivered by midwives and nurses. The positive impacts of midwife/nurse-led psychosocial interventions on grief, anxiety, depression posttraumatic stress disorder and other psychosocial outcomes amongst parents experiencing perinatal loss have been demonstrated. In addition, we identified the useful components of these interventions and the experiences of midwives and nurses in delivering psychosocial interventions, thereby highlighting barriers such as lack of knowledge and skills, stressful working environments and inadequate emotional support.

CONCLUSION

Our findings demonstrate that midwife/nurse-led psychosocial interventions have the potential to improve grief, anxiety, depression, posttraumatic stress disorder symptoms and other psychosocial outcomes for parents experiencing perinatal loss. Thus, future research should consider training, workload, time cost and emotional support for midwives/nurses when developing midwife/nurse-led psychosocial interventions for parents with perinatal loss.

REGISTRATION NUMBER

CRD42022369032.

TWEETABLE ABSTRACT

Midwife/nurse-led psychosocial interventions have the potential to improve mental health amongst parents experiencing perinatal loss.

Validation of the Revised Impact of Miscarriage Scale in the Republic of Burundi: A cross-sectional multicenter study

OBJECTIVE

The objective of this study was to translate and validate the Revised Impact of Miscarriage Scale (RIMS) into Kirundi for use among women and men in Burundi. Additionally, the study aimed to compare the experience and personal meaning of miscarriage between women and men.

METHODS

This is a cross-sectional multicentered study. The RIMS was translated into Kirundi. Cronbach coefficient alpha and its internal consistency were measured for both genders. An exploratory factor analysis (EFA) was used to determine the underlying factors and the shared variance. Both women and men completed the RIMS questionnaire, while women completed sociodemographic, reproductive and mental health questions.

RESULTS

In all, 79 couples completed the RIMS. The original factor structure was retained after the EFA, with 68% of the shared variance explained in the three-factor solution with 16 questions. Isolation/guilt, Loss of baby, and Devastating event. The internal consistency for women and men combined was α = 0.928. Although women scored higher on the factors of Isolation/guilt and Loss of baby, there were no significant differences in the Devastating event factor between women and men. Couples scores were positively correlated. Women who had experienced a previous miscarriage were more significantly impacted by all three factors compared to women experiencing their first miscarriage.

CONCLUSIONS

The Kirundi translation of the RIMS retained the original factor structure and demonstrated excellent internal consistency α = 0.928 in women and men combined. The RIMS could be a tool for caregivers to identify individuals who require additional support after a miscarriage.

Navigating Loss Together: A Scoping Review of Couples Therapy Interventions for Perinatal Death

The loss of a pregnancy at any stage can serve as an enormous stressor to a couple's relationship. However, empirically based interventions to reduce distress after perinatal loss have historically been aimed at the pregnant person, not the couple dyad. This excludes non-birthing individuals from receiving professional support and leads to a deficit in evidence-based therapeutic support for the couple dyad at a time in which a lack of connection has been shown to contribute to poor mental health and relationship outcomes for the individual and couple. This scoping review examines existing couple-based interventions for perinatal loss and the measurement of impact on the individual and couple dyad.

Utility of early, short psychological care for women who experience early miscarriage: protocol for the randomized, controlled MisTher trial

BACKGROUND

Around one in ten women will have a miscarriage in their lifetime. Miscarriage is often considered a trivial event by caregivers, but it is associated with a high burden of psychological morbidity, especially during the first 6 months. There is no validated psychological management strategy for women who have had a miscarriage. The MisTher study aims to evaluate the utility of early, short psychological care for women who have had early miscarriage, in terms of anxiety, depression and post-traumatic stress disorder.

METHODS

This is a prospective, multicenter, randomized, controlled, superiority study. In total, 932 women who have experienced early miscarriage (spontaneous interruption of pregnancy prior to 14 weeks of gestation) will be randomly assigned to either the intervention or the control group. The intervention consists of 4 teleconsultations of 45 min with a psychologist. All women, regardless of their allocated group, will be encouraged to seek an early consultation with a general practitioner or midwife. The primary endpoint will be anxiety at 3 months after randomization evaluated using State Trait Anxiety Inventory. The secondary endpoints will be anxiety at 6 months evaluated using State Trait Anxiety Inventory, depression at 3 and 6 months evaluated with the Beck Depression Inventory, and post-traumatic stress disorder at 3 and 6 months, evaluated using the Posttraumatic stress disorder Checklist Scale.

DISCUSSION

This project will validate the importance of early psychological management, based on primary care and accessible to most women, via teleconsultation, in reducing the frequency of psychological disorders after early miscarriage. Our results should provide a basis for new recommendations for the management of women who have experienced miscarriage, notably by recommending the involvement of trained psychologists in the management pathway for these women.

TRIAL REGISTRATION

The trial is registered with ClinicalTrials.gov: NCT05653414. December 15th, 2022.

Why Does Grief Hurt?

Abstract. Grief is a major physical and psychological health concern for adults, as well as a key risk factor for depression. The direct and indirect costs of depression in adults place heavy burdens on societal resources. Indeed, bereavement is a stressful and profound life experience, with the grieving process combining reactions to a loss that may originate in complications for bereaved individuals. The goal of this systematic review is to synthesize the findings regarding depression and grief. Studies related to the topic were obtained from multiple databases through rigorous exclusion and inclusion criteria. Only empirical studies with quantitative methodologies were included. Objectives, sample (type of sample, % male, and age), instruments, and main conclusions were extracted from each study. Overall, there are personality and contextual factors that, in addition to affecting depressive reactions following a loss, may also interface with one’s ability to grieve. Furthermore, after the patient’s death, there was a decrease in depressive symptoms over time, indicating that these symptoms are dynamic. Individuals who experience prolonged grief exhibit depressive symptoms, and those who suffer a loss may have depressive symptoms, but in a natural and non-pathological way, that is, sadness and not depression. Depression tends to decrease over time, with the existence of more children and a focus on occupation.

Estimation of stillbirths attributable to ambient fine particles in 137 countries

Gestational exposure to ambient fine particles (PM_2.5) increases the risk of stillbirth, but the related disease burden is unknown, particularly in low- and middle-income countries (LMICs). We combine state-of-the-art estimates on stillbirths, and multiple exposure-response functions obtained from previous meta-analyses or derived by a self-matched case-control study in 54 LMICs. 13,870 stillbirths and 32,449 livebirths are extracted from 113 geocoded surveys from the Demographic and Health Surveys. Each stillbirth is compared to livebirth(s) of the same mother using a conditional logit regression. We find that 10-µg/m³ increase of PM_2.5 is associated with an 11.0% (95% confidence interval [CI] 6.4, 15.7) increase in the risk of stillbirth, and the association is significantly enhanced by maternal age. Based on age-specific nonlinear PM_2.5-stillbirth curves, we evaluate the PM_2.5-related stillbirths in 137 countries. In 2015, of 2.09 (95% CI: 1.98, 2.20) million stillbirths, 0.83 (0.54, 1.08) million or 39.7% (26.1, 50.8) are attributable to PM_2.5 exposure exceeding the reference level of 10 μg/m³. In LMICs, preventing pregnant women from being exposed to PM_2.5 can improve maternal health.

