Active Grief Research Articles

Women pregnant after previous perinatal loss: relationships between adult attachment, shame, and prenatal psychological outcomes

ABSTRACT Background Insecure adult attachment, shame, self-blame, and isolation following perinatal loss place bereaved women at risk of adverse psychological outcomes, which can impact child and family outcomes. To date, no research has considered how these variables continue to influence women’s psychological health in pregnancy subsequent to loss. Objective This study explored associations between prenatal psychological adjustment (less grief and distress) and adult attachment, shame, and social connectedness, in women pregnant after loss. Method Twenty-nine pregnant Australian women accessing a Pregnancy After Loss Clinic (PALC) completed measures of attachment styles, shame, self-blame, social connectedness, perinatal grief, and psychological distress. Results Four 2-step hierarchical multiple regression analyses revealed adult attachment (secure/avoidant/anxious; Step 1), shame, self-blame, and social connectedness (Step 2) explained 74% difficulty coping, 74% total grief, 65% despair, and 57% active grief. Avoidant attachment predicted more difficulty coping and higher levels of despair. Self-blame predicted more active grief, difficulty coping, and despair. Social connectedness predicted lower active grief, and significantly mediated relationships between perinatal grief and all three attachment patterns (secure/avoidant/anxious). Conclusions Although avoidant attachment and self-blame can heighten grief in pregnancy after loss, focusing on social connectedness may be a helpful way for prenatal clinicians to support pregnant women during their subsequent pregnancy – and in grief.

The Effect of Brief Supportive Psychotherapy on Prevention of Psychiatric Morbidity in Women with Miscarriage: A Randomized Controlled Trial about the First 24-hours of Hospitalization.

ObjectivesMiscarriage is a common pregnancy complication causing substantial psychiatric complications. This study was designed to investigate whether the administration of brief supportive psychotherapy (BSP) is effective on the management of women with miscarriage when conducted in the first 24 hours of hospitalization in order to prevent symptoms of anxiety, depression, and grief at four-months post-miscarriage.MethodsWe conducted a randomized clinical trial on 79 women with miscarriage hospitalized in Ayatollah Rohani teaching hospital. The women were randomly assigned into two groups (39 in the experimental group and 40 in the control group). All interventions were implemented for two study groups during the first 24 hours of hospitalization in a private room in the hospital. The experimental group received a two-hour BSP. The objective outcomes were assessed using Hospital Anxiety and Depression Scale and Perinatal Grief Scale (PGS), which has three subscales (active grief, difficulty coping, and despair) and were measured before the intervention and at four-months post-miscarriage.ResultsThe results of pre-tests in the follow-up of the trial suggested that the participants who received BSP reported significant reductions in the mean scores of active grief (-34.2±9.7 vs. 28.1±-6.9), difficulty coping (27.1±6.4 vs. 23.3±4.3), despair (28.0±8.4 vs. 22.8±5.2), and total PGS (89.6±23.1 vs. 74.4±15.3), in contrast to participants in the control group who did not report such results. Further, the results of generalized estimating equations models revealed that brief supportive psychotherapy caused a significant decrease in the level of factors including active grief, difficulty coping, despair, total perinatal grief, anxiety symptoms, and depressive symptoms in subjects in the experimental group compared to those in the control group after miscarriage. Also, the frequency of anxiety symptoms (13.5% vs. 60.5%), depressive symptoms (32.4% vs. 71.1%), and grief symptoms (10.8% vs. 65.8%) was found to be significantly lower in the group receiving psychotherapy than in the control group at four-months follow-up.ConclusionsAdministration of BSP session during the first 24 hours of hospitalization for women with miscarriage can be considered a reliable method to prevent anxiety symptoms, depression symptoms, and perinatal grief at four-months follow-up.

The level of grief in women with pregnancy loss: a prospective evaluation of the first three months of perinatal loss

