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Women generating narratives after an unwanted prenatal diagnosis result: randomized controlled trial

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We have defined a psychological intervention based on cognitive narrative therapy and the Ottawa decision framework to reduce adjustment problems following a termination of pregnancy (TOP) after a positive prenatal diagnosis (PND). The intervention is composed of four sessions: decision, subjectivation, metaphorization, and projecting. This study aims to assess the effectiveness of a cognitive narrative intervention to prevent depression and anxiety symptoms after TOP. The intervention was accepted by 24 participants. The outcome is compared with a control group of 67 women who also terminated a pregnancy after PND. Participants were from several Portuguese institutions; 64.4% had a genetic and 35.6% had ultrasound diagnosis; the mean age was 30.0 years and the mean gestational age was 19 weeks. There are two evaluations: a baseline at the 15th day and a sixth month follow-up after TOP, using Beck Depression Inventory, Zung Anxiety Scale, Perinatal Grief Scale, and an instrument capturing participant satisfaction. Six months after TOP, there is a lower mean of anxiety and depression (p < 0.05), between groups, with effect sizes on the follow-up of 0.54 for depression, 0.41 for anxiety, and 0.23 for perinatal grief. This intervention has very positive effects on women mental health, and we emphasize the importance of the meaning-making process in the context of terminating a wanted pregnancy.

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  • Andrade AS, Moreira M, Sá M, Pacheco D, Almeida V, Rocha JC (2017) Randomized controlled trial of a cognitive narrative crisis intervention for bereavement in primary healthcare. Behav Cogn Psychother 45(1):85–90

    Article  PubMed  Google Scholar 

  • Barbosa V, Sá M, Rocha JC (2014) Randomised controlled trial of a cognitive narrative intervention for complicated grief in widowhood. Aging Ment Health 18(3):354–362

    Article  PubMed  Google Scholar 

  • Beutler LE (2000) Empirically based decision making in clinical practice. Prevention & Treatment 3(1):27a

    Google Scholar 

  • Chambless DL, Hollon SD (1998) Defining empirically supported therapies. J Consult Clin Psychol 66(1):7–18

    Article  PubMed  CAS  Google Scholar 

  • Clover K, Carter GL, Mackinnon A, Adams C (2009) Is my patient suffering clinically significant emotional distress? Demonstration of a probabilities approach to evaluating algorithms for screening for distress. Support Care Cancer 17(12):1455–1462

    Article  PubMed  Google Scholar 

  • Cohen J (1994) The earth is round (p < .05). Am Psychol 49:997–1003

    Article  Google Scholar 

  • Gonçalves O, Machado P (1999) Cognitive narrative psychotherapy: research foundations. J Clin Psychol 55(10):1179–1191

    Article  PubMed  Google Scholar 

  • Hoffmann TC, Glasziou PP, Boutron I, Milne R, Perera R, Moher D et al (2014) Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ 348:g1687

    Article  PubMed  Google Scholar 

  • Jane-Llopis E, Hosman C, Jenkins R, Anderson P (2003) Predictors of efficacy in depression prevention programmes meta-analysis. Br J Psychiatry 183(5):384–397

    Article  PubMed  Google Scholar 

  • Kersting A, Dorsch M, Kreulich C, Baez E (2004) Psychological stress response after miscarriage and induced abortion. Psychosom Med 66(5):795–796

    Article  PubMed  Google Scholar 

  • Korenromp MJ, Christiaens G, Van den Bout J, Mulder E, Hunfeld J, Bilardo CM et al (2005) Long-term psychological consequences of pregnancy termination for fetal abnormality: a cross-sectional study. Prenat Diagn 25(3):253–260

    Article  PubMed  CAS  Google Scholar 

  • Lafarge C, Mitchell K, Fox P (2013) Women’s experiences of coping with pregnancy termination for fetal abnormality. Qual Health Res 23(7):924–936

    Article  PubMed  Google Scholar 

  • Lafarge C, Mitchell K, Fox P (2014) Termination of pregnancy for fetal abnormality: a meta-ethnography of women’s experiences. Reproductive health matters 22(44):191–201

    Article  PubMed  Google Scholar 

  • O'Connor AM, Jacobsen MJ, Stacey D (2002) An evidence-based approach to managing women’s decisional conflict. J Obstet Gynecol Neonatal Nurs 31:570–581.

    Article  PubMed  Google Scholar 

  • Schulz KF, Altman DG, Moher D (2010) CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMC Med 8(1):18

    Article  PubMed  PubMed Central  Google Scholar 

  • Serra ASV, Abreu JLP (1972) Aferição dos quadros clínicos depressivos. I - Ensaio de aplicação do “Inventário Depressivo de Beck” a uma amostra portuguesa de doentes deprimidos. Coimbra Médica 20:623–644

    Google Scholar 

  • Serra ASV, Ponciano E, Relvas J (1982) Aferição da Escala de Auto Avaliação de Ansiedade de Zung numa amostra de população Portuguesa- II. Sua avaliação como instrumento de medida. Psiquiatria Clínica 4(3):203–213

    Google Scholar 

  • Toedter LJ, Lasker JN, Alhadeff JM (1988) The perinatal grief scale: development and initial validation. Am J Orthopsychiatry 58(3):435–449

    Article  PubMed  CAS  Google Scholar 

  • Wittouck C, Van Autreve S, De Jaegere E, Portzky G, Van Heeringen K (2011) The prevention and treatment of complicated grief: a meta-analysis. Clin Psychol Rev 31(1):69–78

    Article  PubMed  Google Scholar 

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This study was funded by CESPU, Portugal (02-UNIPSA/CICS-11n).

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Correspondence to José Rocha.

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The authors declare that they have no conflict of interest.

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All procedures performed involving human participants were in accordance with the ethical standards of the institutional and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Rocha, J., Nunes, C., Leonardo, A. et al. Women generating narratives after an unwanted prenatal diagnosis result: randomized controlled trial. Arch Womens Ment Health 21, 453–459 (2018).

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