BACKGROUND: Stillbirth is a unique phenomenon with various manifestations influenced by cultural contexts and spiritual beliefs. Chinese cultural and spiritual practices produce different post-stillbirth grief experiences for bereaved mothers in China. However, the majority of research on perinatal loss and grief has been conducted in Western cultures. In the Chinese cultural context, the post-stillbirth grief experience of bereaved mothers may differ from the types of Western bereavement examined in the dominant research.
OBJECTIVE: This study investigated the influence of culture and spirituality on grieving mothers who had experienced a stillbirth in China.
METHODS: This qualitative study was grounded in an interpretivist constructionist epistemology. In-depth interviews were conducted with mothers who had experienced a stillbirth within the previous year. Thematic analysis was used to analyse the data.
RESULTS: A total of 28 women were interviewed by trained interviewers. Three key themes were identified: 1) The influence of culture on grief expression, with four subthemes: restrained expressions of grief, unattainable mourning ceremonies, hospital policy as a barrier to grieving, and others-oriented self; 2) Cultural characteristics of post-stillbirth experiences, with four subthemes: paternalistic medical culture, \"Kong yuezi\", embarrassment during postpartum visits, and cultural taboos on dealing with deceased babies\' possessions; and 3) Finding significance in spiritual healing process, with four subthemes: seeking meaning in the event, accepting and reconciling with the event, reshaping beliefs and views about life and death, and achieving personal growth.
CONCLUSIONS: Chinese culture and spirituality have different influences on bereaved mothers\' expressions of grief and post-stillbirth healing. This research demonstrates specific aspects of spirituality that contribute to or hinder the grieving process and the different roles of Chinese culture and spirituality for individuals. The findings suggest the need for the development of culturally sensitive interventions and support systems to assist mothers in navigating grief and healing. Future studies could explore the roles of Chinese culture and spirituality over time in the different stages of grief and healing after stillbirth.

OBJECTIVE: We aimed to explore the lived experiences and needs of women after a recent stillbirth event.
METHODS: Qualitative phenomenological study.
METHODS: The current study was conducted in a tertiary obstetric hospital in East China between 25 January 2024 and 29 March 2024.
METHODS: 14 women having experienced a stillbirth within the last 6 months.
RESULTS: Researchers agreed on four key themes including individual variations in emotional reaction and recovery, physical recovery and concerns about future pregnancies, the critical role of social support systems and variations in perceptions of stillbirth as the death of a fetus versus a human being, along with related mourning rituals. These themes collectively highlight the multifaceted nature of the stillbirth experience, underscoring the complex interplay between personal, cultural and medical factors that shape women\'s emotional and physical responses.
CONCLUSIONS: Post-stillbirth experiences among Chinese women are deeply individualised and influenced by a complex interplay of personal emotions, cultural contexts and medical interactions. It is imperative for healthcare systems to implement tailored care strategies beyond standard protocols to proactively address their varied emotional landscapes and physical concerns with an enhanced awareness of cultural sensitivities. Specialised training for healthcare providers should be devised to recognise and respond to the unique grief processes. Comprehensive support systems should be established to significantly enhance the recovery journey by providing essential resources and community connections.

BACKGROUND: Relatives of deceased critically ill patients are at high risk for symptoms of complicated grief (CG) with potential individual and social burdens. The prevalence and predictors of CG, and in particular the involvement of individual facets of relatives\' coping strategies, are not well understood.
OBJECTIVE: How high is the prevalence and what are the predictors of CG, and how are coping strategies associated with CG symptoms?
METHODS: In this observational single-center cohort study, relatives of deceased critically ill patients were surveyed 6 months later, using the Inventory of Complicated Grief (ICG) and the Brief-COPE questionnaire to assess CG symptoms and coping strategies, respectively. Patients\' and relatives\' characteristics were obtained. The primary outcome was the ICG sum score.
RESULTS: Relatives of 89 of the 298 patients who died in the ICU during the study period were included. The mean ICG sum score (SD) was 41.6+10.9. Eighty-four relatives (94.4%) had an ICG score of >25. Multivariable analysis revealed that being a partner affected the ICG sum score significantly (coefficient 4.9, 95% confidence interval [1.8; 8.0], p=0.003), as did the coping strategies self-distraction (coefficient 4.4, 95% CI [2.5; 6.3], p<0.001), acceptance (coefficient -4.4, 95% CI [-6.3; -2.5], p<0.001), and self-blame (coefficient 3.8, 95% CI [1.4; 6.3], p=0.002).
CONCLUSIONS: Almost all relatives of deceased critically ill patients show symptoms of CG. Relatives\' functional and dysfunctional coping strategies may be associated with their CG symptoms. Knowledge of individual relatives\' coping strategies may be helpful in supporting them. Adequate supportive interventions should be developed.

