Depressive symptoms in new first-time fathers: associations with age, sociodemographic characteristics, and antenatal psychological well-being

Longitudinal trajectories and associated risk factors of paternal mental illness in the nine years surrounding the transition to fatherhood

BACKGROUND

The arrival of one's first child is a known risk factor for mental illness, yet investigations on fathers' mental health are limited. We conducted a longitudinal investigation on paternal depression and anxiety in the nine years surrounding the transition to fatherhood.

METHODS

Using a national cohort of French men (CONSTANCES, n = 6299), we investigated the prevalence and associated risk factors of mental illness amongst first-time fathers. Responses to the Center for Epidemiological Studies Depression (CES-D) and 12-item General Health Questionnaire (GHQ-12) scales were used to identify clinically significant symptom scores. Self-declared mental illness was also reported by participants. Group-based modelling was used to identify latent trajectory groups for both measures.

RESULTS

Levels of self-declared anxiety (averaging 4.9 % pre-fatherhood, 7.8 % post) exceeded that of depression (1.9 % pre- fatherhood, 3.3 % post) or other disorders. However, rates of clinically significant symptom scores (17-27 %) were consistently higher. Participants' mental health appeared to worsen from two-years prior to their child's arrival and improve from two-years after. We identified three trajectory groups for fathers' self-declared mental illness: Low stable (90.3 %); Low risk with high temporary increase (5.6 %); and Consistent high risk (4.1 %). Risk factors associated with worsening mental health trajectories were unemployment, not living with one's partner, having had adverse childhood experiences and foregoing healthcare due to financial reasons.

LIMITATIONS

All measures of mental illness relied on participant self-reports and are thus subject to bias.

CONCLUSIONS

This study reveals an important period of heightened psychological vulnerability amongst first-time fathers, emphasising the need for increased and better adapted paternal mental health screening.

Relationship between personality traits and postpartum depression in Pakistani fathers

The previous studies have found an association between Big Five personality traits and postpartum depression in women. The present study aimed to find out an association between Big Five personality traits and postpartum depression in a sample of Pakistani fathers. A total of 400 Pakistani fathers who had birth of a child in the past 1 month to 1 year period and had been living with their married partners were recruited purposively by using Google Form based survey from the major cities of Pakistan. The Urdu translated versions of Big Five Personality Inventory (BFI) and Edinburgh Postnatal Depression Scale (EPDS) were used as the main outcome measures to assess the relationship between personality traits and postpartum depression. The results found a significant negative and moderate association between Big Five personality traits and paternal postpartum depression except openness which had a weak association and neuroticism which had a positive and moderate association with PPPD (r(398) = .45). The multiple linear regression analysis found that Big Five personality traits significantly predicted paternal postpartum depression (F(5, 394) = 53.33, p = .001) except openness (B = .007, p = .98). The analysis of variance (ANOVA) found significant differences in paternal postpartum depression for age of father (F(2, 397) = 6.65, p = .001, ηp2 = .03), spouse age (F(2, 393) = 5.97, p = .003, ηp2 = .02), employment type (F(2, 395) = 9.69, p = .001, ηp2 = .04) and time spent at home (F(2, 397) = 6.23, p = .002, ηp2 = .03) while there were found no significant differences for education (F(2, 397) = 1.29, p = .27, ηp2 = .006), marital duration (F(2, 397) = 2.17, p = .11, ηp2 = .01), and birth number of recent child (F(2, 397) = 1.48, p = .22, ηp2 = .007). The study concluded that Big Five personality traits are significantly correlated with and predict paternal postpartum depression except openness which did not predict paternal postpartum depression. The occurrence of paternal postpartum depression varied significantly for age of father, age of spouse, type of employment and time spent at home.

Feasibility and acceptability of an online mental health intervention for pregnant women and their partners: a mixed method study with a pilot randomized control trial

BACKGROUND

Untreated perinatal mood and anxiety disorders (PMAD) have short- and long-term health and social consequences; online cognitive behavioral therapy (CBT) interventions can reduce symptoms. Despite partner support being protective online interventions rarely target couples. This study builds on research on an existing CBT-based intervention, the Mothers and Babies Online Course (eMB), by testing its feasibility with prenatal couples.

