Psychosocial interventions on psychological outcomes of parents with perinatal loss: a systematic review and meta-analysis
Abstract
Background Perinatal loss can occur due to miscarriages and ectopic pregnancies, among other circumstances. Psychological health of parents can deteriorate due to perinatal loss. Parent's negative psychological outcomes include depression, anxiety, and grief.Objective To evaluate the effectiveness of psychosocial interventions in reducing depression, anxiety, and grief among parents after perinatal loss.Design A systematic review and meta-analysis of randomized controlled trials DATA SOURCES: English language articles published from database inception to 19 November 2019 were systematically retrieved from eight electronic databases (CINAHL, Cochrane, EMBASE, ProQuest Dissertations and Theses Global, PsycINFO, PubMed, Scopus, Web of Science).Review methods The Cochrane Risk of Bias tool was used to conduct quality appraisal of each individual article and data was analyzed using Review Manager 5.3. A meta-analysis of randomized controlled trials was conducted using a random-effect model.Results Among this review's 17 included studies, 15 studies' results were included in the meta-analyses. The remaining two studies were summarized narratively. Meta-analyses revealed that psychosocial interventions significantly reduced depression (95% CI: -0.64 to -0.29, Z = 5.17, p = <0.00001), anxiety (95% CI: -0.50 to -0.18, Z = 4.21, p < 0.0001) and grief (95% CI: -0.71 to -0.32, Z = 5.12, p < 0.0001).Conclusion Psychosocial interventions are effective in improving depression, anxiety, and grief amongst parents with perinatal loss. Psychosocial care can be provided by medical healthcare professionals and expanded with technology-assisted implementation.Study registration number CRD42019145526.
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Psychosocial care is the bedrock of bereavement care and may be effectively provided by multidisciplinary teams and HCPs with specialized training.
“Psychosocial care is the bedrock of bereavement care and may be effectively provided by multidisciplinary teams and HCPs with specialized training.19–21”
From Bereavement care guidelines used in health care facilities immediately following perinatal loss: a scoping review (2024) · cites this paper as [19]
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Zhuang, S., Chen, M., Ma, X., Jiang, J., Xiao, G., Zhao, Y., Hou, J., & Wang, Y. (2023) · Women and Birth · doi:10.1016/j.wombi.2023.03.007 · Cited by 19 · see citing works
Perinatal loss: experiences of midwives and nurses
Yenal, K., Tektaş, P., Dönmez, A., & Okumuş, H. (2023) · OMEGA - Journal of Death and Dying · doi:10.1177/00302228211029143 · Cited by 20 · see citing works
“In particular, a meta-analysis (n¼ 15) study revealed that psychosocial interventions significantly reduced depression in women who experienced perinatal loss (Shaohua & Shorey, 2021).”
Riddle, J. N., Hopkins, T. A., Yeaton‐Massey, A., & Hellberg, S. N. (2023) · Current Psychiatry Reports · doi:10.1007/s11920-023-01469-x · Cited by 17 · see citing works
The risk of miscarriage is associated with ambient temperature: evidence from coastal Bangladesh
Das, S., Sagar, S., Chowdhury, S., Akter, K., Haq, M. Z., & Hanifi, S. M. A. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1238275 · Cited by 17 · see citing works
“Miscarriage and stillbirth are the most common spontaneous pregnancy losses (5).”
BackgroundIndividual counseling in mothers bereaved by pregnancy loss: a randomized clinical trial
Haghighi, M., Oladbaniadam, K., Mohaddesi, H., & Rasuli, J. (2022) · Journal of Education and Health Promotion · doi:10.4103/jehp.jehp_1765_21 · Cited by 12 · see citing works
“Journal of Education and Health Promotion | Volume 11 | June 2022 5 women who receive proper intervention, show a lower rate of hopelessness and grief in comparison to those who did not receive appropriate intervention.[34] However, some studies are contrary to the findings of this study.”
ResultLi, S. N., Yang, L., Wang, Q., Pan, S., Xiao, M. H., & Jiao, X. (2024) · Depression and Anxiety · doi:10.1155/2024/2181544 · Cited by 15 · see citing works
“This fi nding aligns with Shaohua and Shorey ʼ s [23] study, which also revealed the effectiveness of psychosocial interventions in reducing depression among parents who decide to TOP.”
