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A child’s death evokes intense and long-lasting grief in parents. However, few interventions exist to address the needs of this population. This mixed methods project used secondary data to evaluate the impact of a four-day, grief-focused mindfulness-based retreat on bereaved parents.

A quasi-experimental design with two nonequivalent groups (intervention grou

A child’s death evokes intense and long-lasting grief in parents. However, few interventions exist to address the needs of this population. This mixed methods project used secondary data to evaluate the impact of a four-day, grief-focused mindfulness-based retreat on bereaved parents.

A quasi-experimental design with two nonequivalent groups (intervention group n = 25, comparison group n = 41) and three observations (pretest and two posttests) was used. Mixed-model repeated-measures analyses of variance were used to assess change over time for the intervention group and relative to a no-intervention comparison group. Outcome measures were depressive and anxious responses, measured by the Hopkins Symptom Checklist-25 (HSCL-25); trauma responses, measured by the Impact of Event Scale-Revised (IES-R); mindfulness, measured by the Five Facet Mindfulness Questionnaire (FFMQ); and self-compassion, measured by the Self-Compassion Scale-Short Form (SCS-SF). The intervention group was expected to show significant decreases in psychological distress and significant increases in mindfulness and self-compassion over time and relative to the comparison group.

The qualitative component consisted of semi-structured interviews with nineteen retreat participants using a constructivist phenomenological approach in order to obtain a richer understanding of the retreat’s impact on participants’ lives.

There were significant time by condition interactions with small to medium effect sizes for the IES-R and its subscales, the HSCL-25 and its depression subscale, and three FFMQ scales (describe, act with awareness, and nonjudge), all favoring the intervention group. However, not all benefits were maintained at follow-up.

Psychoeducation and relationships emerged as key qualitative themes. Psychoeducation included benefits related to present-moment awareness, fully inhabiting grief, self-compassion, emotional equanimity, and reduced distress or judgment of distress. Relationships included benefits related to giving and receiving social support, emotional expression and sharing, validation and normalization of grief-related experiences, resonance and self-other awareness, self-appraisal, changes in relationships, and connection to a deceased child. Mindfulness seemed to be a key component in reducing trauma responses. Relationship factors, combined with psychoeducation and present-moment awareness, seemed responsible for increasing participants’ capacity for nonjudgmental acceptance of experiences.

The retreat may be an effective intervention for helping parents cope with and express their grief and warrants further study.
ContributorsThieleman, Kara (Author) / Cacciatore, Joanne (Thesis advisor) / Segal, Elizabeth (Committee member) / Hodge, David (Committee member) / Arizona State University (Publisher)
Created2019
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Description

Background: In the USA, stillbirth (in utero fetal death ≥20 weeks gestation) is a major public health issue. Women who experience stillbirth, compared to women with live birth, have a nearly sevenfold increased risk of a positive screen for post-traumatic stress disorder (PTSD) and a fourfold increased risk of depressive symptoms.

Background: In the USA, stillbirth (in utero fetal death ≥20 weeks gestation) is a major public health issue. Women who experience stillbirth, compared to women with live birth, have a nearly sevenfold increased risk of a positive screen for post-traumatic stress disorder (PTSD) and a fourfold increased risk of depressive symptoms. Because the majority of women who have experienced the death of their baby become pregnant within 12–18 months and the lack of intervention studies conducted within this population, novel approaches targeting physical and mental health, specific to the needs of this population, are critical. Evidence suggests that yoga is efficacious, safe, acceptable, and cost-effective for improving mental health in a variety of populations, including pregnant and postpartum women. To date, there are no known studies examining online-streaming yoga as a strategy to help mothers cope with PTSD symptoms after stillbirth.

Methods: The present study is a two-phase randomized controlled trial. Phase 1 will involve (1) an iterative design process to develop the online yoga prescription for phase 2 and (2) qualitative interviews to identify cultural barriers to recruitment in non-Caucasian women (i.e., predominately Hispanic and/or African American) who have experienced stillbirth (N = 5). Phase 2 is a three-group randomized feasibility trial with assessments at baseline, and at 12 and 20 weeks post-intervention. Ninety women who have experienced a stillbirth within 6 weeks to 24 months will be randomized into one of the following three arms for 12 weeks: (1) intervention low dose (LD) = 60 min/week online-streaming yoga (n = 30), (2) intervention moderate dose (MD) = 150 min/week online-streaming yoga (n = 30), or (3) stretch and tone control (STC) group = 60 min/week of stretching/toning exercises (n = 30).

