|Marianne Hutti Biography and Abstract|
Marianne Hutti, PhD,WHNP-BC
University of Louisville School of Nursing
Marianne H. Hutti, PhD, WHNP-BC is Professor and Coordinator or the Women's Health-Family Nurse Practitioner Dual Major Program at the University of Louisville School of Nursing, and currently teaches MSN and PhD students. Dr. Hutti has received national and international recognition for her perinatal loss research, has received national awards as a teacher, speaks nationally and internationally on womenâ??s health-related topics, and has published numerous articles, particularly in the area of perinatal loss. She also practices one day/week as a Women's Health Nurse Practitioner (WHNP) in independent practice. She has been an NIH-funded researcher in the area of perinatal/pregnancy loss. She uses a mixed methods approach to studying perinatal loss, and has examined parental grief responses after miscarriage, the effect of perinatal loss on parents in the subsequent pregnancy, and the meaning, experiences, and behaviors of nurses caring for families after perinatal loss. She has spent 30 years studying perinatal loss, and has used the knowledge gleaned from this work to develop a theoretical framework for helping nurses to predict parental grief intensity and need for follow-up after perinatal loss, as well as to give direction to the care nurses provide to bereaved families.
She used the theoretical framework to develop the Perinatal Grief Intensity Scale (PGIS), which is a clinical instrument that health care providers can use to identify parents who are most likely to experience intense grief and the psychological morbidities which may be associated, such as clinical depression, anxiety, and post-traumatic stress. The 2015 AWHONN grant from Kimberly-Clark will be used to fund a study entitled Predicting Grief Intensity after Perinatal Loss. The specific aim of this study is to establish the optimal cut-off value for the PGIS, one that most accurately predicts intense grief at three months post-loss. Identifying the capability of the PGIS to predict intense grief would improve early identification of parents in need of intervention, thereby addressing a critical barrier in this field. To achieve this aim, the following hypothesis will be tested: The Perinatal Grief Intensity Scale, measured within eight weeks of perinatal loss (T1), will distinguish parents who experience intense grief (Perinatal Grief Scale (PGS) score above 91) from those who do not three months later (T2).
Specific Aims: The Perinatal Grief Intensity Scale (PGIS) was developed for clinical use to predict intense grief and identify need for follow-up after perinatal loss. The specific aim of this study is to establish the optimal cut-off value for the PGIS, one that most accurately predicts intense grief at three months post-loss. Identifying the capability of the PGIS to predict intense grief would improve early identification of parents in need of intervention, thereby addressing a critical barrier in this field. To achieve this aim, the following hypothesis will be tested: The Perinatal Grief Intensity Scale, measured within two weeks of perinatal loss, will distinguish parents who experience intense grief (Perinatal Grief Scale [PGS] score above 91) from those who do not at three months post-loss.
Background and Significance: Miscarriage, stillbirth, and neonatal death represent early, late, and post-pregnancy losses. These perinatal losses occur in about 25% of all pregnancies, and affect over two million families annually. Intense grief reactions after perinatal loss have been associated with increased divorce and higher levels of anxiety, depression, and post-traumatic stress disorder (PTSD). In the subsequent healthy pregnancy after perinatal loss, increased anxiety, depression, and healthcare utilization are common, as well as increased postpartum depression after the birth of the subsequent healthy baby. An accurate way to screen parents is needed to identify those in greatest need of counseling and follow-up after perinatal loss.
Theoretical Framework: Hutti's Perinatal Grief Intensity Framework serves as the theoretical framework for the study. The most intense grief experiences are expected in women for whom the pregnancy and baby were perceived as real; when the actual loss experience is perceived as unfolding in a manner women find unacceptable; and in women who perceive themselves as unable to do anything about it.
Design and Methods: Prospective survey data will be collected at 2 weeks (T1) and 3months (T2) post-loss from 71 English-speaking women who have recently experienced a miscarriage, stillbirth, or neonatal death at two regional hospitals with level 3 nurseries. T1 instruments include a demographic form, the PGS, and the PGIS. Data on the PGS will be collected at T2.
Data Analysis: Receiver operating characteristic (ROC) curve analysis (with the PGS used as the gold-standard) will be used to evaluate the hypotheses. In addition, logistic regression modeling will be used to identify independent correlates of intense grief and to adjust for potential confounders. The measure of effect for the ROC analysis will be the odds ratio (OR) estimated from a logistic regression analysis. Participants will be divided into two groups based on their initial score of 91 and above (intense grief) or below 91 (normal grief) on the PGS at T1. Differences in categorical variables among the two groups will be evaluated with chi-square tests. Differences in continuous variables will be examined using one-way ANOVA. Cronbach's alpha will be used to assess the internal consistency of both instruments. To examine intense grief, a mixed-effects general linear model will be developed.