InfluentialHe, H., Wan, N., Li, Z., Zhang, Z., Gao, Z., Liu, Q., Ma, X., Zhang, Y., Li, R., Fu, X., et al. (2023) · Chemosphere · doi:10.1016/j.chemosphere.2023.141057 · Cited by 12 · see citing works
Shen, Q., Luo, X., Feng, X., & Gao, Y. (2022) · Asian Nursing Research · doi:10.1016/j.anr.2022.06.002 · Cited by 11 · see citing works
Thomson, G., McNally, L., & Nowland, R. A. (2024) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-024-06713-7 · Cited by 10 · see citing works
“A further systematic review and meta-analysis of 17 psychosocial interventions for individuals experiencing perinatal loss found significant impacts on reducing depression, anxiety, and grief; with most interventions offering either counselling or structured debriefing sessions [21].”
BackgroundFernandez‐Pineda, M., Swift, A., Dolbier, C. L., & Guard, K. (2024) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-024-06610-z · Cited by 9 · see citing works
“Bereaved mothers tend to suffer clinically significant levels of anxiety with twice the odds of developing generalized anxiety disorder when compared to non-bereaved mothers in the first year after the loss [8].”
BackgroundCassidy, P. R. (2022) · Journal of Perinatal Medicine · doi:10.1515/jpm-2021-0489 · Cited by 9 · see citing works
“This is an important gap because healthcare following perinatal loss is understood to have an important impact on grief and health outcomes [7].”
BackgroundThomson, G., & Nowland, R. A. (2024) · Midwifery · doi:10.1016/j.midw.2024.104185 · Cited by 8 · see citing works
Grief, bereavement and prolonged grief disorder: scoping and mapping the evidence
Raine, G., Khouja, C., Khatwa, M., Fulbright, H., Sutcliffe, K., & Sowden, A. J. (2025) · BJPsych Open · doi:10.1192/bjo.2025.10050 · Cited by 7 · see citing works
Koert, E., Hartwig, T. S., Malling, G. M. H., Schmidt, L., & Nielsen, H. S. (2023) · Human Reproduction Open · doi:10.1093/hropen/hoad032 · Cited by 7 · see citing works
“There are also interventions to reduce depression, anxiety, or grief after perinatal loss (including PL), but these do not target the subsequent pregnancy period specifically (Jensen et al., 2021; Shaohua and Shorey, 2021).”
BackgroundThe Efficacy of Bereavement Interventions: A Systematic Umbrella Review
Avis, K. A., Missler, M. A., van Deursen, D. S., Lenferink, L. I. M., Stroebe, M., & Schut, H. A. W. (2025) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000426 · Cited by 6 · see citing works
Xie, J., Grealish, A., Biesty, L., & Hunter, A. (2025) · Journal of Advanced Nursing · doi:10.1111/jan.70334 · Cited by 5 · see citing works
“…this concept is often expanded to include pregnancy loss from conception up to 28 days after birth, encompassing ectopic pregnancy, miscarriage, termination of pregnancy, stillbirth, neonatal death (Fenstermacher and Hupcey 2013; Fernandez-Basanta et al. 2023; HSE 2022; Shaohua and Shorey 2021).”
Developing text-messaging support for fathers after perinatal loss
Fletcher, R. J., Regan, C., May, C. D., Rennie, A., Ludski, K., & StGeorge, J. M. (2024) · Women and Birth · doi:10.1016/j.wombi.2024.101594 · Cited by 5 · see citing works
Pokharel, A., Ramalho, R., Das, B. K., Rongmei, L., Jatchavala, C., Gürcan, A., & Ransing, R. S. (2024) · PubMed Central · doi:10.1177/02537176231225649 · Cited by 4 · see citing works
Mahmoud, H. A. H., Lakkimsetti, M., Alverde, M. J. B., Shukla, P. S., Nazeer, A. T., Shah, S., Chougule, Y., Nimawat, A., & Pradhan, S. (2024) · Cureus · doi:10.7759/cureus.66478 · Cited by 7 · see citing works
Khalid, J., & Hasaan, A. (2024) · German Journal of Exercise and Sport Research · doi:10.1007/s12662-024-01000-1 · Cited by 5 · see citing works
“Despite interventions that areavailableforparentstocopewithperi-natal loss, their effectiveness on parental psychological outcomes remains inconclusive(Shaohua&Shorey, 2021).”
