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PDF Hosted at the Radboud Repository of the Radboud University Nijmegen PDF hosted at the Radboud Repository of the Radboud University Nijmegen The following full text is a publisher's version. For additional information about this publication click this link. http://hdl.handle.net/2066/146047 Please be advised that this information was generated on 2021-10-09 and may be subject to change. A Longitudinal Prospective Study of the Psychological Impact of Pregnancy Loss on Women Course of grief, pathological grief and prediction of grief intensity een wetenschappelijke proeve op het gebied van de Sociale Wetenschappen proefschrift ter verkrijging van de graad van doctor aan de Katholieke Universiteit Nijmegen, volgens besluit van het College van Decanen in het openbaar te verdedigen op donderdag 2 november 1995, des namiddags om 1.30 uur precies door Henrica Johanna Emanuela Maria Janssen geboren 23 december 1964 te Groeningen, gemeente Vierlingsbeek Promotor Prof. Dr. C.A.L. Hoogduin Co-promotor Dr. M.C.J. Cuisinier Dit onderzoek is mede mogelijk gemaakt door een subsidie van het VSB-fonds. Ontwerp omslag: Hettie Janssen Druk: Drukkerij Quickprint b.v., Nijmegen CIP-GEGEVENS KONINKLIJKE BIBLIOTHEEK, DEN HAAG Janssen, Henrica Johanna Emanuela Maria A longitudinal prospective study of the psychological impact of pregnancy loss on women: course of grief, pathological grief and prediction of grief intensity / Henrica Johanna Emanuela Maria Janssen. - [S.I.: s.п.] (Nijmegen: Quickprint). - 111. Thesis Katholieke Universiteit Nijmegen. - With bibliogr., ref. - With summary in Dutch. ISBN 90-9008782-6 NUGI 733 Subject headings: pregnancy loss / mental health. Valavond Valavond veegt het landschap leeg om alleen te zijn; binnen de vorm van een bosje in het donker zit een klank in het verborgen groen hij valt druppelsgewijs een lijn aan elkaar die soms doet wenen inwendig Roland Jooris Uit Gedichten 1958-1978 Uitgeverij Lotus, Antwerpen 1978 Manuscriptcommissie Prof. Dr. C.P.F, van der Staak (KUN) Prof. Dr. P.M.G. Emmelkamp (RUG) Dr. J.N. Lasker (Lehigh University) Contents Chapter 1. Introduction 1.1. Definitions and causes of pregnancy loss 2 1.2. Specific circumstances characterizing pregnancy loss 3 1.3. Dealing with pregnancy loss 4 1.3.1. Specific grief reactions 5 1.3.2. Differences in grief between mothers and fathers 5 1.3.3. Differences in grief between parents and children 7 1.4. Complicated grief reactions following pregnancy loss 9 1.5. Predicting complicated grief reactions 10 1.6. Professional care following pregnancy loss 12 1.7. Two preliminary investigations on pregnancy loss 14 1.8. A prospective longitudinal study: objectives, design and sample 15 Part I: Course of Grief Following Pregnancy Loss Chapter 2. An International Comparison of Studies Using the Perinatal Grief Scale 2.1. Introduction 19 2.2. The Perinatal Grief Scale 20 2.2.1. The subscales 21 2.3. Description of studies 21 2.4. Results 24 2.5. Discussion 31 Chapter 3. A Controlled Prospective Study on Mental Health in Women Following Pregnancy Loss 3.1. Introduction 33 3.2. Method 34 3.2.1. Study design 34 3.2.2. Measures 35 3.2.3. Samples and réponse rates 35 3.2.4. Background characteristics 36 3.2.4. Analytic strategy 38 3.3. Results 39 3.4. Discussion 41 Part II: Pathological Grief Following Pregnancy Loss Chapter 4. A Critical Review of the Concept of Pathological Grief Following Pregnancy Loss 4.1. Introduction 47 4.2. General bereavement studies 49 4.3. Pregnancy loss research 51 4.3.1. Defining and assessing pathological grief following pregnancy loss 52 4.3.2. Findings related to pathological grief 54 4.3.3. Design characteristics of the studies on pregnancy loss 55 4.4. Discussion 56 Chapter 5. Indications for Complicated Grief Reactions Following Pregnancy Loss 5.1. Introduction 65 5.2. Method 66 5.2.1. Study design 66 5.2.2. Measures 67 5.2.3. Sample description 67 5.2.4. Data analysis 68 5.3. Results 69 5.4. Discussion 72 Part III: Prediction of Grief Intensity Following Pregnancy Loss Chapter 6. Predicting Grief Intensity Shortly Following Pregnancy Loss 6.1. Introduction 77 6.2. Theoretical basis and design of the study 78 6.3. Sample characteristics 80 6.4. Results 81 6.5. Concluding remarks 83 Chapter 7. A Prospective Study of Risk Factors Predicting Grief Intensity Following Pregnancy Loss 7.1. Introduction 85 7.2. Method 87 7.2.1. Design 87 7.2.2. Measures 88 7.2.3. Sample description 89 7.2.4. Analytic Strategy 90 7.3. Results 90 7.4. Discussion 94 Chapter 8. Pregnancy Following Miscarriage: Course of Grief and Some Determining Factors 8.1. Introduction 99 8.2. Methods 100 8.2.1. Sample 100 8.2.2. Data collection 101 8.2.3. Data analysis 102 8.3. Results 102 8.3.1. Subsequent pregnancy and maternal feelings 102 8.3.2. Impact on grief 103 8.3.3. Grief reactivation following child birth 105 8.4. Discussion 106 Concluding Chapter Chapter 9. Recapitulation and General