Peripartum depression – does it occur in fathers and does it matter?

Postpartum Paternal Depression: Its Impact on Family and Child Development

The postpartum period is when parents undergo great changes and gain new responsibilities. Factors such as the changes that come with having a baby, not meeting the expectations about parenthood, having a child with a difficult temperament or health problems, or relational problems can be quite challenging in this period. These problems can deeply affect the psychological well-being of the parents. Although studies on depressive symptoms of mothers during pregnancy and postpartum are at an important level, studies aiming to examine the psychological state of fathers for the same period are still limited. However, perceptions that postpartum depression develops due to hormonal changes during pregnancy have been reshaped by the findings that this situation may also develop due to psychosocial factors. Relatedly, the number of studies on postpartum depression experienced by fathers has increased over time. Results of those studies show that fathers' psychological state also influences their parenting and the development of children. Fathers may experience paternal depression due to a lack of social support, economic conditions, relationship dynamics, and changing living conditions in the postpartum period. This situation may cause fathers to avoid parenting duties, spend less time with their children, be unable to cooperate with the mother, and have anger problems or deterioration in the relationship with the mother. The effects of depression on individuals' parenting styles negatively affect child-parent attachment and may cause children to develop emotional and behavioral problems. Therefore, it is very important to examine fathers' psychological state for children's development and the healthy progress of family dynamics. This review aims to address the effect of paternal depression on parenting and child development.

Investigating the causal association of postpartum depression with cerebrovascular diseases and cognitive impairment: a Mendelian randomization study

Background

Postpartum depression (PPD) is considered the most widespread puerperium complication. The associations of major depressive disorder with certain types of cerebrovascular diseases and cognitive function have been proposed, but the potential causal effects of PPD on these phenotypes are still unknown.

Methods

A Mendelian randomization (MR) research design with various methods (e.g., inverse-variance weighted method and MR pleiotropy residual sum and outlier test) was adopted to establish a causal relationship between PPD with cerebrovascular diseases and cognitive impairment.

Results

No causal relationship between PPD with carotid intima media thickness and cerebrovascular diseases (i.e., stroke, ischemic stroke, and cerebral aneurysm) was found. However, MR analyses indicated a causal association between PPD and decreased cognitive function (P = 3.55 × 10-3), which remained significant even after multiple comparison corrections using the Bonferroni method. Sensitivity analyses using weighted median and MR-Egger methods indicated a consistent direction of the association.

Conclusion

The causal association between PPD and cognitive impairment indicates that cognitive impairment is a critical aspect of PPD and thus cannot be regarded as an epiphenomenon. Addressing cognitive impairment and lessening the symptoms associated with PPD independently play significant roles in the treatment of PPD.

Paternal perinatal depression: A concept analysis

AIM

Our aim is to clarify the concept of paternal perinatal depression including its definition, attributes, antecedents and consequences.

DESIGN

A concept analysis.

METHODS

To obtain relevant evidence, several databases were searched systematically including PubMed, EMBASE, Web of Science, CINAHL, PsycINFO and the Cochrane Library. Qualitative or quantitative articles published in English that focused on paternal perinatal depression were included. After the literature quality assessment, Walker and Avant's concept analysis strategy was used.

RESULTS

Five defining attributes (i.e. symptoms occur during the partner's pregnancy or 1-year postpartum and last at least 2 weeks, emotional symptoms, somatic symptoms, negative parenting behaviours and 'masked' symptoms), four antecedents (i.e. personal issues, pregnancy-related issues, infant-related issues, social issues) and three consequences (i.e. offspring outcomes, marital relationship, maternal negative emotions) were identified.

COVID-19-Related anxieties and parenting stress among first-time mothers and fathers in their first year of parenthood

INTRODUCTION

The changes accompanying the transition to parenthood, joined by the fears aroused by the COVID-19 pandemic, may lead to high levels of parental anxieties and stress, particularly among parents of young infants. This study, conducted in the midst of the crisis, explores the level of COVID-19-related anxieties and parenting stress of Israeli parents in their first year of parenthood.