Individual counseling in mothers bereaved by pregnancy loss: A randomized clinical trial

BACKGROUND

The loss of a pregnancy can result in grief, guilt, self-doubt, anxiety, and post-traumatic stress disorder (PTSD). Considering the side effects mentioned for mental health and the fact that the symptoms will linger if left untreated and even adversely affect the subsequent pregnancies. The current study was designed to assess the impact of individual counseling on stress, anxiety, and depression in mothers with pregnancy loss.

MATERIALS AND METHODS

The study commenced 100 women who experienced pregnancy loss (in Urmia/2018-2019); they were enrolled using convenience sampling and block randomization. The intervention group received four individual counseling sessions (weekly sessions with a duration of 1 h) based on Warden's principles. The control group received routine care. The Depression Anxiety Stress Scale (DASS-42) was filled out at baseline, the pre- and post-intervention. Analyses were performed using the Chi-square, paired, or individual t-tests, when necessary. P value < 0.05 was considered significant.

RESULTS

There were no significant differences regarding socio-demographic characteristics and clinical features between groups at baseline. Intra-group analysis showed that all outcome measures in the intervention group were significantly improved. According to inter-groups analysis, a significant association was found between pre-test and post-test in the intervention group (P < 0.05).

CONCLUSION

Results of this study can clarify the psychological effects of pregnancy loss in these mothers and help the officials and responsible parties to plan the treatment and rehabilitation of these women and include them in the healthcare system.

Spontaneous Miscarriage Management Experience: A Systematic Review

Background: The estimated frequency of spontaneous miscarriage is about a quarter of all clinically identified pregnancies in the United States. Women typically go to the emergency department (ED) or outpatient clinic when they experience symptoms, including but not limited to vaginal bleeding, abdominal pain, and contractions. The care that is provided varies from place to place.

Methods: Researchers searched articles from 2010 to 2021 for reports mentioning treatment for spontaneous abortion. Search terms included "miscarriage aftercare" and "spontaneous abortion care," seeking articles addressing the psychological effects of miscarriage and reporting patient experiences in different clinical settings. Data were independently reviewed, graded for evidence quality, and assessed for risk bias using the AMSTAR checklist.

Results: The search strategy yielded 2,275 articles, six of which met the inclusion criteria. Conservative, medical, and surgical management were provided, with surgical management being more common among women with higher education and socioeconomic status. All qualitative studies reported dissatisfaction with care provided in the emergency department, partially due to a lack of emotional support. Structured bereavement intervention was beneficial for women experiencing early pregnancy loss and led to fewer reports of despair. The quantitative studies referenced interventions that aided patients in coping with pregnancy loss and identified several factors influencing the type of treatment received as well as the patient's ability to cope with feeling depressed following a miscarriage.

Conclusion: Psychological management is not regularly addressed in the emergency department, and protocols including bereavement education for healthcare providers as well as patient involvement in management would improve the overall patient experience with spontaneous miscarriage care.

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).

The miscarriage circle of care: towards leveraging online spaces for social support

Background

Lack of social support during and after miscarriage can greatly affect mental wellbeing. With miscarriages being a common experience, there remains a discrepancy in the social support received after a pregnancy is lost.

Method

42 people who had experienced at least one miscarriage took part in an Asynchronous Remote Community (ARC) study. The study involved 16 activities (discussions, creative tasks, and surveys) in two closed, secret Facebook groups over eight weeks. Descriptive statistics were used to analyse quantitative data, and content analysis was used for qualitative data.

Results

There were two main miscarriage care networks, formal (health care providers) and informal (friends, family, work colleagues). The formal care network was the most trusted informational support source, while the informal care network was the main source of tangible support. However, often, participants’ care networks were unable to provide sufficient informational, emotional, esteem, and network support. Peers who also had experienced miscarriage played a crucial role in addressing these gaps in social support. Technology use varied greatly, with smartphone use as the only common denominator. While there was a range of online support sources, participants tended to focus on only a few, and there was no single common preferred source.

Discussion

We propose a Miscarriage Circle of Care Model (MCCM), with peer advisors playing a central role in improving communication channels and social support provision. We show how the MCCM can be used to identify gaps in service provision and opportunities where technology can be leveraged to fill those gaps.

Developing an Internet-Based Trauma Recovery Nursing Intervention Based on Swanson's Theory of Caring for Trauma Recovery

This study aimed to develop an Internet-based psychiatric nursing intervention, based on Swanson’s theory of caring, that could alleviate post-traumatic stress symptoms and improve the health functioning of adults who had experienced trauma. To evaluate the appropriateness and understanding of the program content, expert advice and content validity were examined using the content validity index. To analyze the participants’ responses and evaluate the appropriateness of conducting Internet-based programs, an online intervention program was implemented with five nurses between February and April 2020. The trauma recovery nursing intervention program was for adults who had experienced trauma and consisted of eight sessions, each lasting 30 min. It included a spoken audio track that was accompanied by visual prompts to provide knowledge on traumatic stress and introduce trauma recovery methods. Its online format made it convenient and widely accessible, and allowed for a low-intensity, cost-effective educational program. The program focused on providing self-help guidelines for clients to develop their mental and physical well-being. The results provide evidence that mental health nurses could develop and implement online programs to care for people who have experienced trauma. Such programs could provide trauma recovery for marginalized people unable to otherwise receive help.

Nursing Interventions to Facilitate the Grieving Process after Perinatal Death: A Systematic Review

Perinatal death is the death of a baby that occurs between the 22nd week of pregnancy (or when the baby weighs more than 500 g) and 7 days after birth. After perinatal death, parents experience the process of perinatal grief. Midwives and nurses can develop interventions to improve the perinatal grief process. The aim of this review was to determine the efficacy of nursing interventions to facilitate the process of grief as a result of perinatal death. A systematic review of the literature was carried out. Studies that met the selection criteria underwent a quality assessment using the Joanna Briggs Institute critical appraisal tool. Four articles were selected out of the 640 found. Two are quasi-experimental studies, and two are randomized controlled clinical studies. The interventions that were analyzed positively improve psychological self-concept and role functions, as well as mutual commitment, depression, post-traumatic stress and symptoms of grief. These interventions are effective if they are carried out both before perinatal loss and after it has occurred. The support of health professionals for affected parents, their participation in the loss, expressing feelings and emotions, using distraction methods, group sessions, social support, physical activity, and family education are some of the effective interventions.

