غم و اندوه ناسازگار یا اشتراکی در زوجهایی که 2-6 سال پس از مرگ نوزاد نارس خود هنوز داغدار هستند؛ اثرات آنها بر رنج و رشد پس از سانحه
|کد مقاله||سال انتشار||مقاله انگلیسی||ترجمه فارسی||تعداد کلمات|
|37438||2009||8 صفحه PDF||سفارش دهید||محاسبه نشده|
Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Psychosomatics, Volume 50, Issue 2, March–April 2009, Pages 123–130
Background : The loss of a baby causes severe short- and long-term distress to parents and their marital relationship, but little is known about how this distress is shared between spouses. The authors hypothesized that the grief-related concordance within a couple 2 to 6 years after the loss of a premature baby could be an indicator of shared emotional distress within a couple. Objective : The authors investigated the long-term grief experience among couples. Method : A group of 44 parents (22 couples) were assessed by questionnaire regarding grief, suffering, posttraumatic growth, and affective symptoms, and semistructured interviews with 6 couples added qualitative information about processes within couples. Results : The extent of grief concordance was found to be related to different patterns of suffering and posttraumatic growth within couples. Conclusion : The emotional exchange between partners after the loss of the child appears to be crucial for a process of concordant grief, which in turn is associated with a more synchronous process of individual posttraumatic growth
نتیجه گیری انگلیسی
Results Characteristics for All Parents (N = 44) At 2 to 6 years after the death of their premature baby, MTS bereavement scores of the whole sample were still high (mean: 57.5; SD: 12.5; range: 33–82). Mean PRISM distance between Self and Baby (SBS) was 4.3 cm (range: 0–8.7 cm; SD: 2.1), indicating that, for most parents, the baby still had a central place in their life as parents. Nine parents (20%) had an SBS of <2 cm, indicating substantial suffering. The mean total PTGI score was 22.8 (SD: 7.4; range: 9–41). Mean HADS Depression score was 3.3 (SD: 2.7; range: 0–11); three parents (7%) scored over 7, indicating a possible depressive disorder. Mean HADS Anxiety score was 5.7 (SD: 2.9; range: 1–12); nine parents (20%) scored over 7, pointing toward a possible anxiety disorder. A HADS score over 10, indicative of probable anxiety disorder, was seen in three parents (7%). Table 2 shows the relevant intercorrelations for MTS, HADS, PRGI, and PRISM. No effects of time since loss of the baby and MTS, PTGI, HADS, and PRISM–SBS were found. Table 2. Intercorrelations (Spearman ρ) of Grief (MTS), Depression and Anxiety (HADS), Posttraumatic Growth (PTGI), and the PRISM Measures for All Parents (N = 44) MTS HADS Depression HADS Anxiety PTGI HADS Depression 0.63** HADS Anxiety 0.47** 0.69*** PTGI 0.38* −0.12 −0.03 PRISM −0.60** −0.29* −0.14 −0.27* MTS: Muünchner Trauerskala; HADS: Hospital Anxiety and Depression Scale; PTGI: Posttraumatic Growth Inventory; PRISM: Pictorial Representation of Illness and Self Measure. * p < 0.05 ** p < 0.01 *** p < 0.001. Table options Sociodemographic Differences Between Couples With Concordant (C) and Discordant (D) Grief No differences were found between the C and D groups for sociodemographic variables, and the average time since death of the baby was similar for both groups. Relative to the Concordant group, the Discordant group showed a tendency to have no other children (D: 5 couples, C: 1 couple; Fisher’s exact test p = 0.06). Effects of Gender and Grief Concordance on Suffering (PRISM), Posttraumatic Growth (PTGI), and Affective Symptoms (HADS) Overall, suffering did not differ between mothers and fathers or between the Concordant (C) and Discordant (D) group. However, there was a significant interaction between gender and grief-concordance group. In couples with discordant grief (D), mothers’ suffering was rated as greater than that of fathers, whereas the opposite was found in the Concordant grief (C) group (Figure 1). Posttraumatic Growth (PTGI) in Couples With Concordant (N=12) and Discordant ... Figure 1. Posttraumatic Growth (PTGI) in Couples With Concordant (N = 12) and Discordant (N = 10) Grief For gender: F[1, 20] = 19.51; p < 0.001; and Grief group: F[1, 20] = 0.10; NS; Interaction: F[1, 20] = 5.87; p < 0.05. Figure options Mothers showed greater posttraumatic growth than fathers. As with suffering, PTGI scores did not differ overall between the C and D groups. However, there was, again, a significant interaction between gender and C and D groups. In the Concordant group, there was little difference between male and female partners in their PTGI scores. In contrast, when compared with the Concordant group, PTGI scores in the Discordant group were significantly higher for mothers but significantly lower for fathers. In Discordant couples, higher differences in posttraumatic growth were found than in Concordant couples (Figure 2). For HADS Depression and HADS Anxiety, no significant effects were found for gender, couple’s grief concordance, or the interaction between them. Adaptation Within Couples With Concordant (C) and Discordant (D) Grief If couples were concordant for grief (C), they were also concordant for posttraumatic growth, suffering, depression, and anxiety. Couples discordant in grief (D) were also less concordant in suffering, depression, and anxiety. PTGI scores for mothers and fathers in the Discordant group were negatively correlated (Table 3). Table 3. Differences and Associations of Grief (MTS), Affective Symptoms (HADS), Posttraumatic Growth (PTGI), and PRISM Within Couples (N = 44) Measure t-test Within Couples (N = 22) Pearson r Within Couples (N = 22) Couples’ Grief Concordant (N = 12) Pearson r Within Couples Discordant (N = 10) Pearson r Within Couples MTS 3.24** 0.52* 