Screening fathers for postpartum depression can be cost-effective: An example from Sweden

Decision tree-Markov model of perinatal depression screening: a cost-utility analysis

Background

Perinatal depression affects the physical and mental health of pregnant women. It also has a negative effect on children, families, and society, and the incidence is high. We constructed a cost-utility analysis model for perinatal depression screening in China and evaluated the model from the perspective of health economics.

Methods

We constructed a Markov model that was consistent with the screening strategy for perinatal depression in China, and two screening strategies (screening and non-screening) were constructed. Each strategy was set as a cycle of 3 months, corresponding to the first trimester, second trimester, third trimester, and postpartum. The state outcome parameters required for the model were obtained based on data from the National Prospective Cohort Study on the Mental Health of Chinese Pregnant Women from August 2015 to October 2016. The cost parameters were obtained from a field investigation on costs and screening effects conducted in maternal and child health care institutions in 2020. The cost-utility ratio and incremental cost-utility ratio of different screening strategies were obtained by multiplicative analysis to evaluate the health economic value of the two screening strategies. Finally, deterministic and probabilistic sensitivity analyses were conducted on the uncertain parameters in the model to explore the sensitivity factors that affected the selection of screening strategies.

Results

The cost-utility analysis showed that the per capita cost of the screening strategy was 129.54 yuan, 0.85 quality-adjusted life years (QALYs) could be obtained, and the average cost per QALY gained was 152.17 yuan. In the non-screening (routine health care) group, the average cost was 171.80 CNY per person, 0.84 QALYs could be obtained, and the average cost per QALY gained was 205.05 CNY. Using one gross domestic product per capita in 2021 as the willingness to pay threshold, the incremental cost-utility ratio of screening versus no screening (routine health care) was about -3,126.77 yuan, which was lower than one gross domestic product per capita. Therefore, the screening strategy was more cost-effective than no screening (routine health care). Sensitivity analysis was performed by adjusting the parameters in the model, and the results were stable and consistent, which did not affect the choice of the optimal strategy.

Conclusion

Compared with no screening (routine health care), the recommended perinatal depression screening strategy in China is cost-effective. In the future, it is necessary to continue to standardize screening and explore different screening modalities and tools suitable for specific regions.

Hostile sexism is related to worse mental health outcomes among fathers

OBJECTIVE

Transition to parenthood is a life-changing yet stressful event for both men and women. The present study aims to: (1) establish the incidence of prenatal paternal depression and anxiety in a sample of expectant fathers and (2) assess the relationship between sexist beliefs and mental health outcomes.

METHODS

We recruited expectant fathers (n = 100) who attended the Gynecology and Obstetrics Outpatient Clinic of Eskişehir Osmangazi University Hospital with their pregnant partners. Fathers completed the Hospital Anxiety and Depression Scale, the Multidimensional Scale of Perceived Social Support, and the Ambivalent Sexism Scale.

RESULTS

36% of expectant fathers reported depression, and 12% reported anxiety. Hostile sexism was correlated with depression (r = 0.303, p < 0.01), and anxiety (r = 0.228, p < 0.05). Benevolent sexism was not related to anxiety or depression (each, p > 0.05). Family social support (p = 0.004) and perceived financial satisfaction (p = 0.027) predicted anxiety, while family social support (p < 0.001) and perceived financial satisfaction (p = 0.036) predicted depression. Hostile sexism predicted both anxiety (B = 0.28, p = 0.004) and depression (B = 0.32, p < 0.001).

LIMITATIONS

Results may not show a causal relationship due to the study's cross-sectional design. We recruited participants in only one center. Our measures of anxiety and depression were purely psychometric.

CONCLUSIONS

Sexist beliefs may serve as environmental stressors among men in the perinatal period by increasing the masculine role stress. Future interventions to treat prenatal paternal depression may target sexism.

Paternal peripartum depression: emerging issues and questions on prevention, diagnosis and treatment. A consensus report from the cost action Riseup-PPD

INTRODUCTION

Paternal peripartum depression (P-PPD) is a serious and understudied public health problem associated with impaired family functioning and child development. The lack of recognition of P-PPD may result in limited access to both information and professional help.

OBJECTIVE

The aim of the study was to review studies on paternal peripartum depression and to identify issues and questions where future research and theory formation are needed.

METHODS

A literature search for systematic reviews, meta-analyses and primary studies was conducted using PubMed, Web of Science, Embase, Scopus, Medline, PsychInfo and Informit databases. Key results within the retrieved articles were summarised and integrated to address the review objectives.

