Complicated Grief After Traumatic Loss: a 14-month Follow up Study

Eur Arch Psychiatry Clin Neurosci. 2007 Dec;257(8):437-43.  
Kersting A, Kroker K, Steinhard J, Lüdorff K, Wesselmann U, Ohrmann P, Arolt V, Suslow T.
 
    Department of Psychiatry, University of Muenster, Albert-Schweitzer-Str. 11, 48129, Muenster, Germany.
 
    The traumatic loss of an unborn child after TOP due to fetal malformation and/or severe chromosomal disorders in late pregnancy is a major life-event and a potential source of serious psychological problems for those women.

To obtain information on the course of grief following a traumatic loss, 62 women who had undergone TOP between the 15th and 32nd gestational week were investigated in a longitudinal study design and compared with 65 women after spontaneous delivery of a full-term healthy child.

Grief, posttraumatic stress, depression, anxiety and psychiatric disorders were evaluated 14 days, 6 months and 14 months after the event, implementing validated self-report and clinician rated instruments.

Compared to women after spontaneous delivery, women after induced TOP were significantly more stressed regarding all psychological outcomes at all three measuring points.

Especially, 14 months after TOP 13.7% of the women fulfilled all criteria of a complicated grief diagnoses following Horowitz et al. (1997, Am J Psychiat 154:7904-7910). 16.7% were diagnosed as having a manifest psychiatric disorder according to DSM-IV. All in all, 25% of these women were critically affected by the traumatic loss. TOP for fetal anomaly is to be seen as a major life event, which causes complicated grief reactions and psychiatric disorders for a substantial number of women.
 
    PMID: 17629729 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/pubmed/17629729?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
 
 
 
 
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A Prospective Study on Parental Coping 4 Months After Termination of Pregnancy for Fetal Anomalies.

Prenat Diagn. 2007 Aug;27(8):709-16.   
Korenromp MJ, Page-Christiaens GC, van den Bout J, Mulder EJ, Hunfeld JA, Potters CM, Erwich JJ, van Binsbergen CJ, Brons JT, Beekhuis JR, Omtzigt AW, Visser GH.
 
    Department of Perinatology and Gynaecology, University Medical Centre Utrecht, The Netherlands.
 
    OBJECTIVE: To identify short-term factors influencing psychological outcome of termination of pregnancy for fetal anomaly, in order to define those patients most vulnerable to psychopathology.

STUDY DESIGN: A prospective cohort of 217 women and 169 men completed standardized questionnaires 4 months after termination. Psychological adjustment was measured by the Inventory of Complicated Grief (ICG), the Impact of Event Scale (IES), the Edinburgh Postnatal Depression Scale (EPDS), and the Symptom Checklist-90 (SCL-90).

RESULTS: Women and men showed high levels of posttraumatic stress (PTS) symptoms (44 and 22%, respectively) and symptoms of depression (28 and 16%, respectively).

Determinants of adverse psychological outcome were the following: high level of doubt in the decision period, inadequate partner support, low self-efficacy, lower parental age, being religious, and advanced gestational age. Whether the condition was Down syndrome or another disability was irrelevant to the outcome. Termination did not have an important effect on future reproductive intentions. Only 2% of women and less than 1% of men regretted the decision to terminate.

CONCLUSION: Termination of pregnancy (TOP) for fetal anomaly affects parents deeply. Four months after termination a considerable part still suffers from posttraumatic stress symptoms and depressive feelings. Patients who are at high risk could benefit from intensified support. Copyright (c) 2007 John Wiley & Sons, Ltd.
 
    PMID: 17533631 [PubMed - indexed for MEDLINE]
 


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Grief After Termination of Pregnancy Due to Fetal Malformation.
   
J Psychosom Obstet Gynaecol. 2004 Jun;25(2):163-9.Links
Kersting A, Reutemann M, Ohrmann P, Baez E, Klockenbusch W, Lanczik M, Arolt V.
 
    Department of Psychiatry, University of Muenster, Germany.
 
    Termination of pregnancy for fetal malformation is a traumatic event which any woman finds hard to withstand and which entails the risk of severe and complicated grieving. This paper presents three cases illustrating the trauma and coping mechanisms. Grieving continued for over 6 months in all cases and included pathological anxiety and depression. We offer advice and counselling to such women.
 
    PMID: 15715039 [PubMed - indexed for MEDLINE
http://www.ncbi.nlm.nih.gov/pubmed/15715039?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=5
 
 

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 Psychologic aspects of early pregnancy loss.
   
Clin Obstet Gynecol. 2007 Mar;50(1):154-65.
Carter D, Misri S, Tomfohr L.
 
    Departments of Psychiatry, Faculty of Medicine, University of British Columbia, Canada.
 
    Early pregnancy loss is a complicated psychologic event that occurs in 12% to 24% of recognized pregnancies. Women who have experienced miscarriage often have common bereavement reactions and while the intensity and experience of these reactions diminishes over time for most women, a substantial minority will develop long-term psychiatric consequences.

Depression, symptoms of anxiety, obsessive-compulsive disorder, and posttraumatic stress disorder are the most commonly reported psychologic reactions to miscarriage. The course and impact of these disorders on a grieving mother and her partner are discussed and treatment recommendations are made. The psychologic effects of therapeutic abortion are also be briefly discussed.
 
    PMID: 17304032 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/pubmed/17304032?ordinalpos=7&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
 



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Diagnostic Categorization of Post-Abortion Syndrome.
   
Actas Esp Psiquiatr. 2005 Jul-Aug;33(4):267-72.
Gómez Lavín C, Zapata García R.
 
    Servicio Navarro de Salud Mental, Pamplona, Navarra, Spain.
 
    Some psychopathological characteristics are frequently observed in women who have voluntarily aborted. However, some resistance currently remains to their recognition as a differentiated nosological category, known as Post-Abortion Syndrome (PAS). We tried to assign a diagnostic category to women with PAS by determining the extent by which they fulfilled the diagnostic criteria of international classifications.

Criteria for Post-Traumatic Stress Disorder (PTSD) were met in the ten PAS cases studied. In addition, patients also showed other non-specific symptoms such as repeated and persistent dreams and nightmares related with the abortion, intense feelings of guilt and the "need to repair".