0.90*** 0.47 HADS Depression 0.87 0.68*** 0.85*** 0.51 HADS Anxiety 1.13 0.14 0.28 0.04 PTGI 3.80*** 0.10 0.49 −0.21 PRISM 0.36 0.39* 0.60* 0.39 MTS: Münchner Trauerskala; PTGI: Posttraumatic Growth Inventory; HADS: Hospital Anxiety and Depression Scale; PRISM: Pictorial Representation of Illness and Self Measure. * p < 0.05 ** p < 0.01 *** p < 0.001. Table options In Table 3, the first two rows present data from the whole parents sample (N = 22 couples), assessing differences (first row) and correlations (second row) within couples. Qualitative Interviews Semistructured interviews were conducted with 12 parents (6 couples). The interviews focused on the development of partnership, suffering, and processes of growth. All interviews were audiotaped and analyzed with qualitative techniques.31 The results will be presented in detail elsewhere.32 To illustrate processes associated with discordant and concordant grief, we present two short, narrative case-histories: one from the couple showing the greatest concordance in their grief scores and one from the couple showing the greatest discordance. Concordant Couple: Mother’s MTS Score: 66; Father’s MTS Score: 62 Jessica and Marco, the twins and first babies of Antonio and Andrea, died 5 years ago, at 24 weeks’ gestation. When Andrea got pregnant, her 3-year-relationship with Antonio was in severe crisis, and they had been making plans to separate. Because of the unexpected pregnancy, the couple finally decided to stay together. At only 23 weeks’ gestation, the obstetrician detected a problem with perfusion of the placentae and sent Andrea as an emergency to the university hospital; 8 days later, a caesarean section had to be performed. Marco died immediately after birth, but Jessica survived for 5 more days. In the first days and weeks after the deaths, Andrea and Antonio had a lot of support from their families. Eighty-five relatives and friends participated in the funerals of Jessica and Marco. Both partners felt much grief, but although Andrea felt the need to talk about her grief, Antonio tried at first to hide his deep sadness, trying to be a “strong” and supportive husband. However, Andrea perceived her husband as distant and unemotional, and, 3 months after the death of the twins, she confronted him with her feelings that she was having to grieve alone. This led to an emotional outburst by Antonio, who cried in front of Andrea for the first time. After this, the couple started to share feelings regularly about the death of their children. For both partners, the deaths led to enormous changes in their personal relationships. With many friends, emotional exchange and closeness increased, while other relationships became more distant. Both partners mentioned separately that they now feel much closer to their spouse than before the death of their twins. Interestingly, each partner seemed to have tried to find meaning in the deaths in a similar way—that the deaths had brought them closer as a couple and had made their relationships even better for the children that followed. Although the couple now has two boys, ages 2 and 4 years, the twins they lost remain very much a part of their family. Discordant Couple: Mother’s MTS Score: 73; Father’s MTS Score: 33 George and Hanna lost their premature baby, Luca, 3 years ago. At the time of the birth, both parents were 27, and had been married for 2 years; it was Hanna’s first pregnancy as well as the couple’s first baby. During the pregnancy, Hanna developed a severe form of preeclampsia. At the time of the interview, Hanna was pregnant for the second time. Hanna is a midwife and was extremely happy when she became pregnant for the first time. Not only professionally but also from a personal and even a philosophical perspective, birth was a major topic in her life. During her pregnancy, she enjoyed an intense relationship with her baby and had planned early-on in the pregnancy to give birth at a clinic specializing in underwater delivery. Her husband George was a successful banker. During Hanna’s pregnancy, he changed jobs and was very absorbed in his work. Hanna’s preeclampsia was an enormous strain on both partners. Within 2 days of the onset of symptoms, a caesarean section had to be done to save Hanna’s life. Luca died 14 hours after birth. George and Hanna wanted to participate in the burial, and (not in keeping with normal procedures), even carried Luca’s dead body out of the hospital themselves in a coffin. For the first week after Luca’s death, the bereaved parents were supported only by George’s parents. They buried Luca alone, and explicitly specified on the obituary notice that they did not wish to receive any cards or letters of condolence. Although George returned to work after 3 days without telling anybody what had happened, Hanna had very strong feelings of grief and sadness for many months. The main ruminating question was: Why did this happen to me? Even at the time of the interview, 38 months after Luca’s death, her level of suffering was still very high. Since Luca’s death, she had suffered from several physical problems, such as chronic pain from a herniated disk in her back, together with fatigue and extremely irregular periods. The couple talked very little about Luca’s death. During their interviews, both mentioned that they were used to solving problems alone and felt embarrassed to talk about their private problems with other people. At 6-to-9 months after Luca’s death, George started to get annoyed when Hanna still ruminated about the circumstances and the meaning of Luca’s death. From time to time, George also thought about Luca, but he “could put this aside.” Both parents were anxious about the second pregnancy, but felt positive that the outcome would be better this time.