Complicated Grief After the Loss of a Baby: A Systematic Review About Risk and Protective Factors for Bereaved Women

Abstract

This study sought to identify the factors associated with the development and prevention of complicated grief in women who have lost a baby. This is a systematic review of scientific articles in the main mental health databases: MEDLINE (PubMed), EMBASE, Latin American and Caribbean Health Sciences Literature (LILACS), and APA Databases (PsycINFO). The selection and data extraction processes occurred independently and blindly by two authors, considering the eligibility criteria. The analysis included publications from 2013 to 2021 of observational studies with adult women who had experienced losing a baby (during pregnancy up to 2 years of life) and that employed standardized instruments to evaluate grief. From the 8,200 records found, 23 articles were selected for analysis. As risk factors, we identified the presence of mother’s psychopathology, history of gestational loss, and social pressure for a new pregnancy, while as protective factors, we identified the presence of another child other than the deceased one, the quality of specialized healthcare, and the social support provided by either a partner, community, or spiritual activities. Furthermore, the studies pointed to the event of losing a baby as an opportunity for posttraumatic growth. Although complicated grief is often associated with other mental health conditions, such as anxiety, depression, or posttraumatic stress, it is necessary to differentiate it for a clearer understanding of the complicated grief as a singular condition, to enable access to appropriate care for bereaved mothers and families, as well as to promote public policies which provide support to them.

The Process Model of Stigmatized Loss: Identity-Threatened Experiences of Bereaved Mothers

“…The study of stigma in social science research covers an array of physical, mental, psychological, and behavioral circumstances such as disability, gender, race, sexual orientation, health conditions, and life choices (Major & O’Brien, 2005; Wigginton & Setchell, 2016). Stigma has profound and long-lasting effects on individuals’ life outcomes, and even concealable stigma identities (e.g., diabetes and depression) can lead to large mental and physical distress (Burden et al, 2016; Flach et al, 2022). Mothers who experienced baby loss are generally perceived and labeled by “others” as being incapable of keeping their unborn or infant babies alive and ultimately responsible for their baby’s death (Pollock et al, 2020b; Wesselmann & Parris, 2022).…”

The role of art therapy on quality of life of women with recent pregnancy loss: A randomized clinical trial

“…Grief can be complex and have an effect on multiple aspects of family life following perinatal loss [ 2 ]. Grief after pregnancy loss can become complicated if there is a mother’s psychopathology, a previous history of pregnancy loss, and social pressure to get pregnant again [ 8 ]. Complicated grief (CG) reactions can increase the risk of psychological and physical well-being [ 6 ].…”

Validation of a Brief Measure for Complicated Grief Specific to Reproductive Loss

“…For the purposes of this paper, the term "complicated grief" will be used, as it conveys that most grief reactions are normal, but some grief reactions can become pathological in duration, severity, and effect on daily function [9]. It is possible for complicated grief to be delayed in onset, last beyond the first year after a loss, and lead to enduring adjustment problems [10][11][12]. Complicated grief can also increase rates of cardiovascular disease, weight gain, diabetes, substance use, and suicide [13,14].…”