METHODS

We conducted a pilot, randomized, controlled feasibility trial using a 1:1 parallel design. To be eligible, participant dyads were pregnant people (between 13-30 weeks gestation and with a score of 10 or greater on either the GAD-7 or PHQ-9 scale indicating elevated symptoms of anxiety or depression) and their cohabitating partners, living in Missouri, with access to the internet; both in the dyad consented to participate. Recruitment occurred via Facebook ads, flyers, and a snowball approach. The intervention group received eMB, and the control group received a list of community resources. We examined retention and adherence data extracted from eMB analytics and study databases. All participants were given depression and anxiety scales at baseline, 4 and 8 weeks to test preliminary efficacy; satisfaction and acceptability were measured at trial end (i.e., eight weeks) and via interview.

RESULTS

There were 441 people who responded to recruitment materials, 74 pregnant people were screened; 19 partners did not complete enrolment, and 25 dyads were ineligible. There were 15 dyads per group (N = 30) who enrolled; all completed the study. The survey response rate was 90% but partners required nearly twice the number of reminders. No participant completed all lessons. Mean depression and anxiety scores dropped over time for dyads in control (M = -1.99, -1.53) and intervention (M = -4.80, -1.99). Intervention pregnant people's anxiety significantly decreased (M = -4.05; 95% CI [0.82, 7.27]) at time two compared to control. Twelve pregnant people and four partners participated in post-intervention interviews and suggested improvements for eMB.

CONCLUSION

Online dyadic interventions can potentially reduce PMAD symptoms. However, to feasibly study eMB with couples, strategies to increase program adherence are necessary. Tailoring interventions to overtly include partners may be advantageous.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05867680, 19/05/2023.

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.

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.

Psychosocial predictors of early postpartum depressive and anxious symptoms in primiparous women and their partners

BACKGROUND

While the majority of research on postpartum depressive and anxious symptoms has focused on mothers, a growing body of research suggests a need to understand the role of the partner's health and relationship quality as predictors of postpartum maternal depression, while also better understanding correlates of partner or paternal depression in the postpartum period. The purpose of the current study is to evaluate mother and partner stress, anxiety, mood, infant care support, and relationship quality as predictors of perinatal depressive and anxious symptoms in first time mothers and partners during the postpartum hospital stay.

METHODS

First time parent couples (n = 116) completed a survey during the two-day postpartum stay in a Midwest hospital. Depressive (EPDS) and anxiety symptoms (DASS-21-Anxiety) were assessed in both mothers and partners. Hierarchical linear regression was used to evaluate relationship satisfaction, partner infant care support, stress, and co-parent mood as predictors of mood in mothers and partners separately.

RESULTS

Stress was a predictor of anxiety and depression symptoms in both mothers and partners. Additionally, co-parent anxiety significantly predicted anxiety in both mothers and partners. Maternal relationship satisfaction was a predictor of the partner's depressive symptoms, and maternal perceptions of partner infant support predicted maternal depressive symptoms.

CONCLUSIONS

Together, these results suggest that stress, relationship satisfaction, and co-parent mood are related to depressive and anxious symptoms in mothers and partner, underscoring the need to continue exploring mother and partner mental health in a dyadic framework.

Recognition and CBT for Paternal Perinatal Depression in Primary Care: A Case Report

Perinatal depression is prevalent in primary care in the United Kingdom. The recent NHS agenda implemented specialist perinatal mental health services to improve women's access to evidence-based care. Although there is ample research on maternal perinatal depression, paternal perinatal depression remains overlooked. Fatherhood can have a positive long-term protective impact on men's health. However, a proportion of fathers also experience perinatal depression which often correlates with maternal depression. Research reports that paternal perinatal depression is a highly prevalent public health concern. As there are no current specific guidelines for screening for paternal perinatal depression, it is often unrecognized, misdiagnosed, or untreated in primary care. This is concerning as research reports a positive correlation between paternal perinatal depression with maternal perinatal depression and overall family well-being. This study illustrates the successful recognition and treatment of a paternal perinatal depression case in a primary care service. The client was a 22-year-old White male living with a partner who was 6 months pregnant. He attended primary care with symptoms consistent with paternal perinatal depression as indicated by his interview and specified clinical measures. The client attended 12 sessions of cognitive behavioral therapy, conducted weekly over a period of 4 months. At the end of treatment, he no longer portrayed symptoms of depression. This was maintained at 3-month follow-up. This study highlights the importance of screening for paternal perinatal depression in primary care. It could benefit clinicians and researchers who may wish to better recognize and treat this clinical presentation.

Dads in Distress: symptoms of depression and traumatic stress in fathers following poor fetal, neonatal, and maternal outcomes

BACKGROUND

This study aims to explore the prevalence of symptoms of depression and traumatic stress in fathers in the setting of poor fetal, neonatal, and maternal outcomes.

