Family implications during deprivation of liberty and Attachment Theory: a qualitative metasynthesis

Implicaciones familiares durante la privación de libertad y la Teoría del Apego: una metasíntesis cualitativa

ABSTRACT

Objectives:

to synthesize evidence from qualitative studies about the implications that the deprivation of liberty process has on incarcerated adults’ family relationships.

Methods:

a qualitative meta-synthesis, carried out in January 2021, by searching for publications indexed in six databases. The sample consisted of 10 studies, which were analyzed by MaxQDA®, and an interpretative synthesis was performed based on Attachment Theory.

Results:

based on first-order concepts, it was possible to synthesize second- and third-order concepts and present them in two interpretive context units: Strategies for strengthening family ties; Relationships that contribute to breaking down family ties. It was evidenced that visits, phone calls and letters favor the strengthening of secure attachment.

Final Considerations:

incarceration causes consequences in tie formation, reflecting on the attachment process between family members.

Descriptors:
Family Relations; Family; Prisoners; Affect; Nursing

RESUMEN

Objetivos:

sintetizar evidencias de estudios cualitativos sobre las implicaciones que tiene el proceso de privación de libertad en las relaciones familiares de los prisioneros.

Métodos:

metasíntesis cualitativa, realizada en enero de 2021, mediante búsqueda de publicaciones indexadas en seis bases de datos. La muestra estuvo compuesta por 10 estudios, los cuales fueron analizados por el software MaxQDA®, y se realizó una síntesis interpretativa basada en la Teoría del Apego.

Resultados:

a partir de los conceptos de primer orden, fue posible sintetizar los conceptos de segundo y tercer orden y presentarlos en dos unidades de contexto interpretativo: Estrategias para el fortalecimiento de los vínculos familiares; Relaciones que contribuyen a la ruptura de los lazos familiares. Se evidenció que las visitas, llamadas telefónicas y cartas favorecen el fortalecimiento del apego seguro.

Consideraciones Finales:

el encarcelamiento provoca consecuencias en la formación de vínculos, reflexionando sobre el proceso de apego entre los miembros de la familia.

Descriptores:
Relaciones Familiares; Familia; Prisioneros; Afecto; Enfermería

RESUMO

Objetivos:

sintetizar as evidências de estudos qualitativos acerca das implicações que o processo de privação de liberdade apresenta nas relações familiares de adultos apenados.

Métodos:

metassíntese qualitativa, realizada em janeiro de 2021, por meio da busca de publicações indexadas em seis bases de dados. A amostra foi composta por 10 estudos, que foram analisados pelo software MaxQDA®, e realizada a síntese interpretativa com base na Teoria do Apego.

Resultados:

com base nos conceitos de primeira ordem, foi possível sintetizar os conceitos de segunda e terceira ordem e apresentá-los em duas unidades de contexto interpretativo: Estratégias de fortalecimento de vínculos familiares; Relações que contribuem para a ruptura de vínculos familiares. Foi evidenciado que as visitas, telefonemas e cartas favorecem o fortalecimento do apego seguro.

Considerações Finais:

o encarceramento provoca consequências na formação de vínculos, refletindo no processo de apego entre os familiares.

Descritores:
Relações Familiares; Família; Prisioneiros; Afeto; Enfermagem

INTRODUCTION

Over time, the concept of family was influenced by numerous changes, concomitant with the historical, political, economic and social events experienced in Brazil and in the world. Despite the structural changes, the family remains the institution that promotes and strengthens ties and the affective support necessary for human development, providing indispensable subsidies for the well-being of those who integrate it(¹). Furthermore, it also plays a decisive role in education and health, because, within its structure, it transmits the cultural, moral and ethical values that influence behavior and life in society.

The families occupy different places in the struggle for the reproduction of life and survival. In these relations of coexistence, conflicting or not, they exchange experiences, accumulate knowledge and skills, habits and customs that help in the production and reproduction of conceptions and cultural values(²). Incarceration favors breakdowns in the flow of life, as it directly affects the distance of family life from children, friends and everyone who is part of the social environment(³).

According to the World Prison Brief(⁴), a worldwide survey on prison data carried out by the Institute for Crime & Justice Research (ICPR)and by Birkbeck University of London, Brazil ranks third in number of persons deprived of their liberty, behind only the United States and China. Data from the Brazilian National Penitentiary Department show that, in December 2019, the Brazilian prison population reached the number of 748,009 people, including men and women from all prison regimes(⁵).