Discussion: This study will explore the feasibility and acceptability of a 12-week, home-based, online-streamed yoga intervention, with varying doses among mothers after a stillbirth. If feasible, the findings from this study will inform a full-scale trial to determine the effectiveness of home-based online-streamed yoga to improve PTSD. Long-term, health care providers could use online yoga as a non-pharmaceutical, inexpensive resource for stillbirth aftercare.

ContributorsHuberty, Jennifer (Author) / Matthews, Jeni (Author) / Leiferman, Jenn (Author) / Cacciatore, Joanne (Author) / Gold, Katherine J. (Author) / College of Health Solutions (Contributor)
Created2017-07-06
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Intense and enduring psychological distress has been well-documented in numerous studies on bereaved parents including anxious, depressive, and traumatic stress symptoms. A state of poverty is also known to increase the risk of psychological distress in the general population, yet this variable has not yet been sufficiently evaluated in outcomes

Intense and enduring psychological distress has been well-documented in numerous studies on bereaved parents including anxious, depressive, and traumatic stress symptoms. A state of poverty is also known to increase the risk of psychological distress in the general population, yet this variable has not yet been sufficiently evaluated in outcomes specifically for bereaved parents. This study is the first to investigate poverty, education, and parental bereavement while examining the relative risk of other variables as informed by the literature. The findings reveal that poverty was the strongest predictor of psychological distress when compared to others factors which have traditionally been considered significant in parental bereavement. Bereaved parents living in poverty may be less likely to seek support and have fewer available resources. Practice and policy implications are discussed.

Created2016-12
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Background: Postmortem memento photography has emerged in Western hospitals as part of compassionate bereavement care for parents facing perinatal death. Many parents endorse this psychosocial intervention, yet implementation varies greatly and little research on parents’ specific needs guides health care professionals. Parents are in crisis and vulnerable after the death of

Background: Postmortem memento photography has emerged in Western hospitals as part of compassionate bereavement care for parents facing perinatal death. Many parents endorse this psychosocial intervention, yet implementation varies greatly and little research on parents’ specific needs guides health care professionals. Parents are in crisis and vulnerable after the death of their child, thus best practice is crucial. This study contributes 104 parents’ experiences and opinions toward the understanding of best practice in perinatal bereavement photography.

Methods: Parents who experienced the perinatal death of their child were recruited from U.S.-based bereavement organizations and social media sites. Volunteers completed an anonymous internet survey with open- and closed-ended questions. Direct recommendations and pertinent statements regarding the process of postmortem photography were analyzed for thematic content in keeping with conventional content analysis. Recurrent themes and sub-themes were counted to identify response patterns.

Results: Of 93 parents with pictures, 92 endorsed them. Of 11 without pictures, nine wanted them. Parents made a variety of recommendations regarding appropriate psychosocial support, the consent process, obstacles to photography, logistics of photography, and material aspects of photographs themselves. Overall, parents wanted many pictures and much variety. Some wanted professional photography while others wanted support for taking their own pictures. Parents wanted guidance from staff who respected their particular needs. Many said decisions were difficult during their crisis. Parents who were initially resistant expressed current appreciation for pictures or expressed regret that they had not participated. Parents recommended that professionals strongly encourage parents to create memento photos despite parents’ initial reservations. Persistent cultural reasons against photography emerged in one case. Quotes by parents illuminate themes and enable respondents to speak directly to health care professionals.

Conclusions: Parents overwhelmingly support postmortem bereavement photography when conducted sensitively, even if imperfectly executed. Providers significantly influence parents during their crises; mindful, patient-centered care with appropriate respect for difference is necessary. Providers must understand the importance of postmortem photographs to parents who have limited opportunity to capture memories of their child. Hospitals should provide education and support for this important psychosocial intervention.

Created2014-06-23
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Background: Despite improvements in maternity healthcare services over the last few decades, more than 2.7 million babies worldwide are stillborn each year. The global health agenda is silent about stillbirth, perhaps, in part, because its wider impact has not been systematically analysed or understood before now across the world. Our

Background: Despite improvements in maternity healthcare services over the last few decades, more than 2.7 million babies worldwide are stillborn each year. The global health agenda is silent about stillbirth, perhaps, in part, because its wider impact has not been systematically analysed or understood before now across the world. Our study aimed to systematically review, evaluate and summarise the current evidence regarding the psychosocial impact of stillbirth to parents and their families, with the aim of improving guidance in bereavement care worldwide.

Methods: Systematic review and meta-summary (quantitative aggregation of qualitative findings) of quantitative, qualitative, and mixed-methods studies. All languages and countries were included.

