Men's Experiences With Perinatal Loss: An Integrative Review.

Miscarriage or perinatal loss constitutes one of the most important emotional stressors a woman can experience and can be associated with bereavement. This mourning is a way of adapting and coping with the circumstances. However, inadequate management of this process can lead to the development of complicated grief and psychopathologies such as anxiety, depression, and post-traumatic stress disorder. The aim of this systematic review was to evaluate the prevalence of psychopathology (anxiety, depression, and post-traumatic stress disorder) in women with a history of miscarriage or perinatal loss in the year prior, and to compare these results with women without this history. A peer review was conducted in PubMed, Cochrane, Scopus, and Web of Science databases. We included (1) articles that included women of any age who had had a miscarriage or perinatal loss in the year prior, and (2) articles with a longitudinal cohort design with a comparison group of women without a history of miscarriage or perinatal loss. After the screening process, three articles met these inclusion criteria and were included in this study. Psychopathology in women after miscarriage or perinatal loss was higher than in the control groups. In addition, it was observed that these psychopathologies gradually decreased over the first year from the loss. In conclusion, abortion and perinatal loss pose a risk factor for the development of psychopathology. Therefore, we emphasize the importance of implementing a mental health plan for these women.

Emotional care is an important part of the holistic labor and should be considered when providing care to people affected by perinatal losses. To synthesize the findings from recently published scientific evidence on the emotional care needed following perinatal loss, a search in PubMed, CINAHL, SCOPUS, and Web of Science was carried out in January 2020 yielding 22 studies which met the inclusion criteria and were analyzed following Whittemore and Knafl's (2005) methodology. One category on "offering emotional care" was identified: "Aspects influencing the psychosocial well-being of women after perinatal loss," comprising eight themes: risk of complicated grief, cultural values, perinatal losses in multiple pregnancies, experience of subsequent pregnancies, need of information, contact with the deceased baby, impact on relatives, and strategies for emotional care. In conclusion, the evidence highlights the need of specific emotional grief care.

The objective of this review was to synthesize the experiences of health professionals who have experienced grief as a result of a pediatric patient dying. There has been some research into health professionals' grief experiences associated with the death of pediatric patients, but there has not been a review that synthesizes the findings of these experiences. Other related reviews have focused on prenatal, perinatal or adult deaths or the coping strategies employed by health professionals. This review highlights the complexities of experiences faced by pediatric health professionals. Qualitative studies involving pediatric health professionals working in any healthcare setting who had experienced grief from the death of a patient were considered for inclusion. Studies were conducted in any country, at any time and published in English. The search was conducted in PubMed, CINAHL, Embase, PsycINFO, Scopus and ProQuest Dissertations and Theses. The search was completed in January 2019. The review followed principles of meta-aggregation in line with the JBI approach. Methodological quality assessment was based on representation of participants' voices and congruence between research methodology and both research question and analysis of data. Meta-aggregation led to three synthesized findings from 12 qualitative studies that met the inclusion and methodological quality criteria. Studies predominantly included nurses working in a hospital, with sample sizes ranging from six to 25 participants. The synthesized findings were physical, behavioral, psychological or spiritual symptoms; compounding grief; and alleviating grief. Physical, behavioral, psychological, or spiritual symptoms highlighted the various characteristics of grief experiences by health professionals. Compounding grief was the largest synthesized finding and incorporated the various factors that contributed to a poorer experience of grief. Alleviating grief showed the limited identified factors that improved the experience of grief. Methodological quality led to synthesized findings receiving a ConQual rating of low or moderate. The synthesized findings from this review highlight the varied reported experiences of grief in health professionals. The methodological quality and reporting of studies, however, led to decreased confidence in the synthesized findings and recommendations arising from this review. Healthcare professionals should be aware of the potential for experiencing grief when a patient dies and the compounding and alleviating factors associated with this. Further research could expand participant and language limitations, and improve methodological quality and reporting.