Over the years, this theme was addressed and discussed mainly from the perspective of human and social sciences(⁶), whose studies highlighted the epidemiological profile of this population(⁷), education in the prison environment(⁸), health and public policies(⁹,¹⁰,¹¹), among others. It is noteworthy that nurses and the health team have an important role in the process of socialization and health promotion to the family. However, knowledge about deprivation of liberty and its repercussions on family relationships still presents a gap in scientific literature, which prevents these professionals from using the best evidence to direct their practices to this population.

From this perspective, synthesizing the knowledge produced about this phenomenon and interpreting how attachment issues are established during the imprisonment of a family member strengthens the search for strategies that intend to mitigate possible implications for mental and physical health, especially for children and caregivers who experience this reality.

Given the above and the importance of better clarifying how convicts’ family relationships work, the need emerged to synthesize the evidence of qualitative studies about the implications that the deprivation of liberty process has on convicts’ family relationships.

OBJECTIVES

To synthesize evidence from qualitative studies about the implications that the deprivation of liberty process has on incarcerated adults’ family relationships.

METHODS

This is a qualitative metasynthesis, a method used to create an interpretative synthesis of qualitative primary evidence in order to assist in making possible clinical decisions(¹²). Therefore, the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) recommendations were used to conduct the five stages(¹³) of the development of this review, as shown in Figure 1.

Figure 1
Flowchart of meta-synthesis operationalization according to Enhancing Transparency in Reporting the Synthesis of Qualitative Research, Chapecó, Santa Catarina, Brazil, 2021

The SPIDER(¹⁴) strategy was used to conduct the elaboration of the research question and the search used, in which the acronym of the words was structured by: sample (S): adults convicted; phenomenon of interest (PI): possible implications established in the relations between convicts and their families during the deprivation of liberty process; design (D): ethnography, phenomenology, grounded theory, case studies, conversation analysis, narrative, hermeneutics, history, action research, thematic, content or generic descriptive analysis; sample group assessment on the phenomenon of interest (E): perspective or experience about the phenomenon; research design (R): qualitative. Thus, the following research question was elaborated: what are the implications of the deprivation of liberty process in convicts’ family relationships?

To identify eligible studies in literature, a systematic search was carried out by two independent researchers in six databases (in this order of access): PubMed, Web of Science, Embase, Science Direct, PsycINFO and LILACS. The search strategy was developed by combining the MeSH, EMTREE, APA thesaurus and DeCS terms, such as family relations, family, prisons and prisoners, as well as their synonyms and keywords, which were combined with the Boolean operators OR and AND. The following advanced search strategyis presented in the MEDLINE database: (((((((((((((Family Relations]) OR (Family[Title/Abstract])) AND ((((((Prison [Title/ Abstract]) OR (Prisoners Title/Abstract])). From this, the other strategies were adapted according to the specificities of each database. The search was conducted in January 2021, limited to the period between January 2010 and December 2020.

Original references, written in Portuguese, English or Spanish, which exclusively used the qualitative method and which investigated family relationships linked to the deprivation of liberty process, were included. Literature considered gray (books, course conclusion works, theses and dissertations), editorials, letters to the editor, reflective and review studies were excluded.

The systematic search resulted in the identification of a total of 4,827 records: 2,769 in the PubMed database, 162 in Web of Science, 651 in Embase, 1,165 in Science Direct, 77 in PsycINFO, and three in LILACS. Two references were obtained through unsystematic search. Therefore, 4,829 publications were identified. To optimize the process, two researchers, independently (first and last author), conducted the selection of studies through the Rayyan®(¹⁵) platform. Blinding was ensured, and possible disagreements were resolved by consultation with a third reviewer. Initially, the identified records were uploaded to the platform and, after removing the duplicates, 4,770 were analyzed by reading titles and abstracts. Then, the selection criteria were applied, and 4,671 records were excluded, because they were studies with quantitative, theoretical-reflective, mixed (qualitative and quantitative) methodologies, review studies and because they did not address the phenomenon of interest. In this process, 99 records were elected, which were analyzed in full, and, among these, 89 were excluded for not answering the research question. It should be noted that, respecting the search order of the databases, the double records were considered only once. For the final synthesis, 10 studies were selected. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) (¹⁶) was used to report the selection process of studies included in the meta-synthesis (Figure 2).

