Journal of Obstetric, Gynecologic & Neonatal Nursing
ResearchThe Influence of Prior Perinatal Loss on Parents' Psychological Distress After the Birth of a Subsequent Healthy Infant
Section snippets
Review of Literature
Depressive symptoms affect a woman's ability to function and have considerable adverse influence on family outcomes and maternal-child interactions as well as on infant and child development (Lundy et al., 1996, Mandl et al., 1999, Weinberg and Tronick 1998, Weinberg and Tronick 1998). However, depressive symptoms are recognized and treated in as few as 10% of those affected (Mandl et al.). Depressive symptomology during pregnancy increases the risk for depression in the postpartum period (Beck
Study Design and Sample
A longitudinal cohort study design was used to collect data from expectant mothers and fathers during the third trimester of pregnancy (T1), 2 to 3 months postpartum (T2), and again 6 to 8 months after birth (T3). The sample consisted of 72 expectant parents (36 couples). Preliminary pilot data obtained by Armstrong (2007) yielded correlations of .67 between Center for Epidemiologic Studies-Depression Scale (CES-D) and Impact of Event Scale (IES) scores at baseline and .63 at follow-up for
Findings
As seen in Table 1, at baseline fathers graduated from vocational/technical schools more often (8.7% vs. 0.0%, p=.001), had less depressive symptoms (9.11 vs. 15.08, p=.0048), and had less intrusive thoughts (13.17 vs. 20.75, p=.0029) when compared to mothers. In addition, in this mostly White, middle to upper income, highly educated sample of participants there were no gender differences identified in mean age, ethnicity, income levels, marital status, and number of living children. Further,
Discussion
Mothers' level of depressive symptoms indicated a potential risk for depression during pregnancy similar to previous research (Armstrong 2002, Armstrong 2004, Armstrong and Hutti 1998, Cote-Arsenault and Mahlangu 1999). In addition, mothers' levels of depressive symptoms and anxiety were higher than fathers during pregnancy; however, there was no significant difference between their levels of PTS. This also is similar to that found in other studies (Armstrong 2002, Armstrong 2004). Mothers
Implications for Clinical Practice
Clinicians who work with families with a history of prior perinatal loss should be aware of the potential for continued distress. Becoming pregnant again may not “make everything better” for these parents. The current study as well as previous research demonstrates that mothers in particular may experience significant levels of depressive symptoms and anxiety in the subsequent pregnancy, some potentially to the level of clinical depression (Armstrong 2002, Armstrong 2004, Armstrong 2007,
Limitations
The small sample size and its homogeneity are limitations of this preliminary research. While every effort was made to recruit more diverse study participants, because the study relied on a volunteer sample, this was not possible. In future studies greater attention to recruiting in areas with more diverse populations may help.
Limited confidence in results from the MAQ's differentiation subscale is needed because of its low Cronbach's α, which may be related to the design of this instrument for
Future Directions for Research
Different, more specific instruments to measure the threats or vulnerabilities that parents may experience related to their prior perinatal losses are needed. The generalized psychological distress that the questionnaires evaluated in this study may not focus on the specific anxieties and stress parents with a history of loss are dealing with when they parent a subsequent child. Replication of the current study or similar ones with different, more specific questionnaires related to the
Acknowledgment
Funded by National Institute of Nursing Research Grant 1-R-15 NR08492-01.
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2019, MidwiferyCitation Excerpt :The third trimester has been identified as a key time point for elevated paternal anxiety, and this may be the most applicable time to provide information, and implement programmes that reduce anxiety. The findings from this systematic review indicate that experience anxiety which increases from the antenatal period to the time of birth, with a decrease in anxiety from the time of birth to the later postnatal period (Keeton et al., 2008; Castle et al., 2008; Armstrong et al., 2009; Vismara et al., 2016; Figueiredo and Conde, 2011a,b). An increase in anxiety from the antenatal period to the time of birth, was followed by a decrease in anxiety from the time of birth to the later postnatal period.