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Hettie J. E. M. Janssen, PhD; Marian C. J. Cuisinier, PhD; Kees P. H. M. de Graauw, PhD; Kees A. L. Hoogduin, MD, PhD

Arch Gen Psychiatry. 1997;54(1):56-61.

Abstract
Background
This prospective longitudinal study investigated which selected person-oriented, social environment, demographic, and pregnancy-related risk factors could best predict women's grief intensity following pregnancy loss.

Method
In a prospective longitudinal study, 2140 pregnant women within 12 weeks' gestation answered a first questionnaire in writing. Of this sample, 227 women experienced an involuntary pregnancy loss and were followed up for a period of 18 months, during which grief was reassessed four times, using the Perinatal Grief Scale. The prospectively measured risk factors were hierarchically ordered and linked to each woman's individual grief response over time.

Results
The hypothesized risk factors, with the exception of a prior pregnancy loss, significantly related to grief intensity following the pregnancy loss and together explained 35% of the variance in grief scores among subjects. Gestational age, preloss neurotic personality, preloss psychiatric symptoms, and family composition showed the strongest relation to grief intensity following a pregnancy loss. Only psychiatric symptoms showed an interaction with time in that the women who evidenced more psychiatric symptoms before the pregnancy loss showed more intense grief shortly following the pregnancy loss. The other risk factors had a constant effect, irrespective of the time that had passed since the loss.

Conclusion
A relatively long preloss pregnancy, a more neurotic personality, more preloss psychiatric symptoms, and the absence of living children appear to be important risk factors for stronger grief responses in women following a pregnancy loss.

Author Affiliations
From the Department of Clinical Psychology and Personality, University of Nijmegen (Drs Janssen, Cuisinier, and Hoogduin); and Alfanumeriek, Software Development and Research, Oosterbeek (Dr Graauw), the Netherlands.

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