Figure 2
Flowchart of meta-synthesis operationalization according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses, Chapecó, Santa Catarina, Brazil, 2021

Using the Critical Appraisal Skills Programme (CASP) criteria, two researchers independently assessed the rigor of the selected studies(¹⁷). Due to divergence in decision regarding one of the records, a third evaluator was consulted, obtaining consensus. After the analytical process, the references were categorized into two classes (A and B). Class A represented references with a small risk bias (at least nine of the ten items were met). Class B indicates references with moderate risk bias (at least 5 of the 10 items met in the analysis). In this process, it was decided not to exclude any reference (Chart 1).

Chart 1
Quality assessment of included studies according to Critical Appraisal Skills Programme, Chapecó, Santa Catarina, Brazil, 2021

Questions	Authors*
	Dennison(23)	Sharratt(24)	Rosa(25)	Pereira(26)	Shlafer(27)	Poehlmann-tynan(28)	Sufrin(29)	Mccarthy(30)	Mccarthy(31)	Davison(32)
1. Have the research objectives been clearly reported?	●	●	●	●	●	⦸	●	●	●	●
2. Has the qualitative methodology been adequate?	●	●	●	●	●	●	●	●	●	●
3. Has the research design been adequate to achieve the proposed objectives?	●	●	●	●	●	●	●	●	●	●
4. Has the recruitment strategy been adequate to the research objectives?	●	●	●	●	●	●	●	●	●	●
5. Has the data been collected in order to address the research question?	●	●	●	●	●	●	●	●	●	●
6. Has the relationship between the researcher and participants been properly considered?	●	☓	☓	☓	●	●	●	☓	☓	☓
7. Have ethical issues been considered?	●	●	●	●	●	●	●	●	●	●
8. Has the data analysis been rigorous enough?	●	●	●	●	☓	●	●	●	●	●
9. Have the results been reported clearly?	●	●	●	●	●	⦸	●	●	●	●
10. Has the survey brought contributions?	●	●	●	●	●	●	●	●	●	●
- Classification ---------------------------	A	A	A	A	A	A	A	A	A	A

• ● Yes; ☓No; ⦸ Partially; *First author of the manuscript

Data extraction of studies was carried out with the aid of an instrument adapted from the Joanna Institute Briggs(¹⁸), composed of the following information: title, authors, country, year, place of publication, phenomenon of interest, study objectives, population, methodology, theory, results, and conclusions(¹⁹). With the data, MaxQDA®, version 2020(²⁰), was used to determine the relationship between the evidence, analyzing its characteristics from a broad perspective.

The software made it possible to go deeper, extrapolating the extracted contents, from the perspective of two different levels of connected analyses: (1) the thematic area and its possible related themes: its representation in quantitative terms (frequency of coded segments) and qualitative (what meaning they conveyed in the studied context); (2) the similarities and differences present in the perspectives addressed in the references. These characteristics allowed us to summarize the studies’ main findings regarding their particularities and, thus, first-order concepts were identified (Figure 3). Subsequently, in an interpretative process, first-order concepts were compared and grouped, from which second-order concepts were extracted(¹²). In order to construct the interpretative synthesis and understand convicts’ perspectives/experiences about family relationships during the deprivation of liberty process, second-order concepts were reinterpreted in the light of a theoretical context, which allowed the elaboration of interpretative syntheses (third-order concepts) about the studied phenomenon(¹²).

Figure 3
Description of first-order concepts, resulting from the analytical process of selected studies, Chapecó, Santa Catarina, Brazil, 2021

The theoretical support used to reinterpret the concepts was the Attachment Theory (AT). Attachment is a feeling biologically stimulated by the search for comfort and security, structured through internal operating models and mental representations of oneself and attachment figures. The way families strengthen their ties, the way a child is linked to parents and/or caregivers, seeking to feel valued and safe, can be explained through this theory(²¹).

The AT highlights the formation of ties during the phases of life. It is based on the interpretation of affective ties that occur between adults, babies and children (family members) that support human socioemotional development, which can be classified as safe and unsafe(²²). Secure attachment can be defined as one in which caregivers (attachment figures) provide children with a positive worldview, enabling family members a feeling of freedom so that they can express their feelings, in addition to allowing autonomy for them to explore the environment and develop their confidence. Insecure attachment, on the other hand, is a demonstration of difficulties and insecurity by family members, evidenced by feelings of anxiety, depression and low self-esteem, the result of living with an attachment figure that presented itself as unstable and vulnerable(²¹).