BACKGROUND: Pregnancy loss affects 1 in 4 women and is linked with poorer overall health and relationship outcomes. Despite sexual well-being\'s importance to health, how sexual well-being changes across time after a pregnancy loss and what might predict such changes, like perinatal grief, have never been examined, leaving practitioners and couples without knowledge of what to expect.
OBJECTIVE: We aimed to examine (1) how sexual satisfaction, sexual desire, sexual distress, and perinatal grief change from 10 to 25 weeks postloss for both couple members; and (2) if perinatal grief levels at 10 weeks postloss predict sexual well-being trajectories.
METHODS: Women and gender-diverse individuals who were pregnant when a pregnancy loss occurred (within the last 4 months) and men, women, and gender-diverse partners who were not pregnant (N = 132 couples) independently completed 4 monthly assessments of sexual well-being and perinatal grief.
RESULTS: Outcomes included sexual satisfaction (Global Measure of Sexual Satisfaction), sexual desire (Sexual Desire Inventory), sexual distress (Sexual Distress Scale-Short Form), perinatal grief (Perinatal Grief Scale).
RESULTS: Dyadic growth curve modeling indicated that, from 10 to 25 weeks postloss, both couple members\' sexual satisfaction increased, and their sexual desire remained stable; sexual distress decreased for partners but remained stable for individuals who were pregnant; and both couple members\' perinatal grief decreased. Perinatal grief levels at 10 weeks postloss did not predict sexual well-being trajectories over time.
CONCLUSIONS: Given sexual well-being\'s dynamic nature, clinicians should regularly discuss sexuality with both couple members after pregnancy loss. During such discussions, clinicians could reassure couples about their sexual relationship\'s recovery by sharing that, on average, sexual satisfaction, sexual desire, and sexual distress tend to improve or stay the same (rather than worsen) from 10 to 25 weeks postloss. They can also share that perinatal grief tends to decrease during this time and is unrelated to trajectories of sexual satisfaction, sexual desire, and sexual distress.
UNASSIGNED: This is the first study, to our knowledge, to examine how sexual well-being changes across time after a pregnancy loss and perinatal grief\'s role in such changes. The results may not generalize broadly, as most couples were in mixed-gender/sex relationships, identified as White, and were relatively affluent.
CONCLUSIONS: From 10 to 25 weeks postloss, both couple members tend to experience improvements in their overall sexual well-being and declines in their perinatal grief. Early perinatal grief levels and subsequent sexual well-being trajectories are seemingly unrelated.

OBJECTIVE: Palliative care patients experience chronic sorrow with loss in dignity and meaning in life. Logotherapy is an effective way to cope with loss. This study aimed to evaluate the effect of logotherapy on chronic sorrow, dignity, and meaning in life of palliative care patients.
METHODS: This study was conducted with 58 adults hospitalized due to advanced cancer and assigned to either intervention or control group by simple randomization. Data were collected with descriptive information form, Palliative Performance Scale, Patient Dignity Inventory (PDI), Prolonged Grief Disorder Scale-Patient Form (PGDS-PF), and Meaning in Life Questionnaire (MIL) on admission, at the 4th and 8th weeks. The intervention group received eight sessions of logotherapy. The control group received routine care.
RESULTS: The mean scores of PGDS-PF (p = 0.01), PDI (p = 0.01), and searched meaning subdimension of MIL (MIL-SM) (p = 0.11) decreased in the intervention group compared to controls, both at the 4th and 8th week evaluation. The mean score of the present meaning subdimension of MIL (MIL-PM) (p = 0.02) increased at the 4th week evaluation but decreased at a non-statistically significant level at the 8th week. The mean scores of PGDS-PF and PDI increased in the control group while MIL-PM and MIL-SM decreased, both at the 4th and 8th week evaluation.
CONCLUSIONS: Logotherapy was found effective in decreasing the sorrow and dignity-related distress of palliative care patients, while increasing finding meaning in life. Logotherapy is recommended to be used by palliative care professionals to empower patients.
BACKGROUND: Clinicaltrials registration number and date: NCT05129059, 19/01/2021.

