title: 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.
authors.affiliation: Department of Psychiatry, St. George's Hospital Medical School, London, UK. p.hughes@sghms.ac.uk
authors.forename: P
authors.initials: P
authors.lastname: Hughes
authors.forename: P
authors.initials: P
authors.lastname: Turton
authors.forename: E
authors.initials: E
authors.lastname: Hopper
authors.forename: G A
authors.initials: GA
authors.lastname: McGauley
authors.forename: P
authors.initials: P
authors.lastname: Fonagy
mesh_terms: D000328:Adult; D001007:Anxiety / Q000523:psychology; D016022:Case-Control Studies; D003863:Depression / Q000523:psychology; D005260:Female; D005313:Fetal Death; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D018730:Infant Behavior / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009034:Mother-Child Relations; D009679:Nuclear Family / Q000523:psychology*; D009769:Object Attachment; D012959:Socioeconomic Factors