Men’s grief following pregnancy loss and neonatal loss: A systematic review and emerging theoretical model

Abstract

Background Emotional distress following pregnancy loss and neonatal loss is common, with enduring grief occurring for many parents. However, little is known about men’s grief, since the majority of existing literature and subsequent bereavement care guidelines have focused on women. To develop a comprehensive understanding of men’s grief, this systematic review sought to summarise and appraise the literature focusing on men’s experiences of grief following pregnancy loss and neonatal loss.Methods Systematic searches were completed across four databases (PsycINFO, PubMed, Embase and CINAHL), guided by two research questions: 1) what are men’s experiences of grief following pregnancy/neonatal loss; and 2) what are the predictors of men’s grief following pregnancy/neonatal loss? Eligible articles were qualitative, quantitative or mixed methods empirical studies including primary data on men’s grief, published between 1998 and October 2018. Eligibility for loss type included any definition of miscarriage or stillbirth, and neonatal death up to 28 days after a live birth.Results A final sample of 46 articles were identified, of which 26 were qualitative, 19 quantitative, and one mixed methods. Findings indicate that men’s grief experiences are highly varied, and current grief measures may not capture all of the complexities of grief for men. Qualitative studies identified that in comparison to women, men may face different challenges including expectations to support female partners, and a lack of social recognition for their grief and subsequent support needs. Men may face double-disenfranchised grief in relation to the pregnancy/neonatal loss experience.Conclusion To refine an emerging socio-ecological model of men’s grief, cohort studies are needed among varied groups of bereaved men to confirm grief-predictor relationships. There remains a need to promote genuine and consistent involvement of fathers as equal partners throughout pregnancy and childbirth. Likewise, engaging men early in the grief process is essential to providing recognition and validation to their experience, and improving awareness of available support services.

Factors Contributing to Men’s Grief Following Pregnancy Loss and Neonatal Death: Further Development of an Emerging Model in an Australian Sample

“…In line with the literature on the 'supporter role' relating to men's grief [10,12,13,16,36,40,60], two author-developed measures were included to determine the extent to which men perceived this to be their role, and whether they felt it interfered with their grief. Participants responded to these questions on a vepoint Likert scale from 1 = strongly disagree to 5 = strongly agree.…”

“…Internal consistency for the full measure was also high in this study (Cronbach's alpha = 0.94). Although questions remain surrounding the accuracy of using the PGS among men, as it may not be sensitive to instrumental grieving styles [36], given a current lack of alternative grief measures speci cally for men following pregnancy loss/neonatal death, we decided that in conjunction with the Grief Patterns Inventory (described below), this was the best available measure to adopt.…”

“…Our recent systematic review of men's grief following pregnancy loss and neonatal death emphasised the importance of examining grief from a holistic, socio-ecological perspective to understand the varied factors which can contribute to men's experiences [36]. At the individual level, factors contributing to men's grief include demographic elements (e.g., age, religion, ethnicity), pregnancy loss/neonatal death history and number of living children.…”

“…Also in relation to systems issues, research indicates that policies regarding bereavement leave within workplaces typically differ for men and women, with some men reporting less access to paid leave following their loss than women [10,29,33]. As many men have reported returning to work soon after pregnancy loss or neonatal death, bereavement leave policies may play a role in grief outcomes [36].…”

“…Importantly, no previous research has considered factors relating to different styles of grief, which may be important, given that studies have suggested gender-speci c grieving styles [27]. Using the socio-ecological model of men's grief developed in our previous systematic review as a basis [36], this study aimed to quantify and further explore the factors which contribute to men's grief, with a particular focus on previously under-explored determinants. Speci cally, we sought to determine the factors associated with grief intensity following pregnancy loss and neonatal death, as well as the factors associated with intuitive and instrumental grief styles.…”