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      Factors associated with the grief after stillbirth: a comparative study between Brazilian and Canadian women Translated title: Fatores associados ao estado de luto após óbito fetal: estudo comparativo entre brasileiras e canadenses Translated title: Factores asociados con el estado después de muerte fetal: estudio comparativo entre Brasileñas y Canadienses

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          Abstract

          Abstract OBJECTIVE To verify the association between complicated grief and sociodemographic, reproductive, mental, marital satisfaction, and professional support characteristics in women after stillbirth. METHOD Cross-sectional study with 26 women who had stillbirth in 2013, living in the city of Maringá, Brazil, and eight women who attended the Centre d'Études et de Rechercheen Intervention Familiale at the University of Quebec en Outaouais, in Canada. The instrument was administered as an interview to a small number of mothers of infants up to three months (n=50), who did not participate in the validation study. RESULTS By applying the short version of the Perinatal Grief Scale, the prevalence of complicated grief in Brazilian women was found to be higher (35%) in relation to Canadian women (12%).Characteristics of the Brazilian women associated with the grief period included the presence of previous pregnancy with live birth, absence of previous perinatal loss, postpartum depression, and lack of marital satisfaction. For the Canadians it was observed that 80% of the women presenting no grief made use of the professional support group. In both populations the occurrence of complicated grief presented a higher prevalence in women with duration of pregnancy higher than 28 weeks. CONCLUSION The women that must be further investigated during the grief period are those living in Brazil, making no use of a professional support group, presenting little to no marital satisfaction, having no religion, and of a low educational level.

          Translated abstract

          Resumo OBJETIVO Verificar aassociação entre o luto complicado e as características sociodemográficas, reprodutivas, mentais, de satisfação conjugal e apoio profissional em mulheres após óbito fetal. MÉTODO Estudo transversal com 26 mulheres que tiveram óbito fetal no ano de 2013 residentes no município de Maringá, Brasil, e 18 mulheres participantes do Centre d'Études et de Rechercheen Intervention Familiale, na Universidade do Quebec em Outaouais, no Canadá. RESULTADOS Por meio da aplicação da versão curta da Perinatal Grief Scale, a prevalência de luto complicado foi maior nas brasileiras (35%) em relação às canadenses (12%). As características das brasileiras associadas ao luto complicado foram a presença de gestação anterior com filho nascido vivo, não ocorrência de perda perinatal anterior, depressão pós-parto e não satisfação conjugal. Para as canadenses, foi observado que 80% das mulheres sem luto utilizaram grupo profissional de apoio. Nas duas populações a ocorrência do luto complicado foi mais frequente nas mulheres com duração na gestação maior que 28 semanas. CONCLUSÃO As mulheres que mais devem ser investigadas no estado de luto são as que moram no Brasil, que não utilizam grupo profissional de apoio, não têm satisfação conjugal, não praticam religião e têm menor escolaridade.

          Translated abstract

          Resumen OBJETIVO Verificar la asociación entre el luto complicado y las características sociodemográficas, reproductivas, mentales, de satisfacción conyugal y apoyo profesional en mujeres después de muerte fetal. MÉTODO Estudio transversal con 26 mujeres que pasaron por muerte fetal en el año de 2013 residentes en el municipio de Maringá, Brasil, y 18 mujeres participantes en el Centre d'Études et de Recherche en Intervention Familiale, en la Universidad de Quebec en Outaouais, Canadá. RESULTADOS Mediante la aplicación de la versión corta de la Perinatal Grief Scale, la prevalencia de luto complicado fue mayor en las brasileñas (35%) con relación a las canadienses (12%). Las características de las brasileñas asociadas con el luto complicado fueron la presencia de embarazo anterior con hijo nacido vivo, no ocurrencia de pérdida perinatal anterior, depresión post parto y no satisfacción conyugal. Para las canadienses, se observó que el 80% de las mujeres sin luto utilizaron grupo profesional de apoyo. En ambas poblaciones, la ocurrencia del luto complicado fue más frecuente en las mujeres con duración de embarazo mayor que 28 semanas. CONCLUSIÓN Las mujeres que más se deben investigar en el estado de luto son las que viven en Brasil, que no utilizan grupo profesional de apoyo, no tienen satisfacción conyugal, no practican religión y tienen menor escolaridad.

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          Stillbirths: recall to action in high-income countries.

