Fears following perinatal loss: Associations with emotional distressand personal life deterioration
DOI:
https://doi.org/10.70478/apuntes.psi.2026.44.15Keywords:
Perinatal loss, Grief, Fear, Emotional distress, Personal life deteriorationAbstract
Introduction. Perinatal loss can give rise to fears related to identity, the future, and social evaluation, which have received less attention than other manifestations of psychological distress. The aim was to analyze fears following perinatal loss and their relationship with emotional distress and perceived deterioration in personal life.
Method. A cross-sectional study was conducted with 158 individuals who had experienced a perinatal loss. Ten fears, emotional
distress, and perceived deterioration were assessed. Linear regressions, Welch’s t tests and Welch’s ANOVA, Spearman correlations, and Necessary Condition Analysis (NCA) were performed.
Results. The most intense fears were fear of not becoming a parent, fear of guilt, and fear of failure. Women and younger participants reported higher levels of fear. Specific fears differed according to characteristics of the loss. All fears were significantly associated with emotional
distress and perceived deterioration, with fear of failure showing the strongest associations. NCA identified four fears as quasi-necessary conditions for high levels of emotional distress, while fear of being judged and fear of stigma were identified as quasi-sufficient conditions.
Discussion. The findings support incorporating the assessment of specific fears into psychological care following perinatal loss.
Downloads
References
Beaumont, Joanna; Smith, Debbie; Bailey, Emilie; Barron, Rebecca; Tomlinson, Emma y Heazell, Alexander E.P. (2025). Psychological distress, post-traumatic stress and emotional suppression in a pregnancy after a perinatal death: A longitudinal survey. BJOG, 132(10), 1469–1480. https://doi.org/10.1111/1471-0528.18212
Beckers, Tom; Hermans, Dirk; Lange, Iris; Luyten, Laura; Scheveneels, Sara y Vervliet, Bram (2023). Understanding clinical fear and anxiety through the lens of human fear conditioning. Nature Reviews Psychology, 2(4), 233–245. https://doi.org/10.1038/s44159-023-00156-1
Bermejo, José Carlos (2024). Estoy en duelo. PCC.
Bhat, Amritha y Byatt, Nancy (2016). Infertility and perinatal loss: When the bough breaks. Current Psychiatry Reports, 18(3), 31. https://doi.org/10.1007/s11920-016-0663-8
Bonanno, George A. (2004). Loss, trauma, and human resilience: Have we underestimated the human capacity to thrive after extremely aversive events? American Psychologist, 59(1), 20–28. https://doi.org/10.1037/0003-066X.59.1.20
Bonanno, George A. y Boerner, Kathrin (2007). The stage theory of grief. JAMA, 297(24), 2692–2694. https://doi.org/10.1001/jama.297.24.2693-a
Bristowe, Katherine; Timmins, Liadh; Pitman, Alexandra; Braybrook, Debbie; Marshall, Steve; Johnson, Katherine; King, Michael; Roach, Anna; Yi, Deokhee; Almack, Kathryn; Day, Elizabeth; Clift, Paul; Rose, Ruth y Harding, Richard (2024). Between loss and restoration: The role of liminality in advancing theories of grief and bereavement. Social Science & Medicine, 344, 116616. https://doi.org/10.1016/j.socscimed.2024.116616
Caldwell, Julia Marysia; Meredith, Pamela J.; Whittingham, Koa; Ziviani, Jenny y Wilson, Trish. (2024). Women pregnant after previous perinatal loss: Relationships between adult attachment, shame, and prenatal psychological outcomes. Journal of Reproductive and Infant Psychology, 42(4), 653–667. https://doi.org/10.1080/02646838.2023.2180142
Camacho-Ávila, Marcos; Fernández-Sola, Cayetano; Jiménez-López, Francisca R.; Granero-Molina, José; Fernández-Medina, Isabel M.; Martínez-Artero, Laura y Hernández-Padilla, José M. (2019). Experience of parents who have suffered a perinatal death in two Spanish hospitals: A qualitative study. BMC Pregnancy and Childbirth, 19(1), 512. https://doi.org/10.1186/s12884-019-2666-z
