Table 3.
Mean grief scores and frequencies for severe grief scores.
| Study | Validated instrument for the assessment of grief | Subgroup | Measurement time | Mean grief score ± standard deviation | Frequency of grief scores above the corresponding cut-off score |
|---|---|---|---|---|---|
| Cross-sectional studies | |||||
| (Black et al., 2021) | ITG (modified) | 2 (pregnancy trimester 1 and 2 in which the miscarriage occurred) | Up to one year | 2.58 ± 0.81 (total sample) Birth mothers: Trimester 1: 2.51 ± 0.83 Trimester 2: 2.85 ± 0.82 | – |
| (Das et al., 2021) | PGS-33 | 3 (mothers): with a deceased child (n = 13), with a deceased neonate (n = 12), with a stillbirth (n = 15) | Six to nine months | Mothers with stillbirths (median) (inter-quartile range): 107** (97–117) AG: 41** (32–42) DC: 32** (25–33) D: 35** (27–43) |
80% |
| (De Montigny et al., 2017) | PGS-33 | – | Up to six years | 78.5 ± 26.6 (1–6 months) 68.9 ± 30.2 (7–12 months) 73.5 ± 31.9 (1–2 years) 65.0 ± 26.5 (>2 years) |
– |
| (Hanschmidt et al., 2018) | ICG | – | On average 3.6 years* | 15.2 ± 12.6 | 17.6% |
| (Keefe-Cooperman, 2005) | PGS-33 | Two (variant of loss) | Up to two years | 101.7** (miscarriage) 103.4** (TOPFA) |
– |
| (Kersting et al., 2005) | MTS | According to measurement time (2-7 years and 14 days) | 2–7 years and 14 days | 2.7 ± 0.6 (2–7 years) 2.9 ± 0.6 (14 days) |
– |
| (Krosch & Shakespeare-Finch, 2017) | PGS-33 | – | On average four years | 95.2** ± 24.9 AG 37.4** ± 8.3 DC 31.0** ± 9.6 D 26.9** ± 9.2 |
– |
| (Kulathilaka et al., 2016) | PGS-33 | – | 6–10 weeks | – | 54.7% |
| (Lafarge et al., 2017) | PGS-33 | – | 29.2%: up to 6 months 19.3%: 7–12 months 14.9%: 1–2 years 36.7%: >2 years |
95.1** ± 27.7 AG 37.7** ± 9.5 DC 29.3** ± 10.5 D 28.1** ± 9.3 |
– |
| (Nazaré et al., 2012) | PGS-33 | – | 1–6 months, on average 2.4 months | – | 32.6% |
| (Rich 2000) | PGS-33 | – | 2–60 months, on average 16.5 months | 92.5** ± 25.2 | – |
| (Séjourné et al., 2016) | TGI | – | Up to 18 months | 63.4 ± 11.6 | – |
| (Serrano & Lima, 2006) | PGS-33 | – | At least three months | 89.9 ± 21.7 AG 38.9** ± 8.6 DC 24.7 ± 9.3 D 25.9 ± 6.9 |
– |
| Prospective longitudinal studies | |||||
| (Burgoine et al., 2005) | PGS-33 | Two (D&E and IOL) | D&E: 4 months | 74.1 ± 16.2 AG 23.2 ± 7.4 DC 27.1 ± 5.3 D 23.8 ± 5.5 |
13% AG 13% DC 40% D 47% |
| – | D&E: 12 months | 73.3 ± 17.1 AG 22.1 ± 7.2 DC 26.1 ± 5.0 D 25.1 ± 6.2 |
27% AG 13% DC 20% D 40% |
||
| – | IOL: 4 months | 90.2 ± 22.8 AG 29.5 ± 9.8 DC 31.9** ± 7.4 D 28.8** ± 7.2 |
46% AG 38% DC 69% D 69% |
||
| – | IOL: 12 months | 86.4 ± 19.8 AG 25.8 ± 7.2 DC 29.8** ± 7.6 D 28.9** ± 7.6 |
38% AG 15% DC 46% D 62% |
||
| (Conway & Russell, 2000) | PGS-33 | – | As fast as possible (up to three weeks) | 88.7 ± 46.9 AG 24.1 ± 11 DC 38.5** ± 10.1 D 42.8** ± 9 |
– |
| – | Two to four months | 125.7** ± 24.6 AG 37.3** ± 11.2 DC 42.1** ± 7.8 D 46.3** ± 7.5 |
– | ||
| (Gozuyesil et al., 2022) | PGS-33 | 10 (age: 20–29, 30–39, 40–49 years; child-lessness (yes/no); number of pregnancy losses (0,2,3+); miscarriages, stillbirths) | Miscarriages: T0: ≤ 48 h T1: month 3 T2: month 6 T3: month 12 after discharge Stillbirths: T0: ≤ 48 h T1: month 3 T2: month 6 T3: month 12 after discharge |
Median (range) 94.5** (50–143) 73.5 (42–117) 57 (36–90) 48 (36–90) Median (range) 92** (43–130) 75 (47–130) 55 (37–120) 45 (38–125) |
Total sample: T0: 55.7% T1: 21.1% T2: 3.5% T3: 3.5% |
| (Güçlü et al., 2021) | PGS-33 | – | T1: week 6 T2: month 6 T3: month 12 |
75.4 ± 20.5 AG 28.9 ± 10.1 DC 24.3 ± 5.6 D 22.1 ± 7.8 67.5 ± 20.3 AG 25.6 ± 10.3 DC 22.6 ± 5.5 D 19.2 ± 6.9 63.8 ± 21.6 AG 22.2 ± 9.9 DC 22.3 ± 6.1 D 19.1 ± 7.5 |