Objective To prospectively investigate perinatal grief in women with pregnancy loss. Methods A total of 215 women (mean (SD) age: 30.7 (5.9) years) who experienced pregnancy loss were included. Data on sociodemographic, marital and obstetric characteristics and Perinatal Grief Scale (PGS) (first 48 h, 1 week, 1 month and 3 months after the loss) were recorded. Results Active grief scores were lower (p ranged < .05 to <.01), while difficulty coping (p < .05 for each) and despair (p < .05 for each) scores were higher in the 3rd month as compared with prior assessments. All PGS scores at the 48 h and 3rd month assessments were significantly higher in assisted and planned pregnancies (p < .01 for each). Maternal age was positively correlated with 48 h active grief (r = 0.19, p < .001), despair (r = 0.13, p < .05) and total PGS (r = 0.13, p < .05) scores. Parity and the number of children were negatively correlated (r ranged from -0.35 to -0.20, p < .01 for each) with all PGS scores. Conclusion Our findings revealed decrease in active grief levels, whereas gradual increase in difficulty coping and despair in women with pregnancy loss within the first 3 months of losing a child. Our finding indicate association of older maternal age, primiparity, assisted and planned pregnancies with regular antenatal follow up with higher total PGS scores as well as active grief, difficulty coping and despair scores in women regardless of the time of assessment within 3 months after the pregnancy loss.

Zaniechanie ukarania z art. 16a i 16b k.k.s. — szczególne rodzaje czynnego żalu czy niepotrzebna kazuistyka?

WAIVING THE PENALTY WITH ARTICLE 16A AND 16B — ARE THESE SPECIAL TYPES OF ACTIVE GRIEF OR UNNECESSARY CASUISTRY?The article is a theoretical study of waiving the penalty of a fiscal penal law violator or a fiscal offender. The issues addressed in the article present major problems that draw the attention of both theorists and practitioners in the field. The aim of the article is to evaluate the contemporary model of waiving the penalty that is formulated by the fiscal penal code within Articles 16, 16a and 16b. The author analyzes in detail the institutions described in the Fiscal Penal Code, Chapter 2: The basic type of active grief and its special types. The article ends with closing remarks, including general conclusions and assumptions that relate to the model of waiving the penalty of a fiscal penal law violator using the institution of active grief, which in turn can contribute to providing a proper solution to the issue.

Factors associated with parental grief reaction following pediatric acquired brain injury

ABSTRACT The present study investigated factors associated with parental grief reaction (PGR) following pediatric acquired brain injury (ABI), and compared PGR to the one exhibited following child death. Fifty-seven parents of 51 children (aged 3–18) whose ABI occurred 1–14 years before participation, completed the multi-scale Two-Track Bereavement Questionnaire; a socio-demographic questionnaire; and a scale assessing perceived behavioural changes in the child. Results from regression analysis indicated that time since injury had no impact on parents’ grief other than having an adverse impact on their overall coping and functioning; A higher amount of weekly caring hours predicted only a greater traumatic perception of the loss; Older children’s ages but mostly greater parental-perceived behavioural changes, predicted greater PGR on most scales. PGR was compared with the pre-existing data of bereaved parents who completed the same grief questionnaire. Although grief response patterns and intensity were similar in both groups, significant differences were found on scales assessing the continuing bond with the child: relational active grief, close and positive relationship, and conflictual relationship. Our findings indicate that parental grief is multi-dimensional following pediatric ABI and illuminate the interplay between elements characterizing parents’ nonfinite vs. finite loss experience.

Impact of Cognitive Behavioral-Based Counseling on Grief Symptoms Severity in Mothers After Stillbirth

Background: An active intervention is necessary for the care and support of women who have experienced stillbirth. Objectives: The aim of the present study was to determine the impact of psychological counseling on the severity of grief symptoms in mothers after stillbirth. Methods: We conducted a semi-experimental study on 100 women who had experienced stillbirth in their most recent delivery in a Central Maternity Hospital affiliated to the University of Medical Sciences, Zahedan, Iran. Participants were randomly assigned to two groups: intervention (n = 50) and control (n = 50). The intervention group received four sessions of small-group psychological counseling over 2 weeks and the control group received the routine postnatal care. We evaluated the severity of grief symptoms in both the groups before the first counseling session as well as at the end of the fourth week following the final session (and at equivalent times in the control group) using the Perinatal Grief Scale. Data were analyzed using independent and paired t-tests, chi-square test, and analysis of covariance. Results: The mean total grief symptom score and three subscale scores (active grief, difficulty coping, and despair) were significantly lower in the participants who received psychological counseling than in those who received the routine care (P < 0.05). Conclusions: Counseling significantly reduces grief symptoms, allowing for faster transition from grieving and preventing complicated grief. It is, therefore, necessary to integrate psychological interventions into the care system for mothers.

