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Measuring grief: A short version of the Perinatal Grief Scale

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Despite a considerable number of studies, there are two major drawbacks in the literature on grief and bereavement. One is a lack of adequate and generally agreed upon measures for assessing grief. The second is a lack of ability to predict from existing measures the likelihood of what has been termed chronic or pathological grief reactions. This paper reports the results of the development of a bereavement measure for the study of perinatal loss which attempts to address these gaps. The measure is specific to a pregnancy-related loss, although it has the potential for adaptation to use for other types of loss. Analysis of responses from 138 women has resulted in the reduction of the original measure from 104 to a more manageable and almost equally comprehensive and reliable 33 items. In addition, a factor analysis has produced three factors, two of which indicate the possibility for longer-term and more severe grief reactions. Because of its sound psychometric qualities and interesting factor structure, the measure shows promise of being useful for both research and clinical purposes.
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... In the 21 included studies, five different tools for the assessment of grief had been applied: the Perinatal Grief Scale-33 (PGS-33) (Potvin et al., 1989), the Munich Grief Scale (original German title: 'Münchner Trauerskala' (MTS) (Beutel et al., 1995)), the Inventory of Complicated Grief Scale (ICG) (Prigerson et al., 1995), adjusted versions of the Texas Grief Inventory (TGI) (Nikcevic et al., 1999) and the Inventory of Traumatic Grief (Prigerson & Jacobs, 2001) which had been adapted for miscarriages (for details see S3 Methods). ...
... The prospective longitudinal study by Burgoine et al. (2005) used the PGS-33 (Potvin et al., 1989) at two measurement times after pregnancy loss (4 months, 12 months) to record the grief scores of two groups distinguished by the type of pregnancy loss for medical reasons (D&E (Dilation and Evacuation for second-trimester pregnancy termination) versus IOL (Induction of Labour for second-trimester pregnancy termination)). For both groups, the mean grief scores at the second measurement time had decreased slightly. ...
... MTS = Münchner Trauerskala (in English: Munich Grief Scale) (Beutel et al., 1995). PGS-33 = Perinatal Grief Scale-33 (Potvin et al., 1989) with the subscales AG = Active Grief, DC = Difficulty Coping, D = Despair. TGI = Texas Grief Inventory (Nikcevic et al., 1999). ...
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Background: Women who have had miscarriages or stillbirths are known to have a high risk for enduring grief. However, the course and frequency of enduring grief in this subgroup are not fully understood. Objective: Our aims were to assess the intensity of grief and its course in women with miscarriages or stillbirths and to estimate the frequency of severe grief reactions in this population. Additionally, we compared subgroups with miscarriages versus stillbirths and with single versus recurrent pregnancy loss. Method: A systematic literature search of the databases MEDLINE, psycINFO and PSYNDEX was conducted to consider all studies published between 2000 and 31 March 2022 in English or German on the prevalence and intensity of grief in women who had miscarriages or stillbirths. Studies that used validated assessment methods were included in this systematic review. The PRISMA guidelines were followed. Results: Study characteristics and grief data were extracted independently by two investigators from 13 cross-sectional and eight longitudinal studies from 11 countries (N = 2597). All studies used self-reporting instruments. According to 17 of 21 studies (81%), grief is markedly elevated in women after miscarriages or stillbirths. The studies are very heterogeneous regarding the samples, the length of pregnancies and the time of assessment regarding grief after miscarriages. Most studies document intense grief and frequent severe grief reactions – with a decrease over time – in women who have had miscarriages or stillbirths. Clear conclusions regarding corresponding differences between women with miscarriages and stillbirths or single and recurrent pregnancy losses cannot be drawn. Conclusions: Pronounced grief is frequent in women who had miscarriages or stillbirths. More longitudinal studies are needed to examine the course of grief in this group and to identify those women who develop prolonged grief disorder, depression or other mental-health problems.
