Introduction and Instructions

Hello!  You are invited to participate in a study that is being conducted by Dr. T. Tempelmeyer and Dr. Beverly Stiles at Midwestern State University.  We understand that the loss of a wanted pregnancy is a very distressing event for many women, but your participation will contribute to our growing understanding of how women respond to these events.  We are interested in how women respond emotionally and socially when they experience the loss of a wanted pregnancy.  

Inclusion criteria for participating in the study include:

     Age 18 or over

     Have experienced one (or more) involuntary loss(es) of a wanted pregnancy (miscarriage).

 If you agree to participate in this study, you will be asked to read and respond to a variety of questions below.  Some questions may ask you to elaborate on your answer.  Your total time commitment should be approximately 30-45 minutes.

 Any questions collected in connection with this study will remain confidential, and the data collected will be stored on a drive that will be locked in our research lab.  Only data averaged for all participants will be disclosed in scientific publications.  Remember, there is no connection between your answers and your name/identity.

The study procedures involve minimal risk.  While participation in this study involves no risk of physical injury, there are potential risks of discomfort or distress in answering questions about your pregnancy loss.  Sometimes problems arise for individuals when sensitive topics are discussed.  Should you experience any discomfort or distress, as a result of answering these questions, you may call the Midwestern State University Counseling Center at 940-397-4618, or the investigators, Dr. T. Tempelmeyer, at 940-397-4207, or Dr. B. Stiles, at 940-397-4901.  Our address is Midwestern State University, 4310 Taft Blvd., Wichita Falls, Texas, 76308.

 Please answer questions in terms of the pregnancy loss that caused you the most distress, if you have experienced more than one.  If you do not have any questions, please continue below. 

You may stop at any time.  If you decide to withdraw from the study, there will be no information gathered about you and the information that has been recorded by you will not be used in any analysis.  Again, thank you for sharing this information with us. We truly appreciate your help in terms of allowing us to try to understand this very painful event better.

Please understand that by completing the questionnaire, you are giving researchers your informed consent and affirming that you are at least 18 years of age.  Continue below to respond to the survey.

Question Title

* 1. I have been informed regarding the current study; I understand the above information and agree to participate.

Question Title

* 2. Age

Question Title

* 3. Your ethnic and racial background

Question Title

* 4. Are you a native English speaker?

Question Title

* 5. If the answer to the question above is NO, how long have you been speaking English (years)?

Question Title

* 6. Do you consider yourself a religious person?

Question Title

* 7. Do you consider yourself a spiritual person?

Question Title

* 8. If you answered YES to the previous question, do you find your religious/spiritual life, in terms of coping with your loss, which of the below?  If you answered No to the previous question, choose "N/A".

Question Title

* 9. How often do you attend church or other religious meetings?

Question Title

* 10. How often do you spend time in private religious activities, such as prayer, meditation, or Bible study?


The following section contains 3 statements about religious belief or experience. Please mark the extent to which each statement is true or not true for you.

Question Title

* 11. In my life, I experience the presence of the Divine (i.e., God).

Question Title

* 12. My religious beliefs are what really lie behind my whole approach to life.

Question Title

* 13. I try hard to carry my religion over into all other dealings in life.

Question Title

* 14. What is your current household income?

Question Title

* 15. Please indicate how many biological children, if any, that you may have.

Question Title

* 16. Please indicate how many adopted children, if any, you may have.

Question Title

* 17. Please indicate how many involuntary pregnancy loss(es), (miscarriage), total you have experienced.

Question Title

* 18. Please indicate how long it has been since your most recent pregnancy loss.

Question Title

* 19. How far along were you in your pregnancy when you experienced your loss?

Question Title

* 20. What is your relationship status?

Question Title

* 21. What is the highest degree or level of school you have completed?

Question Title

* 22. Who lives with you (example: sister, niece)?   Check all that apply.

Question Title

* 23. Who do you feel comfortable with in talking about your pregnancy loss?  Check all that apply.



People sometimes look to others for companions, assistance, or other types of support. How often is each of the following kinds of support used by you to deal with your pregnancy loss if/when you need it? Choose one.

Question Title

* 24. Someone you can count on to listen to you when you need to talk.

Question Title

* 25. Someone to give you information to help you understand a situation.

Question Title

* 26. Someone to give you good advice about a crisis

Question Title

* 27. Someone to confide in or talk to about yourself or your problems

Question Title

* 28. Someone whose advice you really want

Question Title

* 29. Someone to share your most private worries and fears with

Question Title

* 30. Someone to turn to for suggestions about how to deal with a personal problem

Question Title

* 31. Some who understands your problems



Indicate how often each of the statements below is descriptive of you.

Question Title

* 32. I feel in tune with the people around me.