Dobrowolność czynnego żalu związanego z usiłowaniem udolnym i nieudolnym (uwagi na tle uchwały siedmiu sędziów SN z dnia 19 stycznia 2017 r., I KZP 16/16)

The following article critically assesses the ruling of seven justices of the Supreme Court dating January 19, 2017. The crucial issue undertaken by this article consists in the assessment of the validity of the ruling of the Supreme Court which assumes an unsuccessful attempt in the cases of the lack of an object on which to commit a criminal offense and defines the “voluntariness” of active grief exhibited at the stage of attempting to commit a criminal offense. The Supreme Court assumed an objectivist conception in their interpretation of the phrase “lack of an object on which to commit a criminal offense”, thus assuming that what transpires is a successful attempt in the case where there was a lack of a particular object comprising the perpetrator’s intent, but there were other objects which could have become the objects of the crime. At the same time, however, the Supreme Court ruled that the premises of voluntariness resulting in impunity (Article 15 § 1 of the Criminal Code) did not apply, since the perpetrator did not abandon his intent to commit a criminal offense; it was only the object of it that did not fulfill their expectations. According to the author of the article, such a ruling allows to reach two contradictory conclusions. Thus, the author proposes a different conception of assuming successful or unsuccessful attempt with regard to an object on which to commit a criminal offense, as well as a model for assessing the voluntariness of the perpetrator in the cases of the lack of continuation of iter delicti.

Tzw. usiłowanie kwalifikowane – próba nowego spojrzenia

In the doctrine of criminal law, the term “qualified attempt” denotes two cases. Firstly, the term “qualified attempt” describes a situation in which, when the perpetrator, in their intent to commit a criminal act, directly aims to commit it but does not succeed (attempt), while fulfilling all premises of another criminal act (commission). In the second case, the term “qualified attempt” describes a situation in which the attempt at the commission of a criminal act is covered by the impunity clause on the basis of active grief, while the act of the perpetrator needs to be classified as a commission of a different criminal act. The article, following a general overview of the literature on the subject, presents the author’s own understanding of the term “qualified attempt”, which consists in the differentiation among attempt, cumulatively qualified attempt with commission, and non-punishable attempt subsumed as a punishable commission.

Childhood bereavement: The role of the surviving parent and the continuing bond with the deceased

ABSTRACTThis study investigated the relationship between the role of the surviving parent in the child’s grieving process, the continuing bond with the deceased parent and biopsychosocial functioning and active grief in adulthood. A survey of 135 adults, parentally bereaved in childhood, indicated that the surviving parent’s role in facilitating the grieving process promoted a positive continuing bond with the deceased in childhood as well as general functioning in adulthood. The continuing bond with the deceased had a weak association with both better general functioning and relational active grief.

Translation and validation of the Perinatal Grief Scale in a sample of Greek women with perinatal loss during the 1st and 2nd trimester of pregnancy

Objective: To translate and validate the Perinatal Grief Scale (PGS) (short version) in a sample of Greek women with perinatal loss during the first and second trimester of pregnancy.Methods: One hundred seventy-six women were approached a few hours after the loss. Along with the PGS, three more questionnaires were completed: the Edinburgh Postnatal Depression Scale (EPDS), the Hospital Anxiety and Depression Scale (HADS) and the State-Trait Anxiety Inventory (STAI), in order to assess the convergent validity of the PGS.Results: Total sample mean age was 34.1 years (SD = 5.2). Mean values and Cronbach’s alpha coefficients for PGS subscales exceeded the minimum reliability standard of 0.70. Mean score for “Active grief” was 31.47 (SD = 9.31), for “Difficulty Coping” was 23.13 (SD = 7.54) and for “Despair” was 21.07 (SD = 7.07). By applying Pearson’s correlation coefficients, PGS subscales positively correlated with scores on EPDS, STAI and HADS.Conclusions: The PGS Greek version is a reliable instrument in terms of internal consistency and the Cronbach’s alpha coefficients are high. The Greek version of PGS can be a useful instrument for the detection of the psychological impact after a perinatal loss and it has implications for both scientific research and clinical routine.