Effectiveness of empathic caring on stress and depression for women with recurrent miscarriage: A randomized controlled trial

AIM

The purpose of this study was to investigate the effectiveness of empathic caring on sleep quality, depression, stress, and social support in women with recurrent miscarriage.

MATERIALS AND METHODS

Sixty-two eligible women were randomly assigned to either the experimental group (n = 31), which received three face-to-face nursing counseling sessions, or the control group (n = 31). Outcome measures included the Pittsburgh Sleep Quality Index, Edinburgh Prenatal Depression Scale, Perceived Stress Scale, and Interpersonal Support Evaluation List.

RESULTS

Paired-sample t-tests revealed that, after receiving nursing counseling, the participants in the experimental group showed significant decreases in stress and depression. However, no significant mean differences were found in the control group between the pretest and the 12-week posttest for any of the four outcome measures.

CONCLUSION

Clinical healthcare professionals may incorporate empathic caring into health-promotion protocols to assist women with recurrent miscarriage to improve their psychosocial health.

Traditional Masculinity: A Review of Toxicity Rooted in Social Norms and Gender Socialization

The toxicity of traditional masculinity has become a heated topic of mainstream media debate since the American Psychological Association's release of psychological treatment guidelines for men and boys. To recognize how traditional masculinity is toxic, there needs to be greater understanding of the social norms and gender socialization behind traditional masculinity. Gender-based social norms and gender socialization have had dire consequences on how men behave, act in relationships, and care for their health. There is a need to reform the perception of masculinity in the contemporary social climate.

Psychosocial interventions on psychological outcomes of parents with perinatal loss: A systematic review and meta-analysis

BACKGROUND

Perinatal loss can occur due to miscarriages and ectopic pregnancies, among other circumstances. Psychological health of parents can deteriorate due to perinatal loss. Parent's negative psychological outcomes include depression, anxiety, and grief.

OBJECTIVE

To evaluate the effectiveness of psychosocial interventions in reducing depression, anxiety, and grief among parents after perinatal loss.

DESIGN

A systematic review and meta-analysis of randomized controlled trials DATA SOURCES: English language articles published from database inception to 19 November 2019 were systematically retrieved from eight electronic databases (CINAHL, Cochrane, EMBASE, ProQuest Dissertations and Theses Global, PsycINFO, PubMed, Scopus, Web of Science).

REVIEW METHODS

The Cochrane Risk of Bias tool was used to conduct quality appraisal of each individual article and data was analyzed using Review Manager 5.3. A meta-analysis of randomized controlled trials was conducted using a random-effect model.

RESULTS

Among this review's 17 included studies, 15 studies' results were included in the meta-analyses. The remaining two studies were summarized narratively. Meta-analyses revealed that psychosocial interventions significantly reduced depression (95% CI: -0.64 to -0.29, Z = 5.17, p = <0.00001), anxiety (95% CI: -0.50 to -0.18, Z = 4.21, p < 0.0001) and grief (95% CI: -0.71 to -0.32, Z = 5.12, p < 0.0001).

CONCLUSION

Psychosocial interventions are effective in improving depression, anxiety, and grief amongst parents with perinatal loss. Psychosocial care can be provided by medical healthcare professionals and expanded with technology-assisted implementation.

STUDY REGISTRATION NUMBER

CRD42019145526.

Effect of supportive care on the psychosocial health status of women who had a miscarriage

PURPOSE

This study aims to determine the effect of individualized care provided based on Swanson's Caring Theory on the grief, depression, anxiety, and stress levels of women who had a miscarriage.

DESIGN AND METHODS

A total of 104 women who experienced a miscarriage were randomized as study (n = 52) and control (n = 52) groups.

FINDINGS

The women's physical, emotional, behavioral, and cognitive grief symptoms decreased after receiving Swanson's care (P < .001). Negative feelings about the future, level of depression, and anxiety levels diminished after receiving Swanson's Care (P < .001).

PRACTICE IMPLICATIONS

Supportive care and counseling provided after miscarriage were found to contribute to women's psychosocial well-being and to improve their ability to cope with psychological symptoms.

Management of first-trimester miscarriage: a systematic review and network meta-analysis

BACKGROUND

First-trimester miscarriage affects up to a quarter of women worldwide. With many competing treatment options available, there is a need for a comprehensive evidence synthesis.

OBJECTIVES AND RATIONALE

We conducted a systematic review and network meta-analysis to assess the effectiveness and safety of treatment options for first-trimester miscarriage: expectant management (EXP), sharp dilation and curettage (D+C), electric vacuum aspiration (EVAC), manual vacuum aspiration (MVA), misoprostol alone (MISO), mifepristone+misoprostol (MIFE+MISO) and misoprostol plus electric vacuum aspiration (MISO+EVAC).

SEARCH METHODS

We searched MEDLINE, Embase, CINAHL, AMED and Cochrane Library from inception till June 2018. We included randomized trials of women with first-trimester miscarriage (<14 weeks gestation) and conducted a network meta-analysis generating both direct and mixed evidence on the effectiveness and side effects of available treatment options. The primary outcome was complete evacuation of products of conception. We assessed the risk of bias and the global network inconsistency. We compared the surface under the cumulative ranking curve (SUCRA) for each treatment.

OUTCOMES

A total of 46 trials (9250 women) were included. The quality of included studies was overall moderate with some studies demonstrating a high risk of bias. We detected unexplained inconsistency in evidence loops involving MIFE+MISO and adjusted for it. EXP had lower effectiveness compared to other treatment options. The effectiveness of medical treatments was similar compared to surgery. Mixed evidence of low confidence suggests increased effectiveness for MIFE+MISO compared to MISO alone (RR 1.49, 95% CI: 1.09-2.03). Side effects were similar among all options. Fewer women needed analgesia following EVAC compared to MISO (RR for MISO 0.43, 95% CI: 0.27-0.68) and in the EXP group compared to EVAC (RR 2.07, 95% CI: 1.25-3.41). MVA had higher ranking (low likelihood) for post-treatment infection and serious complications (SUCRA 87.6 and 79.2%, respectively) with the highest likelihood for post-treatment satisfaction (SUCRA 98%).