Question Title

* 33. I lack companionship.

Question Title

* 34. There is no one I can turn to.

Question Title

* 35. I do not feel alone.

Question Title

* 36. I feel part of a group of friends.

Question Title

* 37. I have a lot in common with the people around me.

Question Title

* 38. I am no longer close to anyone.

Question Title

* 39. My interests and ideas are not shared by those around me.

Question Title

* 40. I am an outgoing person.

Question Title

* 41. There are people I feel close to.

Question Title

* 42. I feel left out.

Question Title

* 43. My social relationships are superficial.

Question Title

* 44. No one really knows me well.

Question Title

* 45. I feel isolated from others.

Question Title

* 46. I can find companionship when I want it.

Question Title

* 47. There are people who really understand me.

Question Title

* 48. I am unhappy being so withdrawn.

Question Title

* 49. People are around me but not with me.

Question Title

* 50. There are people I can talk to.

Question Title

* 51. There are people I can turn to.

Question Title

* 52. I am reading carefully and honestly answering all the questions.



Do you have....?

Question Title

* 53. Someone to help you if you were confined to bed

Question Title

* 54. Someone to take you to the doctor if you needed it

Question Title

* 55. Someone to prepare your meals if you were unable to do it yourself

Question Title

* 56. Someone to help with daily chores if you were sick

Question Title

* 57. Someone who shows you love and affection

Question Title

* 58. Someone to love and make you feel wanted

Question Title

* 59. Someone who hugs you

Question Title

* 60. Someone to have a good time with

Question Title

* 61. Someone to get together with for relaxation

Question Title

* 62. Someone to do something enjoyable with

Question Title

* 63. Someone to do things with to help you get your mind off things



Read each statement carefully and indicate your degree of agreement using the scale below. In responding, please be completely candid.

Please remember that all of your responses will remain anonymous.

Question Title

* 64. If I believed I was having a mental breakdown, my first inclination would be to get professional attention.

Question Title

* 65. The idea of talking about problems with a psychologist strikes me as a poor way to get rid of emotional conflicts.

Question Title

* 66. If I were experiencing a serious emotional crisis at this point in my life, I would be confident that I could find relief in psychotherapy.

Question Title

* 67. There is something admirable in the attitudes of a person who is willing to cope with his or her conflicts and fears without resorting to professional help.

Question Title

* 68. I would want to get psychological help if I were worried or upset for a long period of time.

Question Title

* 69. I might want to have psychological counseling in the future.

Question Title

* 70. A person with an emotional problem is not likely to solve it alone; he or she is likely to solve it with professional help.

Question Title

* 71. Considering the time and expense involved in psychotherapy, it would have doubtful value for a person like me.

Question Title

* 72. A person should work out his or her own problems; getting psychological counseling would be a last resort.

Question Title

* 73. Personal and emotional troubles, like many things, tend to work out by themselves.


Now, we want to ask some more questions regarding your loss.  Please remember to answer in regards to your most recent loss.

Remember that all of your answers will remain anonymous.

Question Title

* 74. Was your pregnancy planned or unplanned?

Question Title

* 75. Was your pregnancy the result of fertility treatment (such as intrauterine insemination or in vitro fertilization)?

Question Title

* 76. Did you see a sonogram of your baby?

Question Title

* 77. Were you ever given an explanation by your physician or nurse practitioner for what caused your pregnancy loss?

Question Title

* 78. Did medical personnel tell you how common pregnancy loss is?

Question Title

* 79. Did medical personnel tell you it was not your fault?

Question Title

* 80. Did medical personnel tell you how distressing or painful the loss might be for you?

Question Title

* 81. How would you describe your feelings immediately following your pregnancy loss?

Question Title

* 82. Within the last week, have you been feeling ___________________ regarding your loss?  Check all that apply.

Question Title

* 83. In terms of the previous question, what are some of the reasons you might think you felt this way?

Question Title

* 84. How long would you estimate it took to start feeling better?

Question Title

* 85. Did you find yourself withdrawing or isolating from others?

Question Title

* 86. Did you find that people tended to say things that were helpful?

Question Title

* 87. Did you find it helpful or hurtful to talk about the experience?



Please read each statement and choose a number that indicates how much the statement applied to you over the past week. There are no right or wrong answers. Do not spend too much time on any statement.

Question Title

* 88. I found it hard to wind down.

Question Title

* 89. I was aware of dryness of my mouth.

Question Title

* 90. I couldn't seem to experience any positive feeling at all.

Question Title

* 91. I experienced breathing difficulty (e.g., excessively rapid breathing breathlessness in the absence of physical exertion)

Question Title

* 92. I found it difficult to work up the initiative to do things.

Please choose "Next" to continue

T