Qin, C., Li, Y., Wang, Y., Huang, C., Xiao, G., Zeng, L., He, Y., Jiang, W., & Xie, J. (2025) · International Journal of Nursing Studies Advances · doi:10.1016/j.ijnsa.2025.100389 · Cited by 3 · see citing works
INTERNATIONAL MISCARRIAGE RATES: A COMPREHENSIVE OVERVIEW OF PREVALENCE AND CAUSES
", M., Hristova, M., NiaMed", OOD, S. Z., & Angelova, M. (2024) · Journal of IMAB - Annual Proceeding (Scientific Papers) · doi:10.5272/jimab.2024303.5703 · Cited by 3 · see citing works
Jenkinson, B., McKenzie, M., Limmer, A., Charlton, V., Hardiman, L., Payne, S., Ura, A. L., Bonner, C., Lawler, S., Middleton, P., et al. (2025) · Women and Birth · doi:10.1016/j.wombi.2025.101915 · Cited by 3 · see citing works
Mental Health Care during Pregnancy Loss
Riddle, J. N., Hopkins, T., Gores, A. M., & Nathan, M. D. (2024) · Advances in Psychiatry and Behavioral Health · doi:10.1016/j.ypsc.2024.04.008 · Cited by 2 · see citing works
Zeng, J., Guo, S., Zheng, Q., Lin, Z., & Liu, X.-W. (2025) · Annals of General Psychiatry · doi:10.1186/s12991-025-00603-8 · Cited by 2 · see citing works
“Perinatal depression/anxiety-based psychotherapeutic interventions may help reduce posttraumatic stress symptoms among women experiencing perinatal loss [58].”
Caring for Grievers: A Scoping Review of Bereavement Practice Approaches and Support Strategies
Bailey, L., Richardson, K., Paddock, N. L., Allan-Wiseman, S., & Arnone, M. (2025) · Journal of Social Work in End-of-Life & Palliative Care · doi:10.1080/15524256.2025.2588552 · Cited by 2 · see citing works
Huang, W., Zhao, W., Han, Y., Wang, Z., Han, Y., & Zhang, W. (2025) · Worldviews on Evidence-Based Nursing · doi:10.1111/wvn.70085 · Cited by 2 · see citing works
Parents' Needs and Their Perceived Obstacles With Team Members in Perinatal Palliative Care
Yaşar, B. N., & Terzioğlu, F. (2022) · Journal of Hospice and Palliative Nursing · doi:10.1097/njh.0000000000000894 · Cited by 2 · see citing works
Associations of climatic factors with pregnancy loss in Nicosia, Cyprus
Shah, A. P., Achilleos, S., Wang, V. A., Leung, M., Weisskopf, M. G., Kyprianou, T., Koutrakis, P., & Papatheodorou, S. (2025) · Journal of Exposure Science & Environmental Epidemiology · doi:10.1038/s41370-025-00781-3 · Cited by 2 · see citing works
“As a major global public health issue, pregnancy loss can result in physical and psychological stress on patients and their families, and imposes considerable medical and economic burdens on society [11 – 13].”
“The Dark Farewell to the Light of Life”: A Qualitative Study About Prenatal Loss
Öztürk, G. K., & Elmas, S. (2022) · OMEGA - Journal of Death and Dying · doi:10.1177/00302228221131599 · Cited by 2 · see citing works
“While there are many studies on the perinatal period in the literature (Davoudian et al., 2021; Fern´andez-Ordoñez et al., 2021; Shaohua & Shorey, 2021), studies on the prenatal period are limited.”
BackgroundPsychotherapy for Pregnancy Loss
Markin, R. D. (2023) · doi:10.1093/oso/9780197693353.001.0001 · Cited by 2 · see citing works
Turkish Validity and Reliability Study of Perinatal Bereavement Care Competence Scale
Gökçek, A. İ., & Özcan, N. K. (2024) · OMEGA - Journal of Death and Dying · doi:10.1177/00302228241286112 · Cited by 1 · see citing works
“Perinatal loss includes all infant deaths occurring in early pregnancy ( fi rst 12 weeks), after 20 weeks, during labour and in the seven days after birth (Bhat & Byatt, 2016; Palas et al., 2020; Shaohua & Shorey, 2021).”
InfluentialFlynn, B., Sergeant, A., Tam, G., Gomes, M., & Gill, R. K. (2025) · Women s Health · doi:10.1177/17455057241311424 · Cited by 1 · see citing works
Wang, X., Luo, Y., Gao, Y., Li, J., Ouyang, Y., & Wang, R. (2025) · Midwifery · doi:10.1016/j.midw.2025.104520 · Cited by 1 · see citing works
Development of a perinatal bereavement counselling training for midwives: A Delphi methodology study
Gökçek, A. İ., & Özcan, N. K. (2025) · Midwifery · doi:10.1016/j.midw.2025.104670 · Cited by 1 · see citing works
Midwives' competence in perinatal bereavement care: A socio-ecological analysis
Gökçek, A. İ., & Özcan, N. K. (2025) · Nurse Education Today · doi:10.1016/j.nedt.2025.106947 · Cited by 1 · see citing works
Al‐Mamun, F., Mamun, M. A., ALmerab, M. M., Holroyd, S., Gozal, D., & Muhit, M. (2026) · Depression and Anxiety · doi:10.1155/da/9965609 · Cited by 1 · see citing works
“…fi cantly understudied in low-and middle-income countries (LMICs), including Bangladesh, where maternal bereavement is common but often occurs in contexts of limited mental health support and persistent social stigma, which may be associated with elevated and persistent depressive symptoms [21].”
