A Systematic Review of the Peer-Reviewed Literature on Self-Blame, Guilt, and Shame

Abstract

This is the first systematic review of the evidence on the prevalence of self-blame, guilt, and shame in bereaved parents. A search of PsychINFO, MEDLINE, Embase, CINAHL, PubMed, and Science Direct resulted in 18 studies for the period 1975 to 2013 which the authors have appraised. Self-blame, guilt, and shame are common in bereaved parents, albeit to varying degrees, with differential relationships to sex, and diminishing over time. There is some evidence that guilt and shame predict more intense grief reactions and that self-blame predicts posttraumatic symptomology, anxiety, and depression in bereaved parents. Heterogeneity of the studies and numerous methodological concerns limit the synthesis and strength of the evidence and the generalizability of the findings. Self-blame, guilt, and shame are commonly experienced by bereaved parents. Awareness of these affective states may assist clinicians in the identification of bereaved parents who are at a higher risk of developing adverse psychological outcomes. Overall, self-blame, guilt, and shame have received very little attention in the bereavement research, leaving many unanswered questions. Implications for practice and recommendations for future research are discussed. Self-blame, guilt, and shame are common in bereavement and may hinder the healthy progression of mourning (Buckle & Fleming, 2011;Humphrey, 2009;Rando, 1986 , 1989). However, self-blame, guilt, and shame have received relatively little attention in parental bereavement research. Reviews of guilt and shame in bereavement are either not current or comprehensive, narrative in style and therefore more susceptible to researcher bias or focused on various types of bereavement rather than parental bereavement specifically (Buckle & Fleming, 2011;Humphrey, 2009;Rando, 1986). Miles and Demi (1986) have proposed the only current theory of guilt in bereaved parents. While clinicians acknowledge that self-blame, guilt, and shame often hinder the progression of normal grieving, there are currently no robust, empirically tested theories of self-blame, guilt, and shame in bereaved parents to guide either diagnoses or interventions. This is the first systematic review of the literature on self-blame, guilt, and shame in bereaved parents characterized by a specific research question, inclusion and exclusion criteria, an explicit search strategy, systematic data extraction procedure, coding and analysis of the studies, methodological appraisal, and a synthesis of the available evidence text. These characteristics reduce the likelihood of reviewer bias or selective citation and provide readers with the information necessary to appraise both the included studies and the systematic review itself (Mulrow, 1994;Pai et al., 2004).Defining Self-Blame, Guilt, and Shame Both guilt and shame are self-conscious emotions involving self-blame (Tangney & Salovey, 1999) and, because they are intimately related, they are more difficult to observe as separate phenomena (Blum, 2008;Kubany & Watson, 2003;Silfver, 2007). ...

Bereavement Challenges and Their Relationship to Physical and Psychological Adjustment to Loss

“…44 ''Challenges with Guilt'' emerged as a BCS factor associated with worse mental HRQOL and increased risk for a mental disorder, consistent with prior research. [45][46][47] Guilt may interfere with adjustment to bereavement over time 46 and response to psychological treatments. 48 Assessing guilt in bereavement and interventions targeting guilt may be beneficial for some individuals.…”

Culpability, blame, and stigma after pregnancy loss in Qatar

“…Medical models of pregnancy emphasize the ability to control reproduction and leads to assumptions around positive outcomes in pregnancy [20, 21], making pregnant women’s behaviour the target of intense personal and societal scrutiny [22]. Such an emphasis on control and assumptions around pregnancy as success may contribute to a woman’s sense of responsibility for fetal outcome and self- blame in the case of poor outcomes [5, 23].…”

Life after the loss: protocol for a Danish longitudinal follow-up study unfolding life and grief after the death of a child during pregnancy from gestational week 14, during birth or in the first 4 weeks of life

“…Unsurprisingly, the PTSD risk appears to be seven times higher in mothers after a perinatal death compared with mothers with a live birth 28. A review of 18 studies on self-blame, guilt and shame among bereaved parents (including stillbirths and the loss of older children) showed a high prevalence of all three states and an association with grief intensity 29. Higher mortality rates from natural causes among mothers who experienced a perinatal death were found in two large population-based studies established on register data 30 31…”