... After collecting the socio-demographic variables, on discharge from the hospital (visit 0) we conducted different psychopathological scales, including the Spanish version of the Edinburgh Postnatal Depression Scale (EPDS) [29]. After 1 month (± week) after the fetal loss (visit 1), we conducted the Edinburgh Postnatal Depression Scale (EPDS) and the Spanish for Spain version of the Perinatal Grief Scale (PGS-SV-SP) [30][31][32]. ...
... The Perinatal Grief Scale-Spanish version for Spain (PGS-SV-SP) [30][31][32] is a selfadministered scale for the assessment of the intensity and impact of grief secondary to a perinatal loss. It includes 16 items (shorter than the original PGS), scoring between 1 (strongly disagree) and 5 (strongly agree). ...
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(1) Background: Perinatal Loss affects one in ten women worldwide. It is known to have a deep impact on the physical and psychological wellbeing of the mother. Moreover, there is a lack of information in regard to gender differences. The role of culture, environment, personal characteristics, and gender is yet to be determined in most reports; (2) Objective and Methods: Our aim is to study the initial impact of perinatal losses in an unselected sample of couples, focusing on gender differences. We conducted a longitudinal prospective study with 29 mothers and 17 fathers. Upon discharge from the hospital, they filled out the Edinburgh Postnatal Depression Scale (EPDS), among others. After one-month post-loss, they performed the EPDS and the Short Version of the Perinatal Grief Scale. We used descriptive statistics for the sample and non-parametric tests for the comparison of gender; (3) Results: We found no gender differences in initial depressive symptoms, nor in depressive symptoms, perinatal grief symptoms, or grief level (total scores or complicated grief) one month after the loss; (4) Conclusions: we need to better understand the psychological evolution of couples in cases of perinatal loss without falling into preconceived ideas about the influence of gender.
... Patients were also queried regarding their thoughts during the pregnancy, support structures utilized within the 2 months following delivery, professional services obtained, most stressful event of their lives up to that point, and current/subsequent pregnancies and children. Patients were also administered the following surveys: the Perinatal Grief Scale short version (PGS), the Edinburg Postnatal Depression Scale (EPDS), the Impact of Event Scale (IES), and the Post-traumatic Growth Inventory (PTGI) [32][33][34][35]. ...
... The PGS assesses grieving after reproductive loss, with scores ranging from 33 to 165; higher scores reflect more intense grief [32]. The EPDS assesses psychiatric symptoms; scores range from 0 to 30 (higher scores indicate more depressive symptoms), and an aggregate result greater than 10 indicates possible depression [33]. ...
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Objective Stillbirth can result in numerous adverse psychosocial sequelae. Recommendations vary with regard to holding the baby after a stillbirth. Few studies have addressed the impact of fetal abnormalities on these outcomes. Study design Analyses of singleton stillbirths within the Stillbirth Collaborative Research Network were conducted. Patient and stillbirth characteristics were compared between those who did and did not hold their baby. Results from psychometric surveys were compared between cases with and without visible fetal anomalies. Result There were no significant differences between those who held and those who did not hold in any patient or stillborn characteristics. Visible fetal abnormalities were not associated with adverse psychological outcomes. Conclusion Fetal abnormalities, including congenital and post-demise changes, do not differ between those who held and did not hold their baby after stillbirth. This suggests that patients should not be discouraged from holding their stillborn infant in the presence of visible abnormalities.
... ≤ .05). Finally, to verify the existence of moderation, a PROCESS, version 3.5 25 Table 2 shows the descriptive statistics and Pearson's correlations in relation to the subscales used. Although there was a positive and very low correlation between Resignation of loss and Bereavement (p = > 0.05), between Individual Resignation and Marital Satisfaction (p = > 0.05), and between Rituals and Individual Resignation (p = > 0.05), these results were not significant. ...
