Causal Attributions in Parents of Babies With a Cleft Lip and/or Palate and Their Association With Psychological Well-Being

Objective: This study aimed to assess causal attributions of parents of babies with a cleft lip and/or palate. Evidence from causal attribution theory and attribution studies in other medical conditions led to the hypothesis that parents who make internal attributions (self-blame) will have poorer psychological wellbeing. Design: A cross-sectional survey. Setting: Postal questionnaires were sent to parents of children under the care of the South Thames Cleft Service at Guy's Hospital. Participants: Participants were recruited if they had a baby between 12 and 24 months old with a cleft lip and/or palate. Of 204 parents, 42 responded. Main Outcome Measures: A semistructured questionnaire about causal beliefs was completed alongside validated questionnaires measuring anxiety, depression (Hospital Anxiety and Depression Scale), and perceived stress (Perceived Stress Scale). Results: Causal attributions were grouped according to type (environmental, chance, self-blame, and no belief) and loci (external or internal). The most common attribution made was to external factors (54.4%), followed by no causal attribution (38.1%). Parents making an internal (self-blaming) attribution (16.7%) had significantly (p < .05) higher scores on the Hospital Anxiety and Depression Scale anxiety measure (r = .32) and Perceived Stress Scale (r = .33), but not on the Hospital Anxiety and Depression Scale depression measure (p = .283). Conclusions: The high number of parents making an external attribution can be explained by causal attribution theory. However, the percentage of parents making no causal attribution was higher than seen in previous research. Surprisingly, no parents blamed others. The main hypothesis was tentatively accepted because there were significantly higher anxiety and stress scores in parents who self-blamed; although, depression scores were not significantly higher.