DISCUSSION Parks (1998) stated that people with losses are of particular importance to members of the healthcare professions because their physical and mental health may be at risk. In fact, physicians, and nurses may be the only people who are in a position to help. Receiving the news that a mother has lost her baby is difficult and painful to describe. The heartache felt by the mother is an extreme stress that is hard to put into words and the loss can be devastating .
itis a tragedy that is very difficult to cope with (Van and Meleis ,2003) The present studies revealed that the incidence rate of psychiatric disorders was high after spontaneous pregnancy loss among participants from Sohag and Mansoura (58%and 62%, respectively).Itself in a number of psychiatric sequelae such as depression , anniversary reactions ,posttraumatic stress disorders ,suicidal tendencies (65%had suicidal thoughts )and dysfunctional interpersonal and family relationships Vought (1991) stated that as many as 90% of the women recognized guilt and shame feelings related to their abortion, while 74% of the women with spontaneous pregnancy loss admitted feeling of isolation ,76% had suffered from depression ,25% suffered from insomnia ,57% identified a feeling of despair and hopelessness in their lives ,some feel out of control (71%), overemotional (68%,confused (63% ) ,or unable to express emotions at all (56%).He added that 41% reported suicidal thoughts and 10% had attempted suicide . Gissler et al, (1996) concluded that the suicide rate after abortion is three times the common suicide rate and six times that related with birth. A high incidence rate for psychiatric disorders was reported by Reardon (1997), who stated that 94% of participants showed negative psychological effects attributable to abortion .Rue (1998) reported that blame, criticalness, depression, perfectionistic personalities, controlling, even suicidal ideation and /or gestures may all be secondary to unacknowledged or unresolved anger following an abortion. Ney (1994) explained that pregnancy loss creates more psychological turmoil and the loss is much more difficult to mourn because (1) it creates more complicated conflicts ;(2) of the ambivalent regard (love and hate )for the bereaved object ;(3) the fetus is never held ,named ,buried or mourned ;(4) there is no one they can talk to easily ; (5) it is an event that is not supposed to have happened .Moreover ,Rue (1998)added that pregnancy loss may be interpreted by the woman as a personal failure confirmatory of low self-esteem for either actions taken or actions she should have done but did not .
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In the present study, differences in psychiatric disorders between participants according to study location were not manifest .However, the presents study showed that affective – oriented coping strategies were more adopted by Egyptian women than problem-oriented coping strategies, especially in Sohag. Understanding adjustment disorders is s is an understanding of 3 factors: the nature of the stressor, the conscious and unconscious meaning of the sensor, and the patient’s pre-existing vulnerability.
Several psychoanalytic researchers have pointed out that the same stress can produce a range of responses in various normal human beings. The difference in strategies of coping between par-ticipants from Mansour and those from Sohag has been explained by Bonelli and Bugram (2000) , who stated that psychoanalytic research has emphasized the role of rearing environment in a person ‘s later capacity to respond to stress . Sadock and Sadock (2000) noted that defense mechanisms most commonly used by a person to deal with unpleasant situations or distressing internal affective states constitute a significant component of that person ‘s character . Sadock and Sadock (2004) added that throughout early development, each child develops a unique set of defense mechanisms to deal with stressful events. Because of more amounts of trauma or greater constitutional susceptibility, some children have less mature defense constellations than other children. This disadvantage may cause them as adults to react with substantially diminished functioning when they are faced with stressful events. Those who develop mature defense mechanisms are less vulnerable and bounce back quickly from the stressor. The cultural and social differences between women in Mansoura and those in Sohag may explain the differences in observed patterns of adopted coping strategies .
compared with participants from Mansoura, those from Sohag perhaps enjoy relatively better social support from others but are less educated and have less freedom to move .CONCLUSIONS: This study concluded that spontaneous pregnancy loss induces psychiatric disorders and stimulates coping among women. Both effective and problem oriented Coping strategies are usually followed. However, the affective oriented coping strategy is more used by mothers who experience spontaneous pregnancy loss. Cultural and social factors may affect the patterns of coping strategies of women with recent spontaneous pregnancy loss. Ti-centered study of post – Abortion syndrome and post Abortion survivor syndrome .
In Michael T . Mannion (ed.), Post- Abortion Aftermath , Kansas City , Mo.:Sheed nd ward , pp .
69-87 .Parkes CM (1998) :Coping with loss : facing loss . BMJ , 316(143):1521-4 .Potter , P., and Perry , A . (2001) : Basic Nursing critical :Thinking Approach .
5th Ed., mosby , New York . Reardon DC (1997) : Aborted Women :Silent No More Chicago ,III .: Loyola University Press , P 7 . Rue VM (1998) :Post abortion trauma : controversy , Diagnosis ; Treatment. Straham , NH :Institute for pregnancy loss , p .