RESULTS

The construction of this meta-synthesis results from the reinterpretation of the results of ten qualitative studies. The final sample was organized and classified by research title, country and year of publication, main objectives, population and place of development (Chart 2).

Chart 2
Characterization of selected studies, Chapecó, Santa Catarina, Brazil, 2021

Title	Country/Year	Objectives	Population/Place
My life is separated: An Examination of The Challenges And Barriers To Parenting For Indigenous Fathers In Prison(23)	Australia/ 2014	Examine each participant’s identity as parents in prison and the barriers associated with maintaining relationships with their children.	41 Indigenous parents from two prisons in North Queensland.
Children’s Experiences of Contact with Imprisoned Parents: A Comparison between Four European Countries(24)	United Kingdom, Germany, Romania and Sweden/2014	Explore the impact of parental imprisonment on children, including questions about family relationships, physical and emotional well-being, school, social life, and involvement with support services.	135 families of prisoners in European countries.
La persona presa y (en) su trama social: un análisis pertinente (25)	Brazil/2015	Analyze incarcerated adults’ perception of their socio-affective support network in the process of preparing for freedom, through the mapping of microsystems, analysis of the network’s functioning and identification of expectations.	Incarcerated adults in semi-open and open regime.
Famílias de mulheres presas, promoção da saúde e acesso às políticas sociais no Distrito Federal, Brasil (26)	Brazil/2016	Contribute to the construction of health promotion strategies for the female population living in prison.	20 family members (mother, daughter, aunt and partner) of women imprisoned in the Federal District.
Pregnancy and Parenting Support for Incarcerated Women: Lessons Learned(27)	United States/2017	Identify lessons learned in a pilot study by the university community on a pregnancy and parenting support program.	48 women participating in The Minnesota Prison Doula Project.
Attachment in Young Children with Incarcerated Fathers(28)	United States/2017	Examine attachment behavior of young children during parental incarceration and to report the initial validity of a new measure used to classify children related to attachment, behaviors, and emotions during visits in correctional settings.	77 children, ages 2 to 6, and their incarcerated parents and current caregivers participated in the home visiting portion of the study, while 28 of these children participated in the prison visit.
Making mothers in jail: carceral reproduction of normative motherhood(29)	United States/2018	Analyze how women’s reproduction is experienced and managed by prison institutions and how mass incarceration itself is a reproductive technology.	Incarcerated women, jailers and health professionals at the units.
Assessing the deployment of informal support networks for mothers of incarcerated young men(30)	United Kingdom/ 2019	Analyze who caregivers turn to after the offense and the extent to which these networks operate as a means of providing emotional (and sometimes material) support to incarcerated adults’ families.	37 mothers of adolescents/young adults deprived of liberty.
Can family–prisoner relationships ever improve during incarceration? examining the primary caregivers of incarcerated young men(31)	United Kingdom/ 2019	Analyze how caregivers reflect on the change in relationships with young people during incarceration.	61 caregivers who visited two English prisons for young offenders.
Food Security in the Context of Paternal Incarceration: Family Impact Perspectives(32)	Canada/2019	Understand the relationship between paternal incarceration and family food insecurity in Canada.	63 participants, such as previously incarcerated parents, their partners and stakeholders in social reintegration.

The organization of first-order concepts is characterized by the initial stage of analysis of studies, seeking to synthesize the main concepts and ideas found in the original articles. The figure below shows the description of first-order concepts, contextualized according to the person deprived of liberty’s sex.

DISCUSSION

It was evidenced that both in the male and female context, the family represents an emotional and affective support that interferes directly in the way these people experience prison. Moreover, the need and interest in maintaining contact with the children were also highlighted in the studies.

Over the past ten years, research on incarceration and family relationships has had a greater focus on the person deprived of liberty and the context of the prison itself. The scarcity of studies on the deprivation of liberty process and relations with convicts’ family members in developing countries, such as countries in Africa, Central America and the Caribbean, Asia and Oceania, were evidenced, which underscores the need to broaden the focus on this theme.

Based on first-order concepts and AT contribution, it was possible to synthesize second- and third-order concepts and present them in two units of interpretative context, discussed below.

