“My heart still aches with sadness”: Epidemiological Relationships Between Perinatal Grief, Major Depressive Disorder, and Personality Disorders

The experience of perinatal bereavement can be devastating for women and their loved ones, and yet the experience has largely been overlooked by researchers. It is only recently that, along with changed sociocultural conditions, technological advances in neonatal care, and advanced understanding of maternal/fetal attachment, women’s experiences of perinatal loss have been empirically recognised. With an estimated 1 in 3 women experiencing perinatal loss, the profound sorrow that can accompany miscarriage, stillbirth, ectopic pregnancy, and terminations is now more readily acknowledged. Although some women accommodate perinatal loss in the longer-term, previous research has shown that approximately 20% continue to carry disabling symptoms in the years after perinatal loss. The challenge remains for researchers and practitioners alike to identify factors which influence longer-term perinatal grief trajectories. The present study aimed to examine perinatal grief experiences and mental health in a group of community-dwelling Australian women. One hundred and ninety-seven women participated in a clinical interview to assess perinatal history, depression, and personality disorders. It was hypothesised that previously-healthy women who developed de novo Major Depressive Disorder after experiencing perinatal loss would report more intense grief, with depression acting as a significant risk factor for complications in grief. Further, it was hypothesised that women with personality disorders would report more intense grief responses, with the presence of any personality disorder acting as a significant risk factor for greater complications in perinatal grief. These hypotheses were all supported. After an median 11 years post-loss, 6.5% of women continued to report clinically significant levels of perinatal grief. One in four women who were previously mentally healthy responded to perintal loss with the development of de novo depression. For women who did develop de novo depression, and for women with personality disorders, the risk of developing more problematic grief was between two and four times greater than women without such features. It may be that women with personality disorders are more at risk of developing a despair-related form of prolonged grief, whereas women with depression may be at risk of developing a form of prolonged grief associated with poorer coping. Such findings have theoretical and clinical implications whereby certain groups of women appear at greater risk of developing more complicated grief after perinatal loss. Further research should continue to identify these and other risk factors that modulate grief responses, so as to inform diagnosis and treatment of Persistent Complex Bereavement Disorder