The prevalence of unresolved grief among bereaved parents: implications for counselling.

THE PREVALENCE OF UNRESOLVED GRIEF AMONG BEREAVED PARENTS: IMPLICATIONS FOR COUNSELLING.

Unresolved Grief


ABSTRACT

The loss of an infant through stillbirth, miscarriage, or neonatal death is recognized as a traumatic life event. Predictors of development of complicated grief after prenatal loss include lack of social support, pre-existing relationship difficulties, or absence of surviving children, as well as ambivalent attitudes or heightened perception of the reality of the pregnancy. Risk of complicated grief was found to be especially high after termination of a pregnancy due to fetal abnormality. Studies have revealed that men and women show different patterns of grief, potentially exacerbating decline in a relationship. Although it is clear that prenatal loss has a large psychological impact, it is concluded that there is a substantial lack of randomized controlled studies in this field of research.

The loss of a child is recognized as a very difficult life experience, which can often cause complicated grief (CG) reactions that risk negatively affecting psychological and physical well-being. In a population-based sample, bereaved individuals who had lost a child showed the highest prevalence of CG. Perinatal loss is a relatively common occurrence which, in this article, refers to the death of an infant due to miscarriage, stillbirth, and neonatal death. In 2007 in the United States the infant mortality rate was 6.9 deaths per 1000 live births. Miscarriage, generally defined as an unintended termination of the pregnancy prior to 20 weeks of gestation, is the most common type of pregnancy loss. The overall prevalence is 15% to 27% for women aged between 25 and 29, increasing to 75% in women older than 45 years, with elevated risk for women who have lost a previous pregnancy. The death of a fetus after 20 weeks' gestation with a birth weight of over 500 g is referred to as a stillbirth. In these cases, the fetus has either died before or during labour, often unexpectedly or after an uncomplicated pregnancy. A relatively new issue that has emerged in the field of perinatal loss is that continuing development of prenatal diagnostics has increased diagnosis of fetal abnormalities, with relatively high corresponding termination rates. A European survey found average termination rates of 88% for Down's syndrome as well as in cases of neural tube defects.Unresolved Grief

Although parents have not built up a relationship with their infant, grief after pregnancy loss does not differ significantly in intensity from other loss scenarios. As has been found in bereavement involving first-degree relatives, grief symptoms usually decrease in intensity over the first 12 months. Longitudinal studies have demonstrated that in a normal grieving process, grief declines over a period of 2 years after the pregnancy loss. Perinatal losses have also been shown to have a substantial psychological impact on parents and families, and are associated with post-traumatic stress, depression, anxiety, and sleeping disorders. Overall, high levels of CG are generally associated with a poorer state of mental health.Unresolved Grief

This article reviews literature on CG reactions to perinatal loss. Typical grief reactions and unique aspects of bereavement after perinatal loss are described, before a summary of the risk factors which influence grief outcome. The specific issue of termination of pregnancy due to abnormality is outlined and gender differences between fathers and mothers after prenatal loss are then addressed. Finally, clinical implications for parents after pregnancy loss are discussed.Unresolved Grief