Predictors of complicated grief following intrauterine death
Paul Richard Cassidy
Institutions: Universidad Complutense de Madrid, Umamanita (Stillbirth charity)
Following stillbirth or TOPFA women are at risk of complicated grief and other mental health problems. The objective of the study was to identify possible predictors of complicated grief in a Spanish population in order to better inform bereavement care strategies.
A cross-sectional descriptive design with an online instrument, including women who had a stillbirth or TOPFA within 5 years prior to participation. The analysis used binary logistic regression to test for statistically significant (p <0.05) predictors of complicated grief (dependent variable), measured by being above the midpoint on a 12-item sub-scale of a Spanish validated version of the Perinatal Grief Scale.
Responses from 788 women were analysed. Controlling for “time since the loss” (in months), the analysis found significant odds ratio for “being a foreign resident” (aOR 2.77, C.I. 1.32-5.82), “experiencing a crisis of spiritual/religious belief” (OR 2.80, C.I. 1.85-4.23, p<0.001), receiving “low” (aOR 2.84, C.I. 1.52-5.32) or “medium” (OR 1.90, C.I. 1.21-2.87) social support, having been “administered sedatives in the hospital” (aOR 2.13, C.I. 1.47-3.07), “perceiving medical negligence in the death” (aOR 2.17, C.I. 1.47-3.19), “not being accompanied by a partner/other during the birth” (aOR 0.56, C.I. 0.38-0.83). In the ≤12 months group “not being accompanied during the birth” and “being a foreign resident” were dropped by the model. In the 13-60 month group “time since the loss”, “low social support” and “medium social support” were dropped while “having no living children” (aOR 2.60, C.I. 1.09-5.82) was introduced. See attached table.
Time, faith, hospital care, social support and reproductive history are all predictors of complicated grief. Interactions between these predictors most likely complicate the grief process by interfering in personal and social processes of meaning reconstruction, sense making and benefit finding, as well as identity.
The author’s institution (Universidad Complutense de Madrid) did not require ethics approval for non-clinical studies. Consent was given through informed participation in the online survey.