Cassidy, Paul Richard. (2020). Good mothers/bad mothers: Grief, morality and gender inequality in care encounters following perinatal death. Tesis doctoral, Universidad Complutense de Madrid, España. https://hdl.handle.net/20.500.14352/11624
Cassidy, Paul Richard. (2023). The disenfranchisement of perinatal grief: How silence, silencing and self-censorship complicate bereavement (a mixed method study). Omega, 88(2), 709–731. https://doi.org/10.1177/00302228211050500
Chhabra, Jasleen; Wilson, Michael J.; Benakovic, Ruben; Mancini, Vincent; Pilkington, Vita y Seidler, Zac (2026). Social support buffers the association between alcohol use and depression in Australian men. Health Promotion Journal of Australia, 37(1), e70134. https://doi. org/10.1002/hpja.70134
Daniel-Watanabe, Lucie y Fletcher, Paul C. (2021). Are fear and anxiety truly distinct?. Biological Psychiatry Global Open Science, 2(4), 341–349. https://doi.org/10.1016/j.bpsgos.2021.09.006
Davoudian, Teni; Gibbins, Karen y Cirino, Nicole H. (2021). Perinatal loss: The impact on maternal mental health. Obstetrical & Gynecological Survey, 76(4), 223. https://doi.org/10.1097/OGX.0000000000000874
Delacre, Marie; Lakens, Daniël y Leys, Christophe. (2017). Why psychologists should by default use Welch’s t-test instead of Student’s t-test. International Review of Social Psychology, 30(1), 92–101. https://www.rips-irsp.com/articles/10.5334/irsp.661/
Delacre, Marie; Leys, Christophe; Mora, Youri L. y Lakens, Daniël (2019). Taking parametric assumptions seriously: Arguments for the use of Welch’s F-test instead of the classical F-test in one-way ANOVA. International Review of Social Psychology, 32(1), Article 13. https://doi.org/10.5334/irsp.198
Donegan, Gemma; Noonan, Maria y Bradshaw, Carmel (2023). Parents experiences of pregnancy following perinatal loss: An integrative review. Midwifery, 121, 103673. https://doi.org/10.1016/j.midw.2023.103673
Dul, Jan (2016). Necessary Condition Analysis (NCA) logic and methodology of “necessary but not sufficient” causality. Organizational Research Methods, 19(1), 10–52. https://doi.org/10.1177/0049124118782548
Dul, Jan (2024). Necessary Condition Analysis (NCA) with R (version 4.0.0): A quick start guide. https://10.32614/CRAN.package.NCA
Dul, Jan; Hauff, Sven y Bouncken, Ricarda B. (2023). Necessary Condition Analysis (NCA): Review of research topics and guidelines for good practice. Review of Managerial Science, 17(2), 683–714.
Dunsmoor, Joseph E. y Paz, Rony (2015). Fear generalization and anxiety: Behavioral and neural mechanisms. Biological Psychiatry, 78(5), 336–343. https://doi.org/10.1016/j.biopsych.2015.04.010
Fernández-Ordóñez, Eloísa (2020). Duelo perinatal y trastorno de estrés postraumático en una gestación posterior a una pérdida gestacional. Tesis Doctoral, Universidad de Málaga, España. https://riuma.uma.es/xmlui/handle/10630/20944
Fernández-Alcántara, Manuel; Schul-Martin, Laetitia; García-Caro, M. Paz; Montoya-Juárez, Rafael; Pérez-Marfil, M. Nieves y Zech, Emmanuelle (2020). ‘In the hospital there are no care guidelines’: Experiences and practices in perinatal loss in Spain. Scandinavian Journal of Caring Sciences, 34(4), 1063–1073. https://doi.org/10.1111/scs.12816
Fernández-Sola, Cayetano; Camacho-Ávila, Marcos; Hernández-Padilla, José M.; Fernández-Medina, Isabel M.; Jiménez-López, Francisca R.; Hernández-Sánchez, Encarnación; Conesa-Ferrer, M. Belén y Granero-Molina, José. (2020). Impact of perinatal death on the social and family context of the parents. International Journal of Environmental Research and Public Health, 17(10), 3421. https://doi.org/10.3390/ijerph17103421
Freedle, Agata y Oliveira, Emily (2024). Interpersonal and intrapersonal factors contributing to women’s posttraumatic growth following perinatal loss. Psychological Trauma, 16(2), 193–200. https://doi.org/10.1037/tra0001395
Gaudet, Caroline; Séjourné, Nathalène; Camborieux, Laure; Rogers, Rachel y Chabrol, Henri (2010). Pregnancy after perinatal loss: Association of grief, anxiety and attachment. Journal of Reproductive and Infant Psychology, 28(3), 240–251. https://doi.org/10.1080/02646830903487342
