{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T06:05:44Z","timestamp":1788501944469,"version":"build-2803163510"},"reference-count":54,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T00:00:00Z","timestamp":1767571200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["EJIHPE"],"abstract":"<jats:p>(1) Background: Perinatal loss is a deeply painful and often invisible experience, with a significant impact on mental health. This study aimed to assess levels of psychopathological symptoms, shame, and perceived social support according to the type of perinatal loss; explore the relationships between these variables; and analyze the mediating effect of perceived social support on the relationship between shame and symptoms, as well as the moderating effect of the type of loss. (2) Methods: A total of 501 Portuguese women who had experienced perinatal loss participated in the study, recruited through an online questionnaire. Psychopathological symptoms, shame, perceived social support, and type of loss were assessed. Analyses included descriptive statistics, Spearman correlations, normality and homogeneity of variances tests, and mediation and moderation models with PROCESS. (3) Results: The results revealed high levels of anxiety and depression, and moderate levels of shame. Perceived social support, especially from partners and family members, was high. Shame correlated positively with symptoms and negatively with social support. Only social support from friends significantly mediated the relationship between shame and psychological distress. (4) Conclusions: These results reinforce the protective role of support networks and the importance of clinical interventions focused on reducing shame.<\/jats:p>","DOI":"10.3390\/ejihpe16010010","type":"journal-article","created":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T13:35:47Z","timestamp":1767620147000},"page":"10","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Perceived Social Support, Shame, and Psychopathological Symptoms After Perinatal Loss in Portuguese Women"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-0282-4195","authenticated-orcid":false,"given":"Mariana","family":"Ribeiro","sequence":"first","affiliation":[{"name":"Department of Psychology and Education, University of Beira Interior, 6200-209 Covilh\u00e3, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2007-5865","authenticated-orcid":false,"given":"Paula Saraiva","family":"Carvalho","sequence":"additional","affiliation":[{"name":"Department of Psychology and Education, University of Beira Interior, 6200-209 Covilh\u00e3, Portugal"},{"name":"Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), University of Beira Interior, 6200-209 Covilh\u00e3, Portugal"},{"name":"RISE-Health, Department of Medical Sciences, Faculty of Health Sciences, University of Beira Interior, 6200-209 Covilh\u00e3, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8919-0378","authenticated-orcid":false,"given":"Ana","family":"Torres","sequence":"additional","affiliation":[{"name":"Department of Psychology and Education, University of Beira Interior, 6200-209 Covilh\u00e3, Portugal"},{"name":"Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), University of Beira Interior, 6200-209 Covilh\u00e3, Portugal"},{"name":"RISE-Health, Department of Medical Sciences, Faculty of Health Sciences, University of Beira Interior, 6200-209 Covilh\u00e3, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9095-0947","authenticated-orcid":false,"given":"D\u00e1rio","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Department of Mathematics and Center of Mathematics, University of Beira Interior, 6200-209 Covilh\u00e3, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,5]]},"reference":[{"key":"ref_1","first-page":"669","article-title":"The prediction of gender and attachment styles on shame, guilt, and loneliness","volume":"10","author":"Akbag","year":"2010","journal-title":"Educational Sciences: Theory & Practice"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Barr, K. R., Nguyen, T. A., Pickup, W., Cibralic, S., Mendoza Diaz, A., Barnett, B., and Eapen, V. (2024). Perinatal continuity of care for mothers with depressive symptoms: Perspectives of mothers and clinicians. Frontiers in Psychiatry, 15.","DOI":"10.3389\/fpsyt.2024.1385120"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"331","DOI":"10.2190\/OM.56.4.b","article-title":"Problematic emotions and maternal grief","volume":"56","author":"Barr","year":"2008","journal-title":"OMEGA-Journal of Death and Dying"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1037\/0735-7028.36.2.180","article-title":"The scope and impact of perinatal loss: Current status and future directions","volume":"36","author":"Bennett","year":"2005","journal-title":"Professional Psychology: