Lori J. Toedter

Measuring grief: A short version of the perinatal grief scale

Despite a considerable number of studies, there are two major drawbacks in the literature on grief and bereavement. One is a lack of adequate and generally agreed upon measures for assessing grief. The second is a lack of ability to predict from existing measures the likelihood of what has been termed “chronic” or “pathological” grief reactions. This paper reports the results of the development of a bereavement measure for the study of perinatal loss which attempts to address these gaps. The measure is specific to a pregnancy-related loss, although it has the potential for adaptation to use for other types of loss. Analysis of responses from 138 women has resulted in the reduction of the original measure from 104 to a more manageable and almost equally comprehensive and reliable 33 items. In addition, a factor analysis has produced three factors, two of which indicate the possibility for longer-term and more severe grief reactions. Because of its sound psychometric qualities and interesting factor structure, the measure shows promise of being useful for both research and clinical purposes.

INTERNATIONAL COMPARISON OF STUDIES USING THE PERINATAL GRIEF SCALE: A DECADE OF RESEARCH ON PREGNANCY LOSS

The Perinatal Grief Scale (PGS) has been used in many studies of loss in pregnancy, including miscarriage, stillbirth, induced abortion, neonatal death, and relinquishment for adoption. This article describes 22 studies from 4 countries that used the PGS with a total of 2485 participants. Studies that report Cronbachs alpha for their own samples give evidence of very high internal consistency reliability. Evidence for the validity of the PGS is also reviewed, such as convergent validity seen in its association with measures of mental health, social support, and marital satisfaction. The standard errors of the means for the total scale and for the subscales reveal fairly consistent scores, in spite of very different samples and types of loss; computation of means and standard deviations for the studies as a whole permits us to establish normal score ranges. Significantly higher scores were found in studies that recruited participants from support groups and self-selected populations rather than from medical sources, and from U.S. studies compared with those in Europe.The Perinatal Grief Scale (PGS) has been used in many studies of loss in pregnancy, including miscarriage, stillbirth, induced abortion, neonatal death, and relinquishment for adoption. This article describes 22 studies from 4 countries that used the PGS with a total of 2485 participants. Studies that report Cronbachs alpha for their own samples give evidence of very high internal consistency reliability. Evidence for the validity of the PGS is also reviewed, such as convergent validity seen in its association with measures of mental health, social support, and marital satisfaction. The standard errors of the means for the total scale and for the subscales reveal fairly consistent scores, in spite of very different samples and types of loss; computation of means and standard deviations for the studies as a whole permits us to establish normal score ranges. Significantly higher scores were found in studies that recruited participants from support groups and self-selected populations rather than from medical sources, and from U.S. studies compared with those in Europe.

Parent-Child Interactions in Abusive and Nonabusive Families

Parent-child interactions of 439 parent-child dyads were studied. These included 182 interactions with maltreated children, 199 interactions with maltreating adults, with the remaining interactions from control families served by child welfare agencies, day-care programs, Head Start, and private nursery schools. Income was found to be a significant determinant with parental behavior being more child-centered and supportive at the upper income level, and more parent-centered and child rejecting at the lower income level. Maltreatment was found to be associated with more parental rejection and less child warmth, over and above the effects of income level. The results are discussed in terms of an ecological model of child maltreatment and developmental implications for the victims of maltreatment.

Predicting Outcomes after Pregnancy Loss: Results from Studies Using the Perinatal Grief Scale

There are widely diverse findings in the literature on the types of variables that best predict grief following a pregnancy loss. This article compares the results from twenty-two studies, carried out in four countries, which all used the Perinatal Grief Scale as their outcome measure. Results of the comparison support the value of the measure for such investigations and indicate strong commonalities among the findings. Specifically, lower grief scores are consistently related to male gender, older age, shorter pregnancy, passage of more time since the loss, mental health, good marital relationship and social support, and a subsequent pregnancy. Conclusions suggest the need for studies that include more diverse populations and evaluate the impact of attributions, coping, and interventions following a loss.

The role of the journal club in surgical residency programs: a survey of APDS program directors

PURPOSE:To determine the role, organization, and importance of journal clubs in surgical education.Program directors of all general surgical residencies were asked to respond by mail to a structured survey containing questions about their journal club in the following general categories: Setting, Format, Content, and Purpose.With over 80% of the 278 program directors responding, the typical journal club was found to be one that meets once per month to discuss 3 to 6 articles. It is held on site in the early evening hours and requires the attendance of residents. Over half of the directors indicated that their journal club was important or very important to their training program, with learning literature review skills and providing training in research education as the top 2 purposes cited. Few programs reported performing any systematic or formal evaluation of their journal club.Although journal clubs are active in over 65% of general surgery residency programs, little data exist on the purposes served by this aspect of resident training. The data provided by program directors in response to this survey will ideally serve as a starting point for discussion of how to maximize the benefits that residents receive from this part of their curriculum. Adoption of more formalized approaches to evaluating outcomes would assist in this process.

The Collaborative Honors Project in Psychology: Enhancing Student and Faculty Development

A collaborative honors project in psychology, in contrast to the traditional approach, allows more than one student and more than one faculty adviser to investigate a broad range of research issues. We discuss the advantages and demands of collaborative research and review our experience with one such project.

Ruptured Abdominal Aortic Aneurysm and Quality of Life

This study was undertaken to examine the community hospital experience in managing ruptured abdominal aortic aneurysm, and to assess the quality of life in survivors of the abdominal aortic aneurysm procedure. Study parameters included a retrospective chart review with prospective follow-up at a 369-bed, university-affiliated, community teaching hospital. Eighty-one consecutive patients undergoing surgery for ruptured abdominal aortic aneurysm between 1991 and 2000 were included. Main outcome measures included mortality and quality of life, as assessed by the SF-36 health survey. The overall perioperative mortality rate was 34.6%, significantly less (p < 0.005) than the 50% mortality rate reported in the literature. Predictor variables significantly related to mortality were age (p <0.002), preoperative creatinine (p< 0.026), use of suprarenal clamp (p< 0.0001), acute renal failure (p< 0.0001), myocardial infarction (p < 0.0001), respiratory failure (p < 0.0001), and tobacco use (p < 0.05). Multiple regression analysis found that three predictor variables-myocardial infarction, respiratory failure, and use of a suprarenal clamp-predicted 25% of the variability in mortality (p < 0.0001). The quality-of-life analyses showed that the majority of the patients for whom follow-up data could be obtained (n = 26), reported the same or better quality of life compared to SF-36 norms for age-matched individuals. Results from this community hospital sample suggest that ruptured abdominal aortic aneurysm repair can be accomplished in this setting with an acceptable survival rate, and subsequent quality of life that meets or exceeds that of an age-matched sample.

The impact of ectopic pregnancy: a 16-year follow-up study.

Ectopic pregnancy is a potentially life-threatening event that represents the loss of a pregnancy and also may have longer-term consequences for fertility. Despite this triple threat to a woman’s well-being, almost no systematic research exists on the psychological impact of ectopic pregnancy. We sought to reinterview 18 women who had been interviewed 2 months following an ectopic pregnancy as part of a longitudinal study of pregnancy loss 16 years previously. Thirteen of these women responded to questions about the long-term impact of the ectopic pregnancy on their lives in the intervening years. For many of the women, the ectopic pregnancy was a traumatic experience that impaired their fertility, strained their marriages, and led to a crisis of faith. Yet, despite the trauma of the event, overall the women found ways to interpret it positively and to use it as a source of meaning in their lives.