Validation of a grief questionnaire for reproductive loss

Complicated grief reactions follow 3% of pregnancy outcomes like miscarriage, stillbirth, neonatal death, and some selective reductions or terminations 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 complicated grief after reproductive loss are cumbersome. This study designed and validated a five-item questionnaire to detect complicated grief after reproductive loss of any type. A questionnaire patterned after the extensively-validated Brief Grief Questionnaire was created by a group of physicians and lay advocates to employ non-traumatic but specific language about grief after miscarriage, stillbirth, neonatal death, selective reduction, or termination of pregnancy. Validation was planned in 140 women at a large academic center with recruitment in person and via social media, against well-studied instruments for anxiety (7-item Panic Disorder Severity Scale), trauma (22-item Impact of Events Scale), and reproductive grief (33-item Perinatal Grief Intensity Scale). Of 140 participants, 18 (12.8%) experienced their loss in high risk pregnancies, and 65 (46.4%) were recruited via social media. 71 (51%) of respondents had a positive screen (score ≥ 4), a mean of 2 years after the event (IQR 1-5 yrs, see Table 1). Cronbach alpha was 0.77 (95% CI 0.69-0.83). A model that included coping mechanisms outperformed other models (Table 2) with a comparative fit index (CFI) of 0.92 (ideal > 0.9), a root mean square error of approximation (RMSEA) of 0.076 (ideal < 0.08), and a standardized root mean square residual (SRMR) of 0.06 (ideal < 0.08). The average variance extracted (AVE) was 0.42 (ideal > 0.5) and composite reliability (CR) was 0.7 (ideal > 0.6). This investigator-created screening tool is internally consistent and meets Fornell and Larcker criteria for discriminant validity. This tool can be employed for women who experience pregnancy loss in the future. Further studies could refine the survey to optimize performance.View Large Image Figure ViewerDownload Hi-res image Download (PPT)