WIDER IMPLICATIONS

Medical treatments for first-trimester miscarriage have similar effectiveness and side effects compared to surgery. The addition of MIFE could increase the effectiveness of MISO and reduce side effects, although evidence is limited due to inconsistency. EXP has lower effectiveness compared to other treatment options.Systematic review registration: Prospero CRD42016048920.

The Effect of Brief Supportive Psychotherapy on Prevention of Psychiatric Morbidity in Women with Miscarriage: A Randomized Controlled Trial about the First 24-hours of Hospitalization

OBJECTIVES

Miscarriage is a common pregnancy complication causing substantial psychiatric complications. This study was designed to investigate whether the administration of brief supportive psychotherapy (BSP) is effective on the management of women with miscarriage when conducted in the first 24 hours of hospitalization in order to prevent symptoms of anxiety, depression, and grief at four-months post-miscarriage.

METHODS

We conducted a randomized clinical trial on 79 women with miscarriage hospitalized in Ayatollah Rohani teaching hospital. The women were randomly assigned into two groups (39 in the experimental group and 40 in the control group). All interventions were implemented for two study groups during the first 24 hours of hospitalization in a private room in the hospital. The experimental group received a two-hour BSP. The objective outcomes were assessed using Hospital Anxiety and Depression Scale and Perinatal Grief Scale (PGS), which has three subscales (active grief, difficulty coping, and despair) and were measured before the intervention and at four-months post-miscarriage.

RESULTS

The results of pre-tests in the follow-up of the trial suggested that the participants who received BSP reported significant reductions in the mean scores of active grief (-34.2±9.7 vs. 28.1±-6.9), difficulty coping (27.1±6.4 vs. 23.3±4.3), despair (28.0±8.4 vs. 22.8±5.2), and total PGS (89.6±23.1 vs. 74.4±15.3), in contrast to participants in the control group who did not report such results. Further, the results of generalized estimating equations models revealed that brief supportive psychotherapy caused a significant decrease in the level of factors including active grief, difficulty coping, despair, total perinatal grief, anxiety symptoms, and depressive symptoms in subjects in the experimental group compared to those in the control group after miscarriage. Also, the frequency of anxiety symptoms (13.5% vs. 60.5%), depressive symptoms (32.4% vs. 71.1%), and grief symptoms (10.8% vs. 65.8%) was found to be significantly lower in the group receiving psychotherapy than in the control group at four-months follow-up.

CONCLUSIONS

Administration of BSP session during the first 24 hours of hospitalization for women with miscarriage can be considered a reliable method to prevent anxiety symptoms, depression symptoms, and perinatal grief at four-months follow-up.

Men's grief following pregnancy loss and neonatal loss: a systematic review and emerging theoretical model

BACKGROUND

Emotional distress following pregnancy loss and neonatal loss is common, with enduring grief occurring for many parents. However, little is known about men's grief, since the majority of existing literature and subsequent bereavement care guidelines have focused on women. To develop a comprehensive understanding of men's grief, this systematic review sought to summarise and appraise the literature focusing on men's grief following pregnancy loss and neonatal loss.

METHODS

A systematic review was undertaken with searches completed across four databases (PubMed, PsycINFO, Embase, and CINAHL). These were guided by two research questions: 1) what are men's experiences of grief following pregnancy/neonatal loss; and 2) what are the predictors of men's grief following pregnancy/neonatal loss? Eligible articles were qualitative, quantitative or mixed methods empirical studies including primary data on men's grief, published between 1998 and October 2018. Eligibility for loss type included miscarriage or stillbirth (by any definition), termination of pregnancy for nonviable foetal anomaly, and neonatal death up to 28 days after a live birth.

RESULTS

A final sample of 46 articles were identified, including 26 qualitative, 19 quantitative, and one mixed methods paper. Findings indicate that men's grief experiences are highly varied, and current grief measures may not capture all of the complexities of grief for men. Qualitative studies identified that in comparison to women, men may face different challenges including expectations to support female partners, and a lack of social recognition for their grief and subsequent needs. Men may face double-disenfranchised grief in relation to the pregnancy/neonatal loss experience.

CONCLUSION

There is a need to increase the accessibility of support services for men following pregnancy/neonatal loss, and to provide recognition and validation of their experiences of grief. Cohort studies are required among varied groups of bereaved men to confirm grief-predictor relationships, and to refine an emerging socio-ecological model of men's grief.

TRIALS REGISTRATION

PROSPERO registration number: CRD42018103981.

Health professionals' roles and practices in supporting women experiencing miscarriage: A qualitative study

BACKGROUND

Miscarriage can result in significant psychological morbidity. Research suggests health professionals play a role in shaping women's experience of miscarriage.

AIMS

This study explored the views and practices of Australian health professionals in caring for women experiencing miscarriage.

MATERIALS AND METHODS

Twelve health professionals from disciplines including medicine, midwifery and sonography were purposively sampled. Semi-structured interviews were recorded, transcribed and subjected to thematic analysis.

RESULTS

Participants acknowledged miscarriage is often a distressing event associated with feelings of grief and failure. They believed women who conceived through in vitro fertilisation, had experienced multiple miscarriages, or had a pre-existing mental illness were likely to experience more distress than others. Despite limited training, participants generally felt competent in their abilities to provide emotional support. They viewed their role largely as guilt-mitigation, which they achieved by stressing the frequency of miscarriage and emphasising that women were not at fault. Follow-up practices varied, and where they did occur, focused on physical recovery. Generally, participants relied on women to express the need for further support. Participants reported that time and resource issues, compassion fatigue and a need for self-protection restricted their abilities to provide better support care.

CONCLUSIONS

There are discrepancies between the emotional support health professionals think women want and are able to provide, and the support women would like. This exploratory study suggests the need for further investigation into provision of improved health professional support for women.

Hope for the best …but expect the worst: a qualitative study to explore how women with recurrent miscarriage experience the early waiting period of a new pregnancy

OBJECTIVE

To investigate how women experience the initial period of a new pregnancy after suffering recurrent miscarriage (RM).

DESIGN

A qualitative study, nested within a randomised controlled feasibility study of a coping intervention for RM, used semi-structured face-to-face interviews. Interviews were audio-recorded, transcribed verbatim and analysed using a thematic network approach.

SETTING

Participants were recruited from the Recurrent Miscarriage Clinic and Early Pregnancy Unit in two tertiary referral hospitals in the UK.

PARTICIPANTS

14 women with RMs and who had previously participated in the randomised controlled trial (RCT) feasibility component of the study were recruited.

RESULTS

Seven organising themes emerged from the data: (1) turmoil of emotions, (2) preparing for the worst, (3) setting of personal milestones, (4) hypervigilance, (5) social isolation, (6) adoption of pragmatic approaches, (7) need for professional affirmation.