This paper argues that there is a cultural taboo against the public recognition and expression of perinatal grief that hinders parents' ability to mourn and their psychological adjustment following a loss. It is proposed that this cultural taboo is recreated within the therapy relationship, as feelings of grief over a perinatal loss are minimized or avoided by the therapist and parent or patient. Importantly, it is suggested that if these cultural dynamics are recognized within the therapy relationship, then psychotherapy has the immense opportunity to break the taboo by validating the parent's loss as real and helping the parent to mourn within an empathic and affect-regulating relationship. Specifically, it is suggested that therapists break the cultural taboo against perinatal grief and help parents to mourn through: acknowledging and not pathologizing perinatal grief reactions, considering intrapsychic and cultural factors that impact a parent's response to loss, exploring cultural reenactments within the therapy relationship, empathizing with the parent's experience of loss and of having to grieve within a society that does not recognize perinatal loss, coregulating the parent's feelings of grief and loss, and helping patients to create personally meaningful mourning rituals. Lastly, the impact of within and between cultural differences and therapist attitudes on the therapy process is discussed. (PsycINFO Database Record

Summary: A package of mementos of a fetal or perinatal loss has been shown to help with the grieving process. The level of acceptance and the factors influencing acceptance of these mementos in a South Australian population was examined over a 27-month period. Data were available on 447 women and the acceptance rate was 79.6%. Major influences on the acceptance of mementos were maternal age and gestational age. Mothers in the 20–30 year age group were more likely to accept mementos than younger and older mothers. This age-related effect was more noticeable among genetic terminations and neonatal deaths than among spontaneous abortions or stillbirths. Memento acceptance of miscarriages and stillbirths over 20 weeks' gestation was significantly greater than for younger gestation. These findings may have an impact on the psychosocial management of perinatal loss. The high level of acceptance of these mementos is encouraging and vindicates our current practice which we recommend to others involved in the management of perinatal loss.

Shifts in migration and border control policies may increase the likelihood of trauma exposure related to child–parent separation and result in costs to the health system and society. In the present study, we estimated direct and indirect costs per child as well as overall cohort costs of border control policies on migrant children and adolescents who were separated from their parents, detained, and placed in the custody of the United States following the implementation of the 2018 Zero Tolerance Policy. Economic modeling techniques, including a Markov process and Monte Carlo simulation, based on data from the National Child Traumatic Stress Network's Core Data Set (N = 458 migrant youth) and published studies were used to estimate economic costs associated with three immigration policies: No Detention, Family Detention, and Zero Tolerance. Clinical evaluation data on mental health symptoms and disorders were used to estimate the initial health state and risks associated with additional trauma exposure for each scenario. The total direct and indirect costs per child were conservatively estimated at $33,008, $33,790, and $34,544 after 5 years for No Detention, Family Detention, and Zero Tolerance, respectively. From a health system perspective, annual estimated spending increases ranged from $1.5 million to $14.9 million for Family Detention and $2.8 million to $29.3 million for Zero Tolerance compared to baseline spending under the No Detention scenario. Border control policies that increase the likelihood of child and adolescent trauma exposure are not only morally troubling but may also create additional economic concerns in the form of direct health care costs and indirect societal costs.

The occurrence of perinatal losses is an unfortunate, yet common degeneracy that implements perturbing taxation on the mental, emotional, and marital health of mothers considering the grief they impose. This study is a quantitative venture that utilizes psychometrically sound measures such as the Kansas Marital Satisfaction Scale (KMSS), the Mental Health Continuum-Short Form (MHC-SF), and calibrated excerpts from the Perinatal Grief Scale (PGS). By addressing mothers (n = 53) who had recently undergone pregnancy losses, infant deaths, or during-birth child demises—significant links were established among the facets taken into consideration. Findings revealed that both mental health (r = −.48, p < .01) and marital satisfaction (r = −.34, p < .05) significantly deteriorated as an aftermath of the grief inculcated by sustaining the loss. Dimensions of mental health, in the form of emotional, social, and psychological well-being, all followed suit and underwent plunges mediated by the instigated bereavement. Further differences in both mental health and marital satisfaction were evident among participants who had children other than the ones lost to demise, and those who did not. Findings are helpful for mental health practitioners, family counselors, and gynecologists when dealing with such clients.

Background: Perinatal loss is a painful and often invisible experience that deeply challenges mental and emotional health, with lasting impact on those who endure it. Method: This study assessed guilt, depressive symptoms, and self-compassion in portuguese women after perinatal loss, considering timing of the loss. The mediating effect of self-compassion on guilt and depressive symptoms was also examined, as well as the relationships between variables. Of the 545 women who answered the online questionnaire, 501 were eligible. Results: Participants reported high depressive symptoms, and moderate guilt and self-compassion. Self-compassion correlated negatively with guilt and depressive symptoms, which were positively correlated. Mediation analysis using PROCESS (Hayes, 2013) showed that self-compassion significantly mediated the link between guilt and depressive symptoms (ß = .05; 95% CI [.03, .08]). Findings indicate self-compassion plays a protective role, mitigating effects of guilt and depression, and emphasize its clinical relevance as a therapeutic resource in perinatal grief.

