GRIEF AND DEPRESSION AFTER MISCARRIAGE - THEIR SEPARATION, ANTECEDENTS, AND COURSE
GRIEF AND DEPRESSION AFTER MISCARRIAGE - THEIR SEPARATION, ANTECEDENTS, AND COURSE
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DOI：
10.1097/00006842-199511000-00003
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发表时间：
1995-11-01
影响因子：
3.3
通讯作者：
WEINER, H
中科院分区：
文献类型：
--
作者：
BEUTEL, M;DECKARDT, R;WEINER, H
丧亲之痛是身体疾病、悲伤、抑郁和焦虑的主要危险因素。与最近精神病学文献中将悲伤和抑郁等同起来的倾向相反，我们建议，为了诊断、治疗和调查的目的，必须仔细区分两者。我们报告的结果，一个经常发生的，但被忽视的事件，流产早期怀孕，纵向研究，使这一点。区分悲伤和抑郁反应的临床标准是根据现象学标准和理论考虑制定的。我们假设，有害的心理和身体后果发生时，流产是没有哀悼，并导致抑郁反应，而不是在一个对照，有代表性的研究，125名妇女进行了评估后不久，流产（前20周的妊娠）和6个月（N = 94）和12个月（N = 90）后。评估包括生活事件、抑郁、身体不适、焦虑的标准化问卷，以及我们之前开发的一个特定的多维度悲伤量表（慕尼黑悲伤量表）。20%的流产患者表现出悲伤反应，12%表现出抑郁反应，20%表现出抑郁和悲伤反应。其余的女性（48%）报告说，她们的情绪反应没有变化。正如预测的那样，较长时间的心理，社会和健康状况的变化遵循最初的抑郁，但不是悲伤的反应。抑郁反应是由先前的抑郁症史，缺乏社会资源，以及对失去的胎儿的矛盾态度预测的。悲伤的措施是可靠的，并有可能区分悲伤和抑郁症。
Bereavement is a major risk factor for physical illness, grief, depression, and anxiety. In contrast to recent tendencies in the psychiatric literature to equate grief and depression, we propose that a careful discrimination between the two must be made for diagnostic, therapeutic, and investigative purposes. We report the results of a longitudinal study of a frequent but neglected event, miscarriage early in pregnancy, to make this point. Clinical criteria for differentiating grief and depressive reactions were developed based on phenomenological criteria and theoretical considerations. We hypothesized that the detrimental psychological and physical consequences occur only when the miscarriage was not mourned and resulted in a depressive reaction, but not in a grief reaction.In a controlled, representative study, 125 consecutive women were assessed shortly after their miscarriage (before the 20th week of gestation) and 6 months (N = 94) and 12 months (N = 90) later. Assessments included standardized questionnaires for life events, depression, physical complaints, anxiety, and a specific, multidimensional grief scale (Munich Grief Scale) that we had developed previously.Immediately after the miscarriage, the average anxiety and depression scores were elevated when compared with 80 pregnant and 125 age-matched community controls. Twenty percent of the patients who had miscarried showed a grief reaction, 12% showed a depressive reaction, and 20% responded with a combined depressive and grief reaction. The remaining women (48%) reported no changes in their emotional reactions. As predicted, longer-lasting psychological, social, and health status changes followed the initial depressive, but not the grief reactions. Depressive reactions were predicted by a history of previous depression, a lack of social resources, and an ambivalent attitude to the lost fetus. The grief measures were reliable and made it possible to discriminate between grief and depression.