CONCLUSIONS

The study established that for women with a history of RM, the waiting period of a new pregnancy is a traumatic time of great uncertainty and emotional turmoil and one in which they express a need for emotional support. Consideration should be given to the manner in which supportive care is best delivered within the constraints of current health service provision.

TRIAL REGISTRATION NUMBER

ISRCTN43571276.

Application of Caring Theory to Nursing Care of Women Experiencing Stillbirth

PURPOSE

The purpose of this study was to determine the extent to which labor and delivery nurses used the tenets of Swanson's middle-range theory to care for women whose babies were stillborn.

STUDY DESIGN AND METHODS

A secondary analysis of qualitative in-depth interview data from 20 labor and delivery nurses obtained during a recent grounded theory study was conducted using the directed content analysis method. The five caring processes as described in Swanson's theory were used as a priori codes to conduct the analysis.

RESULTS

Nursing care of a woman experiencing a stillbirth included finding a way to connect with her and to understand what she was experiencing (knowing), spending extra time with her (being with), protecting her and preserving her dignity (doing for), providing information and explanations in a clear and methodical manner (enabling), and ensuring that she did not blame herself to facilitate the grieving/healing process (maintaining belief).

CLINICAL IMPLICATIONS

The caring processes outlined in Swanson's theory of caring provide a valuable guide that can be used when caring for women experiencing stillbirth.

Outcomes in prevention and management of miscarriage trials: a systematic review

BACKGROUND

There is a substantial body of research evaluating ways to prevent and manage miscarriage, but all studies do not report on the same outcomes.

OBJECTIVE

To review systematically, outcomes reported in existing miscarriage trials.

SEARCH STRATEGY

MEDLINE, Embase, CINAHL, and Cochrane were searched from inception until January 2017.

SELECTION CRITERIA

Randomised controlled trials (RCTs) reporting prevention or management of miscarriage. Miscarriage was defined as a pregnancy loss in the first trimester.

DATA COLLECTION AND ANALYSIS

Data about the study characteristics, primary, and secondary outcomes were extracted.

MAIN RESULTS

We retrieved 1553 titles and abstracts, from which 208 RCTs were included. For prevention of miscarriage, the most commonly reported primary outcome was live birth and the top four reported outcomes were pregnancy loss/stillbirth (n = 112), gestation of birth (n = 68), birth dimensions (n = 65), and live birth (n = 49). For these four outcomes, 58 specific measures were used for evaluation. For management of miscarriage, the most commonly reported primary outcome was efficacy of treatment. The top four reported outcomes were bleeding (n = 186), efficacy of miscarriage treatment (n = 105), infection (n = 97), and quality of life (n = 90). For these outcomes, 130 specific measures were used for evaluation.

CONCLUSIONS

Our review found considerable variation in the reporting of primary and secondary outcomes along with the measures used to assess them. There is a need for standardised patient-centred clinical outcomes through the development of a core outcome set; the work from this systematic review will form the foundation of the core outcome set for miscarriage.

TWEETABLE ABSTRACT

There is disparity in the reporting of outcomes and the measures used to assess them in miscarriage trials.

Couple therapy for depression

BACKGROUND

Couple therapy for depression has the twofold aim of modifying negative interaction patterns and increasing mutually supportive aspects of intimate relationships, changing the interpersonal context of depression. Couple therapy is included in several guidelines among the suggested treatments for depression.

OBJECTIVES

1. The main objective was to examine the effects of couple therapy compared to individual psychotherapy for depression.2. Secondary objectives were to examine the effects of couple therapy compared to drug therapy and no/minimal treatment for depression.

SEARCH METHODS

The Cochrane Common Mental Disorders Group Controlled Trials Register (CCMDCTR), the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase (Ovid) and PsycINFO (Ovid) were searched to 19 February 2018. Relevant journals and reference lists were checked.

SELECTION CRITERIA

Randomised and quasi-randomised controlled trials examining the effects of couple therapy versus individual psychotherapy, drug therapy, or no treatment/minimal treatment for depression were included in the review.

DATA COLLECTION AND ANALYSIS

We considered as primary outcomes the depressive symptom level, the depression persistence, and the dropouts; the relationship distress level was a secondary outcome. We extracted data using a standardised spreadsheet. Where data were not included in published papers, we tried to obtain the data from the authors. We synthesised data using Review Manager software version 5.3. We pooled dichotomous data using the relative risk (RR), and continuous data calculating the standardised mean difference (SMD), together with 95% confidence intervals (CIs). We employed the random-effects model for all comparisons and also calculated a formal test for heterogeneity, the natural approximate Chi² test.

MAIN RESULTS

We included fourteen studies from Europe, North America, and Israel, with 651 participants. Eighty per cent of participants were Caucasian. Therefore, the findings cannot be considered as applicable to non-Western countries or to other ethnic groups in Western countries. On average, participants had moderate depression, preventing the extension of results to severely depressed patients. Almost all participants were aged between 36 and 47 years.There was no evidence of difference in effect at the end of treatment between couple therapy and individual psychotherapy, either for the continuous outcome of depressive symptoms, based on nine studies with 304 participants (SMD -0.17, 95% CI -0.44 to 0.10, low-quality evidence), or the proportion of participants remaining depressed, based on six studies with 237 participants (RR 0.94, 95% CI 0.72 to 1.22, low-quality evidence). Findings from studies with 6-month or longer follow-up confirmed the lack of difference between the two conditions.No trial gave information on harmful effects. However, we considered rates of treatment discontinuation for any reason as a proxy indicator of adverse outcomes. There was no evidence of difference for dropout rates between couple therapy and individual psychotherapy, based on eight studies with 316 participants (RR 0.85, 95% CI 0.51 to 1.41, low-quality evidence).Few data were available for the comparison with drug therapy. Data from a small study with 12 participants showed no difference for the continuous outcome of depressive symptoms at end of treatment (SMD -0.51, 95% CI -1.69 to 0.66, very low-quality evidence) and at 6-month follow-up (SMD -1.07, 95% CI -2.45 to 0.31, very low-quality evidence). Data on dropouts from two studies with 95 participants showed a clear advantage for couple therapy (RR 0.31, 95% CI 0.15 to 0.61, very low-quality evidence). However, this finding was heavily influenced by a single study, probably affected by a selection bias favouring couple therapy.The comparison between couple therapy plus drug therapy and drug therapy alone showed no difference in depressive symptom level, based on two studies with 34 participants (SMD -1.04, 95% CI -3.97 to 1.89, very low-quality evidence) and on dropouts, based on two studies with 45 participants (RR 1.03, 95% CI 0.07 to 15.52, very low-quality evidence).The comparison with no/minimal treatment showed a large significant effect favouring couple therapy both for depressive symptom level, based on three studies with 90 participants: (SMD -0.95, 95% CI -1.59 to -0.32, very low-quality evidence) and persistence of depression, based on two studies with 65 participants (RR 0.48, 95% CI 0.32 to 0.70, very low-quality evidence). No data were available for dropouts for this comparison.Concerning relationship distress, the comparison with individual psychotherapy showed that couple therapy appeared more effective in reducing distress level at the end of treatment, based on six studies with 187 participants (SMD -0.50, CI -0.97 to -0.02, very low-quality evidence) and the persistence of distress, based on two studies with 81 participants (RR 0.71, 95% CI 0.51 to 0.98, very low-quality evidence). The quality of evidence was heavily affected by substantial heterogeneity (I² = 59%). In the analysis restricted to studies including only distressed couples, no heterogeneity was found and the effect in distress level at the end of treatment was larger (SMD -1.10, 95% CI -1.59 to -0.61). Very few data on this outcome were available for other comparisons.We assessed the certainty of the evidence using the GRADE system. The results were weakened by the low quality of evidence related to the effects on depressive symptoms, in comparison with individual psychotherapy, and by very low quality evidence for all other comparisons and for the effects on relationship distress. Most studies were affected by problems such as the small number of cases, performance bias, assessment bias due to the non-blinding outcome assessment, incomplete outcome reporting and the allegiance bias of investigators. Heterogeneity was, in particular, a problem for data about relationship distress.