RESULTS

Based on the literature, the knowledge related to prevalence, screening, risk factorsunique to fathers, management strategies and outcomes of P-PPD is lacking. Currently, there is no consensual understanding of the definition of P-PPD and recommendations for dealing with P-PPD. Limited data were available regarding the barriers preventing fathers from accessing support systems.

CONCLUSION

Emerging issues that need to be addressed in future research include: P-PPD definition and pathogenetic pathways; prevention strategies and assessment tools; self-help seeking and engagement with interventions; the cost-effectiveness of P-PPD management; needs of health professionals; effect on child development, and public awareness. Future studies and clinical practice should account the complexities that may arise from the father's perceptions of health care services. Results from this review highlights the critical issues on how to plan, provide and resource health services, to meet the health needs of fathers.

Paternal postpartum depression, coparenting, and father-infant bonding: Testing two mediated models using structural equation modeling

BACKGROUND

Impaired father-infant bonding is a mental health issue that has been understudied. The current study aimed to examine the extent to which fathers' depression symptoms and coparenting relationship, respectively, are associated with infant bonding, as well as how these two variables mediate in the association with infant bonding.

METHODS

Cross-sectional data from 612 fathers of infants (0-24 months) were used in this study. Path analyses on two competing mediation models were used to examine the direct and indirect associations between fathers' depression symptoms, coparenting relationship, and infant bonding, after controlling for several known covariates.

RESULTS

Whether fathers reported depression symptoms (Model 1) or reported lower levels of coparenting relationships (Model 2), they also reported higher levels of impaired infant bonding, rejection and anger, and anxiety about care after controlling for the covariates. The analysis further found significant indirect associations between father depression symptoms and father-infant bonding via the coparenting relationship (Model 1) as well as significant indirect associations between the coparenting relationship and father-infant bonding via father depression symptoms (Model 2).

LIMITATIONS

The cross-sectional data cannot show causal links. Specific efforts were made to recruit fathers with depression symptoms, and therefore prevalence rates may appear skewed.

CONCLUSIONS

Decreasing depression symptoms and improving coparenting quality can potentially improve father-infant bonding. Fathers' depression symptoms and coparenting quality can be bi-directionally related in the association with father-infant bonding. Early detection and preventive treatments for paternal depression symptoms and coparenting are warranted.

Being a "Warrior" to Care for the New Family: A Meta-ethnography of Nurses' Perspectives on Municipal Postnatal Healthcare

Care in the postnatal period is a goal for all families with a newborn baby, and support from nurses might prevent long-term health problems and contribute to a positive postnatal experience. This meta-ethnography aims to integrate and synthesize qualitative studies that illuminate and describe nurses' perspectives on municipal postnatal health care in high-income countries. Systematic literature searches for qualitative studies were conducted and 13 articles were included. The analysis followed the seven phases of Noblit and Hare. Being a "warrior" to care for the new family was identified as an overarching metaphor accompanied by three main themes: Stretching human boundaries, Stretching system boundaries, and Stretching knowledge boundaries. The overarching metaphor offers a deeper understanding of the nurses as "warriors" who despite tight timeframes and heavy workloads are stretching toward a caring relationship with the families. Being a warrior continuously pushing system boundaries puts the nurses in risk of being overstretched, balancing between their ideals and the reality. As more knowledge and clearer policies and procedures regarding the inclusion of fathers and LGBTQ parents in municipal postnatal healthcare are needed, more focus placed on the father or non-birthing parent, different cultural traditions and family constellations in practice and education is suggested.

Cost-effectiveness of mental health interventions during and after pregnancy: A systematic review

BACKGROUND

Mental health problems during and after pregnancy such as depression, anxiety, post-traumatic stress disorder (PTSD), or addiction are common and can have lifelong implications for both parents and offspring. This review investigates the cost-effectiveness of interventions tackling these problems, assesses the methodological quality of included studies, and indicates suggestions for further research.

METHODS

Thirteen databases were searched for economic evaluations of interventions related to antenatal, perinatal, and postnatal mental health conditions, published between 2000 and September 2021, in high-income countries.

RESULTS

Thirty-nine studies met all inclusion criteria. Interventions considered were screening programs, pharmacological treatments, and various forms of psychosocial and psychological support. Six studies reported that the intervention was cost-saving. Eighteen were cost-effective and seven likely to be cost-effective. Only six studies included health outcomes for the child; one study considered paternal health. The time horizon for which costs and consequences were considered was for most evaluations limited to 1 year (n = 18) or 2 years (n = 11) postpartum.

