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Centre for Evidence-
Based Medicine

Grief after pregnancy loss - predicted by length of pregnancy, neuroticisim, psychiatric symptoms,and absence of other children

Clinical Bottom Line

Patients with pre-pregnancy neuroticism or psychiatric symptoms, and without other children are at increased risk of a more intense grief reaction.


Janssen HG, Cuisinier MC, de Graauw KP, Hoogduin KA. A prospective study of risk factors predicting grief intensity following pregnancy loss. Arch Gen Psychiatry. 1997;54:56-61.

Clinical Question

In healthy women who have had a miscarriage, what is the usual grieving process and are any factors associated with longer than normal grieving?

Search Terms

Both MEDLINE and Best Evidence retrieve the same citation. MEDLINE search terms were "grief" as an index term AND ("abortion" as an index term OR "pregnancy loss" as a text phrase) AND "risk" as an index term or text word). The Best Evidence search terms were "grief" and "pregnancy loss".

The Study

  • The Study Patients: 227 women (mean age 29 years) who had volunteered for a study on coping with normal pregnancy, delivery, and complications and who reported a miscarriage. 91% of the losses occurred at < 20 weeks of pregnancy. 97% of the women were married or in stable relationships, 32% had no other children, and 41% had a previous pregnancy loss. Follow-up at 18 months after miscarriage was 94%.
  • Prognostic Factors: Risk factors were assessed using the Dutch version of the Symptom Checklist-90 (psychiatric symptoms) and the Dutch Personality Questionnaire (neuroticism, low self-esteem, social inadequacy, general inadequacy, and aggrievedness). Information was also collected on quality of partner relationships, education, employment, religious background, social support, feelings about the pregnancy, pregnancy and conception variables, family demographics, and physical symptoms.
  • The Outcome: Grief and its categories (active grief, difficulty coping, and despair) measured by the Perinatal Grief Scale immediately after the miscarriage and at 6, 12, and 18 months.
Study Feature Yes No Can't Tell
Well-defined sample at uniform (early) stage of illness? x
Follow-up long enough? x
Follow-up complete? x
Blind and objective outcome criteria? x
Adjustment for other prognostic factors? x
Validation in an independent "test-set" of patients? x

The Evidence

Multivariate analysis showed that grief intensity was higher for women who had been pregnant longer (p < 0.001), had pre-loss neurotic personalities (p < 0.001), had pre-loss psychiatric symptoms (p = 0.02), and did not have other living children (p = 0.01). Grief intensity, active grief, difficulty coping, and despair decreased with time (p < 0.001 for all 4 comparisons).


Bottom line is that all factors except previous pregnancy loss predicted grief intensity on univariate analysis.

Appraised By

K. Ann McKibbon, MLS.
Research Associate
Health Information Research Unit
McMaster University, Hamilton, Ontario, Canada.
Fax: (905) 546-0401
Email: mckib@fhs.mcmaster.ca
Appraised February 1999.

Expiry Date