Perinatal loss is an intense emotional experience that causes significant pain for parents during the grieving process, requiring care beyond the physical. In this context, hospital psychologists play a fundamental role, offering emotional support, support, and active listening during the grieving process in an appropriate and empathetic manner. This work validates the suffering experienced by parents, provides coping tools, and provides guidance for the team, creating a humane and safe working environment. Therefore, the general objective of this project was to analyze whether hospital psychologists' work is effective in supporting grieving parents in cases of perinatal loss. Specific objectives included highlighting the role of hospital psychologists within the hospital in this process, analyzing their ability to create a safe space, and describing how psychological support helps parents recognize, express, and process their emotions. The study was conducted through a systematic review with a qualitative approach, synthesizing publications relevant to the proposed theme to assess the hospital psychologist's approach.

Pre- and perinatal loss and grief tend to be referred to as complicated grief denoting the experience of ongoing trauma. It is considered a burden for the affected parents, their families and the helping professionals alike. Yet this phenomenon remains an underrepresented field in analytical studies. Our aim is to systematically review the literature that deals with personal grief caused by pre- and perinatal loss - as experienced by healthcare staff. We shall present a comprehensive view of relevant international and national attitudes including existing grief management options. The above-mentioned complex issue deserves greater attention, which should result in the establishment of dynamic, up-to-date support programmes on all professional levels.

Historically, African American women have faced racial disparities in perinatal and neonatal mortality rates. There is limited research on the sustained stress and amplified emotional and psychological strain that African American women undergo during perinatal loss. Studies are even scarcer concerning the heightened emotional and psychological difficulties during pregnancies subsequent to loss. Semi-structured interviews were carried out with 22 African American women who had experienced perinatal loss and were either pregnant or had given birth after their loss. Descriptive coding and thematic analysis revealed three main themes: life stressors, mental health complexities, and coping strategies. The results showed a potential pattern of increased risk of adverse perinatal outcomes due to social determinants, including income, access to healthcare, and housing. Furthermore, participants described experiences of systemic racism that appeared to exacerbate psychological distress after perinatal loss, often manifesting as depression and anxiety. The study reveals the urgent need to dismantle systemic racism in maternity and mental healthcare to boost perinatal outcomes for African American women. It provides essential insights for developing effective support programs.

This article explores men's experiences of using peer support groups for coping with mental distress. Support groups are organised groups in which people come together to mutually support each other with a shared health concern. There has been increasing research on men's mental health help seeking, but men's use of support groups for mental health difficulties, and the ways support groups could benefit men, is not well understood. Drawing upon 19 interviews from a South Wales, UK qualitative study which explored men's mental health help seeking, coping and management, this article explores the perceived benefits of support groups for men experiencing emotional difficulties. Findings highlight how men who attended groups valued the sense of shared understanding of experiences and the mutual respect that group settings presented them with. Support groups provided a safe space with opportunities to reconstruct traditional masculine norms through reciprocating unique and tailored mental health support to others and developing a certain role within that group. This gave men a sense of purpose which further facilitated mental health management. Findings also indicated the social benefits that support groups can have to men who may have limited social networks or be experiencing isolation. This article adds to the growing literature that focuses on men's mental health experiences and illustrates the benefits of support groups for men in distress. The author suggests that primary services need to be aware of how support groups can positively support men and promote them as an opportunity for connection and unique support.

Perinatal loss is rare in high-income countries. In Danish neonatology, the psychosocial approach to neonatal care has been to acknowledge the personhood of the newborn infant with the goal of enabling grief and healing. However, one question is how the family lives with the memory of a child they hardly had time to know. Mothers of 40 newborn infants who died in hospital more than 15 years ago were invited. Five couples, seven mothers, and one father were interviewed. The focus was on the remembrance of the child and the significance of the death for the life of the parents. Recorded interviews were analysed thematically. Most children died within days. The children were regarded as family members. Physical tokens and birthdays played a central role in remembrance practices. Although the process of grief was described as long and painful, it was also described as an existential experience and a source of better priorities in life. After 15 years, the dead newborn child was still considered a family member. There was little expression of regret about what happened at the time. Due to the low response rate, it is possible that diverging lived experiences may be common.

