Continuing Psychometric Evaluation of the Perinatal Grief Intensity Scale in the Subsequent Pregnancy After Perinatal Loss

Abstract

Objective To examine the relation of grief intensity, psychological wellbeing, and the quality of intimate partner relationships of women in the subsequent pregnancy after a miscarriage, stillbirth, or neonatal death. Design Descriptive, cross‐sectional, correlational research design. Based on the theoretical framework of perinatal grief intensity developed by the author, we examined the reliability and convergent validity of the Perinatal Grief Intensity Scale (PGIS) in the subsequent pregnancy after a perinatal loss. Setting Web‐based study. Sample Currently pregnant women (N = 227) who had experienced a perinatal loss in their immediate past pregnancies. Analysis indicated the sample of 227 women who completed the instruments (48% of total) afforded sufficient power to test the hypotheses. Methods Instruments included the Pregnancy Outcome Questionnaire (POQ) for pregnancy‐specific anxiety; Impact of Event Scale (IES) for posttraumatic stress; Center for Epidemiologic Studies‐Depression Scale (CES‐D) for depression symptoms; Autonomy and Relatedness Inventory (ARI) for quality of intimate primary relationship; and the PGIS for perinatal grief intensity. Data were analyzed using descriptive statistics. Results Cronbach's alphas for all total scales and subscales used in the study were high and ranged from .75 (PGIS total) to .95 (ARI total). Increased grief intensity was associated with significantly increased pregnancy‐specific anxiety; depression symptoms; posttraumatic stress; and poorer, primary, intimate relationships. Participants in all three groups (miscarriage, stillbirth, and neonatal death) reported significantly higher mean CES‐D scores (range 25.2‐29.6, p < .001) than the traditional cutoff score of 16 used for suggesting depression symptoms. Similarly, all mean loss group scores were significantly higher than 23 (range 34.4‐35.5, p < .001), the IES cutoff score used to suggest posttraumatic stress. Conclusion/Implications for Nursing Practice The consequences associated with intense grieving may include significant couple relationship issues, depression, pregnancy‐specific anxiety, and posttraumatic stress that may also extend into the subsequent healthy pregnancy. The PGIS demonstrated total and subscale internal consistency reliability when used with all types of perinatal loss within the context of subsequent pregnancy. It demonstrated convergent validity by establishing statistically significant and appropriate directional relationships with concepts thought to be associated with intense grief, including pregnancy‐specific anxiety, depression symptoms, posttraumatic stress, and the quality of the primary intimate relationship. It may eventually be useful as a clinical instrument to help health care providers identify parents at risk for intense grief reactions and other clinically relevant symptoms. To examine the relation of grief intensity, psychological wellbeing, and the quality of intimate partner relationships of women in the subsequent pregnancy after a miscarriage, stillbirth, or neonatal death. Descriptive, cross‐sectional, correlational research design. Based on the theoretical framework of perinatal grief intensity developed by the author, we examined the reliability and convergent validity of the Perinatal Grief Intensity Scale (PGIS) in the subsequent pregnancy after a perinatal loss. Web‐based study. Currently pregnant women (N = 227) who had experienced a perinatal loss in their immediate past pregnancies. Analysis indicated the sample of 227 women who completed the instruments (48% of total) afforded sufficient power to test the hypotheses. Instruments included the Pregnancy Outcome Questionnaire (POQ) for pregnancy‐specific anxiety; Impact of Event Scale (IES) for posttraumatic stress; Center for Epidemiologic Studies‐Depression Scale (CES‐D) for depression symptoms; Autonomy and Relatedness Inventory (ARI) for quality of intimate primary relationship; and the PGIS for perinatal grief intensity. Data were analyzed using descriptive statistics. Cronbach's alphas for all total scales and subscales used in the study were high and ranged from .75 (PGIS total) to .95 (ARI total). Increased grief intensity was associated with significantly increased pregnancy‐specific anxiety; depression symptoms; posttraumatic stress; and poorer, primary, intimate relationships. Participants in all three groups (miscarriage, stillbirth, and neonatal death) reported significantly higher mean CES‐D scores (range 25.2‐29.6, p < .001) than the traditional cutoff score of 16 used for suggesting depression symptoms. Similarly, all mean loss group scores were significantly higher than 23 (range 34.4‐35.5, p < .001), the IES cutoff score used to suggest posttraumatic stress. The consequences associated with intense grieving may include significant couple relationship issues, depression, pregnancy‐specific anxiety, and posttraumatic stress that may also extend into the subsequent healthy pregnancy. The PGIS demonstrated total and subscale internal consistency reliability when used with all types of perinatal loss within the context of subsequent pregnancy. It demonstrated convergent validity by establishing statistically significant and appropriate directional relationships with concepts thought to be associated with intense grief, including pregnancy‐specific anxiety, depression symptoms, posttraumatic stress, and the quality of the primary intimate relationship. It may eventually be useful as a clinical instrument to help health care providers identify parents at risk for intense grief reactions and other clinically relevant symptoms.