UNC News Service

CHAPEL HILL -- Couples who have suffered a miscarriage can resolve their loss more quickly with the help of nurse-led joint counseling sessions, according to a new study from UNC.

The study, by Kristen M. Swanson, dean of the School of Nursing, found women who received three nurse counseling sessions were three times to almost eight times more likely to see a faster decline in their symptoms of depression than women who received similar but limited or no such help.

Swanson compared three different types of couples-focused interventions to no treatment, in order to identify strategies to help men and women resolve depression and grief during the first year after a miscarriage.

The study, published in a recent issue of the Journal of Women's Health and Gender-Based Medicine, is the first published randomized clinical trial of such interventions.

"During the study, I found that while men and women both experience sadness after a pregnancy loss, they are, most often, grieving over different things. While women typically mourn the loss of an unborn child, their husband or partner is more likely to mourn the loss of the relationship he had with the woman as she withdraws into her sadness," Swanson said.

"But even though couples tend to feel distraught over separate aspects of the pregnancy loss, we found that both individuals responded most favorably to an intervention that involved three hour-long counseling sessions with a nurse," Swanson said.

Existing research shows that 85 percent of couples have limited -- if any -- discussions about their feelings surrounding miscarriage, even though most women wish to talk about it. In earlier studies, Swanson found that at one year after miscarriage, couples are likely to experience decreased emotional and physical intimacy if they have not openly shared their feelings or if the male has not demonstrated his concerns by doing little things to show he cares.

Swanson's latest study divided 341 couples within 12 weeks of miscarriage into three groups -- one that received three one-hour long, couples-focused counseling sessions with a nurse (nurse caring); another that got three video and workbook modules (self caring); and a third that combined one nurse-led session with three self-caring modules (combined caring). A fourth control group received no intervention.

All interventions were offered at one week, five weeks and 11 weeks after study enrollment.

Each intervention was based on Swanson's theory of caring and meaning of miscarriage models. These frameworks are based on Swanson's earlier studies with women after miscarriage. The first defines five distinct characteristics of caring relationships and the latter identifies six common issues that confront couples after miscarriage.

Overall, the study showed that while participation in any of the three intervention arms accelerated women's grief resolution, their resolution of depression was best enhanced by the three nurse-led counseling sessions.

However, men's responses were more complex. While the men in the nurse caring and control group took equally long to resolve symptoms of depression, men who received either the self or combined caring intervention took longer.

On the other hand, men's grief abated most rapidly among those receiving the combined-caring intervention. Swanson said men's complex responses to treatment suggest that grief (a transitional response to loss) and depression (either situational or clinical in origin) need to be studied and treated as different emotional responses.

"Through these findings, we saw that the three nursing-led counseling sessions were the most effective way to support the couple as a unit. They provided more time for the nurse and couple to connect and jointly address the meaning of miscarriage in the overall context of their lives," Swanson said.

All improvements in depression were self-reported. Swanson acknowledged the research project had certain limitations -- including that the couples enrolled were predominantly white and all were heterosexual -- but that as a notable strength, the study's statistical analysis took into account how each individual's healing was impacted by their mate's recovery.