Supplementary Material for: Brief Internet-Based Intervention Reduces Posttraumatic Stress and Prolonged Grief in Parents after the Loss of a Child during Pregnancy: A Randomized Controlled Trial

Background: The loss of a child during pregnancy causes significant psychological distress for many women and their partners, and may lead to long-lasting psychiatric disorders. Internet-based interventions using exposure techniques and cognitive restructuring have proved effective for posttraumatic stress disorder (PTSD) and prolonged grief. This study compared the effects of an Internet-based intervention for parents after prenatal loss with a waiting list condition (WLC). Methods: The Impact of Event Scale - Revised assessed symptoms of PTSD; the Inventory of Complicated Grief and the Brief Symptom Inventory assessed depression, anxiety, and general mental health. The 228 participants (92% female) were randomly allocated to a treatment group (TG; n = 115) or a WLC group (n = 113). The TG received a 5-week cognitive behavioral intervention including (1) self-confrontation, (2) cognitive restructuring, and (3) social sharing. Results: The TG showed significantly reduced symptoms of posttraumatic stress, prolonged grief, depression, and anxiety relative to the WLC control group. Intention-to-treat analysis revealed treatment effects of between d = 0.84 and d = 1.02 for posttraumatic stress and prolonged grief from pre- to posttreatment time points. Further significant improvement in all symptoms of PTSD and prolonged grief was found from the posttreatment evaluation to the 12-month follow-up. The attrition rate of 14% was relatively low. Conclusions: The Internet-based intervention proved to be a feasible and cost-effective treatment, reducing symptoms of posttraumatic stress, grief, depression, anxiety, and general mental health after pregnancy loss. Low-threshold e-health interventions should be further evaluated and implemented routinely to improve psychological support after pregnancy loss.研究背景：孕期失子会对众多女性及其伴侣造成严重的心理痛苦，甚至可能引发长期精神障碍。采用暴露疗法与认知重构技术的互联网干预手段，已被证实对创伤后应激障碍（Posttraumatic Stress Disorder, PTSD）及持续性哀伤具有良好疗效。本研究针对产前失子父母的互联网干预手段，与等候名单对照组（Waiting List Condition, WLC）的干预效果进行了对比。 研究方法：采用《事件影响量表-修订版》（Impact of Event Scale - Revised）评估创伤后应激障碍症状；使用《复杂哀伤量表》（Inventory of Complicated Grief）与《简易症状问卷》（Brief Symptom Inventory）评估抑郁、焦虑及整体心理健康状况。本研究共纳入228名受试者（其中92%为女性），采用随机分配方式将其分为干预组（Treatment Group, TG，n=115）与等候名单对照组（WLC组，n=113）。干预组接受为期5周的认知行为干预，内容包括：（1）自我直面技术，（2）认知重构，（3）社会分享。 研究结果：相较于等候名单对照组，干预组的创伤后应激、持续性哀伤、抑郁及焦虑症状均得到显著缓解。意向性治疗分析（Intention-to-treat analysis）结果显示，从干预前至干预后，创伤后应激与持续性哀伤的干预效应量d值介于0.84至1.02之间。从干预后评估至12个月随访阶段，受试者的所有创伤后应激障碍及持续性哀伤症状均得到进一步显著改善。本研究的脱落率为14%，处于较低水平。 研究结论：本研究证实，针对孕期失子父母的互联网干预手段具备可行性与成本效益优势，可有效缓解失子后出现的创伤后应激、哀伤、抑郁、焦虑及整体心理健康问题。应进一步评估并常规推广低门槛电子健康干预手段，以优化孕期失子后的心理支持服务。