Patricia Hughes

The psychological effects of stillbirth and neonatal death on fathers: Systematic review

Objective. To review the available evidence on the psychological effects of perinatal death on fathers. Method. Electronic search of CINAHL, MEDLINE and PsycINFO databases from 1966–2005. Inclusion criteria: papers describing at least one psychological outcome for fathers who had experienced stillbirth or neonatal death. Exclusion criteria: papers not in English, dissertations, reviews, books without original data, intervention studies, studies of parents without separate results for fathers, studies where perinatal loss was not distinguished from other losses, first person accounts of a single experience, studies reporting on fewer than five fathers. Seventy-seven potential papers were obtained and screened by two authors. Seventeen studies were included. Study quality was rated using a checklist and main findings were summarized. Results. Quality of methodology varied. Qualitative studies described classical grief responses, but less guilt than mothers. Fathers described experiences related to their social role and potential conflict between grieving couples. Quantitative research reported symptoms of anxiety and depression, but at a lower level than mothers. Fathers may develop post-traumatic stress disorder following stillbirth. Discussion. Case prevalence of psychological disorders is unknown. More good quality research is needed. The social role of fathers as carers for their partners needs recognition when planning care for bereaved families.

ADHD and Infant Disorganized Attachment A Prospective Study of Children Next-Born After Stillbirth

Objective: To examine whether infant disorganized attachment predicts ADHD at school age. Method: A cohort of 53 children who had been identified as having significant levels of disorganized attachment in infancy is compared to a control group. Symptoms and signs of ADHD at age 7 are evaluated together with a range of relevant maternal variables. Results: An association is found between infant disorganized attachment scores and teacher-rated symptoms of ADHD (but not ADHD caseness). Probable ADHD caseness in the child is associated with self-rated retrospective ADHD scores in mothers. Possible ADHD caseness is associated with a measure of unresolved mourning in mothers. Mother-rated ADHD in the child was associated with low overall maternal psychosocial functioning. Conclusion: The finding of a link between scores for disorganized attachment at 1 year and later teacher-rated symptoms of ADHD suggests the need for further studies.

An investigation into the possible overlap between PTSD and unresolved responses following stillbirth: an absence of linkage with only unresolved status predicting infant disorganization.

It has been suggested that the characteristic lapses in thinking and reasoning of the unresolved/disorganized (U) state of mind following traumatic loss involve psychological mechanisms similar to those found in PTSD and that a fuller understanding of these mechanisms may help explain the disruptions in parental caretaking behaviour that lead to disorganized infant attachment. This paper investigates whether PTSD, assessed in 60 mothers in the pregnancy after stillbirth, predicts infant disorganized (D) attachment in next-born children, and whether there was any association between U and PTSD. We report that in this population there was no significant correspondence between U and PTSD scores or caseness and no association between maternal PTSD and infant D. We discuss possible interpretations of these findings.

Medical students and mental health : the UK perspective

In the general population, one in four adults experiences significant mental disorder at some point in life, and the majority (with the exception of dementia) commonly present as young adults. Table 1 shows the relative population prevalence of some common disorders. Medical students are not representative of the general population, even where widening participation programmes have been particularly successful. People with established serious mental health problems are less likely to achieve the academic and social success required for medical school, and high achieving people are less likely to have been exposed to the chronic childhood adversities associated with more severe personality disorders or substance misuse.

Perinatal death and fathers

Following our review on the effects of perinatal death on fathers [1], a paper not identified by our keyword search strategy was brought to our attention. Peter Barr [2] investigated 158 parents identified from hospital records at one month and 13 months following stillbirth or neonatal death (overall response rate 44%). In addition to the Perinatal Grief Scale (PGS, Potvin et al. 2003) [3] used in similar studies, three measures of proneness to guilt and shame were used: the Test of Self-Conscious Affect2 (TOSCA-2, Tangey et al. 1996) [4], the Personal Feelings Questionnaire-2 (PFQ-2, Harder & Zalma 1990) [5], and relevant items from the Interpersonal Guilt Questionnaire-67 (IGQ-67, O’Connor et al. 1998) [6]. Men (N1⁄4 72) experienced less intense symptoms than women following perinatal bereavement. Early guilt and shame symptoms contributed significantly to the variance in grief intensity at 13 months, although the study design did not allow for causal direction to be established, and did not control for depression or other psychiatric disorder. This study meets seven of the 11 criteria used in our review for evaluating methodological strength (i.e. it clearly stated its a priori aims, had a clearly defined, non-biased study population, valid outcome measures, appropriate timing of assessments, appropriate statistical analysis and conclusions justified from the available data). In addition to confirming previous findings about grief in fathers, it also adds a valuable perspective on the role of shame following perinatal bereavement. Further investigation on this aspect of bereavement would be very welcome.