          Variation in stillbirth rates across high-income countries and large equity gaps within high-income countries persist. If all high-income countries achieved stillbirth rates equal to the best performing countries, 19,439 late gestation (28 weeks or more) stillbirths could have been avoided in 2015. The proportion of unexplained stillbirths is high and can be addressed through improvements in data collection, investigation, and classification, and with a better understanding of causal pathways. Substandard care contributes to 20-30% of all stillbirths and the contribution is even higher for late gestation intrapartum stillbirths. National perinatal mortality audit programmes need to be implemented in all high-income countries. The need to reduce stigma and fatalism related to stillbirth and to improve bereavement care are also clear, persisting priorities for action. In high-income countries, a woman living under adverse socioeconomic circumstances has twice the risk of having a stillborn child when compared to her more advantaged counterparts. Programmes at community and country level need to improve health in disadvantaged families to address these inequities.
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            Depressive disorder and grief following spontaneous abortion

            Background Abortion is associated with moderate to high risk of psychological problems such as depression, use of alcohol or marijuana, anxiety, depression and suicidal behaviours. The increased risk of depression after spontaneous abortion in Asian populations has not been clearly established. Only a few studies have explored the relationship between grief and depression after abortion. Methods A study was conducted to assess the prevalence and risk factors of depressive disorder and complicated grief among women 6–10 weeks after spontaneous abortion and compare the risk of depression with pregnant women attending an antenatal clinic. Spontaneous abortion group consisted of women diagnosed with spontaneous abortion by a Consultant Obstetrician. Women with confirmed or suspected induced abortion were excluded. The comparison group consisted of randomly selected pregnant, females attending the antenatal clinics of the two hospitals. Diagnosis of depressive disorder was made according to ICD-10 clinical criteria based on a structured clinical interview. This assessment was conducted in both groups. The severity of depressive symptoms were assessed using the Patients Health Questionnaire (PHQ-9). Grief was assessed using the Perinatal Grief Scale which was administered to the women who had experienced spontaneous abortion. Results The sample consisted of 137 women in each group. The spontaneous abortion group (mean age 30.39 years (SD = 6.38) were significantly older than the comparison group (mean age 28.79 years (SD = 6.26)). There were more females with ≥10 years of education in the spontaneous abortion group (n = 54; SD = 39.4) compared to the comparison group (n = 37; SD = 27.0). The prevalence of depression in the spontaneous abortion group was 18.6 % (95 CI, 11.51–25.77). The prevalence of depression in the comparison group was 9.5 % (95 CI, 4.52–14.46). Of the 64 women fulfilling criteria for grief, 17 (26.6 %) also fulfilled criteria for a depressive episode. The relative risk of developing a depressive episode after spontaneous abortion was significantly higher than in females with a viable pregnancy (RR = 2.19, 95 % CI, 1.05 to 4.56). After adjustment for age and period of amenorrhoea, the difference was not significant. Prevalence of complicated grief was 54.74 % (95 % CI, 46.3–63.18). Conclusion The relative risk of developing a depressive episode after spontaneous abortion was not significantly higher compared to pregnant women after taking into account age and period of amenorrhoea (POA). Almost half the women developed complicated grief after spontaneous abortion. Of these, a significant proportion also had features of depressive disorder. Electronic supplementary material The online version of this article (doi:10.1186/s12888-016-0812-y) contains supplementary material, which is available to authorized users.
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              Avaliação estrutural da escala de ajustamento diádico

              O objetivo deste estudo foi avaliar a Escala de Ajustamento Diádico respondida por uma amostra não-probabilística de homens e mulheres brasileiros que estavam em relacionamento amoroso de diversos tipos. Os 542 sujeitos foram recrutados em diversos locais de Porto Alegre/RS e região metropolitana. Através da técnica estatística Análise Fatorial, este estudo realizou um exame da estrutura da escala. Os resultados obtidos foram comparados com o estudo original de construção do instrumento e outras confirmações subseqüentes. Através da comparação dos escores médios dos diferentes tipos de casais da amostra atual se pôde verificar o poder discriminativo do instrumento e, além disso, foi examinada sua fidedignidade. Apareceram evidências que dão razoável suporte à versão brasileira do instrumento para sua utilização na pesquisa e na clínica psicológica.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                reeusp
                Revista da Escola de Enfermagem da USP
                Rev. esc. enferm. USP
                Universidade de São Paulo, Escola de Enfermagem
                1980-220X
                August 2016
                : 50
                : 4
                : 546-553
                Affiliations
                [1 ] Universidade Estadual do Oeste do Paraná Brazil
                [2 ] Université du Québec en Outaouais Canada
                [3 ] Universidade Estadual de Maringá Brazil
                Article
                S0080-62342016000400546
                10.1590/S0080-623420160000500002
                27680038
                3486afe8-dca3-4a6c-ac0a-3e5408641a3e

                This work is licensed under a Creative Commons Attribution 4.0 International License.

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                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=0080-6234&lng=en
                Categories
                NURSING

                Nursing
                Morte Fetal,Pesar,Enfermagem Obstétrica;Psicometria,Estudo Comparativo,Muerte Fetal,Enfermería Obstétrica,Psicometría,Estudio Comparativo,Fetal Death,Grief,Obstetric Nursing,Psychometrics,Comparative Study

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