Perinatal loss and parental distress after the birth of a healthy infant.
OBJECTIVE
Determine whether levels of depressive symptoms and current stress related to prior perinatal loss differ from similar prenatal evaluations after the birth of a subsequent healthy full-term infant and investigate differences in depressive symptoms in the postpartum period among parents with and without a history of perinatal loss.


METHODS
Seventy-four of the original 206 parents who participated in an earlier prenatal study agreed to participate at follow-up and were divided into 2 groups (38 parents with a history of perinatal loss and 36 parents with no prior losses).


METHODS
A 2-wave, 2-group comparative design was used. Both mothers and fathers were recruited for this study. Surveys were completed via telephone interviews. Data were analyzed using descriptive statistics, chi-square tests, t tests and Pearson correlations.


METHODS
The Impact of the Event Scale (IES) is broadly used to evaluate the continuing influence of a past stressful life event. In the current study, the items were anchored to the traumatic event of perinatal loss. The IES contains 2 subscales: Intrusion and Avoidance. Cronbach's alphas for the current study were .80 (total scale), .85 (Intrusion subscale), and .69 (Avoidance subscale). The Center for Epidemiologic Studies-Depression Scale (CES-D) is used to identify the duration and frequency of depressive symptoms experienced by the respondent during the previous week. The Cronbach's alpha for the current study was .92.


RESULTS
There was a significant overall decrease in depressive symptoms after the birth of a healthy infant for fathers but not for mothers with prior perinatal losses. Nevertheless, approximately one third of the mothers with a history of loss continued to report CES-D scores that placed them at high risk for depression. There also was a significant decrease in stress related to the prior loss for both mother and fathers. The greater the stress associated with the prior loss, the greater were parents' depressive symptoms after birth. In contrast to the prenatal assessment, there were no significant differences in levels of depressive symptoms between the loss and nonloss groups at the postnatal assessment.


CONCLUSIONS
The stress associated with perinatal loss, although diminished after the subsequent birth of a healthy infant compared with that during pregnancy, remained high for many parents, especially mothers. Neonatal nurses need to continue to evaluate parents with a history of perinatal loss for ongoing psychological distress after the birth of a subsequent healthy infant.
Armstrong
Deborah S
DS
School of Nursing, University of Louisville, Louisville, KY 40292, USA. dsarms01@louisville.edu
D000022:Abortion, Spontaneous / Q000523:psychology*; D000328:Adult; D001294:Attitude to Health; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D019052:Depression, Postpartum / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D005220:Fathers / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D008016:Life Change Events; D008297:Male; D009035:Mothers / Q000523:psychology*; D017283:Neonatal Nursing; D015404:Nursing Methodology Research; D010865:Pilot Projects; D015995:Prevalence; D012307:Risk Factors; D012720:Severity of Illness Index; D050497:Stillbirth / Q000523:psychology*; D013315:Stress, Psychological / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D011795:Surveys and Questionnaires