AUTHORS' CONCLUSIONS

Although there is suggestion that couple therapy is as effective as individual psychotherapy in improving depressive symptoms and more effective in improving relations in distressed couples, the low or very low quality of the evidence seriously limits the possibility of drawing firm conclusions. Very few data were available for comparisons with no/minimal treatment and drug therapy. Future trials of high quality should test in large samples with a long follow-up of the effects of couple therapy in comparison to other interventions in discordant couples with a depressed partner, considering the role of relationship quality as a potential effect mediator in the improvement of depression.

Longitudinal study of emotional experiences, grief and depressive symptoms in women and men after miscarriage

OBJECTIVE

Although miscarriage is common and affects up to 20% of pregnant women, little is known about these couples' short term and long term experiences after miscarriage. The aim of the present study was to study emotional experience, grief and depressive symptoms in women and men, one week and four months after miscarriage.

RESEARCH DESIGN /SETTING

Women, (n = 103), and their male partner (n = 78), were recruited at the gynecological clinic after miscarriage. Control women were recruited from the general population. Three validated questionnaires concerning psychological wellbeing and mental health, RIMS, PGS and MADRS-S were answered by the participants one week and four months after the miscarriage.

FINDINGS

It was shown that for women, the emotional experiences of miscarriage, grief and depressive symptoms were more pronounced than for their male partners. Grief and depressive symptoms were reduced with time, which was not the case for the emotional experiences of miscarriage. Previous children was favorable for emotional experience while previous miscarriage or infertility treatment made the emotional experience worse.

CONCLUSION

Grief and depressive symptoms is reduced over time while emotional experiences such as isolation, loss of baby and a devastating event persist for longer time than four months. Lack of previous children, previous miscarriage and infertility diagnosis could increase negative emotional experiences after miscarriage, this was especially pronounced for grief reaction. The questionnaires could be used both clinically and in research to understand the emotional experiences after miscarriage.

Parents' Verbal and Nonverbal Caring Behaviors and Child Distress During Cancer-Related Port Access Procedures: A Time-Window Sequential Analysis

PURPOSE/OBJECTIVES

To study the relationship between parental verbal and nonverbal caring behaviors and child distress during cancer-related port access placement using correlational and time-window sequential analyses.
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DESIGN

Longitudinal, observational design.
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SETTING

Children's Hospital of Michigan and St. Jude Children's Research Hospital.
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SAMPLE

43 child-parent dyads, each with two or three video recordings of the child undergoing cancer-related port placement.
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METHODS

Two trained raters coded parent interaction behaviors and child distress using the Parent Caring Response Scoring System and Karmanos Child Coping and Distress Scale, respectively. Mixed modeling with generalized estimating equations examined the associations between parent interaction behaviors and parent distress, child distress, and child cooperation reported by multiple raters. Time-window sequential analyses were performed to investigate the temporal relationships in parent-child interactions within a five-second window.
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MAIN RESEARCH VARIABLES

Parent caring behaviors, child distress, and child cooperation.
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FINDINGS

Parent caring interaction behaviors were significantly correlated with parent distress, child distress, and child cooperation during repeated cancer port accessing. Sequential analyses showed that children were significantly less likely to display behavioral and verbal distress following parent caring behaviors than at any other time. If a child is already distressed, parent verbal and nonverbal caring behaviors can significantly reduce child behavioral and verbal distress.
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CONCLUSIONS

Parent caring behaviors, particularly the rarely studied nonverbal behaviors (e.g., eye contact, distance close to touch, supporting/allowing), can reduce the child's distress during cancer port accessing procedures.
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IMPLICATIONS FOR NURSING

Studying parent-child interactions during painful cancer-related procedures can provide evidence to develop nursing interventions to support parents in caring for their child during painful procedures.

Psychological and support interventions to reduce levels of stress, anxiety or depression on women's subsequent pregnancy with a history of miscarriage: an empty systematic review

OBJECTIVE

The aim of this systematic review was to assess the effect of interventions to reduce stress in pregnant women with a history of miscarriage.

DESIGN

A systematic review of randomised controlled trials (RCTs).

DATA SOURCE

A total of 13 medical, psychological and social electronic databases were searched from January 1995 to April 2016 including PUBMED, CENTRAL, Web of Science and EMBASE.

ELIGIBILITY CRITERIA

This review focused on women in their subsequent pregnancy following miscarriage. All published RCTs which assessed the effect of non-medical interventions such as counselling or support interventions on psychological and mental health outcomes such as stress, anxiety or depression when compared with a control group were included. Stress, anxiety or depression had to be measured at least preintervention and postintervention.

RESULTS

This systematic review found no RCT which met our initial inclusion criteria. Of the 4140 titles screened, 17 RCTs were identified. All of them were excluded. One RCT, which implemented a caring-based intervention, included pregnant women in their subsequent pregnancy; however, miscarriage was analysed as a composite variable among other pregnancy losses such as stillbirth and neonatal death. Levels of perceived stress were measured by four RCTs. Different types of non-medical interventions, time of follow-up and small sample sizes were found.

