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Psychological Outcomes of Those Experiencing Early Pregnancy Loss

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Psychological Outcomes of Those Experiencing Early Pregnancy Loss Psychological Outcomes of Those Experiencing Early Pregnancy Loss Jessie Bendavid ORCID Identifier: https://orcid.org/0000-0002-4216-7437 Submitted in total fulfilment of the requirements of the degree of Doctor of Philosophy April 2019 Melbourne School of Psychological Sciences Faculty of Medicine, Dentistry and Health Sciences The University of Melbourne 2 Abstract Early Pregnancy Loss (EPL), a loss occurring before 14 weeks gestation, is a relatively common event, occurring in about 20% of pregnancies. Although many women and their partners do not experience psychological difficulties associated with this loss, a significant minority experience intense and sustained grief, depression and anxiety symptoms. Reliable prevalence rates of serious psychological consequences for women are not well established, and those of partners are largely unknown. Furthermore, it is unclear what factors increase the risk for developing serious psychological symptoms. A range of potential risk factors have been identified, but remain under- researched and have not been rigorously studied. According to Cognitive Behavioural Theory, it is possible that cognitions surrounding the loss may be a particularly relevant risk factor. Yet this topic has rarely been examined and the studies that have are characterised by major methodological shortcomings. Importantly, partners are rarely included in these studies. This study aimed to determine prevalence rates for grief depression and anxiety over the first three and a half months after EPL. It also investigated cognitions after EPL through the Common-Sense Model of Illness Representation, and their link with grief, depression and anxiety symptoms. This study included 28 male partners and 68 women diagnosed with EPL who attended the Early Pregnancy Assessment Service at the Royal Women’s Hospital in Melbourne, Australia. Participants completed self-report measures two weeks (T1), and three months (T2) post-loss. These included the Perinatal Grief Scale, the Centre for Epidemiological Studies-Depression scale, the State Trait Anxiety Inventory, and the Illness Perception Questionnaire-Revised. Results showed that the prevalence of grief, depression and anxiety symptoms for women at T1 were 20.6%, 54.4%, and 52.9%, respectively. For partners, the prevalence rates were 0% for grief, 32.1% for depression, and 25% for anxiety. These rates decreased by T2. Illness perceptions were found to significantly predict grief, depression and anxiety. Unexpectedly, it was often better perceptions of the loss that predicted worse psychological outcomes. These findings provide new 3 information about the experience of EPL and suggest that critical timing for assessment and treatment would be within the first 3 months after EPL. Treatment options, particularly in terms of grief theories presented in the introduction, are discussed. Considering the surprising results and that this is the first study to examine illness perceptions among this sample, replication of these results is needed. 4 Declaration This is to certify that: i) the thesis comprises only my original work towards the PhD ii) due acknowledgement has been made in the text to all other material used; iii) and the thesis is fewer than 100 000 words, exclusive of tables, maps, bibliographies and appendices. Jessie Bendavid 5 Acknowledgements I am incredibly privileged to have received the guidance of two phenomenal supervisors. Christina, your knowledge in this field, generosity with your time, unwavering support and mentorship have been integral to my completion of this dissertation. Fiona, your wisdom and expertise you have shared with me during my candidature have been inspiring. You have both shaped me into the psychologist and researcher I am today, and for that, I thank you. Isabel Krug, I am so grateful for your insights, ideas and feedback you have given over the years. I am also very thankful for the practical support offered by Jennifer Boldero. To the entire CWMH team, especially Lesley Stafford and Angela Komiti, your views on this project have been most appreciated. Rebecca Cockburn, thank you so much for your support with the recruitment process. This thesis would not be possible without the contribution of the EPAS team. Patricia Moore, thank you so much for providing access into EPAS, for donating your time to this project and for your input into this study. To Mary and Geraldine, you went above and beyond to recruit participants for this project, showing your passion for your job and care of your patients. I am very lucky to have had the support of friends and family from Montreal and Australia throughout this process. Marcelo, you have been there for the highs and lows and have been my cheerleader the whole way through. I am so glad to say that we can be parents at the same time again and look forward to lots of family time together. To my children – Harper, Jake and Reagan, thank you for making me a mom and giving me a new perspective on this topic. Jake, your occasional disruptions to my writing process for some delicious hugs were much appreciated and Harper, I hope one day you can do your own “GhB”, if you so choose. Reagan, thanks for giving me a surprising reason to try get this thesis finished. I am very grateful for your arrival. Laura and Mike, thanks for taking an interest in what I do and the laughs along the way. Solange, Eliel, Cris, Rene and Fernanda, your help watching the kids so I could complete this thesis, feeding me, and giving me 6 some much-needed rest have been incredibly necessary. Ely, Jack, Jaime and Marissa, you have given me sanity and balance during this and all times in my life. To Caitlin, Carmen, Chaille, Emily, Olivia and Tamsyn – you have shared all parts of this experience with me and your support through it has been such a comfort. Thank you all. Finally, I am extremely grateful to the participants of this study. They donated their time during a stressful period in their lives to take part in this research and provided in depth and personal insights into their experience. This project would not have been possible without their generous contribution. 7 Table of Contents Abstract ....................................................................................................................................... 2 Declaration .................................................................................................................................. 4 Acknowledgements...................................................................................................................... 5 Table of Contents ......................................................................................................................... 7 List of Tables .............................................................................................................................. 13 List of Figures ............................................................................................................................. 17 Chapter One: Introduction ......................................................................................................... 18 1.1 Research on the Psychological Sequelae after EPL ............................................................... 18 1.2 Risk Factors for the Development of Psychological Distress After Perinatal Loss ................ 20 1.3 Cognitions in Relation to Psychological Distress After Perinatal Loss .................................. 20 1.4 Aims of the Study .................................................................................................................. 21 1.5 Outline of the Dissertation .................................................................................................... 22 Chapter Two: Introduction to Early Pregnancy Loss ..................................................................... 23 2.1 Overview ............................................................................................................................... 23 2.2 Key Terms .............................................................................................................................. 23 2.2.1 Perinatal loss. ........................................................................................................................ 23 2.2.2 Miscarriage............................................................................................................................ 24 2.2.3 Ectopic pregnancy. ................................................................................................................ 25 2.2.4 Molar pregnancy. .................................................................................................................. 25 2.2.5 Anembryonic pregnancy (blighted ovum). ........................................................................... 25 2.2.6 Stillbirth. ................................................................................................................................ 25 2.2.7 Early pregnancy loss. ............................................................................................................. 25 2.3 Scientific and Societal Views of EPL ...................................................................................... 26 2.4 The Subjective Experience of Perinatal Loss ......................................................................... 26 8 2.5 Unique Features of Early Pregnancy Loss ............................................................................. 29 2.6 Prevalence
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