41-3.Sadock BJ , Sadock VA (2000) : The Psychiatric inter-view , history and mental status examination . Kaplan ; Sadock’s comprehensive Textbook of Psychiatry 7th ed , vol .1 , Baltimore :Lippincott Williams & wilkins , p .6250 . These findings are in agreement with those reported by several authors. Turell et al. (1990) described that women experience emotional distress after abortion .
they noted the existence of a post abortion syndrome, (a sense of loss, emptiness and grief) similar to that reported by trauma survivors’ .CUtE-Aresnault and Mahlangu (1999) stated that both depression and anxiety were greater in women who had experienced stillbirth. However, they are variable patterns and incidence rates for psychiatric disorders among women who realize that they have lost their current pregnancy. Speckhard (1987) reported that after spontaneous pregnancy loss, 69% of participants experienced self –hatred /self–degradation, 73% had the feeling of bitterness, and 92% had the feeling of depression .She added that unresolved grief may persist and manifest. The finding is consistent with the reported by Kanona (2002), in Menoufiya .Egypt, who concluded that Egyptians patients used affective –oriented coping methods more than problem –oriented coping methods.
She explained that, by nature, Egyptian females tend to use affective –oriented coping more than males. According to Mahat (1997), who emphasized the relationship between perceived stressors and the methods of coping, the reasons why affective oriented coping was more followed by our patients could be the result of several factors .First ,all patients are females .Second ,low educational levels ,as low educated people may not consider their problems ,or try to solve their problems and educated people are usually knowledgeable about their health and manage their health problem-focused coping strategies to be more effective. The present study also showed that the incidence of psychiatric disorders among participants who had spontaneous pregnancy loss was significantly lower among those who adopted problem –oriented coping than those who adopted affective –oriented coping. Turell et al. (1990) emphasized that it is important to identify the demographic, geographic, social, and psychological factors that place them at risk of such are action.
Of the significant social variables lack of support from significant others has been linked in some studies to emotional distress after abortion. Sadock and Sadock (2000) noted that defense mechanisms may be adaptive and healthy, as well as pathological .In normal functioning ,they are critical to the preservation of the psychological welfare .the level of self-protective functioning results in optimal adaptation in the control of stressors .These defenses usually maximize gratifications and allow the conscious awareness of feelings ,ideas ,and their consequences .
They also promote an optimal balance among conflicting motives .Commonly ,the more the healthy coping is adopted by a stressed person, the less psychiatric disorders may develop . Sadock and Sadock (2004) noted that pivotal to RECOMMENDATIONS Proper management of pregnancy loss, psychiatrist and nursing staff should offer the necessary support by providing counseling. Support, information, critical analysis, and alternative problem- solving strategies to further improve their coping mechanisms. Medical treatment for pregnancy loss should cover any observed psychiatric disorders. Further in- depth study of social and cultural factors that influence the patterns of psychiatric sequelae and coping strategies of women with recent spontaneous pregnancy loss is recommended. REFERENCES Bakemans-kranenburg MJ, Schuengel C , Van Ijzen-doorn MH (1999) :unresolved loss due to miscarriage an addition to the adult attachment Interview . Attach Hum Dev , 1(2):157_70Black D (1998) : Coping with loss :the dying child .
BMJ , 316(7141):1376-8 .Bonelli RM , Bugram R , Additional A (2000) :Criterion for adjustment disorders , Can J Psychiatry , 45 :763 .Cote-Arsenault D , Mahlangu N (1999) : Impact of perinatal loss on the subsequent pregnancy and self: womenis experience . J Obstet Gyneocol Neonat Nurs, 28:274382Gissler M, Hemminki E, Lonnqvist J(1996): suicides after pregnancy in finland , 1987-94 :register linkage study . BMJ;313:1431-1434 .
Hsu MT, Tseng YF, Kuo LL (2002): Transforming loss :Taiwanese Women’s adaptation to stillbirth . J Adv Nurs , 40(4) :387-95 .Jalowiec A, Powers M (1981) :Stress and coping in hypertensive and emergency room patients . Nursing Research and health:an inquiry into hardiness .
journal of personality and social Psychology , 37(1):1-11 . Kanona AM (2002): The Relationship between the perceived stressors and coping strategies among Arthritic Patients in Shebin El-kom University Hospital Thesis submitted for the DNS Degree , in medical Surgical Nursing , Menoufiya University . McCaffery M, Pasero CH (1999): Chronic Nonmalignant Pain , pain clinical manual , second edition , Mos-by St.louis Baltimore , Chapter eleven , PP501-502 . Ney PG (1994) : Emotional and Physical Effects of pregnancy Loss on the woman and her family : A Mul-Sadock BJ, Sadock VA (2004): Kaplan & Sadock’s synopsis of psychiatry.
Behavioral Sciences / Clinical Psychiatry. 9th ed. Speckhard A (1987): Psycho-social stress following Abortion Kansas City, Mo.:Sheed ;Ward , pp . 41-58.Turell SC , Armsworth MW , Gaa JP (1990) :Emotional response to abortion : a critical review of the literature .
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Van P, Meleis Al(2003) :Coping with grief after in-voluntary pregnancy loss :perspectives of African American Women . J Obster Gyneocol Neontal Nurs, 32 (1):28-39.Vought J (1991): Post –Abortion Trauma , Grand Rapids , Mich .: Zondervan publishing hiuse , 1991 ) , pp.97-106 .