Perinatal grief and the impact on parental mental health: A narrative review.
DOI:
https://doi.org/10.25118/2763-9037.2024.v14.1350Keywords:
stillbirth, perinatal grief, perinatal loss, neonatal death, miscarriageAbstract
Introduction: The loss of a child is a devastating experience, especially in the perinatal period, with specificities that make it unique. There is a significant financial impact on the healthcare system, with an increased risk of complicated grief and severe mental disorders, including suicidal attempts. Despite advances in understanding perinatal grief, parents report feeling silenced and stigmatized in the process. Method: A narrative review on perinatal grief and its impact on parents' mental health, based on searches of key studies on PubMed, MEDLINE, Embase and Cochrane using descriptors such as "perinatal grief," "perinatal loss," "miscarriage," "stillbirth," "TOPFA," "neonatal death," and "anxiety," "depression," or "PTSD". Results: Perinatal grief is deprived of social rights, with the absence of partner support and social support networks as major risk factors for developing mental disorders. Key characteristics include the loss of one's sense of identity, parental role, and sense of being a female reproductive entity. It features dysfunctional ruminative thoughts and feelings related to guilt and self-pity, fear, disappointment, anger, failure, envy of other women who can have children, and the perception of having been betrayed by one's own body. The prevalence of mental disorders in the literature varies widely from 8.6% to 49%, with the main disorders being depression, anxiety, and post-traumatic stress disorder (PTSD). Conclusion: Perinatal grief represents a devastating and unique experience, with significant impacts on parents' mental health. The lack of social support, loss of identity, and risks of mental disorders highlight the urgent need for a more equipped approach by mental health professionals. It is essential to provide adequate support and treatment to mitigate the psychosocial and economic impacts of this challenging process for these families.
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.1. Herbert D, Young K, Pietrusinska M, MacBeth A. The mental health impact of perinatal loss: a systematic review and meta-analysis. J Affect Disord. 2022;297:118-29. https://doi.org/10.1016/j.jad.2021.10.026 PMID:34678403 DOI: https://doi.org/10.1016/j.jad.2021.10.026
.2. Heazell AEP, Siassakos D, Blencowe H, Burden C, Bhutta ZA, Cacciatore J, Dang N, Das J, Flenady V, Gold KJ, Mensah OK, Millum J, Nuzum D, O'Donoghue K, Redshaw M, Rizvi A, Roberts T, Toyin Saraki HE, Storey C, Wojcieszek AM, Downe S; Lancet Ending Preventable Stillbirths Series study group; Lancet Ending Preventable Stillbirths investigator group. Stillbirths: economic and psychosocial consequences. Lancet. 2016;387(10018):604-16. https://doi.org/10.1016/s0140-6736(15)00836-3 PMID:26794073 DOI: https://doi.org/10.1016/S0140-6736(15)00836-3
.3. Koopmans L, Wilson T, Cacciatore J, Flenady V. Support for mothers, fathers and families after perinatal death. Cochrane Database Syst Rev. 2013;2013(6):CD000452. https://doi.org/10.1002/14651858.cd000452.pub3 PMID:23784865 PMCID:PMC7086381 DOI: https://doi.org/10.1002/14651858.CD000452.pub3
.4. Burden C, Bradley S, Storey C, Ellis A, Heazell AE, Downe S, Cacciatore J, Siassakos D. From grief, guilt pain and stigma to hope and pride - a systematic review and meta-analysis of mixed-method research of the psychosocial impact of stillbirth. BMC Pregnancy Childbirth. 2016;16:9. https://doi.org/10.1186/s12884-016-0800-8 PMID:26785915 - PMCID:PMC4719709 DOI: https://doi.org/10.1186/s12884-016-0800-8