Strategies for strengthening family ties

Mediated by first-order concepts, the evidence highlights the development of a sense of responsibility of men and women deprived of freedom to maintain assiduous contact with their children and other family members, actively participating in decisions that involve aspects of children’s development. In addition to monitoring school progress, they feel directly responsible for the future of their children in the decisions they will make, in encouraging study and engagement at work, as well as in the responsibility of conveying knowledge about family cultural practices(²³).

The family is characterized as a protective link, constituting the main form of social interaction during the sentence, functioning as a support in the search for beliefs, values and behaviors that give individuals a sense of identity and belonging to the world and to themselves, leading convicts in the way of acting and making decisions(²⁵).

Among the strategies used to strengthen family ties, we highlight telephone communication, letters and personal contact through visits to prisons, which favor incarcerated adults’ and children’s emotional health, and the strengthening of relations between incarcerated adults and family(²³,²⁴,²⁵). Evidence points out that maintaining communication makes visits less stressful, because, especially children, feel safer in the presence of a person they see as a reference of care and protection during their incarceration(²³,²⁴,²⁸,³¹).

The act of accompanying the family member deprived of liberty represents a frequent renewal of ties of sociability that unite these subjects, functioning as a system of feedback of news and events related to life outside and inside prison(²⁶). Frequent visits were identified as responsible for positive changes in relationships, with the quality of visits and the types of visits (prolonged visits, days with the family, normal visits) important aspects that can impact the ways family members interact with each other and build ties with prisoners.

In the context experienced by imprisoned women, it was evidenced that they find their presence in families’ and children’s lives indispensable, so that they remain active as a family member. Thus, strategies such as solidarity and help, care for children and the home that was left out of prison help to strengthen healthy relationships with their families(²⁶). Another factor that contributed to strengthen the relationships was the participation in support groups. Support groups for pregnant women helped them to increase confidence in aspects involving motherhood, trust by family members, emotional support and physical support by other group members and by doulas(²⁷).

Attachment is defined as a relationship that is established between one person and another in particular, called an attachment figure, to which one resorts when facing a situation of stress, suffering, or a particular demand of affection. The attachment system, on the other hand, is configured by the identification of risk situations, attachment figure availability, with expression of emotional behaviors, such as crying, smiling, screaming, destined to generate affective responses that strengthen supports, ties and affections. The system has the function of making people feel safe, classifying personal relationships and the environment as non-hazardous and susceptible to exploitation; however, if any threat is identified, it returns to seek security in the attachment figure, used as an affective support to face moments of difficulty(²¹).

Researchers(³³) argue that the relationship between mother (attachment figure) and child can be reflected in aspects of children’s emotional, social and cognitive development. This development is manifested in indicators such as nutritional value, education, socioeconomic factors, father’s participation in the tie and others. Thus, it is possible to observe the attachment behavior throughout a child’s life, seeking patterns that may interfere with growth and in the future in adulthood, bringing disorders caused by an unsafe tie with the attachment figure.

Among the evidence analyzed, the family was recognized as a basis for secure attachment relationships. Deprivation of liberty, depending on the context in which it is experienced, was configured as a threat to such attachment, since many convicts are recognized as attachment figures by their families, who, during risk situations, find themselves deprived of access to their attachment system, fostering unhealthy feelings such as insecurity, phobia and loneliness. It was also pointed out(²²) that attachment systems with other family members, colleagues, friends and spouses play an important role in mental health and well-being, from childhood to adulthood.

Secure attachment favors the construction of a positive mental model that leads to a harmonious and reliable social development, promoting valuable relationships, such as the strengthening of friendship relations, development of affective moral behavior, affinity and stability in marital relations, development of social skills, mediation of everyday conflicts and regulation of adaptive behaviors in adverse situations(³³,³⁴,³⁵).

As highlighted among the concepts analyzed, attachment relationships in the prison context are strengthened by strategies such as telephone calls, letters, face-to-face visits and the possibility of the family to effectively participate in decisions that involve children’s life and future. The system and attachment figures nourish the development of secure attachment, also through demonstration of feelings, physical and visual contact, providing affection and affection to family relationships(³⁶).

According to the second-order concepts described, the family constitutes the main social interaction of individuals and functions as a basis for forming a sense of identity(²⁵). Some aspects are fundamental for secure attachment to be built in this context, such as the need to assure the family a close and secure contact with the attachment figure, the teaching of trust and reciprocity thinking about the future experiences of these members, and encouraging comforting feelings with a view to self-confidence and resilience, with the aim of reducing lifelong trauma(³⁶).