Gelman, Andrew y Carlin, John (2014). Beyond power calculations: Assessing type S (sign) and type M (magnitude) errors. Perspectives on Psychological Science, 9(6), 641–651. https://doi.org/10.1177/1745691614551642
Glaser Chodik, Nurit y Baum, Nehami (2025). The experience of men following stillbirth: The case of Israeli bereaved fathers. Journal of Reproductive and Infant Psychology, 43(2), 443–458. https://doi.org/10.1080/02646838.2023.2237541
Goertz, Gary; Hak, Tony y Dul, Jan (2012). Ceilings and floors: Where are there no observations? Sociological Methods & Research, 42(1), 3–40. https://doi.org/10.1177/0049124112460375
Gómez Albo, Luján (2022). Sin latido: Entender y acompañar el duelo gestacional. San Pablo.
González-Ramos, Zuleika; Zuriguel-Pérez, Esperanza; Collado-Palomares, Anna y Casadó-Marín, Lina (2023). ‘My biggest fear is that people will forget about him’: Mothers’ emotional transitions after terminating their pregnancy for medical reasons. Journal of Clinical Nursing, 32(13-14), 3967–3980. https://doi.org/10.1111/jocn.16504
Hanschmidt, Franz; Linde, Katja; Hilbert, Anja; Riedel-Heller, Steffi G. y Kersting, Anette (2016). Abortion stigma: A systematic review. Perspectives on Sexual and Reproductive Health, 48(4), 169–177. https://doi.org/10.1363/48e8516
Hanschmidt, Franz; Treml, Julia; Klingner, Johanna; Stepan, Holger y Kersting, Anette (2018). Stigma in the context of pregnancy termination after diagnosis of fetal anomaly: Associations with grief, trauma, and depression. Archives of Women’s Mental Health, 21(4), 391–399. https://doi.org/10.1007/s00737-017-0807-9
Herbert, Danielle; Young, Kerry; Pietrusińska, Maria y MacBeth, Angus (2022). The mental health impact of perinatal loss: A systematic review and meta-analysis. Journal of Affective Disorders, 297, 118–129. https://doi.org/10.1016/j.jad.2021.10.026
Holland, Jason M. y Neimeyer, Robert A. (2010). An examination of stage theory of grief among individuals bereaved by natural and violent causes: A meaning-oriented contribution. OMEGA: Journal of Death and Dying, 61(2), 103–120. https://doi.org/10.2190/OM.61.2.b
Hunter, Amanda; Tussis, Lorena y MacBeth, Angus (2017). The presence of anxiety, depression and stress in women and their partners during pregnancies following perinatal loss: A meta-analysis. Journal of Affective Disorders, 223, 153–164. https://doi.org/10.1016/j.jad.2017.07.004
Instituto Nacional de Estadística. (2025). Tasa de mortalidad perinatal por comunidad autónoma según sexo (Tabla 1699). Recuperado de https://www.ine.es/jaxiT3/Datos.htm?t=1699#_tabs-tabla
Jones, Kerry; Robb, Martin; Murphy, Sam y Davies, Alison (2019). New understandings of fathers’ experiences of grief and loss following stillbirth and neonatal death: A scoping review. Midwifery, 79, 102531. https://doi.org/10.1016/j.midw.2019.102531
Kerns, Jennifer; Cheeks, Morgan; Cassidy, Arianna; Pearlson, Geffan y Mengesha, Biftu (2022). Abortion stigma and its relationship with grief, post-traumatic stress, and mental health-related quality of life after abortion for fetal anomalies. Women’s Health Reports, 3(1), 385–394. https://doi.org/10.1089/whr.2021.0027
Keser, Emrah y Kahya, Yasemin (2025). Perinatal grief creates vulnerability to anxiety in subsequent pregnancy: The mediating role of bereavementrelated guilt. Journal of Reproductive and Infant Psychology, 43(5), 1263–1275. https://doi.org/10.1080/02646838.2024.2335176
Kishimoto, Makiko; Yamaguchi, Arisa; Niimura, Marina; Mizumoto, Miki; Hikitsuchi, Tatsuo; Ogawa, Kohei; Ozawa, Nobuaki y Tachibana, Yoshiyuki (2021). Factors affecting the grieving process after perinatal loss. BMC Women’s Health, 21(1), 313. https://doi.org/10.1186/s12905-021-01457-4
Kokou-Kpolou, Kossigan; Megalakaki, Olga y Nieuviarts, Nicolas (2018). Persistent depressive and grief symptoms for up to 10 years following perinatal loss: Involvement of negative cognitions. Journal of Affective Disorders, 241, 360–366. https://doi.org/10.1016/j.jad.2018.08.063
Magaña, Marisa (2021). Introducción al duelo. Sal Terrae.