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Objective The present study analyzed the effects of the use and perceived usefulness of bereavement rituals and marital satisfaction on perinatal bereavement. Method 74 Portuguese women who attended a public hospital in Porto - Portugal, after experiencing one or more abortions in 2019, responded to a self-report survey. The effects of ritual utility and marital satisfaction on bereavement experience, as well as interaction effects, were analyzed. Results With adjustment to bereavement after pregnancy loss as the dependent variable, a negative effect of marital satisfaction (b=.33) and a positive effect of ritual utility (b =.46) were observed. No significant moderation effect was observed. Conclusion This study highlights the importance of addressing bereavement rituals and conjugality in providing emotional support for the loss, with the figure of the nurse being paramount in the contexts of abortion and neonatal loss. DESCRIPTORS: Abortion; Bereavement; Reproductive Health; Conjugal Relationship; Maternal Bereavement.
... Scores can range from 33 (low intensity) to 165 (high intensity). 27 The Cronbach alpha was 0.93 for the prior loss group. ...
Article
Objective: To describe sleep characteristics in the third trimester of pregnancy for women who had a prior pregnancy loss compared to women with no history of loss. Design: Descriptive comparison of baseline data prior to randomization for a clinical trial. Setting: Participants' homes. Participants: Eligible women recruited from childbirth education classes during third trimester were over 18 years old, in partnered relationships, spoke English, did not work nightshift or have a diagnosed sleep disorder, and had no current complications or prior pregnancy loss (n = 140). Women with prior miscarriage or stillbirth were offered enrollment in an ancillary study (n = 20). Measurements: Sleep was assessed with the Pittsburgh Sleep Quality Index (PSQI) and wrist actigraphy. Other measures included relationship satisfaction, perceived stress, and depressive symptoms. For this analysis, only third trimester data prior to randomization were compared. Results: Both groups had similar actigraphy-recorded sleep duration (7.1 ± 1.1 hours) and sleep efficiency (83.7 ± 7.9%). However, the pregnancy loss group had significantly (p = .050) worse PSQI scores (7.8 ± 2.6) than controls (6.7 ± 3.1), resulting primarily from the sleep disturbance component (p = .003), specifically bad dreams (p = .030) and legs twitching/jerking (p = .071). Controlling for demographic and health factors in multivariate analyses, prior pregnancy loss was significant for sleep disturbance (p = .047), bad dreams (p = .018), and partner-reported leg twitching/jerking (p = .048). Conclusions: Long after the acute grief of a pregnancy loss, perceived sleep quality can be problematic during the next pregnancy. Whether poor sleep quality is present prior to the pregnancy loss or reflects long-term maternal sleep characteristics require further research.
... [21] High internal consistency was reported for the scale with an alpha coefficient of 0.92. [23] The Iranian version of the scale showed an alpha coefficient of 0.95. [24] In order to assess the reliability of the scale, internal consistency and intraclass correlation coefficients (ICCs) were calculated. ...
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BACKGROUND: Mother–child attachment is formed from early stages of pregnancy and peaks in the second trimester and continues until after childbirth. The fetal or neonatal death as a tragic event could lead to the grief experience among parents, especially mothers. The present study aimed to determine the effect of a coping program on mothers' grief following perinatal deaths. MATERIALS AND METHODS: This trial study was performed on 56 women with the experience of perinatal death during the last 1–3 months with a score of Perinatal Grief Scale (PGS) ≥91, who were referred to the health centers of Tabriz, Iran, from September 2020 to June 2021. Participants were randomly assigned into the intervention and control groups through stratified blocking on the basis of the stillbirth and neonatal death using Random Allocation Software with a block size of 4 and 6 with a ratio of 1:1. The intervention group received a coping program individually during three sessions, once a week for 45–60 min. Data collection tools included the demographic and obstetric characteristic questionnaire and PGS. The data were analyzed using SPSS24. The groups were compared through t-test, and ANCOVA after adjusting the effect of baseline score. RESULTS: Prior to coping program, the mean standard deviation of the grief total score was 108.32 (14.31) in the intervention group and 107.92 (6.65) in the control group (P = 0.89). After coping program, the mean of the grief total score was 82.28 (16.72) in the intervention group and 101.05 (12.78) in the control group. After adjusting the effect of baseline score and stratified factors, the mean of the grief total score in the intervention group was significantly lower than that in the control group [Adjusted mean difference (AMD): −18.77, 95% confidence interval: −26.79 to − 10.75, P ≤ 0.001]. CONCLUSION: Conducting a coping program during 1–3 months after experiencing perinatal deaths is effective in reducing the mothers' grief reactions. It is recommended to evaluate the effectiveness of the same intervention after perinatal deaths for both parents with a longer follow-up period in further studies.