As for family relationships developed between parents and children, the understanding of the meaning of feelings and behaviors needs to be a process built, learned and shared, through interaction between members, so that children develop, in the experiences with the figures and the attachment systems, their own world and relationship models(³⁷). Observing the importance of secure attachment and the way it develops in relationships, the need for strengthened and quality family ties between parents and children during incarceration is evident. Researchers(³⁷) argue that secure affective tie is essential for human development (emotional, cognitive and social), allowing the formation of future citizens who are fair, supportive and who seek to interrupt the cycle of culture of violence.

Relationships that contribute to breaking down family ties

The existence of toxic relations was mainly observed in preexisting conflicts, i.e., those that occurred before the arrest and intensified in that context. This shows how prison can be understood as a risk or protective factor, depending on how incarcerated adults interpret and deal with the situation experienced. The perception of imprisonment as a risk can happen with the removal and/or fragility of socio-affective support networks and the effects of incarceration on individuals(²⁵).

Among the risk factors evidenced, the following stand out: pathological interpersonal relationships, family violence, communication problems, lack of parental integration and control, mental illness and/or drug dependence. In addition to these factors, there are also social vulnerabilities, such as not being able to provide one’s own financial support and for the family, prejudices that place convicts and their family in a situation of inferiority, demerit related to socioeconomic class, status, ethnicity and sex(²³,²⁴,²⁵).

As for visits, some participants describe them as an emotionally intense experience for their children, often as restrictive and in conditions that end up exposing children to safety procedures that generate embarrassment, anxiety and resistance to repeat the visitation(²⁴). The distance between the family home and the prison, in addition to the financial issues for travel and lodging, are also factors that restrict the frequency of face-to-face contact between incarcerated adults and their families(²³,²⁴).

Some men consider that incarceration built a barrier between them and their children, while, for others, this father-child relationship was sporadic even before the arrest and, therefore, the absence in children’s lives is less significant(²³). It is evident that this event causes a breakdown in the relationship between father and children through forced and sudden separation that occurs at the time of arrest and in the absence experienced from then on(²³,²⁸).

In the female context, daily battles in search of rights, services and social recognition contribute to conflicts and weaknesses in relationships. In this context, woman imprisonment is understood from two perspectives: on the one hand, there are those who consider imprisonment an individual act that produces a narrative of personal suffering; on the other hand, there are those who interpret imprisonment as another event in a life marked by uncertainties and difficulties(²⁶).

Reproductive vulnerability and motherhood are also experiences that influence relationships and cause numerous problems in women’s lives. Incarceration disrupts conventional modes of reproduction, because it invalidates the freedom of reproductive choice and also interferes with the way women can participate in family dynamics, separating some families in such a context and, in extreme cases, sending children to orphanages as a way of circumventing the vulnerabilities generated by the absence of parents who are incarcerated(²⁹).

Evidence has shown that social vulnerability and lack of support are barriers faced that also cause breakdown in relationships. Incarceration contributes to financial instability, generating food insecurity and deficits in human and social capital, making it impossible for a family to have consistent access to appropriate food(³²). Another aspect evidenced concerns the offer of support, ambiguous or tense support networks such as: restrictions on telling family and friends about the crime; secrecy, due to stigma of the criminal act; mothers who have had arguments with family and friends since the crime occurred, or generally had tenuous ties before the crime. These situations can reflect on family members’ lives, causing instability and conflicts that shake the contact of convicts with those who are out of prison(²⁶,²⁷,²⁸,²⁹,³⁰).

Researchers(³⁷) state that affective deprivation and exposure to unstable and impersonal care, added to tie breakdown, can be detrimental to a child’s development, resulting in the formation of unsafe attachment. A knowledge synthesis(²¹), published in the Brazilian and international scientific literature of research on how attachment style has been studied among children with chronic diseases in the period from 2007 to 2018, highlighted that early attachment relationships are related to long-term consequences in a child’s life, influencing cognitive and language development, self-esteem, independence and school performance.

Insecure attachment, added to an unfavorable physical and social environment, can evolve as a response to a non-responsive, insensitive care with characteristics of a certain affective distance from parents. Characteristics such as these worsen the feeling of insecurity, conflict and distrust about relationships of affection(³⁸). Supporting this thought, as described among the investigated evidence, convicted family members who are not inserted in an environment favorable to sensitive behavior, mediated by affection, will be more predisposed to provoke insecure attachment and expose children and other family members to unhealthy future parental ties, which generate feelings such as fear, anxiety, detachment and suffering(²³,²⁵,²⁸).