Martínez-García, Encarnación; Lara-Rodríguez, Helen; Álvarez-Serrano, M. Adelaida; González-García, Alberto; Martín-Salvador, Adelina; Gázquez-López, María y Pérez-Morente, M. Ángeles (2023). Good practices in perinatal bereavement care in public maternity hospitals in Southern Spain. Midwifery, 124, 103749. https://doi.org/10.1016/j.midw.2023.103749
Mendes, Diana C. Gonçalves; Fonseca, Ana y Cameirão, Mónica S. (2023). The psychological impact of early pregnancy loss in Portugal: Incidence and the effect on psychological morbidity. Frontiers in Public Health, 11, 1188060. https://doi.org/10.3389/fpubh.2023.1188060
Mergl, Roland; Quaatz, Sarah Miriam; Edeler, Lisa-Madeleine y Allgaier, Antje-Kathrin (2022). Grief in women with previous miscarriage or stillbirth: A systematic review of cross-sectional and longitudinal prospective studies. European Journal of Psychotraumatology, 13(2), 2108578. https://doi.org/10.1080/20008066.2022.2108578
Mørk, Sofie; Hvidtjørn, Dorte; Möller, Sören; Henriksen, Tine Brink; O’Connor, Maja y Bonanno, George A. (2023). Grief trajectories after loss in pregnancy and during the neonatal period. Journal of Psychiatric Research, 168, 293–299. https://doi.org/10.1016/j.jpsychires.2023.10.052
Mota, Cecilia; Sánchez, Claudia; Carreño, Jorge y Gómez, María Eugenia (2023). Paternal experiences of perinatal loss —A scoping review. International Journal of Environmental Research and Public Health, 20(6), 4886. https://doi.org/10.3390/ijerph20064886
O’Dea, Gypsy A.; Youssef, George J.; Hagg, Lauryn J.; Francis, Lauren M.; Spry, Elizabeth A.; Rossen, Larissa; Smith, Imogene; Teague, Samantha J.; Mansour, Kayla; Booth, Anna; Davies, Sasha; Hutchinson, Delyse y Macdonald, Jacqui A. (2023). Associations between maternal psychological distress and mother-infant bonding: A systematic review and meta-analysis. Archives of Women’s Mental Health, 26(4), 441–452. https://doi.org/10.1007/s00737-023-01332-1
Obst, Kate L.; Due, Clemence; Oxlad, Melissa y Middleton, Philippa (2020). Men’s grief following pregnancy loss and neonatal loss: A systematic review and emerging theoretical model. BMC Pregnancy and Childbirth, 20(1), 11. https://doi.org/10.1186/s12884-019-2677-9
Organización Mundial de la Salud (World Health Organization) (2021). Maternal and perinatal death surveillance and response: Materials to support implementation. https://www.who.int/publications/i/item/9789240036666
Ortiz-Aparicio, Fabiola; Rodríguez-Gómez, José R. y González-Viruet, Maribella (2020). Gestational, perinatal and neonatal loss: Emotional and psychological consequences on mothers, fathers and healthcare professionals. Social Behavior Research and Practice, 5(2), 43–52.
