Resolution of depression and grief during the first year after miscarriage: a randomized controlled clinical trial of couples-focused interventions.
OBJECTIVE
The purpose of this randomized controlled clinical trial was to examine the effects of three couples-focused interventions and a control condition on women and men's resolution of depression and grief during the first year after miscarriage.


METHODS
Three hundred forty-one couples were randomly assigned to nurse caring (NC) (three counseling sessions), self-caring (SC) (three video and workbook modules), combined caring (CC) (one counseling session plus three SC modules), or control (no treatment). Interventions, based on Swanson's Caring Theory and Meaning of Miscarriage Model, were offered 1, 5, and 11 weeks after enrollment. Outcomes included depression (CES-D) and grief, pure grief (PG) and grief-related emotions (GRE). Differences in rates of recovery were estimated via multilevel modeling conducted in a Bayesian framework.


RESULTS
Bayesian odds (BO) ranging from 3.0 to 7.9 favored NC over all other conditions for accelerating women's resolution of depression. BO of 3.2-6.6 favored NC and no treatment over SC and CC for resolving men's depression. BO of 3.1-7.0 favored all three interventions over no treatment for accelerating women's PG resolution, and BO of 18.7-22.6 favored NC and CC over SC or no treatment for resolving men's PG. BO ranging from 2.4 to 6.1 favored NC and SC over CC or no treatment for hastening women's resolution of GRE. BO from 3.5 to 17.9 favored NC, CC, and control over SC for resolving men's GRE.


CONCLUSIONS
NC had the overall broadest positive impact on couples' resolution of grief and depression. In addition, grief resolution (PG and GRE) was accelerated by SC for women and CC for men.
Swanson
Kristen M
KM
School of Nursing, University of North Carolina, Chapel Hill, NC 27599-7460, USA. kswanson@unc.edu
Chen
Hsien-Tzu
HT
Graham
J Christopher
JC
Wojnar
Danuta M
DM
Petras
Anthippy
A
D000022:Abortion, Spontaneous / Q000453:epidemiology / Q000523:psychology* / Q000534:rehabilitation*; D000223:Adaptation, Psychological; D000328:Adult; D003131:Combined Modality Therapy; D015897:Comorbidity; D003376:Counseling / Q000379:methods*; D019546:Couples Therapy / Q000379:methods*; D003863:Depression / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006117:Grief; D006801:Humans; D008297:Male; D010353:Patient Education as Topic / Q000379:methods*; D011247:Pregnancy; D011788:Quality of Life; D012107:Research Design; D018454:Spouses / Q000523:psychology*; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult