Trauerverarbeitung nach Prä- und Perinatalverlust

 

 Buy Article Permissions and Reprints

Zusammenfassung

Der perinatale Verlust eines Kindes ist vor allem in fortgeschrittenen Stadien der Schwangerschaft mit gravierenden psychischen Belastungen verbunden. Für einen Teil der Betroffenen mündet die unzureichende Verarbeitung der Verlusterfahrung in die Entwicklung einer psychischen Störung ein. Dies gilt insbesondere für Frauen, die einen Verlust der Schwangerschaft nach der 20. SSW erlitten haben. Im Vordergrund stehen dabei depressive Störungen, Angstsymptome, posttraumatische Belastungsstörungen und funktionelle körperliche Beschwerden. Die vorliegenden Studien zur Evaluation psychotherapeutischer Maßnahmen nach Schwangerschaftsverlust geben nach Einschätzung eines aktuellen Cochrane Reviews [1] keine eindeutigen Anhaltspunkte für evidenzbasierte Vorgehensweisen im Rahmen der sekundären Prävention. Da andererseits die Gefährdung der Gesundheit bei den durch einen Schwangerschaftsverlust betroffenen Frauen durch eine große Zahl von Studien belegt ist, besteht ein erkennbares Forschungsdesiderat hinsichtlich der Durchführung weiterer empirisch kontrollierter Psychotherapiestudien zur Evaluation der Behandlung bei Trauerreaktionen nach Schwangerschaftsverlust.

Abstract

Miscarriage and perinatal loss are associated with considerable psychosocial distress. A substantial proportion of women who suffered the loss of a child develop a psychological disorder. Depression, anxiety disorder, post-traumatic stress disorder and somatoform disorder all have been linked in various studies to grief reactions in response to perinatal loss. A number of studies based on clinical and empirical evidence suggest various therapeutic procedures. However, a current Cochrane review [1] fails to provide empirical evidence favouring a specific treatment strategy. In Germany in routine care in gynaecology no psychological support is offered to women suffering from grief reactions due to perinatal loss. Further research is needed to develop evidence based treatment strategies for secondary prevention in this field.