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Introduction: The most common manifestation of complicated grief comes with the death of a child. In this context, there is an urgent need for using scales aimed at parents in order to identify parental grief. Objective: To establish an equivalence from the Perinatal Grief Scale to the Parental Grief Scale after the loss of a child. Method: This is a methodological study involving data collection and analysis by means of a linguistic, semantic, cultural, conceptual and colloquial equivalence from the perinatal grief scale (Perinatal GS) to the parental grief scale (Parental GS) in Brazilian Portuguese. Results: For the equivalence from the Perinatal GS to the Parental GS, one proposal, applied to Brazilian Portuguese, and bearing in mind that the latter is a language with gendered words, was to replace bebê (baby) with filho(a) (son/daughter), and both feminine and masculine words were used when referring to parents. The committee of expert judges participating in the cross-cultural adaptation and validation of the Perinatal GS agreed on 100% of the changes. Conclusion: The proposal of the Parental GS expands the investigation of complicated grief for parents who have lost their children in all age groups.
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The possibility of posttraumatic growth in the aftermath of pregnancy loss has received limited attention to date. This study investigated posttraumatic growth in mothers following stillbirth compared to early miscarriage. It was hypothesised that mothers following stillbirth will demonstrate more posttraumatic growth, challenge to assumptive beliefs, and disclosure than mothers following early miscarriage. The study also sought to understand how theoretically-derived variables of the Model of Growth in Grief (challenge to assumptive beliefs and disclosure) explained unique variance in posttraumatic growth when key factors were controlled for. One-hundred and twenty women who had experienced a stillbirth (N = 57) or early miscarriage (N = 63) within the last two to six years completed validated questionnaires in an online survey relating to posttraumatic growth and key variables relevant to emotional adjustment post-bereavement. Participants who had experienced a stillbirth demonstrated significantly higher levels of posttraumatic growth, posttraumatic stress symptoms, perinatal grief, disclosure, challenge to assumptive beliefs and rumination than participants who had experienced an early miscarriage (Cohen’s d ranged .38-.94). In a hierarchical stepwise regression analysis, challenge to assumptive beliefs alone predicted 17.5% of the variance in posttraumatic growth. Intrusive and deliberate rumination predicted an additional 5.5% of variance, with urge to talk, reluctance to talk, and actual self-disclosure predicting a further 15.3%. A final model including these variables explained 47.9% of the variance in posttraumatic growth. Interventions targeting challenge to assumptive beliefs, disclosure, and rumination are likely to be clinically useful to promote psychological adjustment in mothers who have experienced stillbirth and early miscarriage.
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We tested use of an online support group for women of color who had experienced stillbirth or early infant loss. We recruited recently bereaved mothers and asked them to participate in an existing online community for pregnancy and infant loss hosted on a commercial platform. Participants were asked to go online at least three times weekly for 6 weeks to read posts. Using a mixed-methods approach, we assessed attitudes toward online support, mental health, and experiences pre- and postintervention using written surveys and a brief phone interview. We used summary statistics for quantitative data and a deductive coding approach for qualitative data. Twenty participants completed the study. We found nonsignificant improvements in all four mental health domains (depression, post-traumatic stress disorder, moderate-severe generalized anxiety, and perinatal grief). Women reported the group allowed them to help others and feel less alone. They also reported that at times, posts could increase the intensity of their loss emotions. This study demonstrated feasibility to recruit, retain, and track participation in an online support group for perinatally-bereaved mothers of color. Although the study was not powered for outcome, all mental health measures showed nonsignificant improvements, suggesting value in further investigating online social support for improving women's mental health after perinatal loss. Clinical Trial Registration: Registered on clinicaltrials.gov [NCT04600076], October 19, 2020.
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