Validation of a Brief Measure for Complicated Grief Specific to Reproductive  Loss

Cara Buskmiller; Kathryn R Grauerholz; Jennifer Bute; Maria Brann; Michaelene Fredenburg; Jerrie S Refuerzo

doi:10.7759/cureus.37884

Research Methods Measurement and Statistics

Validation of a Brief Measure for Complicated Grief Specific to Reproductive Loss

Buskmiller C, Grauerholz KR, Bute J, Brann M, Fredenburg M, Refuerzo JS

Published April 2023 Cureus, 15(4), e37884

DOI 10.7759/cureus.37884 PMID 37214013 PMC PMC10199718

RRM Academy Synopsis

Five-item grief screen for reproductive loss is internally consistent

A five-item grief screen showed good reliability in 140 women after reproductive loss. The pilot study adapted the Brief Grief Questionnaire. About 5 of 10 women scored positive on its original cutoff.

Key Findings

Cronbach's alpha was 0.77 (95% CI: 0.69-0.83) across the five items in 140 women, a level the authors call acceptable (>0.7).
In a factor analysis with the Perinatal Grief Scale, RMSEA was 0.167, CFI 0.89 and SRMR 0.06; the authors report the Fornell-Larcker criterion was met (screen AVE 0.42, CR 0.78).
Seventy-one of 140 women (51%) reached the positive-screen score of the original Brief Grief Questionnaire, above the 15-25% complicated grief rate reported in the literature.
The screen's latent factor correlated −0.95 with the 33-item Perinatal Grief Scale, 0.92 with the Impact of Events Scale (trauma), and 0.66 with the Panic Disorder Severity Scale (anxiety).
A subsequent pregnancy was associated with a lower total score (p < 0.001), and a loss after delivery was associated with a higher total score (p = 0.003).

Interpretation

This pilot study tested the new five-item screen against three longer tools: the Perinatal Grief Scale, the Impact of Events Scale, and the Panic Disorder Severity Scale. The screen tracked closely with the grief scale and with the trauma scale. Reliability met the authors' bar for a short screen. Scores moved as expected: lower after a later pregnancy, higher after a loss that happened post-delivery. The authors note that sensitivity and specificity remain untested. The findings support larger studies of this short screen for grief after reproductive loss.

RRM Context

Restorative reproductive medicine cares for the couple as a whole. A pregnancy loss raises a medical question: why it happened. It also raises an emotional question: how each partner copes. A short, reliable grief screen fits that wider view of care.

Our editorial summary of this paper, not the article's abstract.

Abstract

Objective

Complicated grief reactions follow some pregnancy outcomes, like miscarriage, stillbirth, neonatal death, infant death, selective reduction, or termination 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 prolonged or complicated grief after a reproductive loss are cumbersome. In this study, a five-item questionnaire to detect complicated grief after reproductive loss of any type was designed and preliminary validated.

Methods

A questionnaire patterned after the extensively validated Brief Grief Questionnaire (BGQ) was created by a group of physicians and lay advocates to employ non-traumatic but specific language related to grief after miscarriage, stillbirth, neonatal death, infant death, selective reduction, or termination of pregnancy. One hundred and forty women at a large academic center were recruited in person and via social media to validate the questionnaire with well-studied instruments for anxiety (7-item Panic Disorder Severity Scale, PDSS), trauma (22-item Impact of Events Scale), and reproductive grief and depressive symptoms (33-item Perinatal Grief Scale [PGS]).

Results

The response rate was 74.9%. Of the 140 participants, 18 (12.8%) experienced their loss during high-risk pregnancies, and 65 (46.4%) were recruited via social media. Seventy-one (51%) respondents had a score > 4, a positive screen for the BGQ. On average, women experienced their loss 2 years prior to participation (IQR 1-5 years). Cronbach's alpha was 0.77 (95% CI: 0.69-0.83). The goodness of fit indices of the model met Fornell and Larker criteria (RMSEA = 0.167, CFI = 0.89, SRMR = 0.06). The AVE was 0.42 and the CR 0.78.

Conclusions

This investigator-created screening tool is internally consistent and meets preliminary criteria for discriminant validity. This tool can be refined prior to testing for sensitivity and specificity in screening for complicated grief after a reproductive loss.

Topics

Research Methods › Measurement and Statistics › Instrument Development and Validation · Mental Health and Psychosocial Care › Grief and Loss › Bereavement Care

Cara Buskmiller, Kathryn R Grauerholz, Jennifer Bute, Maria Brann, Michaelene Fredenburg, Jerrie S Refuerzo

C Buskmiller, Kathy Grauerholz, Kate Grauerholz, K Grauerholz, Jen Bute, Jenny Bute, J Bute, M Brann, M Fredenburg, J Refuerzo

PMID 37214013 37214013 DOI 10.7759/cureus.37884 10.7759/cureus.37884 Buskmiller et al. 2023, Buskmiller 2023