METHODS

A prospective mixed-methods study was conducted at an outer metropolitan public teaching hospital in Brisbane, Australia, with quantitative results presented here. Subjects included 28 fathers whose male partners had experienced pregnancy or childbirth complicated by a significant congenital abnormality or aneuploidy, termination of pregnancy, fetal death in-utero, stillbirth, admission to the neonatal intensive care unit or special care nursery or significant maternal morbidity, such as a postpartum haemorrhage or an emergency postpartum hysterectomy. These experiences were classified into two groups: anticipatory (time to prepare) and sudden (no warning). The fathers were screened using the Edinburgh Postnatal Depression Scale (EPDS) and the Impact of Events Scale-Revised (IES-R) to assess subjective distress at 2-3 weeks (timepoint 1) and 3-4 months (timepoint 2) after the event.

RESULTS

Data for both the EPDS and IES-R scales was available for 26 fathers (92.9%) at timepoint 1 and for 15 fathers (53.6%) at timepoint 2. High overall EPDS scores (≥10) were noted in 16/27 (59.3%) fathers at timepoint 1 and 6/15 fathers (40.0%) at timepoint 2. High overall IES-R scores ≥33 were noted in 12/26 (46.2%) fathers at timepoint 1 and 4/15 fathers (26.7%) at timepoint 2. A higher percentage of fathers who experienced anticipatory events had EPDS and IES-R score above these cut-offs at timepoint 1 (8/13 or 61.5%) compared to those experiencing sudden events (8/14 or 57.1%), however, percentages were similar between groups at time point 2 (2/7 or 28.6%% and 4/8 or 50.0%, respectively). More fathers who experienced anticipatory events had IES-R scores ≥33 at timepoint 1 (7/13 or 53.8%) compared to those experiencing sudden events (5/14 or 38.0%).

CONCLUSION

Our study indicates high rates of distress in fathers exposed to poor fetal, neonatal, and maternal outcomes, which can persist for months after the event. Increased support for fathers in this setting may be required to prevent poor mental health. Further research on the long-term effects of these adverse events is warranted.

Repetitive negative thinking in the perinatal period and its relationship with anxiety and depression

BACKGROUND

Rumination and worry represent two types of repetitive negative thinking (RNT), and their predictive and maintaining roles are well-established in depression and anxiety, respectively. Furthermore, there is an emerging literature on the link between RNT and psychological wellbeing in the perinatal period.

METHODS

We conducted a scoping review of studies that have investigated the relationship between RNT and perinatal depression and anxiety. We identified 87 papers eligible for inclusion in the review; they included cross-sectional and longitudinal studies, as well as treatment evaluations (pilot trials and randomised controlled trials).

RESULTS

Cross-sectional studies provided evidence of an association between RNT (i.e., rumination and worry) and depression and anxiety, in both pregnancy and postpartum. Longitudinal findings were mixed. Whilst antenatal worry consistently predicted subsequent depression and anxiety (both later in pregnancy and postpartum), rumination did not consistently predict depression. However, there was some evidence that rumination interacted with other processes to predict later psychopathology. Three randomised controlled trials evaluated whether psychological treatments reduce RNT in the perinatal period, only one of which included a clinical sample.

LIMITATIONS

No experimental investigations were eligible for inclusion in the review.

CONCLUSIONS

Further studies are needed to further our understanding of the nature and role of RNT in pregnancy and postpartum, and its consequences for maternal mental health. These include (but are not limited to) experimental investigations, studies with large clinical samples, and RCTs evaluating the effectiveness of psychological interventions targeting RNT to prevent and treat perinatal depression and anxiety.

Depressive Symptoms in Fathers during the First Postpartum Year: The Influence of Severity of Preterm Birth, Parenting Stress and Partners’ Depression

Although preterm birth constitutes a risk factor for postpartum depressive symptomatology, perinatal depression (PND) has not been investigated extensively in fathers of very low (VLBW) and extremely low birth weight (ELBW) infants. This study explored paternal depression levels at 3, 9, and 12 months of infant corrected age, investigating also the predictive role played by the severity of prematurity, maternal and paternal PND levels, and parenting stress. We recruited 153 fathers of 33 ELBW, 42 VLBW, and 78 full-term (FT) infants, respectively. Depression was investigated by the Edinburgh Postnatal Depression Scale (EPDS) and distress by the Parenting Stress Index-Short Form-PSI-SF (Total and subscales: Parental Distress, Parent–Child Dysfunctional Interaction, and Difficult Child). ELBW fathers showed a significant decrease (improvement) in EPDS, total PSI-SF, and Parental Distress mean scores after 3 months. Paternal EPDS scores at 12 months were significantly predicted by VLBW and FT infants’ birth weight categories, fathers’ EPDS scores at 3 and 9 months, Parent–Child Dysfunctional Interaction subscale at 3 months, and Difficult Child subscale at 9 months. This study strengthens the relevance of including early routine screening and parenting support for fathers in perinatal health services, with particular attention to fathers who might be more vulnerable to mental health difficulties due to severely preterm birth.

