Disorganised Attachment Behaviour among Infants Born Subsequent to Stillbirth

Abstract

There is limited evidence that siblings of stillborn infants are more vulnerable to psychological problems. This case-controlled study examines the relationship between previous stillbirth and the next child's pattern of attachment and explores factors in the mother which may be associated with and which may explain the pattern of infant attachment. We examined 53 infants next-born after a stillbirth, and 53 control infants of primigravid mothers. Maternal demographic, psychiatric, and attachment data were collected in pregnancy, and self-report measures of depression collected in the first year. Infant attachment patterns to the mothers were assessed when the infants were 12 months old using the Ainsworth Strange Situation Procedure. Infants next-born after stillbirth showed significant increase in disorganisation of attachment to the mother compared with control infants (p < .04). The difference was not accounted for by differences in psychiatric symptoms or demography. It was strongly predicted by maternal unresolved status with respect to loss as measured in the Adult Attachment Interview, and less strongly by maternal experience of elective termination of pregnancy and by the mother having seen her stillborn infant. The study adds weight to previously reported clinical observations, that infants born after stillbirth may be at risk of an increase in psychological and behavioural problems in later childhood. The strong association between disorganisation of infant attachment and maternal state of mind with respect to loss suggests that the mother's state of mind may be causal, and raises interesting questions about the mechanism of intergenerational transmission. Given the existing evidence of later developmental problems, longer-term follow-up of these children would be valuable.

Previous prenatal loss as a predictor of perinatal depression and anxiety

“…Limited available data suggest that mothers may have more concerns about and greater difficulty managing the needs of a child born after a prenatal loss; 19,28 also, 12-month-old infants born following prenatal loss were reported to show higher rates of disorganised attachment patterns to their mothers than children born into families without a loss history. 29,30 Thus, even if there is no persistence of mood disturbance into the postnatal period, there may still be adverse effects of a previous prenatal loss on the parent–child relationship and child outcomes. This possibility requires further attention.…”

Psychological vulnerability in children next‐born after stillbirth: a case–control follow‐up study

“…Where statistically significant between‐group differences were found in univariate analyses, this significance was largely lost after controlling for possible mediator variables. However, this is perhaps unsurprising given the strong interaction effects between mediating variables (maternal antenatal and postnatal psychological symptoms) and the strong association between stillbirth and antenatal psychological morbidity, infant insecure disorganised attachment and parental separation (Hughes et al, 1999; Turton et al, 2001; Hughes et al, 2001; Turton et al, 2009). The finding that teachers did not report the difficulties that mothers perceived is consistent with other reports that parents generally perceive more problems than teachers (Touliatos & Lindholm, 1981).…”

“…Baseline assessments of maternal depression, anxiety and PTSD were recorded in the third trimester of pregnancy (following loss) and at 1 year post‐partum; quality of infant attachment to the mother was assessed at 1 year using The Strange Situation procedure (Ainsworth, Blehar, Waters, & Wall, 1978). Full details of the Phase 1 methodology have been described elsewhere (Hughes et al, 2001; Turton et al, 2001).…”

“…The proposal that next‐born siblings of infants who have died perinatally are psychologically vulnerable has received empirical support from reports of significant levels of insecure disorganised attachment compared to controls (Heller & Zeanah, 1999; Hughes, Turton, Hopper, McGauley, & Fonagy, 2001). A number of longitudinal studies have implicated disorganised infant attachment in a wide range of subsequent problems in a child’s development (see Lyons‐Ruth & Jacobvitz, 1999 for review).…”

Threat Appraisal, Coping, and Emotions Across Pregnancy Subsequent to Perinatal Loss

“…Babies born subsequent to loss have been shown to have disorganized attachments to their mothers (Heller & Zeanah, 1999;Hughes et al, 2001). Babies born subsequent to loss have been shown to have disorganized attachments to their mothers (Heller & Zeanah, 1999;Hughes et al, 2001).…”