Bellali, T., Papadopoulou, A., Liamopoulou, P., & Karagkounis, C. (2026) · Healthcare · doi:10.3390/healthcare14142141 · Cited by 1 · see citing works
“Similar conclusions were reported by Shaohua and Shorey [37], who found that psychosocial interventions were associated with significant improvements in grief, depression, and anxiety among bereaved parents.”
InfluentialHassan, H., & Holmes, N. (2023) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x23000259 · Cited by 1 · see citing works
“There is a need for more robust research evaluating the effectiveness of interventions for PTSD or depression after pregnancy loss (Martin and Reid, 2022; Shaohua and Shorey, 2021).”
BackgroundRelacion, C. (2024) · doi:10.33774/coe-2024-33zhw · Cited by 1 · see citing works
The Miscarriage Circle of Care: Towards Leveraging eHealth for Social SupportPreprint
Alqassim, M. Y., Kresnye, K. C., Siek, K. A., Lee, J. R., & Wolters, M. K. (2021) · Research Square · doi:10.21203/rs.3.rs-564669/v1
“Recent relevant systematic reviews [63, 64] show that Kersting et al.”
BackgroundPregnancy after miscarriage: Psychological implications and emotional care
Iordăchescu, D., Vladislav, E. O., Paica, C.-I., Gică, C., Panaitescu, A. M., Peltecu, G. C., & Gică, N. (2021) · Romanian Medical Journal · doi:10.37897/rmj.2021.4.4
Empathy in Psychotherapy for Pregnancy Loss
Markin, R. D. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780197693353.003.0004
Managing Countertransference in Psychotherapy for Pregnancy Loss
Markin, R. D. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780197693353.003.0007
Markin, R. D. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780197693353.003.0001
Markin, R. D. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780197693353.003.0009
Emotion in Psychotherapy for Pregnancy Loss
Markin, R. D. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780197693353.003.0005
Markin, R. D. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780197693353.002.0006
The Alliance in Individual and Couples Therapy for Pregnancy Loss
Markin, R. D. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780197693353.003.0003
Alliance Rupture and Repair Episodes in Psychotherapy for Pregnancy Loss
Markin, R. D. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780197693353.003.0006
Understanding and Treating Pregnancy Loss
Markin, R. D. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780197693353.003.0002
Client Attachment in Therapy for Recurrent Pregnancy Loss and Infertility
Markin, R. D. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780197693353.003.0008
Markin, R. D. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780197693353.003.0010
Markin, R. D. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780197693353.002.0003
Sureda, B., García-Gibert, C., Martínez, A., Giménez, Y., Segú, X., Mallorquí, A., Gelabert, E., Roca, A., & Torres, A. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1593306
“Most evidence is based on studies evaluating the ef fi cacy of counseling, primarily conducted by nurses or midwives (8).”
Ajith, T., Barnhart, K. T., Bender-Atik, R., Bourne, T., Chong, K. Y., Condous, G., Andrieu, P. C., Derdelis, G., Horne, A. W., Huirne, J. A. F., et al. (2025) · Fertility and Sterility · doi:10.1016/j.fertnstert.2025.09.032
Solmaz, E., & Çelik, A. S. (2025) · Ordu Üniversitesi Hemşirelik Çalışmaları Dergisi · doi:10.38108/ouhcd.1454958
Epple, F., Reichert, J., Rüdiger, M., Birdir, C., & Mense, L. (2025) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-025-08363-9
“After pediatric death, bereavement counselling was more effective in reducing grief than peer support [18].”
Grief and Psychological Symptoms of Women and Men at 1–12 months After Pregnancy Loss
Tarhan, N., Çimete, G., & Südütemiz, B. (2025) · OMEGA - Journal of Death and Dying · doi:10.1177/00302228251397864
Teixeira, S. L., Rodrigues, P. F. S., Caetano, A. P., & Bártolo, A. (2025) · Children and Youth Services Review · doi:10.1016/j.childyouth.2025.108737
Practices of maternity nurses regarding perinatal bereavement care: a cross-sectional study
Elsaka, N. M., Elrefaeey, A., AbdElhay, E. S., Hassan, S. I., & El-Sayed, H. M. (2025) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-025-08563-3
“It also signifies a main loss of parental status as well as secondary losses, including a loss of hope, security, and child-rearing experience [7, 8].”
