Stillbirth – psychological impact on fathers

Although there is a lot of information on the psychological impact of stillbirth on mothers, data on the effect on fathers is very rare. We often fail to acknowledge that fathers can have a difficult time after a stillbirth in separating their own grief from that of the mother. Their role in supporting the mother through this ordeal cannot be overemphasised and the recent article by Turton et al (2006) is important because it describes the psychological stress and needs of fathers during subsequent pregnancy and the puerperium. However, I would like to raise a few points which need further discussion.

Social support from family or partner following such a life event can have a substantial impact on subsequent mental and physical well-being, which may also determine the subsequent level of coping. Turton et al measured support from partner and family as a dichotomous (yes/no) variable, which does not seem entirely appropriate. Social support is a multidimensional construct and should have been analysed in terms of quantity and quality. Various questionnaires such as the Norbeck Social Support Questionnaire; http://nurseweb.ucsf.edu/www/NSSQ-Instrument.pdf are available to evaluate social support in a holistic and objective manner. Second, Turton et al, relaxed the inclusion criteria by including four couples after the safe arrival of their babies. This might have skewed the final result.

Interestingly, the fact that fathers often refused to take part in the interview could have led to underestimation of the psychological impact of stillbirth and the underlying psychiatric morbidity. It would have been informative if the authors had identified the reasons for their refusal. This is particularly important since it is well accepted that fathers generally tend to minimise their problems, put on a ‘brave face’ and refuse to speak out. There is no mention of the reliability or validity of the scale used for the assessment of marital satisfaction. Moreover, exclusion of Black participants and those from minority ethnic groups limits the application of the results to a wider general population.

However, I think this is a relevant and significant study which may prove to be beneficial for a wider understanding of this poorly recognised problem. It highlights the importance of actively encouraging fathers to be more forthcoming about their problems and also helps health professionals to focus on high-risk couples.