Research and Practice"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1080\/15325020802171268","article-title":"An exploratory study of the psychological impact and clinical care of perinatal loss","volume":"13","author":"Bennett","year":"2008","journal-title":"Journal of Loss and Trauma"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1007\/s11920-016-0663-8","article-title":"Infertility and perinatal loss: When the bough breaks","volume":"18","author":"Bhat","year":"2016","journal-title":"Current Psychiatry Reports"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1192\/bjp.bp.110.083105","article-title":"Previous prenatal loss as a predictor of perinatal depression and anxiety","volume":"198","author":"Blackmore","year":"2011","journal-title":"British Journal of Psychiatry"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Burden, C., Bradley, S., Storey, C., Ellis, A., Heazell, A. E., Downe, S., Cacciatore, J., and Siassakos, D. (2016). From grief, guilt, pain and stigma to hope and pride: A systematic review and meta-analysis of mixed-method research of the psychosocial impact of stillbirth. BMC Pregnancy and Childbirth, 16.","DOI":"10.1186\/s12884-016-0800-8"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1093\/sw\/54.1.91","article-title":"The silent birth: A feminist perspective","volume":"54","author":"Cacciatore","year":"2009","journal-title":"Social Work"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.siny.2012.09.001","article-title":"Psychological effects of stillbirth","volume":"18","author":"Cacciatore","year":"2013","journal-title":"Seminars in Fetal and Neonatal Medicine"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1111\/j.1365-2524.2008.00814.x","article-title":"The effects of social support on maternal anxiety and depression after stillbirth","volume":"17","author":"Cacciatore","year":"2009","journal-title":"Health & Social Care in the Community"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1080\/02646838.2023.2180142","article-title":"Women pregnant after previous perinatal loss: Relationships between adult attachment, shame, and prenatal psychological outcomes","volume":"42","author":"Caldwell","year":"2023","journal-title":"Journal of Reproductive and Infant Psychology"},{"key":"ref_13","unstructured":"Gon\u00e7alves, M. M., Sim\u00f5es, M. R., and Almeida, L. (2017). Invent\u00e1rio de sintomas psicopatol\u00f3gicos 18 (BSI-18). Psicologia cl\u00ednica e da sa\u00fade: Instrumentos de avalia\u00e7\u00e3o, Editora Pactor."},{"key":"ref_14","unstructured":"Clauss, D. K. (2009). Psychological distress following miscarriage and stillbirth: An examination of grief, depression and anxiety in relation to gestational length, women\u2019s attributions, perception of care and provision of information. [Doctoral dissertation, Drexel University]. Available online: https:\/\/www.proquest.com\/docview\/304878488\/."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1177\/008124630303300103","article-title":"Women\u2019s perceptions of partner support in the context of pregnancy loss(es)","volume":"33","year":"2003","journal-title":"South African Journal of Psychology"},{"key":"ref_16","unstructured":"Derogatis, L. R. (1993). BSI brief symptom inventory: Administration, scoring, and procedures manual, National Computer Systems. [4th ed.]."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"126","DOI":"10.3390\/psychiatryint4020015","article-title":"Psychopathology present in women after miscarriage or perinatal loss: A systematic review","volume":"4","author":"Haro","year":"2023","journal-title":"Psychiatry International"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1177\/0030222815572604","article-title":"A systematic review of the peer-reviewed literature on self-blame, guilt, and shame","volume":"71","author":"Duncan","year":"2015","journal-title":"OMEGA\u2014Journal of Death and Dying"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Feasey, R. (2019). Pregnancy loss: Shame and silence over a shared experience. Infertility and non-traditional family building, Springer.","DOI":"10.1007\/978-3-030-17787-4"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1353","DOI":"10.1016\/S0140-6736(10)62232-5","article-title":"Stillbirths: Why they matter","volume":"377","author":"Cacciatore","year":"2011","journal-title":"The Lancet"},{"key":"ref_21","unstructured":"Geada, M. (2003). Question\u00e1rio de sentimentos pessoais, Manuscrito n\u00e3o publicado, Faculdade de Psicologia da Universidade de Lisboa."},{"key":"ref_22","unstructured":"Gilbert, P., and Miles, J. (2002). Body shame: A biopsychosocial conceptualisation and overview, with treatment implications. Body shame: Conceptualisation, research and treatment, Brunner."