UNASSIGNED: The purpose of this study was to examine women\'s recollected lifespan perceptions of the effect of grief intensity following adolescent perinatal death.
UNASSIGNED: Nineteen adult women who had experienced either a miscarriage or an abortion during adolescence. The study involved the recollection of events surrounding the experience which had occurred between three and 28 years previously.
UNASSIGNED: A 55-item online survey was used to gather recollected perceptions of adolescent miscarriage and abortion experiences. The Perinatal Grief Intensity Scale was embedded within this survey. The participants were instructed to recall their responses to the perinatal loss at the time of the event as an adolescent (T1; Time 1) and how they feel currently as adults about their previous adolescent perinatal death (T2; Time 2). Data were collected at both T1 and T2. The Perinatal Grief Intensity Scale is accompanied by an appropriately weighted Excel scoring sheet which was utilised to analyse the data at both T1 and T2.
UNASSIGNED: As adolescents, participants perceived similar high and medium grief intensity when compared by type of loss (miscarriage, n = 6; abortion, n = 6). However, more women who had an abortion (n = 5) experienced low grief intensity compared with participants who had a miscarriage (n = 2). As adults, participants continued to perceive similar high and medium grief intensity when compared by type of loss (miscarriage, n = 6; abortion, n = 5). In addition, women who had an abortion continued to experience more low grief intensity (n = 6) compared with participants who had a miscarriage (n = 2). Approximately one quarter of adult female respondents, 26 % (n = 5) exhibited increased grief intensity as measured by the scores over time. Thirty seven percent (n = 7) exhibited no change in scores, and 37 % (n = 7) exhibited decreased scores over time in response to adolescent miscarriage or abortion.
UNASSIGNED: Support for the adoption of the Perinatal Grief Intensity Scale to identify women in need of follow-up for grief intensity after an adolescent miscarried or terminated pregnancy is evident. The results of this study have demonstrated that grief can resurge or appear in adult females as they respond to events across the lifespan, including further reproductive experiences. Therefore there is a compulsion for health care professionals to identify women at risk of intensive grief responses due to previous contributory events.
UNASSIGNED: Healthcare providers should screen adult women who have experienced a previous adolescent miscarriage or termination for adverse mental health issues in adulthood.

BACKGROUND: How individuals are informed of the traumatic loss of a loved one can influence their grieving process and quality of life.
OBJECTIVE: This qualitative study aimed to explore, through thematic analysis, how life stages might influence the experience and feelings of those who have received communication of a traumatic death from police officers or healthcare professionals.
METHODS: Recruited through social networks and word of mouth, 30 people participated in the study. Subjects were divided into three groups according to age (Group 1: ten participants aged between 20 and 35 years; Group 2: ten participants aged between 45 and 55 years; and Group 3: ten participants aged 60 and over). Participants completed an ad hoc questionnaire online. Atlas.ti software 8 was used to perform thematic analysis.
RESULTS: The three age groups had the following four key themes in common: (a) emotional reactions; (b) subjective valuation of the notification; (c) support; and (d) needs. Subtle differences emerged between age groups; yet the quality of the reactions and main themes did not vary greatly between the groups considered.
CONCLUSIONS: The communication of an unexpected and violent death seems to provoke rather similar effects in survivors of different life stages. A few differences were noted in sub-themes (increased need for professional training in younger recipients; absence of suicidal ideation in older adults); perhaps quantitative designs could provide further details in future investigations.