METHODS

First-time mothers (n = 469) and fathers (n = 137), aged 21-50, completed self-report questionnaires in April, 2020. They were divided into two groups: parents of younger infants (aged 3-6 months); parents of older infants (aged 7-12 months).

RESULTS

The levels of all COVID-19-related anxieties were quite high, with the greatest concern aroused by public transportation and public places, followed by concerns over the possible infection of family members and the infant, going for infant check-ups, getting the virus themselves, and the health of the infant. In both groups, mothers reported higher COVID-19-related anxieties than fathers. Fathers of older infants reported higher parenting stress than mothers.

DISCUSSION

The results highlight the need to be attentive to the double stress of new parents in the first year of parenthood in a time of crisis, and to the potentially greater vulnerability of fathers of older infants.

Predictors of postpartum depression in first-time fathers

OBJECTIVE

A significant number of men suffer from paternal postpartum depression (PPPD). This is detrimental to family and personal well-being. This study aims to report rates of PPPD in first-time fathers in New Zealand. It also aims to find predictors of PPPD.

METHODS

Data from 116 men were analysed. Men completed questionnaires at 24 weeks gestation, 36 weeks gestation, post-birth and 6 months after the baby was born. The outcome of interest was scores on the Edinburgh Postnatal Depression Scale 6 months after the baby was born.

RESULTS

Twelve percent of the participants met criteria for PPPD. Factors that predicted PPPD were: earlier depression, family life satisfaction, expectations, birth interventions, pain management for their partner and pregnancy anxiety.

CONCLUSIONS

It is important that PPPD is recognised and treated. More research is needed on the mental health of fathers.

Mental Health Literacy of Maternal and Paternal Postnatal Depression in a Community Sample of Romanian Adults

Postnatal depression affects a large proportion of Romanian parents, but no existing research has examined knowledge of postnatal depression in Romanian adults. To rectify this, we examined the ability of Romanian adults to correctly identify cases of maternal and paternal postnatal depression, as well as attitudes toward cases of postnatal depression. A total of 1,248 Romanian adults were presented with vignettes describing cases of maternal or paternal postnatal depression. Based on the vignettes, participants were asked to report if they thought anything was wrong with the targets and, if so, to describe what they thought was wrong. Participants also rated the targets on several attitudinal dimensions. Participants were more likely to indicate that something was wrong when the target was female (67.9%) compared with male (46.4%). Of those who believed something was wrong, 57.7% of participants correctly described the female target as experiencing postnatal depression, but only 37.1% did so for the male target. Women held significantly more positive attitudes toward the targets than men, particularly when the target was female. Mental health literacy of postnatal depression appears to be poor in Romanian adults compared with other national groups, especially in the case of paternal postnatal depression.

Psychosocial Factors Associated with Paternal Perinatal Depression in the United States: A Systematic Review

Paternal perinatal depression can occur in approximately one out of ten fathers. However, research within this population is limited. A previous systematic review suggested that United States had higher rates of paternal perinatal depression compared to other countries. Therefore, this systematic review identified psychosocial factors for depression during the perinatal period in fathers who live in the United States. A literature search was conducted from multiple databases using keywords and MeSH terms to retrieve articles up to the year 2019. Twenty five articles were included in this review. A social-ecological framework was applied to identify psychosocial factors associated with paternal depression. Individual factors include prior history of depression, having maladaptive cognitive coping styles, fathers who self-identified as African-American or Hispanic, parenting stress, substance use, and history of criminal conviction. Interpersonal factors include lack of social support, quality of relationship with the mother of the baby, coparenting conflict, quality of current and childhood relationships with their own parents, and maternal depression. Community factors include frequent daily experiences with racism, and limited access to transportation and housing. These findings underscore the importance of assessing depression and developing father-inclusive interventions that address the psychological needs of fathers.

