The Effects of Self-Blame On Anxiety and Depression Among Women Who Have Experienced a Stillbirth

Background: Approximately 1 out of 110 pregnancies result in stillbirth, making stillbirth at least ten times more prevalent than Sudden Infant Death Syndrome. Stillbirth represents a traumatic experience for many mothers, and some of those women will go on to suffer long-term psychological distress. The development of depression and/or anxiety following stillbirth is, thus, common. Previous research has identified variables correlated with the development of anxiety and depression (e.g., social support, time since stillbirth, and abuse during pregnancy), but research is needed regarding other predictive variables in the development of negative psychological outcomes following stillbirth. Existential emotions such as guilt, shame, and blame are likely to play in important role.

Purpose: To model the relationship between self-blame and the development of clinically significant depression or anxiety following the death of a baby to stillbirth.

Method: Data from a non-probability survey of women who had experienced a stillbirth (n=2,332) were used to construct several logistic regression models. Separate models were created for depression and anxiety, using the clinical cut-off score of 1.75 on the Hopkins Symptom Checklist (HSCL) depression and anxiety subscales.

Results: Women reporting that they blamed themselves for the stillbirth were roughly 84% more likely to develop clinical anxiety (reference category: no self blame; Wald test=30.6, df=1, p<.001, OR=1.84, 95% CI=1.48, 2.28). Women who blamed health care providers or others had an elevated risk of anxiety, but less than self-blame (for health care providers blamed versus not, Wald test=4.39, df=1, p<.036, OR=1.25, 95% CI= 1.01, 1.54; for all other external sources of blame versus not, Wald test=6.42, df=1, p<.011, OR=1.47, 95% CI= 1.09, 1.98). The other variables in the model were age of the mother, years since stillbirth, level of education, and abuse during pregnancy, all of which were statistically significant. Women with self-blame had were 2.7 times more likely to develop depression (reference category: no self blame, Wald test=69.0, df=1, p<.001, OR=2.70, 95% CI= 2.10, 3.46), and almost twice as likely when blaming others (Wald test=13.0, df=1, p<.001, OR=1.98, 95% CI= 1.37, 2.88). Level of education, years since stillbirth, and abuse during the pregnancy were also statistically significant predictors of depression. Blame directed at health care providers and age of the mother were not statistically significant in this model (for overall model, χ²=249.1, df=7, p<.001).

Conclusion: In the prediction of both depression and anxiety after experiencing stillbirth, self-blame had the highest effect size of all variables tested. This has important implications for clinicians working with women who have suffered the death of a baby to stillbirth. Mothers who exhibit self-blaming attributes during psychotherapy may be at increased risk for negative psychological outcomes. While more research is needed in this area, clinical social workers should be aware of the potential role of self-blame when treating clients who have experienced a stillbirth.