Objective:The literature exploring the relationship between miscarriage and grief is sparse. This paper summarizes the literature on grief subsequent to an early miscarriage to elucidate the nature, incidence, intensity, and duration of grief at this time and to identify potential moderators.Methods: An electronic search of the Medline and Psych Info databases was conducted. Studies were selected for inclusion if they related to early miscarriage, used a standardized measure to assess perinatal grief, and specified the assessment intervals employed. Qualitative studies were included when helpful to develop hypotheses.Results: Descriptions of grief following miscarriage are highly variable but tend to match descriptions of grief used to characterize other types of significant losses. A sizable percentage of women seem to experience a grief reaction, with the actual incidence of grief unclear. Suggestively, grief, when present, seems to be similar in intensity to grief after other types of major losses and is significantly less intense by about 6 months. Few conclusions can be drawn in regard to potential moderators of grief following a miscarriage.Conclusions: Although additional research is clearly needed, guidelines for coping with grief following miscarriage can be based on the data available on coping with other significant types of losses. Given the range of potential meanings for this primarily prospective and symbolic loss, practitioners need to encourage patients to articulate the specific nature of their loss and assist in helping them concretize the experience. 451

The experience of loss following a miscarriage tends not to be recognized or validated by many key people in a woman's life, including her physician. Surveys of patient satisfaction following miscarriage indicate a high percentage of anger and dissatisfaction with the medical care received. The main complaints center on physician insensitivity and lack of opportunity to discuss the personal significance of the loss. Satisfaction was highest when there was a follow-up appointment soon after the loss, at which time answers to the almost universally asked questions of why the miscarriage occurred and whether it would happen again were addressed, and sufficient time was allowed to focus on the patient's feelings. The most likely emotions to be present relate to a relatively brief period of loss characterized by grief, dysphoria, and anxiety. The risk of a more intense or longer lasting distress is likely to occur if the woman strongly desired the pregnancy, waited a long time to conceive, has no living children, had elective abortions or other losses in the past, had few warning signs that a loss might occur, experienced the loss relatively late in the pregnancy, has little social support, or has a history of coping poorly. When there is an elevated level of distress, it tends to take the form of depressive and anxiety disorders, often accompanied by feelings of guilt and worries about future reproductive competence. In addition to validating the significance and nature of the patient's feelings, a physician can help the patient develop rituals to facilitate grieving and plan for anticipated, stressful occasions.

Practitioners, as part of routine care after a miscarriage, should screen for signs of anxiety as well as depression. When signs of anxiety are present, opportunities for catharsis, understanding, and legitimation are likely to be helpful, as is reassurance that the stress is likely to appreciably lessen over the next 6 months.

Data are presented on the prevalence of learning disabilities among populations of delinquents. Current hypotheses proposed to explain the relatively high prevalence rate are examined in the context of the research literature pertaining to the psychosocial characteristics of youngsters with learning disabilities and the research literature pertaining to delinquency. A multifactorial explanation is offered, according to which the probability of a youngster with a learning disability becoming delinquent is seen as a consequence of the interaction between specific elements of learning disabilities and specific psychosocial correlates of delinquency.