Results: Two thousand, six hundred and nineteen abstracts were identified; 144 studies were included. Frequency effect sizes (FES %) were calculated for each theme, as a measure of their prevalence in the literature. Themes ranged from negative psychological symptoms post bereavement (77 · 1) and in subsequent pregnancies (27 · 1), to disenfranchised grief (31 · 2), and incongruent grief (28 · 5), There was also impact on siblings (23 · 6) and on the wider family (2 · 8). They included mixed-feelings about decisions made when the baby died (12 · 5), avoidance of memories (13 · 2), anxiety over other children (7 · 6), chronic pain and fatigue (6 · 9), and a different approach to the use of healthcare services (6 · 9). Some themes were particularly prominent in studies of fathers; grief suppression (avoidance)(18 · 1), employment difficulties, financial debt (5 · 6), and increased substance use (4 · 2). Others found in studies specific to mothers included altered body image (3 · 5) and impact on quality of life (2 · 1). Counter-intuitively, Some themes had mixed connotations. These included parental pride in the baby (5 · 6), motivation for engagement in healthcare improvement (4 · 2) and changed approaches to life and death, self-esteem, and own identity (25 · 7). In studies from low/middle income countries, stigmatisation (13 · 2) and pressure to prioritise or delay conception (9) were especially prevalent.

Conclusion: Experiencing the birth of a stillborn child is a life-changing event. The focus of the consequences may vary with parent gender and country. Stillbirth can have devastating psychological, physical and social costs, with ongoing effects on interpersonal relationships and subsequently born children. However, parents who experience the tragedy of stillbirth can develop resilience and new life-skills and capacities. Future research should focus on developing interventions that may reduce the psychosocial cost of stillbirth.

ContributorsBurden, Christy (Author) / Bradley, Stephanie (Author) / Storey, Claire (Author) / Ellis, Alison (Author) / Heazell, Alexander E. P. (Author) / Downe, Soo (Author) / Cacciatore, Joanne (Author) / Siassakos, Dimitrios (Author) / College of Public Service and Community Solutions (Contributor)
Created2016-01-19
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Description

Background: In the United States, approximately one in 110 pregnancies end in stillbirth affecting more than 26,000 women annually. Women experiencing stillbirth have a threefold greater risk of developing depressive symptoms compared to women experiencing live birth. Depression contributes negatively to health outcomes for both mothers and babies subsequent to stillbirth.

Background: In the United States, approximately one in 110 pregnancies end in stillbirth affecting more than 26,000 women annually. Women experiencing stillbirth have a threefold greater risk of developing depressive symptoms compared to women experiencing live birth. Depression contributes negatively to health outcomes for both mothers and babies subsequent to stillbirth. Physical activity may improve depression in these women, however, little is known about acceptable physical activity interventions for women after stillbirth. This is the purpose of this descriptive exploratory study.

Methods: Eligible women were between ages 19 and 45, and experienced stillbirth within one year of the study. An online survey was used to ask questions related to 1) pregnancy and family information (i.e., time since stillbirth, weight gain during pregnancy, number of other children) 2) physical activity participation, 3) depressive symptomatology, and 4) demographics.

Results: One hundred seventy-five women participated in the study (M age = 31.26 ± 5.52). Women reported participating in regular physical activity (at least 150 minutes of moderate activity weekly) before (60%) and during (47%) their pregnancy, as well as after their stillbirth (61%). Only 37% were currently meeting physical activity recommendations. Approximately 88% reported depression (i.e., score of >10 on depression scale). When asked how women cope with depression, anxiety, or grief, 38% said physical activity. Of those that reported using physical activity to cope after stillbirth, they did so to help with depression (58%), weight loss (55%), and better overall physical health (52%). To cope with stillbirth, women used walking (67%), followed by jogging (35%), and yoga (23%). Women who participated in physical activity after stillbirth reported significantly lower depressive symptoms (M = 15.10, SD = 5.32) compared to women who did not participate in physical activity (M = 18.06, SD = 5.57; t = -3.45, p = .001).

Conclusions: Physical activity may serve as a unique opportunity to help women cope with the multiple mental sequelae after stillbirth. This study provides data to inform healthcare providers about the potential role of physical activity in bereavement and recovery for women who have experienced stillbirth. Additional research is necessary in this vulnerable population.