LettersJuly 2023Mental Health and Health-Related Quality of Life After Firearm Injury: A Preliminary Descriptive StudyFREESydney C. Timmer-Murillo, PhD, Sarah J.H. Melin, MPH, Carissa W. Tomas, PhD, Timothy J. Geier, PhD, Amber Brandolino, MS, Andrew T. Schramm, PhD, Christine L. Larson, PhD, Terri A. deRoon-Cassini, PhDSydney C. Timmer-Murillo, PhDDivision of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, Sarah J.H. Melin, MPHMedical College of Wisconsin, Milwaukee, Wisconsin, Carissa W. Tomas, PhDDivision of Epidemiology & Social Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, Timothy J. Geier, PhDDivision of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, Amber Brandolino, MSDivision of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee, and Division of Data Surveillance & Informatics, Comprehensive Injury Center, Medical College of Wisconsin, Milwaukee, Wisconsin, Andrew T. Schramm, PhDDivision of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, Christine L. Larson, PhDDepartment of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, Terri A. deRoon-Cassini, PhDDivision of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee, and Division of Data Surveillance & Informatics, Comprehensive Injury Center, Medical College of Wisconsin, Milwaukee, WisconsinAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M23-0309 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Firearm injury is a public health crisis in the United States (1). Organizations have called for the consideration of long-term consequences of firearm violence, particularly for those directly impacted. Interpersonal firearm violence survivors report significantly worse physical health and functioning compared with the general population and other mechanisms of traumatic injury (1). Furthermore, firearm violence impacts the mental health of survivors and communities. Yet, there is limited work examining self-reported mental and physical health consequences of firearm violence for survivors acutely after injury, thwarting health care systems' ability to comprehensively intervene.Objective: To describe the mental health symptoms and health-related quality of life of firearm injury survivors 6 months after injury.Methods: A convenience sample of 87 adults was recruited from the trauma service of a level 1 trauma center in a midwestern, mid-sized city. Data were pooled from 2 studies occurring at the same center between the years of 2014 to 2016 and 2017 to 2021; both studies examined psychological and biological outcomes of traumatic injury (2). Participants were recruited in the emergency department or during hospitalization. Inclusion criteria were: 1) being 18 years of age or older, 2) having a Glasgow Coma Scale score of at least 13 on arrival, 3) having an unintentional suicidal self-injury, and 4) communicating in English. Exclusion criteria were: 1) experiencing loss of consciousness greater than 30 minutes, 2) experiencing posttraumatic amnesia for more than 24 hours, or 3) being in police custody. Although both studies recruited participants with all mechanisms of injury, the current investigation presents data on patients with interpersonal firearm-related injuries. Baseline sessions occurred up to 1 month postinjury and follow-up approximately 6 months after injury. After consent, participants completed measures on posttraumatic stress disorder (PTSD; PTSD Symptom Checklist for DSM-5); depression, anxiety, and stress (Depression, Anxiety, and Stress Scale [DASS-21]); and physical health-related quality of life (Short Form 12). Studies were approved by the Medical College of Wisconsin institutional review board and were funded by the National Institute of Mental Health. The funding organization was not involved in study design, data collection, or analyses.Findings: The Table provides demographic characteristics and outcome variables at baseline and 6 months. At baseline, patients exhibited symptoms of PTSD with a mean score of 27.15 (SD, 19.19), but symptoms were more severe at 6 months at a mean score of 38.66 (SD, 19.91). The PTSD mean score was above the recommended diagnostic cutoff of 34 for PTSD after interpersonal trauma and was higher than previous injury samples (3). Using interpretation guidelines from DASS-21, anxiety was "mild" at baseline with a mean score of 9.28 (SD, 9.23) and "moderate" at 6 months with a mean score of 11.20 (SD, 11.17). Depressive symptoms were in the "normal" range at baseline with a mean score of 7.25 (SD, 8.91), and higher at 6 months, nearing the cutoff to mild range at a mean score of 9.56 (SD, 10.87). Patients reported normal stress levels at a mean score of 9.52 (SD, 9.31) at baseline. Although reported stress was higher