Literatur

• 1 Chambers H M, Chan F Y. Support of women/families after perinatal death.  Cochrane Database of Systematic Reviews. 2004;  1
  PubMedGoogle Scholar
• 2 Leon I G. When a baby dies: psychotherapy for pregnancy and newborn loss. New Haven CO; Yale University Press 1990
  Google Scholar
• 3 Beutel M. Der frühe Verlust eines Kindes: Bewältigung und Hilfe bei Fehl-, Totgeburt und Plötzlichem Kindestod. Göttingen; Hofgrefe 2002
  Google Scholar
• 4 Conway K, Russell G. Couple's grief and experience of support in the aftermath of miscarriage.  Brit J Psychol. 2000;  73 531-545
  PubMedGoogle Scholar
• 5 Robinson M, Baker L, Nackerud L. The relationship of attachment theory and perinatal loss.  Death Stud. 1999;  23 257-270
  CrossrefPubMedGoogle Scholar
• 6 Schauer G M, Kalousek D K, Magee J F. Genetic causes of stillbirth.  Semin Perinatol. 1992;  16 341-351
  PubMedGoogle Scholar
• 7 Maier W. Perinatale Mortalität und Müttersterblichkeit. In: Käser O, Friedberg V (Hrsg) Schwangerschaft und Geburt, Bd 2. Stuttgart; Georg Thieme 1981: 20.1-20.10
  Google Scholar
• 8 Statistisches Bundesamt Deutschland .Die Gesundheitsberichterstattung des Bundes im Auftrag des Bundesministeriums für Bildung und Forschung. 2002 http://www.gbe-bund.de
  Google Scholar
• 9 Stroebe M S. Handbook of bereavement research: consequences, coping and care. Washington DC; American Psychological Association 2001
  Google Scholar
• 10 Li J, Precht D H, Mortensen P B, Olsen J. Hospitalization for mental illness among parents after the death of child.  N Engl J Med. 2005;  352 1190-1196
  CrossrefPubMedGoogle Scholar
• 11 Parkes C M. Bereavement: studies of grief in adult life (3^rd ed.). Hammondsworth; Pelican Books 1996
  Google Scholar
• 12 Middleton W, Raphael B, Martinek N, Misso V. Pathological grief reactions. In: Stroebe MS, Stroebe W, Hanssen RO (eds) Handbook of bereavement: theory, research, and intervention. NY; Cambridge University Press 1993: 44-61
  Google Scholar
• 13 Zisook S, Shuchter S R. Uncomplicated bereavement.  J Clin Psychiat. 1993;  54 365-372
  PubMedGoogle Scholar
• 14 Li J, Precht D H, Mortensen P B, Olsen J. Mortality in parents after death of a child in Denmark: a nationwide follow-up study.  Lancet. 2003;  361 363-367
  CrossrefPubMedGoogle Scholar
• 15 Lichtenstein P, Gatz M, Berg S. A twin study of mortality after spousal bereavement.  Psycholog Med. 1998;  28 635-643
  PubMedGoogle Scholar
• 16 Bowlby J. Verlust, Trauer und Depression. Frankfurt; Fischer 1983
  Google Scholar
• 17 Horowitz M J. Stress response syndromes (2^nd ed.). Northvale NJ; Jason Aronson 1997
  Google Scholar
• 18 Klier C, Geller P, Ritsher J. Affective disorders in the aftermath of miscarriage: a comprehensive review.  Arch Womens Ment Health. 2002;  5 129-149
  CrossrefPubMedGoogle Scholar
• 19 Zisook S, Vaul R A De, Click M A. Measuring symptoms of grief and bereavement.  Am J Psychiat. 1982;  139 1590-1593
  PubMedGoogle Scholar
• 20 Zisook S, Shucter R, Lyons L E. Adjustment to widowhood. In: Zisook S (ed) Biopsychsocial aspects of bereavement. Washington DC; American Psychiatric Press 1987: 49-74
  Google Scholar
• 21 Horowitz M J, Siegel B, Holen A. et al . Diagnostic criteria for complicated grief disorder.  Am J Psychiat. 1997;  154 904-910
  PubMedGoogle Scholar
• 22 Prigerson H G, Shear M K, Jacobs S C. et al . Consensus criteria for traumatic grief: a preliminary empirical test.  Brit J Psychiat. 1999;  174 67-73
  CrossrefPubMedGoogle Scholar
• 23 Kersting A, Fisch S, Suslow T. et al . Messinstrumente zur Erfassung von Trauer - Ein kritischer Überblick.  Psychother Psych Med. 2003;  53 475-484