Payne, Elena; Silverio, Sergio A.; Fellows, Rebecca E.; Heywood, Lauren E.; Burgess, Karen; Storey, Claire; Oza, Munira; Kent-Nye, Flora E.; Haddad, Leonie; Sampson, Amy y Knighting, Katherine (2025). From mourning to memorialising –A lasting connection through remembrance: The role of memory making in preserving the identity of parenthood amongst women who have suffered a perinatal bereavement. Women and Birth, 38(3), 101902. https://doi.org/10.1016/j.wombi.2025.101902
Pekyiğit, Aylin; Yildiz, Dilek; Deniz, Ayşe Özge y Çalik Bağriyanik, Burcu (2024). White tears: A phenomenological study of perinatal loss. OMEGA: Journal of Death and Dying, 93(1), 124–142. https://doi.org/10.1177/00302228241234381
Pinilla, Rafael y Hermosillo, Rocío (2021). Perinatal grief characteristics. European Psychiatry, 64(1), S603. https://doi.org/10.1192/j.eurpsy.2021.1609
Pollock, Danielle; Pearson, Elissa; Cooper, Megan; Ziaian, Tahereh; Foord, Claire y Warland, Jane (2020). Voices of the unheard: A qualitative survey exploring bereaved parents experiences of stillbirth stigma. Women and Birth, 33(2), 165–174. https://doi.org/10.1016/j.wombi.2019.03.002
Porcelli, Piero (2020). Fear, anxiety and health-related consequences after the Covid-19 epidemic. Clinical Neuropsychiatry, 17(2), 103–111. https://doi.org/10.36131/CN20200215
Ridaura, Isabel; Penelo, Eva y Raich, Rosa M. (2017). Sintomatología depresiva y duelo en mujeres españolas que han sufrido una pérdida perinatal. Psicothema, 29(1), 43–48.
Sociedad Española de Ginecología y Obstetricia (2021). Guía de asistencia en la muerte perinatal. Progresos de Obstetricia y Ginecología, 64, 124–154.
Stroebe, Margaret; Schut, Henk y Boerner, Kathrin (2017). Cautioning healthcare professionals: Bereaved persons are misguided through the stages of grief. OMEGA: Journal of Death and Dying, 74(4), 455–473. https://doi.org/10.1177/0030222817691870
Tseng, Ying-Feng; Cheng, Hsiu-Rong; Chen, Yu-Ping; Yang, Shu-Fei y Cheng, Pi-Tzu (2017). Grief reactions of couples to perinatal loss: A one-year prospective follow-up. Journal of Clinical Nursing, 26(23-24), 5133–5142. https://doi.org/10.1111/jocn.14059
Wei, Taiyun; Simko, Viliam; Levy, Michael; Xie, Yihue; Jin, Yan y Zemla, Jeff (2017). Package ‘corrplot’. Statistician, 56(316), e24.
Wickham, Hadley; Chang, Winston; Henry, Lionel; Pedersen, Thomas Lin; Takahashi, Kohske; Wilke, Claus; Woo, Kara; Yutani, Hiroaki; Dunnington, Dewey; Van Den Brand, Teun y Posit, PBC (2025). ggplot2: Create elegant data visualisations using the grammar of graphics. R package version 4.0.0. https://doi.org/10.32614/CRAN.package.ggplot2
Worden, J. William (2022). El tratamiento del duelo: Asesoramiento psicológico y terapia (5ª edición revisada y ampliada). Paidós.
Zhang, Xi; Chen, Ye; Zhao, Meizhen; Yuan, Mengmei; Zeng, Tieying y Wu, Meiliyang (2024). Complicated grief following the perinatal loss: A systematic review. BMC Pregnancy and Childbirth, 24(1), 772. https://doi.org/10.1186/s12884-024-06986-y
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Luján Gómez Albo, Rosa Ruiz Aragoneses, Alejandro Rujano, David Almaraz, José Carlos Bermejo
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
