Infanticide and its relationship with postpartum psychosis : a critical interpretive synthesis

Abstract

Homicide is the cause of death in one in five deaths related to injury globally in children aged younger than five years (Child Trends, 2015). Infanticide is defined as the homicide of an infant within its first year of life (Ellonen, Kaarianeh, Lethi, & Aaltonen, 2015). The most likely perpetrators of infanticide are the biological mothers of the infants (Stockl et al., 2017). Infanticide in developed countries occurs at an estimated rate of 2.1 to 6.9 per 100 000 live births (Abrahams et al., 2016). South Africa's infanticide rate is estimated at 28.9 per 100 000 live births, more than double that of the global estimates (Abrahams et al., 2016). Postpartum psychosis is currently considered a 'rare' phenomenon in the literature, occurring in approximately one to two per 1000 births (Doucet, Letoutneau, & Robertson-Blackmore, 2011). Postpartum psychosis is considered as a psychiatric emergency (Barnes & Brown, 2016). The most noticeable symptoms of postpartum psychosis include delusions, hallucinations, and disorganised behaviour (Stewart et al., 2003). Infanticide is one of the well-known risk factors for women suffering from postpartum psychosis (Spinelli, 2009). The current literature on the phenomenon of infanticide within the context of postpartum psychosis is predominantly either medically informed or informed by legislation. The study aimed to synthesise the available literature on the phenomenon of infanticide within the context of postpartum psychosis. The method used to achieve this was Critical interpretive synthesis (CIS), as coined by Dixon-Woods et al. (2006). The study further aimed to shift its focus to the environmental aspects involved in the outcome of infanticide within the context of postpartum psychosis, as well as the chosen method of inflicting death. A synthesis of the literature from a different perspective added to the existing body of knowledge in a new and meaningful manner. This could possibly lead to greater awareness on the phenomenon and inform further research. An electronic search of the literature using the EBSCO Discovery Service was used. Ultimately, 51 sources were considered of which 15 were included in the final sample. Sources were included based on their quality and ability to answer the research questions. Non-peer reviewed studies and studies without the potential to adequately address the research questions were excluded. All sources under consideration were independently reviewed by the primary and co-reviewer in terms of their title and abstract. The studies were then examined in full text to finalise inclusion or exclusion independently by the reviewers. The reviewers ultimately agreed to include the final 15 sources. The reviewers critically appraised the sources using the two-pronged approach as suggested by Dixon-Woods et al. (2006). The reviewers then proceeded to the data analysis phase and ultimately constructed a list of initial themes which emerged from the literature. The initial themes became synthetic constructs which assisted with the exploration and discussion of the phenomenon of infanticide within the context of postpartum psychosis. In addition, due to the natural critique arising from CIS (Dixon-Woods et al., 2006), a critical reflection of the current body of literature formed part of the study. The first synthetic construct involved the prior psychiatric history of the perpetrator as well as prior psychiatric care. The second construct involved the demographics of the perpetrator including age, marital status, and employment. The third synthetic construct involved the perceptions on motherhood e.g., wanting to become a mother and planning pregnancy, as well as those perceptions resulting from the individuals in their environment such as the women being superior caretakers. An additional construct involved the victims: the synthesis found that victims were often aged between three and 11 months, which had implications for diagnostic considerations, i.e., that there are often multiple victims including older biological children and that victims are commonly killed using hands. The following synthetic construct was based on the presence of warning behaviour before infanticide was committed. The study also reflected on the current state of literature. The study indicated that most research on the topic is outdated, with a mean publication date of 2000. In addition, the current available literature is heavily informed by the medical or legislative disciplines. Furthermore, the manner in which both the concepts of infanticide and postpartum psychosis is described and understood is reflective of society's view on motherhood and how mothers 'should' be. Lastly, the study discusses the implications of describing the phenomenon of psychotic infanticide as rare.