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

Cara Buskmiller; Kathryn R Grauerholz; Jennifer Bute; Maria Brann; Michaelene Fredenburg; Jerrie S Refuerzo

doi:10.7759/cureus.37884

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

Cureus. 2023 Apr 20;15(4):e37884. doi: 10.7759/cureus.37884. eCollection 2023 Apr.

Authors

Cara Buskmiller¹, Kathryn R Grauerholz², Jennifer Bute³, Maria Brann⁴, Michaelene Fredenburg⁵, Jerrie S Refuerzo⁶

Affiliations

¹ Obstetrics and Gynecology, Baylor College of Medicine, Houston, USA.
² Hospital Medicine, Institute for Reproductive Grief Care, San Diego, USA.
³ Communication, Indiana University-Purdue University Indianapolis (IUPUI), Indianpolis, USA.
⁴ Communication Studies, Indiana University Purdue University Indianapolis, Indianapolis, USA.
⁵ Health Care Task Force, Institute for Reproductive Grief Care, San Diego, USA.
⁶ Obstetrics, Gynecology, and Reproductive Sciences, University of Texas Health Science Center at Houston McGovern Medical School, Houston, USA.

Abstract

Objective Complicated grief reactions follow some pregnancy outcomes, like miscarriage, stillbirth, neonatal death, infant death, selective reduction, or termination of pregnancy. Stigma can delay treatment and worsen outcomes. Screening tools such as the Edinburgh Postnatal Depression Scale detect complicated grief poorly, and specific tools for prolonged or complicated grief after a reproductive loss are cumbersome. In this study, a five-item questionnaire to detect complicated grief after reproductive loss of any type was designed and preliminary validated. Methods A questionnaire patterned after the extensively validated Brief Grief Questionnaire (BGQ) was created by a group of physicians and lay advocates to employ non-traumatic but specific language related to grief after miscarriage, stillbirth, neonatal death, infant death, selective reduction, or termination of pregnancy. One hundred and forty women at a large academic center were recruited in person and via social media to validate the questionnaire with well-studied instruments for anxiety (7-item Panic Disorder Severity Scale, PDSS), trauma (22-item Impact of Events Scale), and reproductive grief and depressive symptoms (33-item Perinatal Grief Scale [PGS]). Results The response rate was 74.9%. Of the 140 participants, 18 (12.8%) experienced their loss during high-risk pregnancies, and 65 (46.4%) were recruited via social media. Seventy-one (51%) respondents had a score > 4, a positive screen for the BGQ. On average, women experienced their loss 2 years prior to participation (IQR 1-5 years). Cronbach's alpha was 0.77 (95% CI: 0.69-0.83). The goodness of fit indices of the model met Fornell and Larker criteria (RMSEA = 0.167, CFI = 0.89, SRMR = 0.06). The AVE was 0.42 and the CR 0.78. Conclusions This investigator-created screening tool is internally consistent and meets preliminary criteria for discriminant validity. This tool can be refined prior to testing for sensitivity and specificity in screening for complicated grief after a reproductive loss.

Keywords: abortion; miscarriage; neonatal death; persistent complex bereavement disorder; postpartum depression; pregnancy loss; prolonged grief; screening; stillbirth; survey.