Predictive Factors for Depression and Anxiety in Men During the Perinatal Period: A Mixed Methods Study

The purpose of this study was to identify the risk factors associated with paternal perinatal mental distress in a sample of Australian men. A mixed-methods design was used. The qualitative component (N = 13) using thematic analysis identified maternal depression, marital distress, masculine gender role stress, unplanned pregnancy, work–family conflict, and sleep disturbance as risk factors for paternal perinatal mental distress. The quantitative component (N = 525) expanded on the qualitative findings and examined the associations between the identified risk factors and mental distress of fathers in the perinatal period measured by Edinburgh postnatal depression scale. Hierarchical multiple regression analysis revealed six significant predictors of paternal perinatal mental distress with masculine gender role stress being the most significant risk factor for paternal perinatal mental distress. The results from this study provide an insight into how masculine gender role may affect the expression and experience of mental distress in fathers within the perinatal period. Implications of research findings are discussed.

The role of early adversity and cognitive vulnerability in postnatal stress and depression

The purpose of the present study was to examine vulnerability factors in expecting parents that might lead to mental illness in the perinatal period. Specifically, we studied how parental early adversity, attentional bias to infant faces, repetitive negative thinking, and demographic factors, were associated with pre- and postnatal depressive symptoms and parenting stress. Participants were expecting parents taking part in the Northern Babies Longitudinal Study, where assessments were made both pre- and postnatally. Assessments included both questionnaires and cognitive tasks. About half of the participants received the Newborn Behavior Observation (NBO)-intervention after birth, between pre- and postnatal assessments. Results show that repetitive negative thinking was a significant predictor of both depressive symptoms and parenting stress, while education, social support, and parity came out as protective factors, especially in mothers. Parental early adversity had an indirect effect on postnatal depressive symptoms and parenting stress, mediated by prenatal and postnatal depressive symptoms, respectively. The NBO intervention did not affect the results, signifying the importance of early childhood adverse events and negative thinking on parents' postnatal adjustment and mood, even when an intervention is provided. In conclusion, repetitive negative thinking is a significant vulnerability factor independent of the presence of depressive symptoms, and health professionals must be aware of parents’ thinking style both during pregnancy and after birth.

Prevalence and associated factors of paternal stress, anxiety, and depression symptoms in the early postnatal period

BACKGROUND

The changes experienced during the transition to first-time or subsequent fatherhood are mainly positive; however, fathers can also experience adverse mental health outcomes such as stress, anxiety, and depression. The aim of this study was to investigate the prevalence and associated factors of paternal stress, anxiety, and depression symptoms in the early postnatal period.

METHODS

A quantitative, descriptive correlational design was used. Data were collected using a self-administered questionnaire comprising of the Perceived Stress Scale, the State-Trait Anxiety Inventory, and the Edinburgh Postnatal Depression Scale.

RESULTS

A total of 336 fathers were included in the study. The prevalence rates were 41.1% (n = 138) for moderate/high stress symptoms, 20.8% (n = 70) for state anxiety symptoms, 25.9% (n = 87) for trait anxiety symptoms, and 13.4% (n = 45) for depression symptoms. In the multivariable analysis, several factors were associated with increased stress, anxiety, and depression symptoms including being a subsequent father (p = 0.009), not living in a house (p = 0.009), having a history of adverse mental health (p = 0.008), and having a partner with a history of anxiety (p = 0.040).

CONCLUSION

The findings suggest that fathers are at risk of adverse mental health in the early postnatal period which is a pivotal time for fathers in terms of bonding with their infant and redefining their relationship with their partner.

