Trial lecture: Psychological mismatch: when a generation of expectancy meets global instability and uncertainty.
Ordinary opponents:
- First opponent: Professor Rebecca Pearson, Manchester Metropolitan University, UK
- Second opponent: Associate Professor Cathrine Ebbing, University of Bergen/Haukeland University Hospital
- Leader of the committee: Associate Professor Peter Forde Hougaard, OsloMet
Leader of the public defence is Professor Ellen Blix, OsloMet.
Supervisors:
- Professor Anne Kaasen, OsloMet
- Associate Professor Mona Bekkhus, University of Oslo
- Professor Guttorm Haugen, University of Oslo
Thesis abstract
Receiving a diagnosis of fetal anomaly during pregnancy can be a traumatic experience that causes distress for the expectant parents.
Aim
The aim of this thesis was to examine parental stress reactions and resilience following ultrasound findings of fetal anomaly, and to compare this to expectant parents without findings of fetal anomaly.
Resilience regards the ability to manage stress. Stress can be understood as a biopsychosocial phenomenon, meaning that stress responses are considered an interaction between biological, psychological, and social variables.
Method
The participants included 93 pregnant women with detected fetal anomaly and 80 of their partners, as well as 110 pregnant women with normal ultrasound findings and 98 of their partners.
Data was collected at four timepoints during pregnancy (T1-T4), six weeks after birth (T5), and ten-to-twelve years after birth (T6).
This included self-reported traumatic stress and depression, blood samples for cortisol and other stress hormones (T1 and T3 only), and self-reported resilience and relationship satisfaction (T6 only).
Findings
It was found that parents who received a diagnosis of fetal anomaly experienced elevated symptoms of depression and traumatic stress, compared to parents without findings of fetal anomaly.
All expectant parents reacted to the diagnosis with high levels of acute psychological stress. Across time in pregnancy, women in the study group had lower cortisol levels than women in the comparison group.
Lower cortisol was predicted by elevated symptoms of depression and traumatic stress. Six weeks postpartum we observed a divergence in stress trajectories among parents in the study group, such that those with the most severe diagnoses experienced increased stress after birth compared to during pregnancy, and those with a less serious diagnosis experienced a decline.
Prognostic ambiguity and changes in the diagnoses were also associated with increased stress among women. At ten-to-twelve-year follow-up we found that parents to children with congenital malformations continue to experience elevated levels of traumatic stress, however they reported resilience and relationship satisfaction at comparable levels to non-affected parents.
High levels of stress in pregnancy and in the family over time can adversely affect developmental outcomes and family dynamics. Factors influencing parental adjustment to a child’s disability are important to delineate in order to provide optimal care for families.
In the thesis we discuss the ways in which biological, psychological and social variables interact over time to shape parental stress responses and resilience, and ways in which interventions can be targeted to improve outcomes for families.
