Delaying parenthood: choice or circumstance?

People, especially women, are delaying having children until later ages. The average age of first birth in the UK is now 29.5, an increase of six years over the past four decades. This may be problematic not only due to the fact that fertility declines with age (with a marked decrease after age 35) but also due to the fact that older age is associated with more complications during pregnancy and delivery to both mother and baby. Previous research has shown that although people have awareness of fertility risks and issues in general they often underestimate the risks and may not apply them to themselves. The aim of the present thesis is to examine reasons why people may be delaying childbearing, whether they know about the risks associated with reduced fertility and how we can better educate people about these risks

Psychosis and homicide

Purpose of review The contribution of people with psychosis to homicide statistics is small, but there is a statistically significantly higher rate of homicide among them than in the general population. Legal authorities and the wider public call for more information. Our aim was a narrative synthesis of empirical literature generated by systematic searches for the five complete years 2013–2017. Recent findings One article showed that people with psychosis are five times more likely to be homicide victims than those without, but focus remains on perpetrators. Consensus is that although psychotic symptoms contribute to homicidal acts, so do many of the variables that increase homicide risk more generally – including substance use, trauma histories and access to weapons; thus, both the epidemiology of homicide and some details, like method, may be country specific. In 2013–2017, variation in service provision as a risk factor for homicide has emerged more clearly but, overall, research made few homicide-specific advances. Summary Criminal homicide is, fortunately, uncommon in most countries. Homicides by people with psychosis are so rare that they do not rate mention in the 2013 United Nations Global Survey of Homicide. This may account for the limitations to much research for this group. Despite some homicide-specific evidence of advantage for early intervention for psychosis, impact of improving treatment – the most promising way forward – will generally have to be inferred from the not entirely satisfactory surrogate of effects of treatment on violent offending more generall

Offspring outcomes when a parent experiences one or more major psychiatric disorder(s): a clinical review

We sought evidence on quantifiable offspring outcomes, including problems, needs and strengths, associated with their experience of major parental psychiatric disorder(s), focusing on schizophrenia, affective illnesses and personality disorder(s). We were motivated by the absence of any systematic exploration of the needs of offspring of parents in secure hospitals. Seven electronic databases were searched to identify systematic reviews of studies quantifying offspring outcomes when a parent, or parent surrogate, has major psychiatric disorder(s). Our search (updated in February 2018) identified seven high-quality reviews, which incorporated 291 unique papers, published in 1974–2017. The weight of evidence is of increased risk of poor offspring outcomes, including psychiatric disorder and/or behavioural, emotional, cognitive or social difficulties. No review explored child strengths. Potential moderators and mediators examined included aspects of parental disorder (eg, severity), parent and child gender and age, parenting behaviours, and family functioning. This clinical review is the first review of systematic reviews to focus on quantifiable offspring problems, needs or strengths when a parent has major psychiatric disorder(s). It narratively synthesises findings, emphasising the increased risk of offspring problems, while highlighting limits to what is known, especially the extent to which any increased risk of childhood problems endures and the extent to which aspects of parental disorder moderate offspring outcomes. The absence of the reviews’ consideration of child strengths and protective factors limits opportunity to enhance offspring resilience

Adjustment to short-term imprisonment under low prison staffing

Aims and method To understand experience of early imprisonment in one prison under low staffing levels. A researcher, independent of the prison, interviewed each prisoner soon after reception and 3–4 weeks later. The first question of the second interview was: ‘I’d like to start by asking you about your experience of the last 3–4 weeks in prison'. Data are verbatim answers to this. Narratives were brief, so responses from all 130 participants were analysed, using grounded theory methods. Results The core experience was of ‘routine’ – characterised by repetitive acts of daily living and basic work, and little reference to life outside prison – generally resolved passively, towards boredom and ‘entrapment’. Clinical implications This ‘routine’ seems akin to the ‘institutionalism’ described in the end days of the 1960s’ mental hospitals. In an earlier study of similar men at a similar stage of imprisonment, under higher staff:prisoner ratios, experience was initially more distressing, but resolved actively and positively, suggesting that staff loss may have affected rehabilitative climate

Remorse in psychotic violent offenders: an overvalued idea?

