Penelope Turton

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.

One size fits all: or horses for courses? Recovery-based care in specialist mental health services

IntroductionThe ‘recovery approach’ to the management of severe mental health problems has become a guiding vision of service provision amongst many practitioners, researchers, and policy makers as well as service users.MethodThis qualitative pilot study explored the meaning of ‘recovery’ with users of three specialist mental health services (eating disorders, dual diagnosis, and forensic) in 18 semi-structured interviews.ResultsThe relevance of themes identified in mainstream recovery literature was confirmed; however, the interpretation and relative weight of these themes appeared to be affected by factors that were specific to the diagnosis and treatment context. ‘Clinical’ recovery themes were also seen as important, as were aspects of care that reflect core human values, such as kindness.

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.

Promoting recovery in long-term institutional mental health care: an international Delphi study

OBJECTIVE Service provision in psychiatric and social care is increasingly guided by recovery principles. However, little is known about the degree of consensus among stakeholders in diverse contexts on the components of care that most promote recovery. This study aimed to identify specific items of care that key stakeholders regard as most important in promoting recovery for people with longer-term mental health problems in institutional care, to measure consensus between and across stakeholder groups and countries, and to develop a conceptual framework of the most important domains of care. METHODS Ten European countries in various stages of deinstitutionalization participated in a series of conventional three-round iterative Delphi exercises. In each country individuals in four separate expert groups (service users, mental health professionals, caregivers, and advocates) identified components of care that they considered important to recovery and then rated their groups suggestions in terms of importance. Median and consensus ratings were measured. High-ranking items were grouped into domains. RESULTS A total of 4,098 separate items of care were proposed by the 40 participating groups. Eleven broad domains of care important for recovery were identified: social policy and human rights, social inclusion, self-management and autonomy, therapeutic interventions, governance, staffing, staff attitudes, institutional environment, postdischarge care, caregivers, and physical health care. Consensus between groups and countries was generally high, but some modest differences in priorities were noted. CONCLUSIONS The most consistently highly rated consensus domain was therapeutic interventions. Domains and components of care related to recovery principles were also viewed as important across stakeholder groups.

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.