Relations between Early Childhood Paternal Depression and Preschool- and School-age Psychosocial Functioning

Objective: The present study used a longitudinal design to examine associations between paternal depressive symptoms in toddlerhood and children's psychosocial adjustment during the preschool and school-age periods. Maternal depressive symptoms and intervention status were tested as moderators of associations between paternal depressive symptoms and child maladjustment.Method: The sample (n = 264, 48% female, 62% White, 14% Black, 14% bi-racial, 11% another racial group, and 86% non-Hispanic/Latinx) represented a subsample of families from the Early Steps Multisite Study, a clinical randomized trial testing the effectiveness of the Family Check-Up among low-income families using Women, Infants, and Children Nutritional Supplement Services in three communities varied in urbanicity. Fathers and mothers reported their levels of depressive symptoms at child age 2, primary caregivers (mostly mothers) contributed measures of child adjustment at ages 5, 8.5, and 9.5, and teachers completed questionnaires about child adjustment at ages 8.5 and 9.5.Results: Direct relations were found between paternal depressive symptoms and primary caregivers' reports of children's preschool and school-age internalizing problems. Furthermore, higher levels of paternal depression were associated with higher levels of children's later adjustment problems at preschool-age when maternal depressive symptoms were mild or higher. The Family Check-Up attenuated relations between paternal depressive symptoms and children's internalizing problems at school-age.Conclusions: These findings have important implications for future research on preventing children's early-emerging problem behaviors at home, suggesting that addressing paternal depressive symptoms in early childhood may be an important intervention target, especially in the context of maternal depression.

Depressive symptoms in men immediately after birth

OBJECTIVE

Depression is the second leading cause of morbidity worldwide. This study aimed to assess the prevalence and associated risk factors of paternal postpartum depressive symptoms (PPD).

METHODS

In a cross-sectional study, via a stratified random and convenience sampling method 591 couples who were referred to Mazandaran primary health centers between 2 and 8 weeks postpartum were recruited from March to October 2017. Couples were screened for depressive symptoms using Edinburgh Postnatal Depression Scale (EPDS). Fathers provided information on socio-demographic characteristics, life events, neonatal stressor, perceived stress (Perceived Stress Scale), social support (Multidimensional Scale of Perceived Social Support), and general health status using General Health Questionnaire (GHQ-12) as well. Data was analyzed using multiple logistic regression.

RESULTS

Overall, 93 fathers (15.7%) and 188 mothers (31.8%) reported depressive symptoms above the cut-off EPDS score of 12. In the multiple logistic regression model, older age, maternal depressive symptoms, higher GHQ-12 scores and increased recent life events were related to paternal PPD. A significant inverse association was found between number of children and paternal PPD.

CONCLUSION

Depressive symptoms especially in first-time fathers following the birth of a child are not uncommon. Creating opportunities for men to access special health care services, parental education to help adapting to parenthood, screening programs, and psychiatric/psychosocial interventions to decrease suffering of depression for both depressed parents are recommended.

A dyadic approach to stress and prenatal depression in first-time parents: The mediating role of marital satisfaction

In the field of perinatal clinical psychology, most studies focus on mothers' psychological states during pregnancy, neglecting the role of their partners. This study used an Actor-Partner Interdependence Mediation Model to evaluate the mediating role of dyadic satisfaction on the relationship between perceived stress and prenatal depressive symptomatology in both members of male-female-mixed-gender couples who were expecting their first child. One hundred thirty-eight couples in their third trimester of pregnancy were asked to complete questionnaires about perceived stress, dyadic adjustment, and depression. The model revealed that there was an intrapersonal indirect effect of fathers' perceived stress on prenatal paternal depression through their marital satisfaction. Moreover, an interpersonal indirect effect was found with mothers' perceived stress being associated with prenatal paternal depression through fathers' dyadic satisfaction. Maternal indirect effects were all non-significant, suggesting that their dyadic satisfaction and that of their partner did not mediate the relation between their perceived stress and that of their partner and their prenatal depression. Findings support the importance of assessing the dyadic satisfaction of couples during pregnancy, especially in expectant fathers, and targeting it in the psychological support offered to couples as a way of improving their prenatal distress, and consequently, their mental health.

Factors Influencing Paternal Postpartum Depression: A Systematic Review and Meta-Analysis

BACKGROUND

Postpartum period is a critical time that requires adjustments not only for mothers but also for fathers and may pose risk for depression. Studies show that the prevalence of paternal postpartum depression (PPD) is between 1.2% and 25.5%. PPD is an under-recognized public health issue and its reported influencing factors are still inconclusive.

OBJECTIVE

The purpose of this paper is to extend the literature by examining influencing factors that affect paternal PPD and describe the strength their associations.

