Although existing research shows that men and women process grief and recovery from miscarriage or early pregnancy loss differently, they are best able to resolve their loss together if they undergo three one-hour long couple-focused nurse-led counseling sessions, according to a study conducted by Kristen M. Swanson, RN, PhD, FAAN, dean of the University of North Carolina at Chapel Hill School of Nursing.
Published in the most recent issue of the Journal of Women’s Health and Gender-Based Medicine, Swanson’s study, funded by the National Institute of Nursing Research, National Institutes of Health, compared three couples-focused interventions to no treatment in order to identify strategies
to help men and women with the resolution of depression and grief during the first year after miscarriage. This study was the first published randomized clinical trial of interventions to support couples after miscarriage.
“During the study, I found that, while men and women both experience sadness after a pregnancy loss, they are, most often, grieving over different things – while women typically mourn the loss of an unborn child, their husband or partner is more likely to mourn the loss of the relationship he had with the woman as she withdraws into her sadness,” Swanson said. “But even though couples tend to feel distraught over separate aspects of the pregnancy loss, we found that both individuals responded most favorably to an intervention that involved three hour-long counseling sessions with a nurse.”
Existing research shows that 85 percent of couples have limited discussions (if any) about their feelings surrounding miscarriage, even though most women wish to talk about it. In her earlier research, Swanson discovered that at one year after miscarriage, couples are likely to experience decreased emotional and physical intimacy if they have not openly shared their feelings or if the male has not demonstrated his concerns by doing little things to show he cares.
Swanson’s latest study divided 341 couples who were within 12 weeks of miscarrying into three groups – one that received three counseling sessions with a nurse (nurse caring), another that included three video and workbook modules (self caring) and a third that combined one nurse-led session with three self-caring modules (combined caring). A fourth group that received no intervention was included as a control. All interventions were offered at one week, five weeks and 11 weeks after study enrollment.
Each intervention was based on Swanson’s Theory of Caring and Meaning of Miscarriage Model. These frameworks were based on Swanson’s earlier studies with women after miscarriage. The first defines five distinct characteristics of caring relationships and the latter identifies six common issues that confront couples after miscarriage.
Overall, the study showed that while women’s grief resolution was accelerated by participation in any of the three intervention arms, their resolution of depression was best enhanced through receipt of three one-hour long, couples-focused nurse-led counseling sessions, Men’s responses were more complex. While the men in the nurse caring and control interventions took equally long to resolve their symptoms of depression, men who received either the self or combined caring intervention actually took longer than controls to resolve their depression. Men’s grief resolution, on the other hand, was most rapidly abated among those receiving the combined-caring intervention. Examination of men’s complex responses to treatment suggest that grief (a transitional response to loss) and depression (be it situational or clinical in origin) need to be studied and treated as different emotional responses.
“Through these findings, we saw that the three nursing-led counseling sessions were the most effective way to support the couple as a unit. They provided more time for the nurse and couple to connect and jointly address the meaning of miscarriage in the overall context of their lives,” Swanson said.
All improvements in depression were self-reported. Compared to women in the combined-caring, self-caring, or control arms, women who received three nurse counseling sessions were from 3.0 to 7.9 times more likely to realize a faster decline in their symptoms of depression.
Swanson acknowledges certain limitations to the study: the study sample was predominantly white and all couples were heterosexual. A notable strength of the study was that statistical analysis took into account how each individual’s healing was impacted by their mate’s recovery.
This research was funded by the National Institute of Nursing Research, National Institutes of Health, 5 R01 NR005343.