Grief and Post-Traumatic Growth in Parents 2–6 Years after the Death of Their Extremely Premature Baby

Objective: To assess grief and post-traumatic growth in parents 2–6 years after the death of a premature baby (24–26 weeks’ gestation) and to evaluate Pictorial Representation of Illness and Self-Measure (PRISM) in the assessment of bereavement. Method: Fifty-four parents were assessed for their experiences during hospitalization and by questionnaires regarding grief (MTS), post-traumatic growth, affective symptoms and the visual representation of the baby and the self of the parents (PRISM). Results: Even 2–6 years after the loss of their extremely preterm infant the parents still suffer a lot from their bereavement, mothers more so than fathers (Mann-Whitney U test, U = 230.5, p < 0.05). Having another child reduced the level of grief (U = 119.0, p < 0.05). Mothers showed more post-traumatic growth than fathers (U = 140.5, p < 0.001). For all parents a shorter distance between the baby and the self (PRISM) correlated with greater grief (ρ = –0.62, p < 0.001); in multiple regression analysis MTS explained 38% of the SBS-variance. Conclusions: Clinicians should be aware that the death of an extremely premature infant triggers not only a painful long-term process of mourning but also of individual personal growth. Adaptation processes after the death differ depending on gender, with mothers experiencing more intense grief but also more growth than fathers. The modified PRISM test is recommended as a visual, non-verbal and easy-to-use instrument to assess bereavement.

[1]  A. Kersting,et al.  Trauma and grief 2–7 years after termination of pregnancy because of fetal anomalies – a pilot study , 2005, Journal of psychosomatic obstetrics and gynaecology.

[2]  H. Rumpf,et al.  A Self-Administered Version of a Brief Measure of Suffering: First Aspects of Validity , 2003, Psychotherapy and Psychosomatics.

[3]  N. Christakis,et al.  The health impact of health care on families: a matched cohort study of hospice use by decedents and mortality outcomes in surviving, widowed spouses. , 2003, Social science & medicine.

[4]  T. Sensky,et al.  Preliminary Validation of PRISM (Pictorial Representation of Illness and Self Measure) – A Brief Method to Assess Suffering , 2002, Psychotherapy and Psychosomatics.

[5]  P. Mortensen,et al.  Myocardial Infarction in Parents Who Lost a Child: A Nationwide Prospective Cohort Study in Denmark , 2002, Circulation.

[6]  H. Znoj,et al.  MOURNING PARENTS: CONSIDERING SAFEGUARDS AND THEIR RELATION TO HEALTH , 2002, Death studies.

[7]  C. Wastell,et al.  ATTACHMENT AND MEANING-MAKING IN PERINATAL BEREAVEMENT , 2002, Death studies.

[8]  A. Maercker,et al.  Persönliche Reifung (Personal Growth) durch Belastungen und Traumata , 2001 .

[9]  D. Rich.  The Impact of Postpregnancy Loss Services on Grief Outcome: Integrating Research and Practice in the Design of Perinatal Bereavement Programs , 2000 .

[10]  T. Sensky,et al.  PRISM (Pictorial Representation of Illness and Self Measure) - a novel visual method to assess the global burden of illness in patients with systemic lupus erythematosus , 2000, Lupus.

[11]  T. Sensky,et al.  PRISM: Pictorial Representation of Illness and Self Measure. A brief nonverbal measure of illness impact and therapeutic aid in psychosomatic medicine. , 1999, Psychosomatics.

[12]  D. Mazza.  Bereavement in adult life , 1998, BMJ.

[13]  Christopher G. Davis,et al.  Making sense of loss and benefiting from the experience: two construals of meaning. , 1998, Journal of personality and social psychology.

[14]  T. Sensky,et al.  Graphic Representation of Illness: A Novel Method of Measuring Patients’ Perceptions of the Impact of Illness , 1998, Psychotherapy and Psychosomatics.

[15]  J. Puddifoot,et al.  Miscarriage : Is vividness of visual imagery a factor in the grief reaction of the partner? , 1998 .

[16]  D. Armstrong,et al.  Pregnancy after perinatal loss: the relationship between anxiety and prenatal attachment. , 1998, Journal of obstetric, gynecologic, and neonatal nursing : JOGNN.

[17]  H. Wolf,et al.  Long-term impact of perinatal bereavement. Comparison of grief reactions after intrauterine versus neonatal death. , 1997, European journal of obstetrics, gynecology, and reproductive biology.

[18]  G. Bonanno,et al.  Diagnostic criteria for complicated grief disorder. , 1997, The American journal of psychiatry.

[19]  Crystal L. Park,et al.  Assessment and prediction of stress-related growth. , 1996, Journal of personality.

[20]  J. Najman,et al.  Gender Differences in Parental Psychological Distress Following Perinatal Death or Sudden Infant Death Syndrome , 1995, British Journal of Psychiatry.

[21]  M. von Rad,et al.  [Assessment of grief exemplified pregnancy loss: development and initial results on the validity of the Munich Grief Scale]. , 1995, Psychotherapie, Psychosomatik, medizinische Psychologie.

[22]  E. Cassell.  The Nature of Suffering and the Goals of Medicine , 1992, Annals of Internal Medicine.

[23]  J. Lasker,et al.  Measuring grief: A short version of the perinatal grief scale , 1989 .

[24]  E. Cassel.  The nature of suffering and the goals of medicine. , 1982, The New England journal of medicine.

[25]  A. Maercker,et al.  The Janus face of posttraumatic growth: Towards a two component model of posttraumatic growth , 2004 .

[26]  C. Herrmann.  International experiences with the Hospital Anxiety and Depression Scale--a review of validation data and clinical results. , 1997, Journal of psychosomatic research.

[27]  R. Tedeschi,et al.  The Posttraumatic Growth Inventory: Measuring the positive legacy of trauma , 1996, Journal of traumatic stress.

[28]  G. Huston.  The Hospital Anxiety and Depression Scale. , 1987, The Journal of rheumatology.