Previous prenatal loss as a predictor of perinatal depression and anxiety

Department of Psychiatry, University of Rochester Medical Center, New York, NY 14642-8409, USA.
The British journal of psychiatry: the journal of mental science (Impact Factor: 7.34). 03/2011; 198(5):373-8. DOI: 10.1192/bjp.bp.110.083105
Source: PubMed

ABSTRACT Prenatal loss, the death of a fetus/child through miscarriage or stillbirth, is associated with significant depression and anxiety, particularly in a subsequent pregnancy.
This study examined the degree to which symptoms of depression and anxiety associated with a previous loss persisted following a subsequent successful pregnancy.
Data were derived from the Avon Longitudinal Study of Parents and Children cohort, a longitudinal cohort study in the west of England that has followed mothers from pregnancy into the postnatal period. A total of 13,133 mothers reported on the number and conditions of previous perinatal losses and provided self-report measures of depression and anxiety at 18 and 32 weeks' gestation and at 8 weeks and 8, 21 and 33 months postnatally. Controls for pregnancy outcome and obstetric and psychosocial factors were included.
Generalised estimating equations indicated that the number of previous miscarriages/stillbirths significantly predicted symptoms of depression (β = 0.18, s.e. = 0.07, P<0.01) and anxiety (β = 0.14, s.e. = 0.05, P<0.01) in a subsequent pregnancy, independent of key psychosocial and obstetric factors. This association remained constant across the pre- and postnatal period, indicating that the impact of a previous prenatal loss did not diminish significantly following the birth of a healthy child.
Depression and anxiety associated with a previous prenatal loss shows a persisting pattern that continues after the birth of a subsequent (healthy) child. Interventions targeting women with previous prenatal loss may improve the health outcomes of women and their children.

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    • "However, studies which have examined prenatal, perinatal, and post-natal losses have generally found no differences in symptomatology across types of loss (Dyregrov, 1990), although one study has reported more symptomatology following post-natal compared to prenatal loss (Gaudet, Séjourné, Camborieux, Rogers, & Chabrol, 2010). There is significant psychological/psychiatric morbidity associated with infant loss (Blackmore et al., 2011); however , only a few studies have investigated attachment styles and psychological trauma in response to both peri-and post-natal mortality. The primary aim of the current study was to identify attachment styles, or ''classes,'' based on individuals' relationship with their family members, romantic partners, and close friends. "
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    ABSTRACT: Background: Based on Bowlbys (1973) attachment theory, Bartholomew (1990) proposed a four category attachment typology by which individuals judged themselves and adult relationships. This explanatory model has since been utilised to help explain risk of psychiatric comorbidity. Objective: The current study aimed to identify attachment typologies based on Bartholomew’s (1990) attachment styles in a sample of bereaved parents on dimensions of closeness/dependency and anxiety. Additionally, it sought to assess the relationship between the resultant attachment typology with a range of psychological trauma variables. Method: The current study was based on a sample of 445 bereaved parents who had experienced, either peri or post natal death of an infant. Adult attachment was assessed using the Revised Adult Attachment Scale (RAAS) while reaction to trauma was assessed using The Trauma Symptom Checklist (TSC). A latent profile analysis was conducted on scores from the RAAS closeness/dependency and anxiety subscales to ascertain if there were underlying homogeneous attachment classes. Emergent classes were used to determine if these were significantly different in terms of mean scores on TSC scales. Results: A four class solution was considered the optimal based on fit statistics and interpretability of the results. Classes were labelled ‘Fearful’, ‘Preoccupied’ ‘Dismissing’ and ‘Secure’. Females were almost eight times more likely than males to be members of the fearful attachment class. This class evidenced the highest scores across all TSC scales while the secure class showed the lowest scores. Conclusions: The results are consistent with Bartholomew’s four category attachment styles with classes representing secure, fearful, preoccupied and dismissing types. While the loss of an infant is devastating experience for any parent, securely attached individuals showed the lowest levels of psychopathology compared to fearful, preoccupied or dismissing attachment styles. This may suggest that a secure attachment style is protective against trauma related psychological distress.
    European Journal of Psychotraumatology 04/2014; DOI:10.3402/ejpt.v5.23295 · 2.40 Impact Factor
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    • "Others found 25% of bereaved couples had at least one distressed partner 30 months after a baby's death (Vance et al., 2002). Depression and anxiety after loss may continue for years, even after subsequently giving birth to a healthy infant (Blackmore et al., 2011). Two thirds of parents whose babies died of SIDS felt the death still affected them 12 to 15 years later and that few of their friends or associates knew their grief continued (Dyregrov & Dyregrov, 1999). "
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    ABSTRACT: This article presents secondary analysis of data from parents who, 50 to 70 years ago, birthed stillborn babies or babies with lethal anomalies and from adult children born after these losses. The stories reflect a time in history when parents were "protected" from seeing or holding their babies and mothers were unable to attend the funeral. There was no understanding by society or caregivers for parents' need to process the loss or resources to build memories. They provide a strong argument for health care providers to offer such resources to parents today and offer grief support.
    Journal of Family Nursing 07/2013; 19(3). DOI:10.1177/1074840713495972 · 1.57 Impact Factor
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    • "The bereavement response may include feelings of sadness and despair, anxiety, guilt and anger, longing for the lost child and a variety of physiological changes such as sleep disturbances and lack of appetite [3]. Follow-up studies show that bereavement reactions due to miscarriage or stillbirth may persist for years and often are associated with significant psychiatric and somatic symptoms [4] [5] [6] [7] [8]. A proportion of about 25% of women who have suffered from stillbirth are developing clinically significant symptoms of depression, anxiety or PTSD [9]. "
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    ABSTRACT: The purpose of this study was to examine the influence of attachment, social support and the quality of the current partnership on the outcome of bereavement after perinatal loss. In a prospective cohort design 33 women after perinatal loss were approached on admission to hospital and reassessed four weeks, four months and nine months later. The initial assessment included the Adult Attachment Interview and self-report questionnaires for social support and quality of the current partnership. Bereavement outcome was assessed using measures of grief (MTS), depression and anxiety (HADS), psychological distress (BSI), somatisation (BSI-SOM) and symptoms of PTSD (PDS). All measures of outcome showed a significant improvement over time. Standardized effect sizes between the initial assessment and nine month follow-up ranged between .36 for anxiety (HADS) and 1.02 for grief (MTS). Social support, quality of the partnership and secure attachment correlated inversely, and insecure preoccupied attachment correlated positively with the outcome measures. Preoccupied attachment was included as a predictor in two multivariate statistical models of non-linear regression analysis, one with somatisation (adjusted R(2)=.698, P=.016), the other with posttraumatic stress symptoms at nine month follow-up (adjusted R(2)=.416, P=.002) as target variable. Initial assessment scores of psychological distress predicted the course of the respective measure during follow-up (adjusted R(2)=.432, P=.014). Attachment, social support and the quality of the current partnership have an impact on the course of bereavement after perinatal loss. Secondary prevention after the event may focus on these factors in order to offer specific counselling and support.
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