  Google Scholar
• 24 Tomita T, Kitamura T. Clinical and research measures pf grief: a reconsideration.  Compreh Psychiat. 2002;  43 95-102
  PubMedGoogle Scholar
• 25 Zisook S, Schneider D, Shuchter S R. Anxiety and bereavement.  Psychiatr Med. 1990;  8 83-96
  PubMedGoogle Scholar
• 26 Condon J T. Management of established pathological grief reaction after stillbirth.  Am J Psychiat. 1986;  143 987-992
  PubMedGoogle Scholar
• 27 Lasker J N, Toedter L J. Acute versus chronic grief: the case of pregnancy loss.  Am J Orthopsychiat. 1991;  61 510-522
  CrossrefPubMedGoogle Scholar
• 28 Kersting A, Reutemann M, Ohrmann P. et al . Traumatische Trauer - Ein eigenständiges Krankheitsbild?.  Psychotherapeut. 2001;  46 301-308
  CrossrefPubMedGoogle Scholar
• 29 World Health Organization .The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. Geneva; World Health Organization 1992
  Google Scholar
• 30 American Psychiatric Association .Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (4^th ed). Washington, DC; American Psychiatric Association 1994
  Google Scholar
• 31 Kersting A, Fisch S, Baez E. Psychosocial care of mothers after stillbirth.  Lancet. 2002b;  360 1600
  PubMedGoogle Scholar
• 32 Kersting A, Dorsch M, Kreulich C. et al . Trauma and grief 2 - 7 years after termination of pregnancy because of fetal anomalies - a pilot study.  J Psychosom Obstet Gynecol. 2005;  26 9-14
  CrossrefPubMedGoogle Scholar
• 33 Turton P, Hughes P, Evans C DH, Fainman D. Incidence, correlates and predictors of post-traumatic stress disorder in the pregnancy after stillbirth.  Brit J Psychiat. 2001;  178 556-560
  CrossrefPubMedGoogle Scholar
• 34 Clarke M, Williams A J. Depression in woman after perinatal death.  Lancet. 1987;  1 916-917
  PubMedGoogle Scholar
• 35 Dorner S, Atwell J D. Family adjustment to the early loss of a baby born with spina bifida.  Dev Med and Child Neurol. 1985;  27 461-466
  PubMedGoogle Scholar
• 36 Forrest G C, Standish E, Baum J D. Support after perinatal death: a study of support after perinatal bereavement.  BMJ. 1982;  285 1475-1479
  CrossrefPubMedGoogle Scholar
• 37 Franche R L, Bulow C. The impact of a subsequent pregnancy on grief and emotional adjustment following a perinatal loss.  Inf Mental Hlth J. 1999;  20 175-187
  PubMedGoogle Scholar
• 38 Janssen H J, Cuisinier M, Graauw K de, Hoogduin K. A prospective study of risk factors predicting grief intensity following pregnancy loss.  Arch Gen Psychiatr. 1997;  54 56-61
  CrossrefPubMedGoogle Scholar
• 39 Toedter L J, Lasker J N, Janssen H J. International comparison of studies using the perinatal grief scale: a decade of research on pregnancy loss.  Death Stud. 2001;  25 205-228
  PubMedGoogle Scholar
• 40 Beutel M, Deckardt R, Schaudig K, Rolvering M. Chronische Trauer nach einem Spontanabort: Ergebnisse einer Längsschnittstudie nach 13 Monaten.  PPmP. 1993;  44 411-419
  PubMedGoogle Scholar
• 41 Neugebauer R, Kline J, O'Connor P. et al . Depressive symptoms in women in the six month after miscarriage.  Am J Obstet Gynecol. 1992;  166 104-109
  PubMedGoogle Scholar
• 42 Cougle J R, Reardon D C, Coleman P K. Depression associated with abortion and childbirth: a long-term analysis of the NLSY cohort.  DocCheck. 2003;  9 105-112
  PubMedGoogle Scholar
• 43 Beutel M, Deckardt R, Rad M von, Weiner H. Grief and depression after miscarriage. Their separation, antecedents, and course.  Psychosom Med. 1995a;  57 517-526
  PubMedGoogle Scholar
• 44 Beutel M, Kuse-Isingschulte M, Hahlweg B, Stauber M. Verarbeitung einer Totgeburt: Komplikationen, Risikomerkmale und Möglichkeiten ärztlicher Hilfen.  Therapeutische Umschau. 1995b;  52 114-118