CONCLUSIONS

Given the importance of the subject, a relatively low number of studies have investigated the cost-effectiveness of interventions tackling mental health problems during and after pregnancy. The scant evidence available suggests good overall value for money. Likely, cost-effectiveness is underestimated as costly long-term consequences on offspring are systematically excluded. No evidence was found for several frequently occurring conditions. Further research is required to obtain reliable, long-term effectiveness data and to address the methodological challenges related to measuring all relevant health outcomes for all parties affected.

"I Wanted to Be There as a Father, but I Couldn't": A Qualitative Study of Fathers' Experiences of Postpartum Depression and Their Help-Seeking Behavior

Postpartum depression (PPD) is one of the most common mental health problems among new parents. Past studies have examined PPD in women; however, the condition is less understood in men. This study aimed to explore the lived experiences of men or fathers with PPD and to understand the barriers and facilitators of help-seeking among fathers with PPD. Eight fathers with PPD were interviewed and data were subsequently analyzed through interpretative phenomenological analysis. The fathers perceived fatherhood as an overwhelming experience and feelings of inadequacy and powerlessness were two of the main themes in the fathers' experiences of PPD. The feeling of inadequacy and powerlessness was related to the fathers' expectations for themselves and their role as a father. The fathers' sense of inadequacy and powerlessness sometimes turned into anger and frustrations. In addition, the fathers experienced a variety of contributing stressors around the birth of their child. Further, the analysis revealed how the fathers' help-seeking behavior was influenced by five contributing factors: recognition and perception of depressive symptoms; knowledge and beliefs about PPD; taboo, stigma and conforming to masculine norms; the fathers' partner; screening and perinatal healthcare services. Paternal PPD has a significant impact on the fathers' wellbeing and everyday lives. Findings indicate that parents-to-be may benefit from education on paternal PDD, and they highlight the importance of screening for paternal PPD and support tailored to the needs of fathers with signs of PPD.

Paternal postnatal depression and received midwife, child health nurse, and maternal support: A cross-sectional analysis of primiparous and multiparous fathers

BACKGROUND

Fathers want more professional and social support during the transition to fatherhood. It is unclear if these supports are associated with decreased depressive symptoms in fathers of infants.

AIM

The aim of the current study was to assess if fathers' self-reported received professional and social support were related to changes in the odds for having depressive symptoms, with interaction terms focusing on differences of support based on the fathers' parity.

METHODS

In total, 612 fathers from Sweden completed a Facebook-advertised anonymous online survey. The Edinburgh Postnatal Depression Scale was used to detect depressive symptoms (≥10 points). Multiple imputation of missing data was performed. Logistic regressions were used, with interaction terms for fathers' parity.

RESULTS

Around 21% of fathers had depressive symptoms. There were no associations between depressive symptoms frequencies and paternal parity. Fathers reported fewer depressive symptoms when they received professional support from the prenatal midwife (OR = .39, p = .007), labor/birth midwife/nurse team (OR = .42, p = .021), and child health nurse (OR = .25, p = .001), as well as social support from their partner and if they had a higher income (odds ratios vary in different models). Multiparous fathers received significantly less professional and social support and were less frequently invited to child health visits than primiparous fathers.

LIMITATIONS

The data collected was cross-sectional; therefore, causal links cannot be determined.

CONCLUSIONS

Both primiparous and multiparous fathers should receive postnatal depression screenings and interventions to help reduce their depressive symptoms.

Parental Sensitivity and Responsiveness as Mediators Between Postpartum Mental Health and Bonding in Mothers and Fathers

Background: There is a lack of studies that examine the complex relationship between parental mental health, parental sensitivity and responsiveness, and parent-infant bonding. This study aimed to test whether parental sensitivity and responsiveness were mediators between postpartum mental health (depression, anxiety, and stress) and parent-infant bonding in mothers and fathers. Method: Mothers (n = 427) and fathers (n = 170) of infants aged up to 1-year-old participated in an online study. The parents completed questionnaires on depression (Edinburgh Postnatal Depression Scale, EPDS), anxiety and stress (Depression, Anxiety, and Stress Scale, DASS-21). Parent-infant bonding was measured by Postpartum Bonding Questionnaire (PBQ) that has three components: Impaired bonding (PBQ1), Anxiety about care and parental distress (PBQ2), and Lack of enjoyment and affection with infant (PB3Q). Parental sensitivity was measured as the number of correct recognitions of infant facial expressions (City Infant Faces Database, CIFD). Responsiveness was measured as a self-report with two subscales of responsiveness and non-responsiveness (Maternal Infant Responsiveness Instrument, MIRI). Results: The path analysis showed that the model had a good fit to the data. Parental sex was a significant moderator, indicating different paths in mothers and fathers. In mothers, responsiveness and non-responsiveness were significant mediators between depression symptoms and three dimensions of bonding. In fathers, only non-responsiveness was a significant mediator between anxiety and PBQ3. Although recognizing infant facial expressions directly affected PBQ3 in mothers (but not in fathers), it was not a significant mediator between mental health and bonding. Conclusion: Higher levels of parental mental health problems (depression and anxiety) were associated with lower levels of parental responsiveness, which is, in turn, related to poor parent-infant bonding. Prevention and intervention programs should be offered for both mothers and fathers, focusing on postpartum mental health promotion and enhancing responsiveness in infant care.

