How does the mode of inheritance of a genetic condition influence families? A study of guilt, blame, stigma, and understanding of inheritance and reproductive risks in families with X-linked and autosomal recessive diseases.
OBJECTIVE
While the mode of inheritance of a genetic condition has long been considered to have not only medical, but also psychosocial consequences for families, this supposition has never been tested.


METHODS
We surveyed 112 members of 51 families (59% response) with chronic granulomatous disease to determine the influence of mode of inheritance on parents', siblings', and patients' (1) knowledge of inheritance and reproductive risk; (2) concern about risk to future family-members; (3) feelings of guilt and blame; and (4) feelings of stigmatization. Ninety-six members of 51 families (49% response) with Duchenne/Becker muscular dystrophy and spinal muscular atrophy types II/III were also studied.


RESULTS
X-linked families had better understanding of inheritance (P < 0.001) and reproductive risks (P < 0.01). X-linked mothers worried more about risks to future generations; other autosomal-recessive family members were as worried. X-linked mothers were more likely to feel guilty (P < 0.01) and blame themselves (P < 0.001). X-linked fathers blamed their child's mother (P < 0.05) and X-linked mothers felt more blamed by the father (P < 0.01). X-linked family-members were more likely to consider being a carrier stigmatizing (P < 0.05).


CONCLUSIONS
When providing genetic counseling, attention should be given to guilt and blame in X-linked families and understanding reproductive risks in autosomal recessive families.
James
Cynthia A
CA
Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
Hadley
Donald W
DW
Holtzman
Neil A
NA
Winkelstein
Jerry A
JA
D001290:Attitude; D041321:Chromosomes, Human, X; D032882:Comprehension; D005190:Family; D005260:Female; D005808:Genes, Recessive; D005817:Genetic Counseling; D030342:Genetic Diseases, Inborn / Q000523:psychology*; D040181:Genetic Diseases, X-Linked / Q000523:psychology*; D008040:Genetic Linkage; D006167:Guilt; D006801:Humans; D008297:Male; D012307:Risk Factors; D012752:Shame