  PubMedGoogle Scholar
• 45 Hughes P, Turton P, Evans C. Stillbirth as risk factor for depression and anxiety in the subsequent pregnancy: cohort study.  BMJ. 1999;  318 1721-1724
  CrossrefPubMedGoogle Scholar
• 46 Geller P, Kerns D, Klier C. Anxiety following miscarriage and the subsequent pregnancy. A review of the literature and future directions.  J Psychosom Res. 2004;  56 35-45
  CrossrefPubMedGoogle Scholar
• 47 Thapar A, Thapar A. Psychological sequelae of miscarriage: a controlled study using the General Health Questionnaire and the Hospital Anxiety and Depression Scale.  Brit J Gen Pract. 1992;  42 94-96
  PubMedGoogle Scholar
• 48 Lee C, Slade P. Miscarriage as a traumatic event: a review of the literature and new implications for intervention.  J Psychosom Res. 1996;  40 235-244
  CrossrefPubMedGoogle Scholar
• 49 Neziroglu F, Anemone R, Yaryura-Tobias J A. Onset of obsessive-compulsive disorder in pregnancy.  Am J Psychiat. 1992;  149 947-950
  PubMedGoogle Scholar
• 50 Bowles S, James L, Solursh D. et al . Acute and post-traumatic stress disorder after spontaneous abortion.  Am Fam Physician. 2000;  61 1689-1697
  PubMedGoogle Scholar
• 51 Engelhard I M, Hout M A van den, Arntz A. Posttraumatic stress disorder after pregnancy loss.  Gen Hosp Psychiatry. 2001;  23 62-66
  CrossrefPubMedGoogle Scholar
• 52 Hunfeld J A, Wladimiroff J W, Passchier J. Prediction and course of grief four years after perinatal loss due to congenital anomalies: a follow-up study.  Br J Med Psychol. 1997;  70 85-91
  PubMedGoogle Scholar
• 53 Callan V J, Murray J. The role of therapists in helping couples cope with stillbirth and newborn death.  Fam Relat. 1989;  38 248-253
  CrossrefPubMedGoogle Scholar
• 54 Lasker J N, Toedter L J. Predicting outcomes after pregnancy loss: results from studies using the perinatal grief scale.  Illness Crisis Loss. 2000;  8 350-372
  PubMedGoogle Scholar
• 55 Friedman T, Gath D. The psychiatric consequences of spontaneous abortion.  Brit J Psychiat. 1989;  155 810-813
  PubMedGoogle Scholar
• 56 Toedter L J, Lasker J N, Alhadeff J M. The perinatal grief scale: development and initial validation.  Am J Orthopsychiat. 1988;  58 435-449
  PubMedGoogle Scholar
• 57 Day D R, Hooks D. Miscarriage: a special type of family crisis.  Fam Relat. 1987;  36 305-310
  CrossrefPubMedGoogle Scholar
• 58 Läpple M. Gesundheitliche und psychosoziale Auswirkungen der Fehlgeburt.  Fortschr Neurol Psychiat. 1991;  59 155-163
  PubMedGoogle Scholar
• 59 Beutel M, Deckardt R, Schaudig K. et al . Trauer, Depressivität und Angst nach einem Spontanabort. Eine Studie über systematische Erfassung und Einflussfaktoren.  Psychother Psych Med. 1992;  42 158-166
  PubMedGoogle Scholar
• 60 Bakermans-Kranenburg M J, Schuengel C, Ijzendoorn M H van. Unresolved loss due to miscarriage: an addition to the Adult Attachment Interview.  Attach Hum Dev. 1999;  1 157-170
  PubMedGoogle Scholar
• 61 Hughes P, Turton P, Hopper E. et al . Disorganised attachment behaviour among infants born subsequent to stillbirth.  J Child Psychol Psyc. 2001;  42 791-801
  PubMedGoogle Scholar
• 62 Main M, Solomon J. Procedures for identifying infants as disorganized/disoriented during the Ainsworth strange situation. In: Greenberg MT, Cicchetti D, Cummings EM (eds) Attachment in the preschool years. Chicago; University of Chicago Press 1990: 121-185
  Google Scholar
• 63 Ainsworth M DS, Eichberg C. Effect on infant-mother attachment of mother's unresolved loss of an attachment figure, or other traumatic experience. In: Parkes CM, Stevenson-Hinde J, Marris P (eds) Attachment across the life cycle. New York; Tavistock/Routledge 1991: 160-183