Prevalence and Predictors of Postpartum Depression Among Male Partners Who Came to Postnatal Follow-up Clinic with Their Partner in Selected Public Health Centers of Wolaita Zone, Ethiopia, 2019

BACKGROUND

Paternal postpartum depression is a serious public health problem which has a significant effect on mortality and morbidity level. Its effect is not limited to the partner, but it also affects the family, the marital relationship and development of the child. Therefore, this study was planned to assess the prevalence and predictors of paternal postpartum depression among accompanying partners in selected public health centers of Wolaita Zone, Ethiopia.

METHODOLOGY

An institution-based cross-sectional study was conducted among 423 male partners. The study was conducted in 25 randomly selected health centers and samples proportionally allocated to each health center. Finally, the study participants were selected by systematic random sampling method. The collected data were entered into EpiData version 4.2.0 and exported to IBM SPSS for further analysis. The Edinburgh postnatal depression scale was considered at a cutoff point ≥10 to detect depression. Descriptive and binary logistic regression analyses were done. Adjusted odds ratio (AOR) and p-value results in multivariable logistic regression were used to declare strength and presence of association.

RESULTS

Four hundred and ten partners participated in this study making a response rate of 97%. Seventy (17%) of the participants had paternal postpartum depression. Family income (AOR=3.0; 95%CI: 1.1-8.2), substance use (AOR=4.5; 95%CI: 1.5-13.3), family support (AOR=3.9; 95%CI: 1.3-11.3), marital relation (AOR=4.1; 95%CI: 1.5-11.0), unplanned pregnancy (AOR=3.5; 95%CI: 1.4-8.7) and infant sleeping problems (AOR=10.0; 95%CI: 4.1-24.0) were variables significantly associated with paternal postnatal depression.

Parenting stress and its correlates in an infant mental health unit: a cross-sectional study

Background: An infant's development is closely linked to the relationship they have with their parents. Parenting stress, affective disorder, and an upbringing with substance-abusing parents can affect parenting quality and increase the risk of children developing behavioral, mental and social problems. The overall aim of the study was to investigate how parents of children attending an outpatient Infant Mental Health (IMH) unit rate their own psychological health and parenting stress, and to explore predictors of parenting stress.Methods: The sample comprised 197 parents, 129 mothers and 68 fathers, referred with their infant/toddler to an outpatient IMH unit for interplay treatment. On admission, the parents completed self-report questionnaires concerning their own mental health problems and parenting stress.Results: The mothers reported significantly more psychiatric symptoms and parenting stress than the fathers. Fathers with substance-abusing parents had often experienced divorce in the family of origin, had a low level of education, and had often experienced trauma. Depression was a predictor for parenting stress for both mothers and fathers.Conclusion: The parents' situation was strained, presenting a variety of psychiatric symptoms and high levels of parenting stress, making assessment of parental health before starting treatment important. The mothers' situations were more serious compared with the fathers', and for both parents depression was a significant predictor for parenting stress. To increase the chances of a positive treatment outcome for the child, both parents should be included in the treatment.

Assessing the Mental Health of Fathers, Other Co-parents, and Partners in the Perinatal Period: Mixed Methods Evidence Synthesis

Introduction: Five to 10 percentage of fathers experience perinatal depression and 5-15% experience perinatal anxiety, with rates increasing when mothers are also experiencing perinatal mental health disorders. Perinatal mental illness in either parent contributes to adverse child and family outcomes. While there are increasing calls to assess the mental health of both parents, universal services (e.g., maternity) and specialist perinatal mental health services usually focus on the mother (i.e., the gestational parent). The aim of this review was to identify and synthesize evidence on the performance of mental health screening tools and the acceptability of mental health assessment, specifically in relation to fathers, other co-parents and partners in the perinatal period. Methods: A systematic search was conducted using electronic databases (MEDLINE, PsycINFO, Maternity, and Infant Care Database and CINAHL). Articles were eligible if they included expectant or new partners, regardless of the partner's gender or relationship status. Accuracy was determined by comparison of screening tool with diagnostic interview. Acceptability was predominantly assessed through parents' and health professionals' perspectives. Narrative synthesis was applied to all elements of the review, with thematic analysis applied to the acceptability studies. Results: Seven accuracy studies and 20 acceptability studies were included. The review identified that existing evidence focuses on resident fathers and assessing depression in universal settings. All accuracy studies assessed the Edinburgh Postnatal Depression Scale but with highly varied results. Evidence on acceptability in practice is limited to postnatal settings. Amongst both fathers and health professionals, views on assessment are mixed. Identified challenges were categorized at the individual-, practitioner- and service-level. These include: gendered perspectives on mental health; the potential to compromise support offered to mothers; practitioners' knowledge, skills, and confidence; service culture and remit; time pressures; opportunity for contact; and the need for tools, training, supervision and onward referral routes. Conclusion: There is a paucity of published evidence on assessing the mental health of fathers, co-mothers, step-parents and other partners in the perinatal period. Whilst practitioners need to be responsive to mental health needs, further research is needed with stakeholders in a range of practice settings, with attention to ethical and practical considerations, to inform the implementation of evidence-based assessment.