at 6 months with a mean score of 12.93 (SD, 11.29), it was still within the normal range. Patients' health-related quality of life was poor at baseline at a mean score of 30.48 (SD, 13.94), remained poor at 6 months with a mean score of 30.45 (SD, 19.22), and was well below scores reported in previous studies of both injury populations and the general population (4). The Figure shows changes in outcome measures from baseline to 6 months.Table. Sample Demographics, and Mental Health and Health-Related Quality-of-Life Descriptive StatisticsCharacteristicDescriptive StatisticRangeSex, n (%) Female77 (88.5)– Male10 (11.5)–Race, n (%) Asian1 (1.1)– Black/African American69 (79.3)– Hispanic/Latinx11 (12.6)– White/European American6 (6.9)–Psychiatric history,* n (%) Yes36 (41.4)– No50 (57.5)–Mean age (SD), y32.96 (10.06)18–57Mean Injury Severity Score (SD)13.12 (8.49)1–43Mean PCL-5–PTSD score† (SD) Baseline (n = 87)27.15 (19.19)1–72 6 mo (n = 41)38.66 (19.91)2–73Mean DASS-21–Anxiety score† (SD) Baseline (n = 87)9.29 (9.23)0–42 6 mo (n = 41)11.20 (11.17)0–42Mean DASS-21–Depression score† (SD) Baseline (n = 87)7.25 (8.91)0–42 6 mo (n = 41)9.56 (10.87)0–42Mean DASS-21–Stress score† (SD) Baseline (n = 87)9.52 (9.31)0–38 6 mo (n = 41)12.93 (11.29)0–42Mean SF-12 Physical Health score‡ (SD) Baseline (n = 87)30.48 (13.94)5.17–55.48 6 mo (n = 41)30.45 (19.22)0–60.73DASS-21 = Depression, Anxiety, Stress Scale; PCL-5 = PTSD Checklist for DSM-5, measure of PTSD symptom severity; PTSD = posttraumatic stress disorder; SF-12 = Short Form 12, for physical health.* One participant declined to answer.† Higher scores are indicative of worse symptoms for PTSD, Depression, Anxiety, and Stress.‡ Lower scores are indicative of poorer health for Physical Health. Download table Table. Sample Demographics, and Mental Health and Health-Related Quality-of-Life Descriptive StatisticsFigure. Mental and physical health outcome variables across time.Error bars depict SE. DASS-21 = Depression, Anxiety, and Stress Scale; PCL-5 = PTSD Checklist for DSM-5, measure of PTSD symptom severity; PTSD = posttraumatic stress disorder; SF-12 = Short Form 12, for physical health.* Lower SF-12 scores correspond to poorer health. General population average from Haider et al (4). Download figure Download PowerPoint Discussion: The need to understand the physical and mental health consequences of firearm injury in the United States is vital. In this preliminary descriptive study, firearm injury survivors reported poor PTSD acutely after the injury that persisted at 6 months. Furthermore, these patients endorse poor physical health–related quality of life across time, with values worse than previously studied injury samples (4). Medical advancements have increased the survivability of firearm injury, though survivors still carry the burden of injury as the mental and physical health outcomes seem poorer relative to the general population and those who have sustained other traumatic injuries (1, 4). These findings must be considered within the context of limitations including the small convenience sample, relatively short follow-up, and lack of data on preinjury mental health comorbidity. However, this preliminary study highlights the needs to better understand and manage the mental health consequences of firearm injury. Early screening and comprehensive care may improve outcomes in this at-risk population.

The termination of pregnancy, whether spontaneous or voluntary, involves an intense emotional impact on both the woman and her partner which alters their emotional world. The high percentage of women who suffer a perinatal loss, and the emotional repercussions it entails in both the short and long term, make it necessary to rethink the work of the specialties which attend the perinatal population (psychology, pediatrics, gynecology, obstetrics, psychiatry …) to acknowledge the importance of a frequent yet particularly silenced grieving process. In this article focus will be placed on the perinatal losses which occur during gestation, a mourning process which ebbs and flows, which has its own symptomatology and one which also requires its own bespoke attention, training, and therapeutic listening. From reflection and clinical practice, relevant aspects which occur during this therapeutic process will be addressed. This professional accompaniment, which is necessary yet scarce, aims to enable the woman and her partner to sufficiently work through their grief, alleviate the current symptomatology and, in the case of a subsequent pregnancy, reduce the risk of emotional imbalance in the mother, her partner and the future baby, which can lead to perinatal depression in the parents or emotional development problems in the baby.