  Google Scholar
• 64 Heller S S, Zeanah C H. Attachment disturbances in infants born subsequent to perinatal loss: a pilot study.  Inf Mental Hlth J. 1999;  20 188-199
  PubMedGoogle Scholar
• 65 Hughes P, Turton P, Evans C D. Assessment of guidelines for good practice in psychosocial care of mothers after stillbirth: a cohort study.  Lancet. 2002;  16 (360) 114-118
  PubMedGoogle Scholar
• 66 Turton P, Hughes P, Fonagy P, Fainman D. An investigation in the possible overlap between PTSD and unresolved responses following stillbirth: an absence of linkage with only unresolved status predicting infant disorganization.  Attach Hum Dev. 2004;  6 241-253
  PubMedGoogle Scholar
• 67 Jacobvitz D, Hazan N. Developmental pathways from infant disorganization to childhood peer relationships. In: Solomon J, George C (eds) Attachment Disorganization. New York; Guilford Press 1999: 127-159
  Google Scholar
• 68 Lyons-Ruth K, Easterbrooks M A, Cibelli C D. Infant attachment strategies, infant mental lag, and maternal depressive symptoms: predictors of internalizing and externalizing problems at age 7.  Dev Psychol. 1997;  33 681-692
  CrossrefPubMedGoogle Scholar
• 69 IJzendoorn M H Van, Schuengel C, Bakermans-Kranenburg M J. Disorganised attachment in early childhood: meta-analysis of precursors, concomitants and sequelae.  Dev Psychopathol. 1999;  11 225-249
  CrossrefPubMedGoogle Scholar
• 70 George C, Kaplan N, Main M. The Berkeley Adult Attachment Interview. Unpublished protocol. Berkeley; University of California, Department of Psychology 1996
  Google Scholar
• 71 Beutel M. Besonderheiten und Chancen der Psychotherapie nach Spontanabort.  Psychotherapeut. 1994;  40 291-297
  PubMedGoogle Scholar
• 72 Swanson K M. Effects of caring, measurement and time on miscarriage impact and women's well-being in the first year subsequent to loss.  Nurs Res. 1999;  48 288
  CrossrefPubMedGoogle Scholar
• 73 Nikcevic A V. Development and evaluation of a miscarriage follow-up clinic.  J Reprod Infant Psyc. 2003;  21 202-217
  PubMedGoogle Scholar
• 74 Health Education Council, National Association for Mental Health, and the National Stillbirth Study Group .The loss of your baby. London; HEC 1979
  Google Scholar
• 75 Lake M F, Johnson T M, Murphy J, Knuppel R A. Evaluation of a perinatal grief support team.  Am J Obstet Gynecol. 1987;  157 1203-1206
  PubMedGoogle Scholar
• 76 Lilford R J, Stratton P, Godsil S, Prasad A. A randomised trial of routine versus selective counselling in perinatal bereavement from congenital disease.  BJOG. 1994;  101 291-296
  PubMedGoogle Scholar
• 77 Murray J A, Terry D J, Vance J C. et al . Effects of a program of intervention on parental distress following infant death.  Death Stud. 2000;  24 275-305
  CrossrefPubMedGoogle Scholar
• 78 Carrera L, Diez-Domingo J, Montanana V. et al . Depression in women suffering perinatal loss.  Int J Gynaecol Obstet. 1998;  62 149-153
  CrossrefPubMedGoogle Scholar
• 79 Swanson K M. Empirical development of a middle range theory of caring.  Nurs Res. 1991;  40 161-166
  PubMedGoogle Scholar
• 80 Swanson-Kauffman K M. Caring in the instance of unexpected early pregnancy loss.  Top Clin Nurs. 1986;  8 58-69
  PubMedGoogle Scholar
• 81 Schneiderman M D, Winders P, Tallet S, Feldman W. Do child and/or parent bereavement programs work?.  Can J Psychiat. 1994;  39 215-21
  PubMedGoogle Scholar

Prof. Dr. Carl Eduard Scheidt

Abteilung Psychosomatische Medizin und Psychotherapie, Universitätsklinik Feiburg

Hauptstraße 8

79104 Freiburg

Email: carl.eduard.scheidt@uniklinik-freiburg.de