Midwives’ perceptions of perinatal loss and bereavement care: A metaphor analysis
Özcan, N. K., & Gökçek, A. İ. (2025) · Journal of Health Psychology · doi:10.1177/13591053251401287
“Evidence suggests that compassionate and appropriate support from midwives enhances parents’ psychological resilience, decision-making, and long-term well-being (Gandino et al., 2019; Shaohua and Shorey, 2021; Smith et al., 2020; Thomas et al., 2021).”
Parra-Reyes, H., Mendoza-Monsalve, A., Sarabia-Herrera, F. A., Rincon-Ascanio, A. C., Hernández, E. F. M., Hurtado‐Ortiz, A., & Licht-Ardila, M. (2026) · Enfermería Intensiva · doi:10.1016/j.enfi.2025.500585
de-Juan-Iglesias, P., Carretero, S., Garcia-Terol, C., Horsch, A., & Motrico, E. (2026) · Patient Education and Counseling · doi:10.1016/j.pec.2026.109494
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Badran, L., Mahadeen, A. I., Al-Tamimi, D., Noayran, D., & Tarawneh, F. S. (2026) · Research Square · doi:10.21203/rs.3.rs-8936623/v1
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Psychological Aspects of Infertility, Assisted Conception and Perinatal Loss
Healy, S., Vaillancourt, K., & Rosan, C. (2026) · Cambridge University Press eBooks · doi:10.1017/9781911623496.011
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Badran, L., Mahadeen, A. I., Al-Tamimi, D., Noayran, D., Tarawneh, F. S., & Hamdan‐Mansour, A. M. (2026) · Mental Health and Social Inclusion · doi:10.1108/mhsi-03-2026-0094
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Mapping Publication Trends and Research Hotspots in Perinatal Grief: A 45-Year Bibliometric Analysis
Çoru, K., Baransel, E. S., Çelik, O. T., & Baransel, F. (2026) · OMEGA - Journal of Death and Dying · doi:10.1177/00302228261449331
Hosny, E. M., Mahran, D. G., & Ahmed, G. K. (2026) · Middle East Current Psychiatry · doi:10.1186/s43045-026-00641-2
“However, broader perinatal loss data suggests that non-pharmacological, psychosocial interventions—par-ticularly Cognitive Behavioral Therapy (CBT) delivered individually—effectively reduce symptoms of depression and PTSD [51, 52].”
Psychological Support for Recurrent Pregnancy Loss: A Review of the Current State and Challenges
Inoue, D. (2026) · Cureus · doi:10.7759/cureus.112752
“A prior review integrating psychosocial interventions for parents of perinatal loss [36] also pointed out the importance of bereavement care by midwives and nursing staff.”
Xie, J., Grealish, A., Biesty, L., & Hunter, A. (2026) · Journal of Advanced Nursing · doi:10.1111/jan.70740
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Psychosocial Interventions for Bereaved Families: Scoping Review
Sholikhah, A. N. H., Dewani, S. K., Pratiwi, R. M., & Kaloeti, D. V. S. (2026) · Journal of Psychosocial Rehabilitation and Mental Health · doi:10.1007/s40737-026-00550-x
Ghráda, Á. N., Larkin, F., Tothová, K., & Dempsey, M. (2026) · Journal of Health Psychology · doi:10.1177/13591053261487118
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- Authors
- Shaohua, L., & Shorey, S.
- Affiliations
- National University of Singapore (SG)
- Corresponding author
- Shorey, Shefaly
- ORCID
- Shorey, Shefaly
- Venue
- International Journal of Nursing Studies
- Publisher
- Elsevier BV
- Published
- 2021-05
- Volume
- 117
- Pages
- 103871
- ISSN
- 0020-7489 (ISSN-L)
- OpenAlex
- W3120445834
- Cited by
- 91
- References
- 92
- Citations by year
- 2026: 20 · 2025: 21 · 2024: 15 · 2023: 21 · 2022: 8 · 2021: 6
- FWCI
- 1.66
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- International Journal of Nursing Studies (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Grief, Bereavement, and Mental Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Keywords
- perinatal loss, psychosocial interventions, parental depression, parental anxiety, grief, miscarriage, ectopic pregnancy
- MeSH terms
- Psychosocial Intervention, Anxiety, Female, Humans, Mental Health, Parents, Pregnancy, Parturition
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