Is partners' mental health and well-being affected by holding the baby after stillbirth? Mothers' accounts from a national survey.

OBJECTIVE: This study aimed to assess the effects on partners' health and well-being of holding a stillborn baby. BACKGROUND: Findings from quantitative and qualitative studies have produced inconsistent results concerning the effects of holding a stillborn baby on parents. METHODS: Secondary analyses were conducted on postal questionnaire data relating to 455 partners of women who had a stillbirth. Women answered questions about their partners' behaviour, perceptions of care, mental health and well-being at three and nine months after the stillbirth. Demographic, clinical and care characteristics were compared between partners who, according to the mothers, did and did not hold their baby. Sub-group analyses assessed hypothesised moderating effects. RESULTS: Mothers reported that most partners saw (92%) and held (82%) their stillborn baby. However, partners born outside the UK were less likely to have held their baby. Higher gestational age, shorter time interval between antepartum death and delivery, and mother's holding the baby all predicted a higher rate of partner's holding. There was a consistent negative effect of holding the baby across mental health and well-being outcomes, although after adjustment only higher odds of depression (OR 2.72, 95% CI 1.35-5.50) and post-traumatic stress type symptoms (OR 1.95, 95% CI 1.01-3.78) at 3 months were significantly associated with having held the baby following stillbirth. CONCLUSIONS: This study is the first to assess the impact of holding the baby on partners' mental health and well-being. The prevalence of depression and anxiety were high, and the negative effects of holding the baby were significant 3 months later.

Exposure to food cues moderates the indirect effect of reward sensitivity and external eating via implicit eating expectancies.

Previous research has suggested that the expectancy "eating is rewarding" is one pathway driving the relationship between trait reward sensitivity and externally-driven eating. The aim of the current study was to extend previous research by examining the conditions under which the indirect effect of reward sensitivity and external eating via this eating expectancy occurs. Using a conditional indirect effects approach we tested the moderating effect of exposure to food cues (e.g., images) relative to non-food cues on the association between reward sensitivity and external eating, via eating expectancies. Participants (N = 119, M = 18.67 years of age, SD = 2.40) were university women who completed a computerised food expectancies task (E-TASK) in which they were randomly assigned to either an appetitive food cue condition or non-food cue condition and then responded to a series of eating expectancy statements or self-description personality statements. Participants also completed self-report trait measures of reward sensitivity in addition to measures of eating expectancies (i.e., endorsement of the belief that eating is a rewarding experience). Results revealed higher reward sensitivity was associated with faster reaction times to the eating expectancies statement. This was moderated by cue-condition such that the association between reward sensitivity and faster reaction time was only found in the food cue condition. Faster endorsement of this belief (i.e., reaction time) was also associated with greater external eating. These results provide additional support for the proposal that individuals high in reward sensitivity form implicit associations with positive beliefs about eating when exposed to food cues.

Impact of holding the baby following stillbirth on maternal mental health and well-being: findings from a national survey.

OBJECTIVES: To compare mental health and well-being outcomes at 3 and 9 months after the stillbirth among women who held or did not hold their baby, adjusting for demographic and clinical differences. DESIGN: Secondary analyses of data from a postal population survey. POPULATION: Women with a registered stillbirth in England in 2012. METHODS: 468 eligible responses were compared. Differences in demographic, clinical and care characteristics between those who held or did not hold their infant were described and adjusted for in subsequent analysis. Mental health and well-being outcomes were compared, and subgroup comparisons tested hypothesised moderating factors. OUTCOME MEASURES: Self-reported depression, anxiety, post-traumatic stress disorder (PTSD) symptoms and relationship difficulties. RESULTS: There was a 30.2% response rate to the survey. Most women saw (97%, n=434) and held (84%, n=394) their baby after stillbirth. There were some demographic differences with migrant women, women who had a multiple birth and those whose pregnancy resulted from fertility treatment being less likely to hold their baby. Women who held their stillborn baby consistently reported higher rates of mental health and relationship difficulties. After adjustment, women who held their baby had 2.12 times higher odds (95% CI 1.11 to 4.04) of reporting anxiety at 9 months and 5.33 times higher odds (95% CI 1.26 to 22.53) of reporting relationship difficulties with family. Some evidence for proposed moderators was observed with poorer mental health reported by women who had held a stillborn baby of <33 weeks' gestation, and those pregnant at outcome assessment. CONCLUSIONS: This study supports concern about the negative impact of holding the infant after stillbirth. Results are limited by the observational nature of the study, survey response rate and inability to adjust for women's baseline anxiety. Findings add important evidence to a mixed body of literature.

Contact with the baby following stillbirth and parental mental health and well-being: a systematic review.

OBJECTIVE: To collate and critically appraise extant evidence for the impact of contact with the stillborn infant on parental mental health, well-being and satisfaction. DESIGN: Systematic review. DATA SOURCES: A structured systematic search was conducted in 13 databases, complemented by hand-searching. STUDY ELIGIBILITY CRITERIA: English language studies providing quantitative comparison of outcomes for parents who held their baby or engaged in other memory-making activities, such as having photos and handprints, compared to those who did not, were eligible for inclusion. OUTCOME MEASURES: Primary outcomes included clinically diagnosed mental health issues, standardised assessment of mental health issues or self-reported psychological distress. Secondary outcomes included poor health, relationship difficulties and satisfaction with the decision to have contact with the baby. RESULTS: Two authors independently screened abstracts, selected potentially eligible studies, extracted data and evaluated the quality of included papers. 11 eligible studies, reported in 18 papers, were included. Studies were heterogeneous, precluding quantitative synthesis, thus a narrative synthesis is presented. Studies presented high risks of bias, particularly in regard to sample representativeness, and confounder identification and adjustment. Results were mixed concerning the impact of holding the stillborn baby on mental health and well-being. One study found no significant effects, and two studies reported no impact on depression. Conflicting effects were found for anxiety and post-traumatic stress. Other memory-making activities were not found to have a significant association with mental health or well-being outcomes. Across studies, mothers were satisfied with their decision to hold their baby or engage in other memory making. CONCLUSIONS: Evidence for the impact of holding the stillborn baby on mental health and well-being is sparse, and of poor quality. High-quality research guided by a priori hypotheses, with attention to potential confounders and moderating effects, is needed to provide more rigorous evidence to guide practitioners' and parents' decision-making for care following stillbirth. REVIEW PROTOCOL NUMBER: PROSPERO CRD42014013890.

Great expectations. Eating expectancies as mediators of reinforcement sensitivity and eating.

Eating expectancies are proposed as cognitive pathways linking reinforcement (reward and punishment) sensitivities and the tendency to over-eat in response to appetitive and emotional cues. In Study One (N=243 university women) explicit eating expectancies were tested as potential mediators of reinforcement sensitivities and eating styles. Broadly, expectancies that eating alleviates negative affect/boredom mediated both reward and punishment sensitivity and emotional eating. The expectancy that eating is pleasurable and rewarding mediated reward sensitivity and external eating. In Study Two (N=109), using an implicit eating expectancy task, reward sensitivity and external eating was mediated via positive expectancy statements, notably, that eating is pleasurable and rewarding. Reward sensitivity and emotional eating was mediated specifically by expectancies that eating manages boredom. Punishment sensitivity was not associated with any implicit expectancies. Findings support the role of expectancies as cognitive mediators in the relationship between reinforcement sensitivities and emotionally-driven versus externally-driven eating styles. However, the largely appetitive implicit expectancies task only supported an association with reward sensitivity.