Mental health and wellbeing during the transition to fatherhood: a systematic review of first time fathers' experiences

OBJECTIVE

The aim of this systematic review was to identify and synthesize the best available evidence on first time fathers' experiences and needs in relation to their mental health and wellbeing during their transition to fatherhood.

INTRODUCTION

Men's mental health and wellbeing during their transition to fatherhood is an important public health issue that is currently under-researched from a qualitative perspective and poorly understood.

INCLUSION CRITERIA

Resident first time fathers (biological and non-biological) of healthy babies born with no identified terminal or long-term conditions were included. The phenomena of interest were their experiences and needs in relation to mental health and wellbeing during their transition to fatherhood, from commencement of pregnancy until one year after birth. Studies based on qualitative data, including, but not limited to, designs within phenomenology, grounded theory, ethnography and action research were included.

METHODS

A three-step search strategy was used. The search strategy explored published and unpublished qualitative studies from 1960 to September 2017. All included studies were assessed by two independent reviewers and any disagreements were resolved by consensus or with a third reviewer. The recommended Joanna Briggs Institute (JBI) approach to critical appraisal, study selection, data extraction and data synthesis was used.

RESULTS

Twenty-two studies met the eligibility criteria and were included in the review, which were then assessed to be of moderate to high quality (scores 5-10) based on the JBI Critical Appraisal Checklist for Qualitative Research. The studies were published between 1990 and 2017, and all used qualitative methodologies to accomplish the overall aim of investigating the experiences of expectant or new fathers. Nine studies were from the UK, three from Sweden, three from Australia, two from Canada, two from the USA, one from Japan, one from Taiwan and one from Singapore. The total number of first time fathers included in the studies was 351. One hundred and forty-four findings were extracted from the included studies. Of these, 142 supported findings were aggregated into 23 categories and seven synthesized findings: 1) New fatherhood identity, 2) Competing challenges of new fatherhood, 3) Negative feelings and fears, 4) Stress and coping, 5) Lack of support, 6) What new fathers want, and 7) Positive aspects of fatherhood.

CONCLUSIONS

Based on the synthesized findings, three main factors that affect first time fathers' mental health and wellbeing during their transition to fatherhood were identified: the formation of the fatherhood identity, competing challenges of the new fatherhood role and negative feelings and fears relating to it. The role restrictions and changes in lifestyle often resulted in feelings of stress, for which fathers used denial or escape activities, such as smoking, working longer hours or listening to music, as coping techniques. Fathers wanted more guidance and support around the preparation for fatherhood, and partner relationship changes. Barriers to accessing support included lack of tailored information resources and acknowledgment from health professionals. Better preparation for fatherhood, and support for couple relationships during the transition to parenthood could facilitate better experiences for new fathers, and contribute to better adjustments and mental wellbeing in new fathers.