Researchers(³⁹,⁴⁰) showed that inadequate parental tie and unsafe attachment potentiate the development of depression in adolescence, increasing risks of suicide in this age group. Still among the consequences of unsafe attachment reflected throughout life, the existence of a relationship between attachment styles and the context of conjugality and parenting in adulthood are evident. Children who become adults with unsafe attachment behaviors are more likely to engage in marital conflict and problematic love relationships(³⁸).

In addition to the harmful attachment system, as highlighted among the evidence analyzed, incarceration causes a forced separation between parents and children, destabilizing the relationship between them and influencing attachment relationships, especially among children who lived with their parents and had significant proximity with them. Concomitantly with this abrupt separation, in some cases, children witnessed the crime committed or the moment of their father’s arrest, a situation that can cause feelings of anxiety and even a trauma to the children involved, and may be another risk to develop unsafe attachment(²⁸).

Researchers(²¹) argue that, if the attachment figure is not present or rejects to satisfy the needs of protection and autonomy of their families, they may develop a sentimental reaction of self-sufficiency and inability to manage conflicting moments of life, due to lack of fraternal experiences of affection, implying insecure attachment of future interpersonal relationships. It was evidenced, between first- and second-order concepts, that deprivation of liberty context can strengthen experiences of insecure attachment. Therefore, researchers(²⁸) emphasize the need to avoid exposing children unnecessarily to the imprisonment of parents, and family members should seek to reduce traumas associated with this incarceration.

It should be noted that some Brazilian prison system institutions have particularities that differentiate it from other countries of the world, such as prison overpopulation, scrapped infrastructure or unhealthy conditions, racism, precarious medical care, lack of food, drug trafficking, among others(³,⁴). As much as one or other of these characteristics are common to convicts living in countries such as the United States, Thailand, China and Russia, several social factors such as politics, education, income distribution and security(³,⁵) directly influence how secure attachment relationships are built, maintained and deconstructed between family members who are incarcerated.

Study limitations

Given the above, this meta-synthesis presents as limiting factors the analysis only of references in English, Portuguese and Spanish, the systematic search carried out in specific databases and the fact that only articles available in full are selected. Such characteristics may have led to the exclusion of some references that, in its entirety, could contribute to expand the present work. Moreover, studying in full the differences between the prison systems present in the study, as well as the absence of empirical studies with families from other parts of the world, such as Africa, Asia and other countries of Latin and Central America, also present themselves as limiting factors that prevent the expansion of discussion in other prison contexts from happening.

Contributions to nursing, health, and public policies

This research contributes to the work of nurses and other health professionals, raising reflections on family attachment, which, when strengthened in environments deprived of liberty, can contribute to formulating strategies with the aim of implementing intervention programs and public policies to combat the harmful consequences of the deprivation of liberty process in family relationships, enabling decision-making based on evidence-based practice.

FINAL CONSIDERATIONS

The deprivation of liberty process affects convicts’ family relationships, reflecting directly on the type of attachment developed, since imprisonment causes an abrupt separation between the individuals who make up this attachment system. However, coping strategies, such as visits, phone calls and letters, are highlighted as strategies that favor the strengthening of secure attachment in environments deprived of freedom. It is important to emphasize the importance of strengthening strategies that form family tie as a factor to protect physical health and prevent injuries related to the country’s and children’s emotional health.

To broaden the discussions on the subject, the need to invest in new research that aims to explore incarceration contexts that involve family feelings, affective relationships, power, care, paternity/maternity, education and health is highlighted.

The results of this meta-synthesis contribute to evidence-based practice, which influences the implementation of protective policies for the family. It is worth noting the professional role of nurses as a reference in family health, integrating the multidisciplinary team. Finally, it is worth remembering the need to expand research that addresses health care and the role of nursing in the prison environment, allowing to broaden and deepen reflections about the care provided to children and families who experience the context of prison and the reflexes of this process on attachment behaviors.

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Edited by

EDITOR IN CHIEF: Álvaro Sousa

ASSOCIATE EDITOR: Ana Cristina Silva

Publication Dates

• Publication in this collection
  27 June 2022
• Date of issue
  2022

History

• Received
  21 Sept 2021
• Accepted
  10 Mar 2022