Brief Internet-based intervention reduces posttraumatic stress and prolonged grief in parents after the loss of a child during pregnancy: a randomized controlled trial.
BACKGROUND
The loss of a child during pregnancy causes significant psychological distress for many women and their partners, and may lead to long-lasting psychiatric disorders. Internet-based interventions using exposure techniques and cognitive restructuring have proved effective for posttraumatic stress disorder (PTSD) and prolonged grief. This study compared the effects of an Internet-based intervention for parents after prenatal loss with a waiting list condition (WLC).


METHODS
The Impact of Event Scale - Revised assessed symptoms of PTSD; the Inventory of Complicated Grief and the Brief Symptom Inventory assessed depression, anxiety, and general mental health. The 228 participants (92% female) were randomly allocated to a treatment group (TG; n = 115) or a WLC group (n = 113). The TG received a 5-week cognitive behavioral intervention including (1) self-confrontation, (2) cognitive restructuring, and (3) social sharing.


RESULTS
The TG showed significantly reduced symptoms of posttraumatic stress, prolonged grief, depression, and anxiety relative to the WLC control group. Intention-to-treat analysis revealed treatment effects of between d = 0.84 and d = 1.02 for posttraumatic stress and prolonged grief from pre- to posttreatment time points. Further significant improvement in all symptoms of PTSD and prolonged grief was found from the posttreatment evaluation to the 12-month follow-up. The attrition rate of 14% was relatively low.


CONCLUSIONS
The Internet-based intervention proved to be a feasible and cost-effective treatment, reducing symptoms of posttraumatic stress, grief, depression, anxiety, and general mental health after pregnancy loss. Low-threshold e-health interventions should be further evaluated and implemented routinely to improve psychological support after pregnancy loss.
Department of Psychosomatic Medicine, University of Leipzig, Leipzig, Germany.
Anette
A
Kersting
Ruth
R
Dölemeyer
Jana
J
Steinig
Franziska
F
Walter
Kristin
K
Kroker
Katja
K
Baust
Birgit
B
Wagner
D000223:Adaptation, Psychological; D000328:Adult; D000704:Analysis of Variance; D001007:Anxiety / Q000628:therapy; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000628:therapy; D005260:Female; D005313:Fetal Death; D005500:Follow-Up Studies; D006117:Grief; D006801:Humans; D057194:Intention to Treat Analysis; D020407:Internet; D008297:Male; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D010290:Parents / Q000523:psychology*; D011247:Pregnancy; D011569:Psychiatric Status Rating Scales; D057566:Self Report; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology / Q000628:therapy*; D013813:Therapy, Computer-Assisted / Q000379:methods*; D014956:Writing