.5. Denney-Koelsch EM, Côté-Arsenault D, editors. Perinatal palliative care: a clinical guide. Cham: Springer; 2020. https://doi.org/10.1007/978-3-030-34751-2 DOI: https://doi.org/10.1007/978-3-030-34751-2
.6. Fernández-Ordoñez E, González-Cano-Caballero M, Guerra-Marmolejo C, Fernández-Fernández E, García-Gámez M. Perinatal grief and post-traumatic stress disorder in pregnancy after perinatal loss: a longitudinal study protocol. Int J Environ Res Public Health. 2021;18(6):2874. https://doi.org/10.3390/ijerph18062874 PMID:33799743 - PMCID:PMC8001458 DOI: https://doi.org/10.3390/ijerph18062874
.7. Kersting A, Wagner B. Complicated grief after perinatal loss. Dialogues Clin Neurosci. 2012;14(2):187-94. https://doi.org/10.31887/dcns.2012.14.2/akersting PMID:22754291 PMCID:PMC3384447 DOI: https://doi.org/10.31887/DCNS.2012.14.2/akersting
.8. Pollock DD, Pearson DE, Cooper DM, Ziaian APT, Foord C, Warland APJ. Breaking the silence: determining prevalence and understanding stillbirth stigma. Midwifery. 2021;93:102884. https://doi.org/10.1016/j.midw.2020.102884 PMID:33246144 DOI: https://doi.org/10.1016/j.midw.2020.102884
.9. Davoudian T, Gibbins K, Cirino NH. Perinatal loss: the impact on maternal mental health. Obstet Gynecol Surv. 2021;76(4):223. https://doi.org/10.1097/ogx.0000000000000874 PMID:33908614 DOI: https://doi.org/10.1097/OGX.0000000000000874
.10. Setubal MS, Bolibio R, Jesus RC, Benute GG, Gibelli MA, Bertolassi N, Barbosa T, Gomes A, Figueiredo F, Ferreira R, Francisco R, Stein Bernardes L. A systematic review of instruments measuring grief after perinatal loss and factors associated with grief reactions. Palliat Support Care. 2021;19(2):246-56. https://doi.org/10.1017/s1478951520000826 PMID:32867873 DOI: https://doi.org/10.1017/S1478951520000826
.11. Parkes CM. Amor e perda: as raízes do luto e suas complicações. São Paulo: Summus; 2009.
.12. Franco MHP. O luto no século 21: uma compreensão abrangente do fenômeno. São Paulo: Summus; 2021.
.13. Hvidtjorn D, Prinds C, Bliddal M, Henriksen TB, Cacciatore J, O'Connor M. Life after the loss: protocol for a Danish longitudinal follow-up study unfolding life and grief after the death of a child during pregnancy from gestational week 14, during birth or in the first 4 weeks of life. BMJ Open. 2018;8(12):e024278. https://doi.org/10.1136/bmjopen-2018-024278 PMID:30580272 PMCID:PMC6318761 DOI: https://doi.org/10.1136/bmjopen-2018-024278
.14. Freire MMNO, Freitas LFMF. Cuidados paliativos: a importância da atuação multidisciplinar no contexto perinatal [monografia]. São Paulo: Instituto Sírio-libanês de Ensino e Pesquisa; 2022.
.15. Hollins Martin CJ, Reid K. A scoping review of therapies used to treat psychological trauma post perinatal bereavement. J Reprod Infant Psychol. 2023;41(5):582-98. https://doi.org/10.1080/02646838.2021.2021477 PMID:34989287 DOI: https://doi.org/10.1080/02646838.2021.2021477
.16. Bhat A, Byatt N. Infertility and perinatal loss: when the bough breaks. Curr Psychiatry Rep. 2016;18(3):31. https://doi.org/10.1007/s11920-016-0663-8 PMID:26847216 PMCID:PMC4896304 DOI: https://doi.org/10.1007/s11920-016-0663-8
.17. Côté-Arsenault D, Denney-Koelsch E. "My baby is a person": parents' experiences with life-threatening fetal diagnosis. J Palliat Med. 2011;14(12):1302-8. https://doi.org/10.1089/jpm.2011.0165 PMID:22077542 DOI: https://doi.org/10.1089/jpm.2011.0165
.18. Gozuyesil E, Manav AI, Yesilot SB, Sucu M. Grief and ruminative thought after perinatal loss among Turkish women: one-year cohort study. Sao Paulo Med J. 2022;140(2):188-98. https://doi.org/10.1590/1516-3180.2021.0148.r1.09062021 PMID:35293934 - PMCID:PMC9610239 DOI: https://doi.org/10.1590/1516-3180.2021.0148.r1.09062021
.19. Mota C, Sánchez C, Carreño J, Gómez ME. Paternal experiences of perinatal loss-a scoping review. Int J Environ Res Public Health. 2023;20(6):4886. https://doi.org/10.3390/ijerph20064886 PMID:36981791 - PMCID:PMC10049302 DOI: https://doi.org/10.3390/ijerph20064886
.20. Lamon L, De Hert M, Detraux J, Hompes T. Depression and post-traumatic stress disorder after perinatal loss in fathers: a systematic review. Eur Psychiatry. 2022;65(1):e72. https://doi.org/10.1192/j.eurpsy.2022.2326 PMID:36305031 PMCID:PMC9677450 DOI: https://doi.org/10.1192/j.eurpsy.2022.2326
.21. Obst KL, Due C, Oxlad M, Middleton P. Men's grief following pregnancy loss and neonatal loss: a systematic review and emerging theoretical model. BMC Pregnancy Childbirth. 2020;20(1):11. https://doi.org/10.1186/s12884-019-2677-9 PMID:31918681 PMCID:PMC6953275 DOI: https://doi.org/10.1186/s12884-019-2677-9
.22. Gold KJ, Leon I, Boggs ME, Sen A. Depression and posttraumatic stress symptoms after perinatal loss in a population-based sample. J Womens Health (Larchmt). 2016;25(3):263-9. https://doi.org/10.1089/jwh.2015.5284 PMID:26258870 - PMCID:PMC4955602 DOI: https://doi.org/10.1089/jwh.2015.5284
.23. Tseng YF, Cheng HR, Chen YP, Yang SF, Cheng PT. Grief reactions of couples to perinatal loss: a one-year prospective follow-up. J Clin Nurs. 2017;26(23-24):5133-42. https://doi.org/10.1111/jocn.14059 PMID:28880461 DOI: https://doi.org/10.1111/jocn.14059
.24. Christiansen DM. Posttraumatic stress disorder in parents following infant death: a systematic review. Clin Psychol Rev. 2017;51:60-74. https://doi.org/10.1016/j.cpr.2016.10.007 PMID:27838460 DOI: https://doi.org/10.1016/j.cpr.2016.10.007
.25. He L, Wang T, Xu H, Chen C, Liu Z, Kang X, Zhao A. Prevalence of depression and anxiety in women with recurrent pregnancy loss and the associated risk factors. Arch Gynecol Obstet. 2019;300(4):1061-6. https://doi.org/10.1007/s00404-019-05264-z PMID:31485778 DOI: https://doi.org/10.1007/s00404-019-05264-z
.26. Westby CL, Erlandsen AR, Nilsen SA, Visted E, Thimm JC. Depression, anxiety, PTSD, and OCD after stillbirth: a systematic review. BMC Pregnancy Childbirth. 2021;21(1):782. https://doi.org/10.1186/s12884-021-04254-x PMID:34794395 PMCID:PMC8600867 DOI: https://doi.org/10.1186/s12884-021-04254-x
.27. Hunter A, Tussis L, MacBeth A. The presence of anxiety, depression and stress in women and their partners during pregnancies following perinatal loss: a meta-analysis. J Affect Disord. 2017;223:153-64. https://doi.org/10.1016/j.jad.2017.07.004 PMID:28755623 DOI: https://doi.org/10.1016/j.jad.2017.07.004
.28. Mainali A, Infanti JJ, Thapa SB, Jacobsen GW, Larose TL. Anxiety and depression in pregnant women who have experienced a previous perinatal loss: a case-cohort study from Scandinavia. BMC Pregnancy Childbirth. 2023;23(1):111. https://doi.org/10.1186/s12884-022-05318-2 PMID:36782148 PMCID:PMC9923894 DOI: https://doi.org/10.1186/s12884-022-05318-2
.29. Stroebe M, Schut H. The dual process model of coping with bereavement: rationale and description. Death Stud. 1999;23(3):197-224. https://doi.org/10.1080/074811899201046 PMID:10848151 DOI: https://doi.org/10.1080/074811899201046
.30. Helps A, O'Donoghue K, O'Connell O, Leitao S. Bereaved parents involvement in maternity hospital perinatal death review processes: 'nobody even thought to ask us anything'. Health Expect. 2023;26(1):183-98. https://doi.org/10.1111/hex.13645 PMID:36335583 - PMCID:PMC9854318 DOI: https://doi.org/10.1111/hex.13645
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Copyright (c) 2024 Maria Marta Neves de Oliveira Freire, Jerônimo Mendes Ribeiro, Igor Emanuel Vasconcelos e Martins Gomes, Sarah Cristina Zanghellini Rückl, Maria Angélica Antunes Nunes, Christiane Carvalho Ribeiro, Antônio Geraldo da Silva, Joel Rennó Junior
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