},{"key":"ref_23","unstructured":"G\u00edslad\u00f3ttir, S. G. (2016). Prior pregnancy loss: Mental health during and after subsequent pregnancies. [Master\u2019s thesis, Reykjav\u00edk University]. Available online: https:\/\/skemman.is\/handle\/1946\/25720?locale=en."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1002\/cpp.627","article-title":"Shame, pride, and eating disorders","volume":"16","author":"Goss","year":"2009","journal-title":"Clinical Psychology & Psychotherapy"},{"key":"ref_25","first-page":"271","article-title":"Further validation of the shame and guilt scales of Harder\u2019s Personal Feelings Questionnaire\u20132","volume":"85","author":"Harder","year":"1999","journal-title":"Psychological Reports"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Irmscher, L., Marx, R., Linke, M., Zimmermann, A., Dr\u00f6ssler, S., and Berth, H. (2024). Anxiety, depression, somatization and psychological distress before and 2\u20136 years after a late termination of pregnancy due to fetal anomalies. BMC Women\u2019s Health, 24.","DOI":"10.1186\/s12905-024-03082-3"},{"key":"ref_27","first-page":"1","article-title":"Quality of life, social support and self-efficacy in women after a miscarriage","volume":"19","year":"2021a","journal-title":"Health and Quality of Life Outcomes"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Iwanowicz-Palus, G., Mr\u00f3z, M., Bie\u0144, A., and Jurek, K. (2021b). Social support and subjective assessment of psychophysical condition, health, and satisfaction with quality of life among women after pregnancy loss. BMC Pregnancy and Childbirth, 21.","DOI":"10.1186\/s12884-021-04093-w"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1016\/j.psychres.2017.08.064","article-title":"Prevalence of depression, anxiety, and adjustment disorders in women with spontaneous abortion in Germany: A retrospective cohort study","volume":"258","author":"Jacob","year":"2017","journal-title":"Psychiatry Research"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"102531","DOI":"10.1016\/j.midw.2019.102531","article-title":"New understandings of fathers\u2019 experiences of grief and loss following stillbirth and neonatal death: A scoping review","volume":"79","author":"Jones","year":"2019","journal-title":"Midwifery"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"3","DOI":"10.59249\/WMGE9032","article-title":"The role of social support in perinatal mental health and psychosocial stimulation","volume":"97","author":"Kay","year":"2024","journal-title":"Yale Journal of Biology and Medicine"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1037\/a0021466","article-title":"Shame, guilt, and depressive symptoms: A meta-analytic review","volume":"137","author":"Kim","year":"2011","journal-title":"Psychological Bulletin"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1016\/j.rbmo.2015.01.017","article-title":"How old is too old? A contribution to the discussion on age limits for assisted reproduction technique access","volume":"30","author":"Burcin","year":"2015","journal-title":"Reproductive BioMedicine Online"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"491.e1","DOI":"10.1016\/j.ajog.2019.06.027","article-title":"Association between stillbirth \u2265 23 weeks\u2019 gestation and acute psychiatric illness within 1 year of delivery","volume":"221","author":"Lewkowitz","year":"2019","journal-title":"American Journal of Obstetrics and Gynecology"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1080\/07481187.2010.496686","article-title":"Predictors of complicated grief: A systematic review of empirical studies","volume":"34","author":"Lobb","year":"2010","journal-title":"Death Studies"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1016\/j.bpobgyn.2006.11.007","article-title":"Psychological morbidity following miscarriage","volume":"21","author":"Lok","year":"2007","journal-title":"Best Practice & Research Clinical Obstetrics & Gynaecology"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e011382","DOI":"10.1136\/bmjopen-2016-011382","article-title":"Experience of miscarriage: An interpretative phenomenological analysis","volume":"7","author":"Meaney","year":"2017","journal-title":"BMJ Open"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Mendes, D. C. G., Fonseca, A., and Cameir\u00e3o, M. S. (2023). The psychological impact of early pregnancy loss in Portugal: Incidence and the effect on psychological morbidity. Frontiers in Public Health, 11.","DOI":"10.3389\/fpubh.2023.1188060"},{"key":"ref_39","unstructured":"Monteiro, M. S. R. M. (2020). A influ\u00eancia da satisfa\u00e7\u00e3o conjugal, do apoio social e dos estados emocionais negativos no processo de luto decorrente de uma perda gestacional. [Master\u2019s thesis, Faculdade de Psicologia, Universidade de Lisboa]."