Abstract
Objective
Responding to the National Institutes of Health Working Group’s call for research on the psychological impact of stillbirth, we compared coping-related behaviors by outcome of an index birth (surviving live birth or perinatal loss – stillbirth or neonatal death) and, among individuals with loss, characterized coping strategies and their association with depressive symptoms 6–36 months postpartum.
Methods
We used data from the Stillbirth Collaborative Research Network follow-up study (2006–2008) of 285 individuals who experienced a stillbirth, 691 a livebirth, and 49 a neonatal death. We conducted a thematic analysis of coping strategies individuals recommended following their loss. We fit logistic regression models, accounting for sampling and inverse probability of follow-up weights to estimate associations between pregnancy outcomes and coping-related behaviors and, separately, coping strategies and probable depression (Edinburgh Postnatal Depression Scale > 12) for those with loss.
Results
Compared to those with a surviving live birth and adjusting for pre-pregnancy drinking and smoking, history of stillbirth, and age, individuals who experienced a loss were more likely to report increased drinking or smoking in the two months postpartum (adjusted OR: 2.7, 95% CI = 1.4–5.4). Those who smoked or drank more had greater odds of probable depression at 6 to 36 months postpartum (adjusted OR 6.4, 95% CI = 2.5–16.4). Among those with loss, recommended coping strategies commonly included communication, support groups, memorializing the loss, and spirituality.
Discussion
Access to a variety of evidence-based and culturally-appropriate positive coping strategies may help individuals experiencing perinatal loss avoid adverse health consequences.
Significance
Experiencing a perinatal loss (stillbirth or neonatal death) is a traumatic event with potential long term psychologic consequences. Effective coping strategies can prevent complicated grief; yet little is known about current practices and preferences among parents who experience perinatal loss.
AbstractSection What this Study Adds?In a population-based study, individuals who experienced perinatal loss reported higher maladaptive coping (increased smoking and drinking) compared to those with healthy live birth. Individuals who experienced perinatal loss recommended a wide range of coping including communication, memorializing the loss, spirituality, and support groups.
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Data Availability
Data is not available for request from the SCRN study due to the sensitive nature of the data.
Code Availability
We will provide SAS code upon reasonable request to the corresponding author (KS).
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Funding
Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health and with supplemental funding from the Office of Research in Women’s Health, National Institutes of Health; U10-HD045953 (Brown University, Rhode Island); U10-HD-045924 (Emory University, Georgia); U10-HD045952 (University of Texas Medical Branch at Galveston); U10-HD045955 (University of Texas Health Sciences Center at San Antonio); UK10-HD045944 (University of Utah Health Sciences Center); U10-HD045945 (RTI International, North Carolina). The funder played no role in conducting this analysis, writing, or interpretation.
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KKS and CRH conceived and planned the mixed methods analysis for this study. KKS wrote the initial draft and led analysis, writing, and revision of all drafts. KKS, CRH, and JRT conducted qualitative analysis. LCL provided expertise and input regarding support services for patients who have experience perinatal loss. CRH, JRT, DD, BJS and MV designed, secured funding for, and supervised the original and follow-up study. CRH, JRT, DD, LCL, BJS, and MV reviewed and provided substantive feedback on all drafts and approved the final submitted manuscript.
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Stanhope, K.K., Temple, J.R., Christiansen-Lindquist, L. et al. Short Term Coping-Behaviors and Postpartum Health in a Population-Based Study of Women with a Live Birth, Stillbirth, or Neonatal Death. Matern Child Health J 28, 1103–1112 (2024). https://doi.org/10.1007/s10995-023-03894-z
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DOI: https://doi.org/10.1007/s10995-023-03894-z