Loneliness, Depression, Social Support, and Quality of Life in Older Chronically Ill Appalachians

ABSTRACT This study's purpose was to describe loneliness and to examine the relationships between loneliness, depression, social support, and QOL in chronically ill, older Appalachians. In-person interviews were conducted with a convenience sample of 60 older, chronically ill, community-dwelling, and rural adults. Those with dementia or active grief were excluded. The UCLA Loneliness Scale (Russell, Peplau, & Cutrona, 1985), Geriatric Depression Scale (Shiekh & Yesavage, 1986), Katz ADL scale (Katz, Down, & Cash, 1970), MOS Social Support Scale (Sherbourne & Stewart, 1991), and a visual analog scale for Quality of Life (Spitzer et al., 1981) scale were used. Diagnoses were obtained through chart reviews. SPSS was used for data analyses. The majority of the 65% female sample (M age = 75 years) were married and impoverished. Participants’ number of chronic illnesses averaged more than 3. Over 88% of participants reported at least 1 area of functional impairment. Loneliness was prevalent with UCLA loneliness scores indicating moderate to high loneliness, ranging from 39 to 62 (possible scores were 20−80). Higher loneliness scores correlated with depression, lower Qol, and lower social support, particularly lower emotional support. This study provides evidence that loneliness is a significant problem for older chronically ill Appalachian adults and that it may be related to low emotional support. Further, it provides evidence that this population may be significantly lonely and may not self-identify as lonely. Screening for loneliness and designing interventions that target the emotional aspects of loneliness could be important in this population.

Religiosity is an Important Part of Coping with Grief in Pregnancy After a Traumatic Second Trimester Loss

Women (n=15) who were pregnant after a traumatic late pregnancy loss (termination because of fetal death or serious anomalies) completed psychometric screening tests and scales, including the Perinatal Grief Scale (PGS), the Impact of Event Scale (IES), the Duke Depression Inventory (DDI), the Generalized Anxiety Disorder-7 (GAD), and the Hoge Scale for Intrinsic Religiosity (IR). Despite a mean elapsed time since the prior loss of 27 (range, 7-47) months, half (7/15, 47%) of the combined groups had high levels of grief on the PGS. Multiple positive scores on psychometric tests were frequent: Sixty percent (9/15) had high scores on the PGS Active Grief subscale or on the IES. Forty percent (6/15) had a high score on the DDI, and 17% (3/15) on the GAD. IR scores significantly and negatively correlated with scores on the Despair subscale of the PGS. The results from this pilot study suggest that high levels of grief and PTS symptoms are significant problems for pregnant women who have suffered late loss of a wanted pregnancy. Religiosity may play an important part in maternal coping during these stressful pregnancies.

Validation of the Perinatal Grief Scale for Use in Chinese Women Who Have Experienced Recent Reproductive Loss

The primary objective of this research was to validate the short version of the Perinatal Grief Scale (SVPGS) in the Chinese population. The Chinese SVPGS was administered to a sample of Chinese women who had experienced recent reproductive loss (N = 314). The results of the confirmatory factor analysis rejected the original 3-factor model delineated by Potvin (1989). A follow-up exploratory factor analysis suggested an alternative 3-factor model, consisting of a 12-item Sense of Worthlessness subscale, a 7-item Social Detachment subscale, and a 7-item Painful Recollection subscale. Further analysis showed that both the original and Chinese SVPGS demonstrated good internal consistency. Cronbach's alpha equaled .86, .83, .90, and .95, respectively, for the three subscales of Active Grief, Difficulty Coping, and Despair, and the total original SVPGS, and .85, .93, .91, and .95, respectively, for the new subscales of Sense of Worthlessness, Social Detachment, and Painful Recollection, and the total Chinese SVPGS. Both versions demonstrated satisfactory correlations with the participants' psychological distress and spousal emotional support. The authors suggest that both versions are useful in measuring the responses of Chinese women to reproductive loss; the original SVPGS should be used for cross-cultural studies, whereas the Chinese SVPGS should be used for local studies.

Effect of a structured follow‐up visit to a midwife on women with early miscarriage: a randomized study

Women's grief after miscarriage is substantial and important. Women who experience early miscarriage do not constitute a homogenous group. The aim of this study is to measure whether a structured follow-up visit to a midwife (group 1) at 21-28 days after early miscarriage could reduce the women's grief, measured using the perinatal grief scale Swedish short version (PGS) after a further 3 months (i.e. 4 months after the miscarriage), compared to a regular follow-up visit to a midwife (group 2). We performed an open randomized study of women who experienced early miscarriage (n = 88). The midwife's attitude in group 1 came from Swanson science theory of midwifery. In group 2, the women were offered only the ordinary type of consultation at a regular visit. A questionnaire with the PGS was used in both groups. Four months after the miscarriage, a second questionnaire with the same perinatal grief scale was sent by post. There was a 30% greater reduction in grief in group 1 than that in group 2, when comparing the first and second measurements (not significant). The biggest differences were in the subscales active grief and difficulty in coping. Women with the subdiagnosis missed abortions had, as a group, significantly higher PGS scores at both visits, especially in active grief and difficulty in coping, regardless of the type of follow-up visit. A structured follow-up visit did not, in comparison with a regular follow-up visit, imply any significant reduction in grief as measured using the PGS scale. However, the subgroup missed abortion had more extensive grief than the other women with miscarriage. Structured follow-up visits are not imperative for all women with early miscarriage.

