The role of rumination in adjusting to termination of pregnancy for fetal abnormality: rumination as a predictor and mediator of posttraumatic growth.

Objective: Rumination is important in adjusting to traumatic events. Evidence suggests that deliberate rumination predicts posttraumatic growth (PTG), and mediates the relationship between coping and PTG. This study examined the relationship between rumination and psychological adjustment following pregnancy termination for fetal abnormality (TFA).
Method: A cross-sectional, online study was conducted with women who had undergone TFA. Women were recruited from a support organisation; 161 women completed the Brief COPE, the Perinatal Grief Scale, the Event-Related Rumination Inventory and the Posttraumatic Growth Inventory. Data were analysed using regression and mediation analyses.
Results: The results show that women engaged in high levels of intrusive and deliberate rumination post-TFA and that intrusive rumination predicted grief. Intrusive and deliberate rumination predicted PTG, although intrusive rumination was a negative predictor of growth. Deliberate rumination mediated the relationship between grief and PTG. It also mediated the path between positive reframing and PTG, and religious coping and PTG, although the mediation effect depended upon the inclusion of the grief variable in the models.
Conclusions: The results confirm the applicability of the PTG model to TFA and support the relevance of rumination to the PTG experience. The results also have clinical implications. Given the positive relationship between deliberate rumination and PTG, promoting interventions that encourage reflective thinking and narrative construction would benefit women post-TFA, particularly those experiencing high levels of distress and/or at risk of complicated grief.