CONCLUSION

Cohort studies and RCTs in non-pregnant women suggest that support and psychological interventions may improve pregnant women's psychological well-being after miscarriage. This improvement may reduce adverse pregnancy-related outcomes in subsequent pregnancies. However, this review found no RCTs which met our criteria. There is a need for targeted RCTs that can provide reliable and conclusive results to determine effective interventions for this vulnerable group.

Parent Caring Response Scoring System: development and psychometric evaluation in the context of childhood cancer-related port starts

RATIONALE

Multiple observational coding systems have been developed and validated to assess parent-child interactions during painful procedures. Most of these coding systems are neither theory-based nor do they well represent parent nonverbal behaviours.

AIMS

Develop the Parent Caring Response Scoring System (P-CaReSS) based on Swanson's Theory of Caring and test its psychometric properties in children in cancer port starts.

METHODS

A hybrid approach of inductive and deductive coding was used to formulate the preliminary observational codes for the P-CaReSS. Twenty-nine children, each with one video-recording of port start available, were selected from the parent study (R01CA138981) to refine the P-CaReSS, train coders and test inter-rater reliability. Videos of another 43 children were used to evaluate the construct validity of P-CaReSS. Per cent agreement and Cohen's kappa were used to present the inter-rater reliability. Spearman rank-order correlations were used to report the construct validity.

RESULTS

The 18-item P-CaReSS includes three types of parent behaviours: verbal, nonverbal and emotional behaviours. These parent interaction behaviours comprise five caring domains - knowing, being with, doing for, enabling, and maintaining belief - and one noncaring domain. On average the per cent agreement was 0.82 for the P-CaReSS overall, with average per cent agreements above 0.80 for both verbal and nonverbal behaviours. Kappa coefficient was 0.81 for the emotional behaviour. The behavioural codes in the P-CaReSS showed significant correlations with independent ratings of parent distress, child distress and child cooperation.

CONCLUSIONS

The P-CaReSS is a promising tool that can be used to evaluate parent verbal, nonverbal and emotional behaviours during cancer-related port starts. This observational tool can be used to guide the development of nursing interventions to help parents caring for their child during cancer procedures.

Impact of Psychological Grief Counseling on the Severity of Post-Traumatic Stress Symptoms in Mothers after Stillbirths

Planned support and interventions are necessary in the care and support of women who have experienced stillbirth. The present study was conducted to determine the effect of psychological grief counseling on the symptom severity of post-traumatic stress disorder (PTSD) in mothers after stillbirths. This interventional study is semi-experimental. The study was conducted on 100 women who had recently had stillbirths. Eligible samples were selected and randomly divided into the two groups of intervention and control. The data collection tool was the PPQ,¹ which was completed as a pre-test and post-test in both groups. The intervention group received four sessions of psychological grief counseling over two weeks, and the control group received only routine postnatal care. PTSD severity was evaluated in both groups at the end of the fourth week after the final session. The results showed that there was a statistically significant difference in the mean score of the severity of the PTSD symptoms in both groups after the intervention (P = 0.0001), which means that psychological grief counseling led to the reduction of PTSD severity in mothers. Given the positive impact of psychological grief counseling on reducing the severity of PTSD, integration of intensive psychological interventions in the maternity care system seems essential for faster transition of grief stages and for the prevention of severe cases of PTSD.

Interpersonal psychotherapy (IPT) for major depression following perinatal loss: a pilot randomized controlled trial

This randomized controlled pilot trial examined the feasibility, acceptability, and preliminary efficacy of an adapted interpersonal psychotherapy (IPT) for major depressive disorder (MDD) following perinatal loss (miscarriage, stillbirth, or early neonatal death). Fifty women who experienced a perinatal loss within the past 18 months, whose current depressive episode onset occurred during or after the loss, were randomized to the group IPT adapted for perinatal loss (the Group IPT for Major Depression Following Perinatal Loss manual developed for this study is available at no cost by contacting either of the first two authors) or to the group Coping with Depression (CWD), a cognitive behavioral treatment which did not focus on perinatal loss nor social support. Assessments occurred at baseline, treatment weeks 4 and 8, post-treatment, and 3 and 6 months after the end of treatment. IPT was feasible and acceptable in this population. Although some participants were initially hesitant to discuss their losses in a group (as occurred in IPT but not CWD), end of treatment satisfaction scores were significantly (p = 0.001) higher in IPT than in CWD. Confidence intervals around between-groups effect sizes favored IPT for reductions in depressive symptoms during treatment as well as for improvement in mode-specific targets (social support, grief symptoms) and recovery from a post-traumatic stress disorder over follow-up. This group IPT treatment adapted for MDD after perinatal loss is feasible, acceptable, and possibly efficacious.

Infertility and Perinatal Loss: When the Bough Breaks

Infertility and perinatal loss are common, and associated with lower quality of life, marital discord, complicated grief, major depressive disorder, anxiety disorders, and post-traumatic stress disorder. Young women, who lack social supports, have experienced recurrent pregnancy loss or a history of trauma and / or preexisting psychiatric illness are at a higher risk of experiencing psychiatric illnesses or symptoms after a perinatal loss or during infertility. It is especially important to detect, assess, and treat depression, anxiety, or other psychiatric symptoms because infertility or perinatal loss may be caused or perpetuated by such symptoms. Screening, psychoeducation, provision of resources and referrals, and an opportunity to discuss their loss and plan for future pregnancies can facilitate addressing mental health concerns that arise. Women at risk of or who are currently experiencing psychiatric symptoms should receive a comprehensive treatment plan that includes the following: (1) proactive clinical monitoring, (2) evidence-based approaches to psychotherapy, and (3) discussion of risks, benefits, and alternatives of medication treatment during preconception and pregnancy.

Nursing perceptions about abortion management and care: a qualitative study

This study aimed to describe management and implementation of care for women hospitalized due to an abortion, from the perspective of nursing professionals. A qualitative study performed in an obstetric hospital unit of a University Hospital in the extreme South of Brazil, by means of a semi-structured interview with 19 nursing professionals. For the analysis, the Collective Subject Discourse technique was used. The statements were ambivalent. Some nursing professionals reported interference in discriminatory behavior and little interaction with the woman, resulting in care being organized with a focus on clinical aspects. Others considered care to be appropriate, regardless of the etiology of abortion, pointing out some humanized initiatives such as emotional support and provision of a private therapeutic environment. This research broadens the range of information about the management and implementation of care for women hospitalized due to abortion, highlighting the importance of articulating perceptions, feelings and ethical behavior with actions to plan, manage and provide care.