GRIEF WORK VERSUS CONTINUING BONDS: A CALL FOR PARADIGM INTEGRATION OR REPLACEMENT?

In this paper we compare grief work and continuing bond models of grief to determine if one explains the data better than the other. Sixty individuals in active grief completed a questionnaire in which they were asked to rate their grief status, perceived similarity to the deceased along 7 dimensions, and closeness of relationship to the deceased. A matched control group was also asked to rate the closeness of relationship and perceived similarity to a living person of the same relationship as the deceased to the griever. In line with grief work, we found that perceived similarity was directly related to severity of grief and that perceived closeness of relationship declined over time. In support of continuing bonds, however, perceived similarity did not decline over time, nor was overall perception of similarity among grievers different from their matched controls.

Psychologic and obstetric predictors of couples’ grief during pregnancy after miscarriage or perinatal death

Objective: To determine if the psychologic constructs of self-criticism and marital adjustment, considered jointly with obstetric and demographic factors, are significant predictors of grief during a pregnancy after a miscarriage or perinatal death. Methods: Participants included 60 pregnant women with previous miscarriages or perinatal deaths, and 50 of their partners. Participants completed a package of psychometric instruments between the tenth and 19th week of gestation. Predictors of grief (active grief, difficulty coping, despair) included (1) psychologic factors: marital adjustment and self-criticism; (2) demographic factors: age and number of living children; and (3) obstetric factors: gestational age at time of loss, number of losses, and time between loss and subsequent conception. Results: Stepwise regression analyses were conducted for each grief component for women and men. For women, active grief was significantly associated with high self-criticism and later losses ( R 2 = 0.31). Later losses and longer time between loss and conception were significantly associated with difficulty coping ( R 2 = 0.55) and despair ( R 2 = 0.44). In men, active grief was associated with high self-criticism and later losses ( R 2 = 0.28), difficulty coping ( R 2 = 0.18), and despair ( R 2 = 0.25) with high self-criticism. A trend was found for poor marital adjustment to be associated with higher levels of difficulty coping and despair in men. Conclusion: High levels of self-criticism and later gestational age at time of loss are predictors of increased grief during a pregnancy after a miscarriage or perinatal death. Increased time between loss and subsequent conception is also predictive of increased grief for women. For men, low levels of marital adjustment are predictive of increased grief. These results may be helpful in counselling couples considering pregnancy after a loss.

Active grief, despair and difficulty coping: Some measured characteristics of male response following their partner's miscarriage

There has been relatively little published research on the effects upon men of their partner's miscarriage. Some interim findings from the first large study in the UK are indicated. Male partners (n = 323) of women who miscarried were administered the Perinatal Grief Scale (PGS), scoring on overall grief not dissimilarly to female cohorts who had miscarried. Analysis of the PGS scores suggests characteristic differences in the way grief is handled by males and females, with males displaying less immediate ‘active grief’, but being more vulnerable to feelings of ‘despair’ and ‘difficulty in coping’. The duration of the pregnancy prior to miscarriage and the experience of seeing an ultrasound scan appear to be factors in raised levels of grief in these men.

The impact of a subsequent pregnancy on grief and emotional adjustment following a perinatal loss

The present study examined the impact of a subsequent pregnancy on emotional adjustment associated with a previous perinatal loss and on the following components of parental grief—active grief, difficulty coping, despair. Participants included 25 women and 24 partners who were expecting a baby for the first time since their loss and 25 women and 18 partners who were not expecting and had not had a child or pregnancy after their loss. Depressive symptomatology, anxiety, marital adjustment, as well as active grief, despair, and difficulty coping were measured. Mothers who were not pregnant were experiencing significantly higher levels of despair and difficulty coping than pregnant mothers, independently from the effect of time elapsed since the loss. For the fathers, no significant group effect in emotional distress or intensity of grief was found. Women reported significantly higher levels of negative affectivity than men. A new pregnancy may be associated with a beneficial effect on the mourning process of women with a previous perinatal loss, primarily by decreasing their despair and difficulty coping. However, in our sample, grief intensity remained high, suggesting that the mourning process may not be hindered by a subsequent pregnancy.