– |
| (Johnson & Johnston, 2021) | PGS-33 | 4 (men versus women; miscarriage/miscarriage versus miscarriage/live birth) | T1: week 6 following the first pregnancy outcome T2: week 6 following the second pregnancy outcome T3: month 6 following the second pregnancy outcome T4: month 12 following the second pregnancy outcome |
Only women: Miscarriage/Miscarriage group: 86.66 ± 11.85 AG 32.19 ± 9.60 DC 25.44 ± 7.07 D 29.06** ± 11.55 Miscarriage/Live Birth group: 86.48 ± 12.02 AG 30.02 ± 7.11 DC 26.05 ± 6.05 D 28.19** ± 10.31 Miscarriage/Miscarriage group: 84.59 ± 10.16 AG 35.16** ± 4.96 DC 21.33 ± 3.80 D 28.11** ± 8.28 Miscarriage/Live Birth group: 85.75 ± 13.47 AG 33.41** ± 5.64 DC 24.09 ± 2.43 D 28.25** ± 6.02 Miscarriage/Miscarriage group: 99.23** ± 7.10 AG 36.97** ± 5.27 DC 30.66** ± 7.30 D 31.61** ± 8.58 Miscarriage/Live Birth group: 63.89 ± 8.63 AG 26.55 ± 5.05 DC 18.59 ± 6.61 D 18.75 ± 3.84 Miscarriage/Miscarriage group: 93.45** ± 7.70 AG 34.06** ± 6.06 DC 29.89** ± 5.92 D 29.50** ± 6.92 Miscarriage/Live Birth group: 61.19 ± 10.99 AG 24.70 ± 5.53 DC 17.53 ± 6.22 D 18.95 ± 4.40 |
– |
| (Köneş & Yildiz, 2021) | PGS-33 | 45*** | T1: first 48 h T2: one week T3: one month T4: three months after the perinatal loss |
Only for women with time of perinatal loss in utero (T2 and T3 data were not available): T1 (first 48 h): 107.3** ± 26.9 AG 45.4** ± 9.9 DC 30.8** ± 9.3 D 31.0** ± 9.8 T4 (three months after the pregnancy loss): 107.7** ± 30.3 AG 44.7** ± 11.3 DC 31.4** ± 10.3 D 31.5** ± 10.8 |
– |
| (Scheidt et al., 2012) | MTS | – | One month | 3.3 ± 0.7 | – |
| – | Six months | 3.1 ± 0.7 | – | ||
| – | Nine months | 3.0 ± 0.7 | – | ||
| (Volgsten et al., 2018) | PGS-33 | – | One week | – AG Median 29.5 (range 11–53) DC Median 19 (range 11–54) D Median 15.5 (range 10–42) |
– |
| – | Four months | – AG Median 22 (range 11–54) DC Median 17 (range 11–54) D Median 15 (range 11–46) |
– | ||
Notes: The table contains the 21 studies which are included in the review. D&E: Dilation and Evacuation for second-trimester pregnancy termination. ICG = Inventory of Complicated Grief (Prigerson et al., 1995). IOL: Induction of Labour for second-trimester pregnancy termination. ITG = Inventory of Traumatic Grief (Prigerson & Jacobs, 2001). 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). TOPFA = Termination of Pregnancy for Foetal Anomaly.
Measurement times refer to the interval since pregnancy loss.
*Study without any pre-specified measurement time.
**The mean grief score was above the cut-off score of the corresponding scale (≥91) or the corresponding subscale (AC > 33, DC > 29, D > 26).
***The subgroups were as follows: Age groups (≤24 years, 25–35 years, ≥36 years) (3); educational status (literate, primary education, secondary education, high school, university) (5); employment status (employed, on maternity leave, unemployed) (3); family type (nuclear, extended) (2); marital status (married, single) (2); high-risk behaviours (none, smoking, alcohol, multiple) (4); type of current pregnancy loss (spontaneous, assisted) (2); pregnancy planning (planned, unplanned, indecisive, unwanted by herself, unwanted by husband) (5); regular antenatal follow-up (yes, no) (2); screening tests (none, double, triple, quad) (4); time of loss (in utero, postnatal) (2); gender of baby (unknown, girl, boy) (3); importance of gender (yes, no, indecisive) (3); gestational age at loss (early pregnancy loss (7–19 gestational week), late pregnancy loss (20–31 gestational week), advanced pregnancy loss (32–40 gestational week)) (3); previous pregnancy loss (yes, no) (2).