Expressing remorse – or not – appears to influence criminal justice outcomes, but preliminary exploration of both judicial and psychological concepts suggests they lack clarity. We asked the following questions: does psychosis impair capacity for, or expression of, remorse for a homicide or other serious harm to others? Is failure to express remorse for an offence associated with recidivism? We conducted systematic reviews of empirical literature on remorse for serious violence while psychotic, and on relationships between remorse and reoffending regardless of mental state. No articles on remorse for homicide or other serious violence while psychotic were identified. There is weak evidence that lack of remorse is associated with reoffending generally, but nothing specific to psychosis. The literature is strong enough to support a case for research into valid measurement of remorse for offending, associations of such measures with recidivism, and whether a change in remorse can be effected – or matters. It is not strong enough to support reliance on perceptions of the presence or absence of remorse as a basis for judicial decisions

What makes people ready to conceive? Findings from the International Fertility Decision-Making Study

This study investigated fertility decision-making in people currently trying to conceive, and examined whether factors that make people ready to conceive differ by gender and country. The study used data from the International Fertility Decision-Making Study, a cross-sectional study of 10,045 participants (1690 men and 8355 women) from 79 countries. Respondents were aged 18–50 years (mean 31.8 years), partnered and had been trying to conceive for >6 months (mean 2.8 years). Respondents indicated their need for parenthood; their own/partner's desire for a child; and the influence of certain preconditions, motivational forces and subjective norms in relation to readiness to conceive. Factor analysis of preconditions and motivational forces revealed four decisional factors: social status of parents, economic preconditions, personal and relational readiness, and physical health and child costs. Significant gender differences were found for desire for a child, decisional factors and subjective norms. Compared with men, women had higher personal desire for a child, and rated economic and personal and relational readiness as more influential. Men were more likely to rate subjective norms and social status of parents as more influential. Country comparisons found significant differences in personal desire for a child, partner's desire for a child, need for parenthood, preconditions, motivational forces and subjective norms. The results demonstrate that some decisional factors have a universal association with starting families (e.g. desire for a child), whilst the influence of others (e.g. personal and relational readiness) is dependent on contextual factors. These findings support the need for contemporary, prospective and international research on reproductive decision-making, and emphasize the need for effective fertility policies to take contextual factors into account

Association between adverse childhood experiences and a combination of psychosis and violence among adults: a systematic review and meta-analysis

Relationships have been well established between adverse childhood experiences (ACEs) and later psychosis (29 systematic reviews) or violence (4 systematic reviews). To date, just one review has explored childhood maltreatment, specifically, and violence risk with psychosis. We conducted a systematic review and meta-analyses of a wider range of ACEs and later psychosis with actual violence compared with psychosis alone, violence alone or neither, completing searches in January 2021. In all, 15 studies met inclusion criteria, but only six included all four groups of interest. Two substantial studies recorded ACEs from sources independent of those affected and probably before emergent psychosis or violence; others relied on retrospective recall. Meta-analyses were possible only for within-psychosis-group comparisons; histories of physical abuse, sexual abuse, and having a criminal/violent parent or living with family alcohol/drug use were each associated with around twice the odds of psychosis with violence as psychosis alone. Although ACE measures in the four-way comparisons were too divergent for firm conclusions, abuse histories, and parental criminality emerged as likely antecedents, one study evidencing psychosis as mediating between ACEs and violence. Without longitudinal prospective study, pathways between ACEs and later problems remain unclear. Our findings add weight to the case for exploring ACEs in addition to abuse as possible indicators of later violence among people with psychosis and for trauma-informed interventions, which is important because some people are reluctant to disclose abuse histories

Benefits and risks of conjugal visits in prison: A systematic literature review

Background Imprisonment impacts on lives beyond the prisoner's. In particular, family and intimate relationships are affected. Only some countries permit private conjugal visits in prison between a prisoner and community living partner. Aims Our aim was to find evidence from published international literature on the safety, benefits or harms of such visits. Methods A systematic literature review was conducted using broad search terms, including words like ‘private’ and ‘family’, to maximise search sensitivity but strict criteria for inclusion – of visits unobserved by prison staff and away from other prisoners. All included papers were quality assessed. Two of us independently extracted data from included papers, according to a prepared checklist. Meta-analysis was considered. Results Seventeen papers were identified from 12 independent studies, all but three of them from North America. The only study of health benefits found a positive association with maintaining sexual relationships. The three before-and-after study of partnership qualities suggested benefit, but conjugal visiting was within a wider family-support programme. Studies with in-prison behaviour as a possible outcome suggest small, if any, association, although one US-wide study found significantly fewer in-prison sexual assaults in states allowing conjugal visiting than those not. Other studies were of prisoner, staff or partner attitudes. There is little evidence of adverse effects, although two qualitative studies raise concerns about the visiting partner's sense of institutionalisation or coercion. Conclusions The balance of evidence about conjugal visiting is positive, but there is little of it. As stable family relationships have, elsewhere, been associated with desistance from crime, the contribution of conjugal visiting to these should be better researched