ContributorsHuberty, Jennifer (Author) / Leiferman, Jenn A. (Author) / Gold, Katherine J. (Author) / Rowedder, Lacey (Author) / Cacciatore, Joanne (Author) / Bonds McClain, Darya (Contributor) / College of Health Solutions (Contributor)
Created2014-11-29
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Description

N2 fixation and ammonia oxidation (AO) are the two most important processes in the nitrogen (N) cycle of biological soil crusts (BSCs). We studied the short-term response of acetylene reduction assay (ARA) rates, an indicator of potential N2 fixation, and AO rates to temperature (T, -5°C to 35°C) in BSC

N2 fixation and ammonia oxidation (AO) are the two most important processes in the nitrogen (N) cycle of biological soil crusts (BSCs). We studied the short-term response of acetylene reduction assay (ARA) rates, an indicator of potential N2 fixation, and AO rates to temperature (T, -5°C to 35°C) in BSC of different successional stages along the BSC ecological succession and geographic origin (hot Chihuahuan and cooler Great Basin deserts). ARA in all BSCs increased with T until saturation occurred between 15 and 20°C, and declined at 30–35°C. Culture studies using cyanobacteria isolated from these crusts indicated that the saturating effect was traceable to their inability to grow well diazotrophically within the high temperature range. Below saturation, temperature response was exponential, with Q10 significantly different in the two areas (~ 5 for Great Basin BSCs; 2–3 for Chihuahuan BSCs), but similar between the two successional stages. However, in contrast to ARA, AO showed a steady increase to 30–35°C in Great Basin, and Chihuhuan BSCs showed no inhibition at any tested temperature. The T response of AO also differed significantly between Great Basin (Q10 of 4.5–4.8) and Chihuahuan (Q10 of 2.4–2.6) BSCs, but not between successional stages. Response of ARA rates to T did not differ from that of AO in either desert. Thus, while both processes scaled to T in unison until 20°C, they separated to an increasing degree at higher temperature. As future warming is likely to occur in the regions where BSCs are often the dominant living cover, this predicted decoupling is expected to result in higher proportion of nitrates in soil relative to ammonium. As nitrate is more easily lost as leachate or to be reduced to gaseous forms, this could mean a depletion of soil N over large landscapes globally.

ContributorsZhou, Xiaobing (Author) / Smith, Hilda (Author) / Girardo Silva, Ana Maria (Author) / Belnap, Jayne (Author) / Garcia-Pichel, Ferran (Author) / College of Liberal Arts and Sciences (Contributor)
Created2016-10-24
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Description
The process of pathologizing grief and othering grievers is historically situated in white supremacist, capitalist patriarchy and is reproduced socially. ‘Grief norms, gender norms’ explores and complicates the ways that grief and gender are co-constitutive; mediated by social norms; and reinforced through institutions like psychiatry and medicine, workplace policies, and

The process of pathologizing grief and othering grievers is historically situated in white supremacist, capitalist patriarchy and is reproduced socially. ‘Grief norms, gender norms’ explores and complicates the ways that grief and gender are co-constitutive; mediated by social norms; and reinforced through institutions like psychiatry and medicine, workplace policies, and public discourses around grief which all work together to create ‘acceptable’ structures of feeling. This dissertation uses a combination of in-depth, semi-structured interviews and digital grief content across two social media sites: Instagram and TikTok in order to explore various sites of this affective social reproduction and the multi-directional impact of gender and grief when studied side by side. This project is made up of three distinct, but thematically related sections: feminine embodied grief and masking; how the Widow is socially reproduced as ‘Other’; and the intimate publics of female grief influencers on Instagram. Each of these chapters explores a different aspect of the shaping of 'acceptable' grief through valences of gendered norms - which are already raced and classed - and explores the ways that those norms socializes individuals of all genders towards expectations about how grief 'should' be experienced and expressed. Feminine embodied grief is experienced beyond linear temporality, and felt sensationally and relationally. This means that grievers experiencing this kind of feminine embodied grief more readily rely on grief masking to 'pass' in non-grieving society. In the third chapter, the experience of the Widow is the primary focus. This chapter examines the social processes that render the Widow as 'Other', socially, and polices the active grief of the Widow through processes of isolation and exclusion. Each widow in this study experienced such othering, including John, whose partner died of AIDS in the 1990s. The end of this chapter explores his experience of ambiguous widowhood. The final chapter takes a wider view and focuses on the intimate publics formed by female grief influencers on Instagram. This chapter highlights two such influencers and the ways that the discourses about grief that they employ both disrupts and reinforces traditional, Western logics about 'acceptable' grief.
ContributorsLacey, Elisabeth (Author) / Switzer, Heather (Thesis advisor) / Anderson, Lisa (Committee member) / Cacciatore, Joanne (Committee member) / Arizona State University (Publisher)
Created2023