[Long-term psychological sequelae of spontaneous abortion: do medical management, recent pregnancy and delivery really help in coping with grief?]. / Psychische Langzeitfolgen nach Spontanabort: Helfen medizinische Betreuung, neuerliche Schwangerschaft und Entbindung wirklich bei der Trauerverarbeitung?

86 patients with spontaneous abortion were interviewed and followed up in a longitudinal study with an interview and standardised questionnaires shortly after the D&C at 7, 13 and 24 months later. Our results indicate profound and long-term adverse psychological sequelae. For most of the patients, a spontaneous abortion was considered to be of major importance. Without regard to the gestational age or ultrasonographic image, the embryo is represented early in fantasies and dreams as a child. The severity of grief reactions following abortion did not correlate well with gestational age or a new pregnancy. Mourning is still present 24 months after the abortion. While grief decreases continuously during the first 7 months following abortion, despair remains constant and self-reproachful coping shows even a statistically significant increase between months 13 and 24. The reason is, because 20% of patients develop a pathological grief reaction with an increase in depression, self-reproachful coping and physical complaints. This risk group of patients, who needs closer and more detailed observation and guidance, may be recognised as early as at the time of abortion.

[Chronic grief after spontaneous abortion: results of a longitudinal study after 13 months]. / Chronische Trauer nach einem Spontanabort: Ergebnisse einer Längsschnittstudie nach 13 Monaten.

Presented are follow-up results on coping with spontaneous abortion. Although the majority of women feel that this is a significant negative life event, their grief gradually decreases within 7 to 13 months. Compared to population standards they are neither depressed nor do they suffer from increased physical complaints. A subgroup of women is identified with chronic ("pathological") grief based on increased or rising levels of grief (PGS), depression (SCL-90) and physical complaints (BL). Independently from a following pregnancy these women (about 20%) report a high importance of their abortion, painful feelings in seeing pregnant women and babies and fears of another abortion even after 13 months. Scores immediately after the abortion permit a good discrimination of patients with chronic grief and uncomplicated course: Patients who later develop chronic grief report a high level of negative feelings during the pregnancy leading to the loss, extensive preparations for the expected baby, an unsettled vocational and family situation and intensive strains and despair immediately thereafter. Conditions and ways of grieving with this specific loss are discussed.

[Grief, depression and anxiety after spontaneous abortion--a study of systematic evaluation and factors of influence]. / Trauer, Depressivität und Angst nach einem Spontanabort--Eine Studie über systematische Erfassung und Einflussfaktoren.

Recent studies demonstrate profound and long-lasting adverse psychological and family sequelae of a spontaneous abortion. However, decisive issues of quality, course and determinants cannot be answered sufficiently due to shortcomings of research (e.g. lack of representative samples and adequate measures, reliance on cross-sectional study designs). Grief reactions and their determinants are differentiated in relation to depressiveness and anxiety in 86 patients from a longitudinal study, employing the Perinatal Grief Scale (Thoedter et al. 1988) and standardized symptom checklists. For the majority of the women, around the 10th week of gestation, the embryo is psychologically represented in fantasies, dreams and concrete arrangements in reality. Immediately after the abortion, these women react with painful feelings of "active grief" and "despair". Additional stresses in the pregnancy and lack of social support predict "self-reproachful coping". Women with recurrent abortions who have no children show depressive reactions. Retrospectively, these also present more anxiety and depressive moods during pregnancy. Results support reliability and validity of the grief scale. Implications for counselling and psychotherapy of women after a spontaneous abortion are discussed with respect to these risk constellations.