Relationship between paternal psychological distress and involvement in childcare among fathers of preschool-aged children: mediating effect of maternal psychological distress

Background

The role of the father as a co-caregiver is becoming increasingly important across cultures. Parental psychological distress is an influencing factor of maladaptive parenting behaviors and negative psychosocial outcomes in children. Considerable research has focused on psychological distress in parents, commonly experienced during the childrearing years; however, the relationship between paternal psychological distress and fathers’ involvement in childcare has been less studied. This study aimed to examine this relationship.

Methods

This study explored the relationship between parental psychological distress and fathers’ involvement in childcare by analyzing data from 1541 children and their parents from the 2011 Panel Study on Korean Children. Psychological distress was assessed using the Kessler 6-Item Psychological Distress Scale. Fathers’ involvement in childcare was measured in terms of the quality and quantity of involvement, using a Father’s Childcare Involvement Scale completed by mothers and the daily hours spent by fathers in childcare.

Results

The mean scores for paternal and maternal psychological distress were 5.26 ± 4.20 and 5.79 ± 4.42, respectively; for the quality of fathers’ involvement in childcare, 14.46 ± 2.63; and for the quantity of fathers’ involvement, 2.53 ± 1.62. Paternal psychological distress was significantly correlated with maternal psychological distress and fathers’ involvement in childcare. Maternal psychological distress demonstrated a partial mediating effect on the relationship between paternal psychological distress and the quality of fathers’ involvement in childcare for preschool-aged children (β = −.085, p < .001); this effect was significant (Sobel test; Z = 3.13, p = .002). Further, maternal psychological distress demonstrated a complete mediating effect on the relationship between paternal psychological distress and the quantity of fathers’ involvement in childcare (β = −.065, p = .018); this effect too was significant (Sobel test; Z = 2.38, p = .018).

Conclusions

Paternal psychological distress influenced the quality and quantity of fathers’ involvement in childcare and was mediated by maternal psychological distress. To promote fathers’ involvement in childcare, a family-centered approach for childcare should reflect the triadic interaction of father–mother–child. These findings have implications for primary health professionals, as well as policymakers who design community health programs for early childhood.

'So, the circle has grown' - Child Health Services nurses' experiences of giving parental interviews with nonbirthing parents

BACKGROUND

Lately, greater focus has been given to the mental health of nonbirthing parents postpartum. However, mothers, but not nonbirthing parents, are routinely screened for postpartum depression, and until recently, nonbirthing parents have not been given the same opportunity as mothers to discuss their parental role without the other parent present. To strengthen the parental role, a separate parental interview with the nonbirthing parent began to be offered as part of the Swedish Child Health Service's (CHS) general programme.

AIM

This study aimed to explore CHS nurses' experiences of performing parental interviews with nonbirthing parents.

METHODS

Content analysis was used when analysing data from six research interviews, of which half were focus group interviews. In total, 11 CHS nurses were interviewed.

RESULTS

Child Health Service nurses reported that although the interview with the nonbirthing parent was a positive experience and that a more family-oriented perspective was something many of them had been longing for, they could also feel that it demanded a lot from them, including things they had perhaps not previously considered. CHS nurses reported difficulties with having such close contact with both parents, and they also described feeling worried about the information that could come up in a standardised conversation and the knowledge provided.

CONCLUSION

There are both possibilities and challenges in widening the responsibilities of the CHS nurse to include the nonbirthing parent by offering a postpartum interview.

IMPLICATIONS

This study provides information to healthcare professionals about the importance of providing proper guidance and education when broadening the duties and responsibilities for CHS nurses to include nonbirthing parents in mental health screening. CHS nurses must be given the resources needed to deal with the challenges they encounter and sufficient time for the interviews to be possible and meaningful.