BACKGROUND: Pregnancy loss and mourning can lead to psychological adverse effects on women\'s quality of life. This study aimed to evaluate the effect of art therapy on the quality of life of women with pregnancy loss.
METHODS: This study was a randomized clinical trial performed on 60 women who recently experienced abortion or stillbirth. After randomization in two groups (30 in each group), women in the intervention group received four session art therapy. In the control group, routine care was performed. The Perinatal Grief Scale and World Health Organization quality of life questionnaire, short version 26, was used to collect data before and eight weeks after intervention, and the result was compared before and after the intervention in both groups.
RESULTS: The mean age of participants was 26.5±4.75 years. Eight weeks after the intervention, the mean score of the total quality of life was significantly different between the two groups (348.64±13.12 vs.254.46±58.35; P>0.01). Also, all physical, psychological, social, and environmental dimensions of quality of life improved in the art therapy group compared to the control group (P>0.01).
CONCLUSIONS: Art therapy could improve the quality-of-life following pregnancy loss, and can be recommended as a complementary method next to routine care.
BACKGROUND: IRCT20200104046002N1.

BACKGROUND: The decision to terminate a pregnancy due to fetal anomalies can have a significant emotional impact, especially in second-trimester terminations. Previous studies on the psychological consequences of pregnancy termination have had limitations, and little is known about the outcomes for partners and the impact of fetal donation. Therefore, we aimed to investigate the psychological effects of second-trimester pregnancy termination and identify factors associated with outcomes in both women and men, including donation of fetal remains to science.
METHODS: A longitudinal cohort study was conducted at the Amsterdam UMC in the Netherlands, involving women and partners who underwent termination at or before 23 weeks and 6 days of gestation. Questionnaires were administered at termination, 6 weeks, and 4 months after. We utilized validated questionnaires to assess psychological morbidity (grief, post-traumatic stress and postnatal depression and quality of life [QoL]), and factors that could potentially influence outcomes.
RESULTS: Of 241 participants, women displayed more pronounced psychological distress than men, though both groups improved over time. Four months after termination, 27.4% of women and 9.1% of men showed signs of pathological grief. Scores indicative for postnatal depression occurred in 19.8% women and 4.1% of men. A prior psychiatric history was a consistent predictor of poorer outcomes. Fetal donation to the Dutch Fetal Biobank was associated with reduced likelihood of symptoms of complicated grief four months after termination.
CONCLUSIONS: Second-trimester termination of pregnancy for fetal anomalies can lead to psychological morbidity, particularly in women. However, there is a notable improvement over time for both groups. Individuals with prior psychiatric history appear more vulnerable post-termination. Also, fetal donation to science did not have a negative impact on psychological well-being.

OBJECTIVE: The study aimed to explore the meaning for adolescents of living with a parent with amyotrophic lateral sclerosis (ALS).
METHODS: The design is qualitative. Interviews were conducted between December 2020 and April 2022 with 11 adolescents (8-25 y), living in households with a parent with ALS in Sweden. The analysis was phenomenologically hermeneutical.
RESULTS: The adolescents were in a difficult and exposed situation, especially if the parent had a severe disability and assistant care providers were in the home. Witnessing the gradual loss of the parent in an indefinite battle against time, while still needing them, elicited grief-filled and hard-to-manage emotions. Everyday life was turned upside down, resulting in greater responsibility for the adolescents, not only in helping with household chores and assisting the ill parent, but also in emotionally protecting both parents. It forced the adolescents to mature faster and put their own life on hold, triggering experiences of being limited. This, together with changing family roles yet being more attached to home, reinforced the imbalance in the adolescents\' lives. The interpreted whole of the adolescents\' narratives revealed that living with a parent with ALS meant a challenging and grieving transition during an already transition-filled adolescence, which left the adolescents struggling to keep a foothold on a life torn apart.
CONCLUSIONS: The unbalanced life situation may hinder the adolescents\' identity formation and emancipation, which are developmentally important for managing a healthy and independent adulthood. The results emphasize the importance of early targeted support to reach this vulnerable group in order to secure their health.