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Arch Womens Ment Health. 2018 Aug;21(4):453-459. doi: 10.1007/s00737-018-0822-5. Epub 2018 Mar 3.

Women generating narratives after an unwanted prenatal diagnosis result: randomized controlled trial.

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IINFACTS, CESPU, Gandra, Portugal.
Centro de Psicologia do Trauma e do Luto, Porto, Portugal.
IINFACTS, CESPU, Gandra, Portugal.
H. Sta. Maria, Lisbon, Portugal.
Mat. Alfredo da Costa, Lisbon, Portugal.
Centro Hospitalar do Porto, Porto, Portugal.
Universidade do Porto, Porto, Portugal.
Centro de Psicologia do Trauma e do Luto, Porto, Portugal.


We have defined a psychological intervention based on cognitive narrative therapy and the Ottawa decision framework to reduce adjustment problems following a termination of pregnancy (TOP) after a positive prenatal diagnosis (PND). The intervention is composed of four sessions: decision, subjectivation, metaphorization, and projecting. This study aims to assess the effectiveness of a cognitive narrative intervention to prevent depression and anxiety symptoms after TOP. The intervention was accepted by 24 participants. The outcome is compared with a control group of 67 women who also terminated a pregnancy after PND. Participants were from several Portuguese institutions; 64.4% had a genetic and 35.6% had ultrasound diagnosis; the mean age was 30.0 years and the mean gestational age was 19 weeks. There are two evaluations: a baseline at the 15th day and a sixth month follow-up after TOP, using Beck Depression Inventory, Zung Anxiety Scale, Perinatal Grief Scale, and an instrument capturing participant satisfaction. Six months after TOP, there is a lower mean of anxiety and depression (p < 0.05), between groups, with effect sizes on the follow-up of 0.54 for depression, 0.41 for anxiety, and 0.23 for perinatal grief. This intervention has very positive effects on women mental health, and we emphasize the importance of the meaning-making process in the context of terminating a wanted pregnancy.


Abortion; Anxiety; Decisions; Depression; Narratives; Perinatal Grief; Prenatal diagnosis; RCT; Termination of pregnancy

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