A feasibility study for a randomised controlled trial of the Positive Reappraisal Coping Intervention, a novel supportive technique for recurrent miscarriage

INTRODUCTION

Recurrent miscarriage (RM) is diagnosed when a woman has had three or more miscarriages. Increased levels of distress and anxiety are common during the waiting period of any subsequent pregnancies, posing a significant threat to psychological well-being. However, only limited support and therapy are available for these women, and many are left to cope alone. The Positive Reappraisal Coping Intervention (PRCI) is a novel self-administered supportive technique which has been shown to be effective in patients awaiting the outcome of in vitro fertilisation treatment. The primary objective of this study is to assess the feasibility and effectiveness of the PRCI in improving quality of life in the difficult waiting period which women with previous RM endure before an ongoing pregnancy can be confirmed.

METHODS AND ANALYSIS

A randomised controlled trial (RCT) feasibility study will establish the viability of conducting a multicentre RCT to definitively test the effects of the PRCI on the psychological well-being of women who have experienced RM during the initial waiting period of a subsequent pregnancy. A second component consists of a qualitative process evaluation exploring the initial experience of pregnancy following repeated miscarriages. Participants (n=50) will be randomised into one of two groups. The PRCI intervention group will receive the PRCI card and weekly questionnaires to assess their psychological well-being during the waiting period of their new pregnancy. The non-intervention group will be asked to complete the same weekly questionnaires. The qualitative process analysis will employ semistructured interviews (n=20) to address relevant aspects of the study objectives.

ETHICS AND DISSEMINATION

Ethics approval has been obtained from the National Research Ethics Service Committee South Central-Hampshire A. Participating centres have given National Health Service R&D approval. Study findings will be disseminated through peer reviewed journals, national and international conferences and lay user groups.

TRIAL REGISTRATION NUMBER

ISRCTN43571276. This study was registered with the ISRCTN 18/02/2014 following adoption onto the United Kingdom Clinical Research Network (UKCRN) portfolio. Recruitment of the first participant occurred 04/02/2014.

Evaluating a bereavement follow-up intervention for grieving mothers after the death of a child

AIM

The aim of this study was to produce information about parental grief intervention and its impacts on maternal grief.

BACKGROUND

The grief after death of a child is a lifelong process. Social support is often stated as the most important factor in coping after the death of a child.

DESIGN

A single measure post-test control group design was used to evaluate whether there are differences in the grief reactions between the mothers in the intervention program (n = 83) and the mothers in the control group (n = 53).

METHOD

The data were collected by using a questionnaire which included background variables and Hogan Grief Reactions Checklist 6 months after the child's death. The data were analysed by statistical methods.

RESULTS

There were no significant differences in the grief reactions between the intervention group and the control group. However, greater support from the healthcare professionals was associated with stronger personal growth. The mothers' age, self-perceived health status and the age of deceased child were associated with the grief reactions. This study emphasises the importance of social support to grieving mothers.

CONCLUSION

Health care professionals are in an important role when considering support for grieving mothers; the given support may relieve the mothers' grief reactions.

Predicting Improvement in Depression Across Therapies Using Indicators of Romantic Relationship Functioning: A Preliminary Investigation

Depression is a common presenting problem, often affected by couple interactions in unique ways. However, research in the area of romantic relationship functioning and depression often replicates previous research or consists of literature reviews, limiting the clinical relevancy. The purpose of this preliminary study is to expand the research on the effects of relational processes on depression treatment outcomes. We tested whether initiator tendency, attachment anxiety, attachment avoidance, and marital satisfaction predicted improvement in depression for women with Major Depressive Disorder enrolled in a depression treatment clinical trial (n = 17). Women completed treatments of either pharmacotherapy or combined Emotionally Focused Therapy for couples and pharmacotherapy. We found that higher baseline levels of partner initiator tendency resulted in less change in depression (worse outcomes), regardless of treatment type and that higher baseline levels of attachment avoidance predicted better depression outcomes in treatment. Marital satisfaction, however, was not linked to change in depression. Initiator tendency is discussed as a critical romantic relationship factor for depression treatment outcomes.

A systematic review of sexual health interventions for adults: narrative evidence

Recent work has explored the intersection between sexual health (as construed by the World Health Organization and others) and public health domains of action in the United States of America. This article reports the narrative results of a systematic review of sexual health intervention effects on public health-relevant outcomes. To qualify, interventions had to be based on the principles (1) that sexual health is intrinsic to individuals and their overall health and (2) that relationships reflecting sexual health must be positive for all parties concerned. Outcomes were classed in domains: knowledge, attitudes, communication, health care use, sexual behavior, and adverse events. We summarized data from 58 studies (English language, adult populations, 1996-2011) by population (adults, parents, sexual minorities, vulnerable populations) across domains. Interventions were predominantly individual and small-group designs that addressed sexual behaviors (72%) and attitudes/norms (55%). They yielded positive effects in that 98% reported a positive finding in at least one domain; 50% also reported null effects. The most consistently positive effects on behaviors and adverse events were found for sexual minorities, vulnerable populations, and parental communication. Whether via direct action or through partnerships, incorporating principles from existing sexual health definitions in public health efforts may help improve sexual health.

Brief Internet-based intervention reduces posttraumatic stress and prolonged grief in parents after the loss of a child during pregnancy: a randomized controlled trial

BACKGROUND

The loss of a child during pregnancy causes significant psychological distress for many women and their partners, and may lead to long-lasting psychiatric disorders. Internet-based interventions using exposure techniques and cognitive restructuring have proved effective for posttraumatic stress disorder (PTSD) and prolonged grief. This study compared the effects of an Internet-based intervention for parents after prenatal loss with a waiting list condition (WLC).

METHODS

The Impact of Event Scale - Revised assessed symptoms of PTSD; the Inventory of Complicated Grief and the Brief Symptom Inventory assessed depression, anxiety, and general mental health. The 228 participants (92% female) were randomly allocated to a treatment group (TG; n = 115) or a WLC group (n = 113). The TG received a 5-week cognitive behavioral intervention including (1) self-confrontation, (2) cognitive restructuring, and (3) social sharing.

RESULTS

The TG showed significantly reduced symptoms of posttraumatic stress, prolonged grief, depression, and anxiety relative to the WLC control group. Intention-to-treat analysis revealed treatment effects of between d = 0.84 and d = 1.02 for posttraumatic stress and prolonged grief from pre- to posttreatment time points. Further significant improvement in all symptoms of PTSD and prolonged grief was found from the posttreatment evaluation to the 12-month follow-up. The attrition rate of 14% was relatively low.

CONCLUSIONS

The Internet-based intervention proved to be a feasible and cost-effective treatment, reducing symptoms of posttraumatic stress, grief, depression, anxiety, and general mental health after pregnancy loss. Low-threshold e-health interventions should be further evaluated and implemented routinely to improve psychological support after pregnancy loss.