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Obst, K. L., Due, C., Oxlad, M., and Middleton, P. (2020). Men\u2019s grief following pregnancy loss and neonatal loss: A systematic review and emerging theoretical model. BMC Pregnancy and Childbirth, 20.","DOI":"10.1186\/s12884-019-2677-9"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1521\/jscp.2006.25.6.688","article-title":"The differential relationships of shame-proneness and guilt-proneness to psychological and somatization symptoms","volume":"25","author":"Pineles","year":"2006","journal-title":"Journal of Social and Clinical Psychology"},{"key":"ref_42","unstructured":"PORDATA (2023). Fertility rate by age group, PORDATA. Available online: https:\/\/www.pordata.pt\/pt\/estatisticas\/populacao\/nascimentos-e-fecundidade\/taxa-de-fecundidade-por-grupo-etario-0."},{"key":"ref_43","unstructured":"PORDATA (2024). \u00d3bitos fetais e neonatais, PORDATA. Available online: https:\/\/www.pordata.pt\/pt\/estatisticas\/saude\/mortalidade\/obitos-fetais-e-neonatais."},{"key":"ref_44","unstructured":"Public Health Agency of Canada (2025, August 04). Family-centred maternity and newborn care: National guidelines (Chapter 7), Available online: https:\/\/www.canada.ca\/en\/public-health\/services\/publications\/healthy-living\/maternity-newborn-care-guidelines-chapter-7.html."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1080\/03630242.2016.1157125","article-title":"Relationship between perceived perinatal stress and depressive symptoms, anxiety, and parental self-efficacy in primiparous mothers and the role of social support","volume":"57","author":"Razurel","year":"2017","journal-title":"Women & Health"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Sarper, E., and Rodrigues, D. L. (2024). The role of perceived social support in the grief experiences of more anxious and self-compassionate people. OMEGA\u2014Journal of Death and Dying, 1\u201318.","DOI":"10.1177\/00302228241229484"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1177\/1948550617715068","article-title":"Determining power and sample size for simple and complex mediation models","volume":"8","author":"Schoemann","year":"2017","journal-title":"Social Psychological and Personality Science"},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Sutan, R., and Miskam, H. M. (2012). Psychosocial impact of perinatal loss among Muslim women. BMC Women\u2019s Health, 12.","DOI":"10.1186\/1472-6874-12-15"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1177\/0022146510395592","article-title":"Mechanisms linking social ties and support to physical and mental health","volume":"52","author":"Thoits","year":"2011","journal-title":"Journal of Health and Social Behavior"},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Thomas, S., Kanske, P., Sch\u00e4fer, J., Hummel, K. V., and Trautmann, S. (2022). Examining bidirectional associations between perceived social support and psychological symptoms in the context of stressful event exposure: A prospective, longitudinal study. BMC Psychiatry, 22.","DOI":"10.1186\/s12888-022-04386-0"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1080\/01674820600646198","article-title":"The impact of miscarriage on women\u2019s pregnancy-specific anxiety and feelings of prenatal maternal\u2013fetal attachment during the course of a subsequent pregnancy","volume":"27","author":"Tsartsara","year":"2006","journal-title":"Journal of Psychosomatic Obstetrics & Gynaecology"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1177\/1066480718770154","article-title":"Fathers\u2019 lived experiences of miscarriage","volume":"26","author":"Wagner","year":"2018","journal-title":"The Family Journal"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1037\/0022-0167.52.4.526","article-title":"Adult attachment, depressive symptoms, and validation from self versus others","volume":"52","author":"Wei","year":"2005","journal-title":"Journal of Counseling Psychology"},{"key":"ref_54","unstructured":"World Health Organization (2025, August 04). The unacceptable stigma and shame women face after baby loss must end, Available online: https:\/\/www.who.int\/news-room\/spotlight\/why-we-need-to-talk-about-losing-a-baby\/unacceptable-stigma-and-shame."}],"container-title":["European Journal of Investigation in Health, Psychology and Education"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2254-9625\/16\/1\/10\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T14:09:34Z","timestamp":1767622174000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2254-9625\/16\/1\/10"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,5]]},"references-count":54,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["ejihpe16010010"],"URL":"https:\/\/doi.org\/10.3390\/ejihpe16010010","relation":{},"ISSN":["2254-9625"],"issn-type":[{"value":"2254-9625","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,5]]}}}