The psychological effects of stillbirth and neonatal death on fathers: systematic review.

OBJECTIVE: To review the available evidence on the psychological effects of perinatal death on fathers. METHOD: Electronic search of CINAHL, MEDLINE and PsycINFO databases from 1966-2005. INCLUSION CRITERIA: papers describing at least one psychological outcome for fathers who had experienced stillbirth or neonatal death. EXCLUSION CRITERIA: papers not in English, dissertations, reviews, books without original data, intervention studies, studies of parents without separate results for fathers, studies where perinatal loss was not distinguished from other losses, first person accounts of a single experience, studies reporting on fewer than five fathers. Seventy-seven potential papers were obtained and screened by two authors. Seventeen studies were included. Study quality was rated using a checklist and main findings were summarized. RESULTS: Quality of methodology varied. Qualitative studies described classical grief responses, but less guilt than mothers. Fathers described experiences related to their social role and potential conflict between grieving couples. Quantitative research reported symptoms of anxiety and depression, but at a lower level than mothers. Fathers may develop post-traumatic stress disorder following stillbirth. DISCUSSION: Case prevalence of psychological disorders is unknown. More good quality research is needed. The social role of fathers as carers for their partners needs recognition when planning care for bereaved families.