Discussion 9.1. Introduction Ill 9.2. Course of grief following pregnancy loss 112 9.3. Pathological grief 113 9.4. Prediction of grief intensity 116 9.5. Recommendations for further research 117 9.6. Implications for professional care 118 9.7. Concluding remarks 119 References 123 Samenvatting 139 Curriculum Vitae 147 Dankwoord 151 Chapter 1 Introduction1 Over the last few years the birth-rate in The Netherlands has been 195,000 babies per annum (CBS, 1994). Not all pregnant women give birth to viable babies, however. Out of every 100 pregnancies, one baby is either stillborn or dies in the week following delivery (CBS, 1994). Moreover, more than 10% of all the officially registered pregnancies, result in an involuntary loss of the baby before the 16th week of gestation (Nederlands Huisartsen Genootschap, 1989). Comparable percentages are reported in other Western countries (Borg & Lasker, 1988; Keirse, 1989; Pfeffer & Woollet, 1985). Since miscarriages are not all registered, the exact occurance remains unclear. Indeed, even less conservative estimates would seem to indicate that percentages actually surpass 15 to 20% (Oakley, McPherson & Roberts, 1984/1985; Scott, 1990), suggesting that miscarriage is a rather common experience, affecting at least 19,500 families in The Netherlands each year. Adding this figure to the almost 2,000 families that are confronted with the death of their baby around the normal time of delivery, means that involuntary pregnancy loss is experienced by approximately 21,000 families each year. The frequency with which pregnancy loss occurs, stands in sharp contrast to the amount of attention it received until recenüy. It took until the seventies for social and medical science to realize that pregnancy loss had been the poor relation of research (Bourne, 1968; Keirse, 1989; Kirk, 1984; Kirkley-Best & Kellner, 1982; Kirkley-Best & VanDevere, 1986; Lewis & Page, 1978). Since 'This chapter is a compilation of a book and several anieles published earlier: Cuisinier, M. & Janssen, H. (1991a). Afscheid van een verwacht kind: Over de verwerking van een zwangerschapsverlies [Saying goodbye to an expected child: On coping with pregnancy loss]. In C.P.F. van der Staak & C.A.L. Hoogduin (Eds.), Psychologische aspecten van leefstijl en adaptatie (pp. 67-78). Nijmegen: Bureau Bêta.; Cuisinier, M. & Janssen, H. (1991b). Met lege handen. Vrouwen over het verlies van hun baby in de zwangerschap of rond de bevalling [Empty Handed. Women about the loss of their baby through miscarriage or perinatal death]. Hoogezand: Stubeg.; Cuisinier, M. & Janssen, H. (1994). Als blijde verwachting omslaat in rouw. Over de verwerking van een zwangerschapsverlies. In A. Vingerhoets & M. Remie, Vrouw zijn - Wel zijn. Gedragswetenschappelijke facetten van de gynaecologie en verloskunde (pp. 116-132). Tilburg: Tilburg University Press.; Janssen, H. & Cuisinier, M. (1992). Het verlies van een baby tijdens de zwangerschap of rond de bevalling: gevolgen voor het gezinsfunctioneren. In C.P.F, van der Staak & C.A.L. Hoogduin (Eds.), Persoonlijke relaties en psychopathologie (pp. 39-48). Nijmegen: Bureau Bèta.; Janssen, H.J.E.M. (1994). De mogelijkheden vroegtijdig te voorspellen hoe ouders het verlies van een baby zullen verwerken. In M. Cuisinier & С Hoogduin (Eds.), De psychosociale zorg rond miskraam en perinatale sterfte (pp. 86-92). Houten: Bohn Stafleu Van Loghum. 2 Introduction then more attention has been paid to parents who have to go through the trauma of dealing with pregnancy loss. This introduction presents an overview of the 'state of the art' of pregnancy loss research. After giving the definitions and causes of pregnancy loss, this chapter will proceed to discuss the consequences of pregnancy loss for parents and siblings, and reviews the results of research into psychosocial risk factors for a problematic outcome. Some questions that still remain unanswered are presented, followed by a description of the design of a new study, the results of which will be presented in subsequent chapters. Definitions and causes of pregnancy loss Involuntary pregnancy loss is defined in several ways, each referring to the length of pregnancy and the developmental stage of the foetus at the time of the loss. The definitions vary from country to country (Keirse, 1989; Peppers & Knapp, 1980a). In The Netherlands, the term miscarriage or spontaneous abortion refers to a loss before the 16th week of gestation (Nederlands Huisartsen Genootschap, 1989), as opposed to international literature where it is frequently used to refer to a loss up to the first 20 weeks (Scott, 1990), or 28 weeks (Oakley et al., 1984/1985). The term fetal death or stillbirth refers to the death of a baby shortly before or at the time of delivery, irrespective of pregnancy length if this had exceeded at least 20 weeks (Kochenour, 1990) or 28 weeks, or if the birthweight is over 1000 grams (Keirse, 1989).
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