Mental health literacy of maternal and paternal postnatal (postpartum) depression in British adults

Background: Postnatal depression affects between 6 and 13% of new parents, but only a small proportion of individuals who meet diagnostic criteria receive optimal treatment. One reason for this is poor mental health literacy of postnatal depression.Aims: Studies have examined mental health literacy of maternal postnatal depression, but there are no similar studies of paternal postnatal depression, which we sought to rectify.Methods: A sample of 406 British adults was presented with vignettes describing cases of either maternal or paternal postnatal depression. Based on the vignettes, participants were asked to report if they thought anything was wrong with the targets and, if so, to describe what they thought was wrong. Participants also rated the targets on a range of attitudinal dimensions.Results: Participants were more likely to indicate that something was wrong when the target was female (97.0%) compared to male (75.9%). Of those who believed something was wrong, 90.1% of participants correctly described the female target as experiencing postnatal depression, but only 46.3% did so for the male target. Participants also held more positive attitudes toward the female target than the male target.Conclusions: There is a gender binary in symptom recognition of postnatal depression, which highlights the need for greater awareness of paternal postnatal depression.

Postpartum Depression Risk in Husbands of Women Who Had Caesarean Section Deliveries in Turkey

This study was conducted to determine the risk of postpartum depression in husbands of women who had a caesarean section and the factors affecting this risk. The study sample included husbands of 298 women who gave birth for the first time and via caesarean in Zonguldak Maternity and Child Health Hospital in Turkey. Data were collected using a data collection form and the Edinburgh Postnatal Depression Scale. This study revealed that more than one-third of the fathers had a risk of postpartum depression. It also revealed that postpartum depression risk was high in fathers who had girl babies and whose wives had postpartum depression risk.

First-time fathers' needs and experiences of transition to fatherhood in relation to their mental health and wellbeing: a qualitative systematic review protocol

REVIEW QUESTION/OBJECTIVE

This qualitative review seeks to identify first-time fathers' needs and experiences in relation to their mental health and wellbeing during their transition to fatherhood. This will include resident first-time fathers who are either the biological or non-biological father.The objectives are to explore first-time fathers' experiences in relation to.

New Fathers' Perinatal Depression and Anxiety-Treatment Options: An Integrative Review

More than 10% of fathers experience depression and anxiety during the perinatal period, but paternal perinatal depression (PPND) and anxiety have received less attention than maternal perinatal mental health problems. Few mainstream treatment options are available for men with PPND and anxiety. The aim of this literature review was to summarize the current understanding of PPND and the treatment programs specifically designed for fathers with perinatal depression. Eight electronic databases were searched using a predefined strategy, and reference lists were also hand searched. PPND and anxiety were identified to have a negative impact on family relationships, as well as the health of mothers and children. Evidence suggests a lack of support and tailored treatment options for men having trouble adjusting to the transition to fatherhood. Of the limited options available, cognitive behavioral therapy, group work, and blended delivery programs, including e-support approaches appear to be most effective in helping fathers with perinatal depression and anxiety. The review findings have important implications for the understanding of PPND and anxiety. Future research is needed to address the adoption of father-inclusive and father-specific models of care to encourage fathers' help-seeking behavior. Inclusion of male-specific requirements into support and treatment options can improve the ability of services to engage new fathers. Psychotherapeutic intervention could assist to address the cognitive differences and dissonance for men adjusting to the role of father, including male identity and role expectations.

An integrative review of paternal depression

The aim of this project was to review current research regarding postnatal depression in fathers and to present potential screening and referral options. The search was limited to scholarly (peer reviewed) journals and all articles were retrieved with date limits. Initial search parameters were the following: antenatal depression OR pregnancy depression OR postnatal depression OR perinatal depression AND father* OR men OR paternal. The search yielded 311 abstracts returned. With reference to the inclusion criteria and primary and secondary outcomes intended for the focus of this review, N=63 articles were retrieved and read in full by the researchers. These articles were included in the final integrative review. Depression in fathers following the birth of their child was associated with a personal history of depression and with the existence of depression in their partner during pregnancy and soon after delivery. Based on the review the authors suggest routine screening and assessment of both parents should occur across the pregnancy and postnatal period. The use of the Edinburgh Postnatal Depression Scale for screening of depression in men needs to be linked to referral guidelines for those individuals who require further investigation and care.