METHODS

We conducted keyword search of Web of Science, PubMed, Embase, the Cochrane Library and PsycARTICLES electronic databases up to Jan 17, 2020, without language restrictions, for observational studies investigating the factors influencing paternal PPD and its effects. Fixed or random effect model was used to pool odds ratio (OR) and 95% confidence intervals (CI) with Stata software 12.0. Heterogeneity between studies was evaluated using Cochran's chi-squared test (Cochran's Q) and I² values.

RESULTS

Nineteen cross-sectional studies and eighteen cohort studies published from 1996 to 2019 were included in this review and seventeen studies in the meta-analysis. Factors affecting paternal PPD can be classified into paternal, maternal, infant and family factors. In Meta-analysis, 9 of 17 influencing factors were revealed to be statistically significant: 1) paternal factors: unemployment OR= 2.59 (95%CI:1.42-4.74), low social support OR=1.05 (95%CI:1.03-1.08), negative life events OR=1.45 (95%CI:1.13-1.87), perceived stress OR=1.08 (95%CI:1.03-1.12), financial strain OR=2.07 (95%CI:1.13-3.81), history of mental illness OR=3.48 (95%CI:2.49-4.86); 2) maternal factors: parity OR=1.36 (95%CI:1.13-1.65) and maternal postnatal depression OR=1.17 (95%CI:1.03-1.33); 3) family factors: low marital satisfaction OR=1.40 (95%CI:1.22-1.61). No statistically significant association with infant factors was found in the meta-analysis.

LIMITATIONS

There was publication bias since we only included English studies. Samples were under-represented in low-and middle-income countries. The meta-analysis results are subject to unobserved confounding factors and cannot explain causality.

CONCLUSION

This overview of the evidence suggests a relationship between paternal employment, psychological status, history of maternal mental illness, first pregnancy, marital relationship and paternal PPD. The low number of studies for some infant factors in meta-analysis leaves gaps in knowledge that need to be addressed. The mechanisms underlying the reported associations and their causal relationship still remain unclear. The awareness of the serious long-term consequences of paternal PPD should encourage better identification of those at risk and the development of effective interventions to protect fathers from PPD.

Associations Between Marital Discord and Depressive Symptoms: A Cross-Cultural Analysis

The objectives of this study were to investigate actor and partner effects of the association between marital discord and depressive symptoms in a sample of 4,779 couples from 11 European countries that were divided into three groups (i.e., Northern, Central, Southern Europe), and evaluate the potential gender and cross-cultural invariance of this association. Actor-partner interdependence models were used to analyze the cross-sectional associations between self-reported perceived marital conflict and depressive symptoms. Marital conflict was significantly and positively associated with self-reported depressive symptoms for husbands and wives (actor effects), as well as with partner-reported depressive symptoms (partner effects). Pooling across cultural groups, no significant difference in the magnitude of actor or partner effects based on gender was found. The magnitude of the actor effects varied across cultural groupings only for women: a significantly weaker association existed for women residing in Northern Europe relative to women in Central or Southern Europe. These results suggest that marital discord is a reliable correlate of depressive symptoms for European couples and that the magnitude of the positive association varies by culture for women. Should these results be replicated longitudinally, couple-based interventions may be indicated to reduce marital discord and prevent and treat depression in Europe.

Disjunctures in Experiences of Support During the Transition to Fatherhood of Men Who Have Used Intimate Partner Violence

The transition to fatherhood has been shown to be a stressful time for men, and their experiences of identifying and accessing formal and informal support are mixed. However, research on the experience of men who use intimate partner violence (IPV) during the transition to fatherhood is limited. The evidence documenting the prevalence and short- and long-term impact of violence perpetrated by men against women during pregnancy and postpartum demonstrates the seriousness of this public health issue. To understand the mechanisms of interrupting IPV by engaging men, the gap between what is known about experiences of identifying the need for and access to support during the transition to fatherhood of men with past and current histories of using IPV must be bridged. The study described explores experiences of support during the transition to fatherhood of men who have used IPV. Descriptive findings revealed that men had a range of types of supports from multiple sources; however, most also identified crucial unmet instrumental and socioemotional needs. Four themes surfaced disjunctures in how participants described resources they needed, accessed, and desired. Specifically, these disjunctures were related to men's adherence to a self-reliant identity, a lack of male-specific peer or role model support, the tendency for childbirth classes to be geared toward mothers and not seen by fathers as sources of support, and a gap between men's goals for themselves as fathers, and the actual tools, resources, and modeling that were accessible and "acceptable." The implications include suggestions for group-based programmatic efforts, and three initial steps for organizations to assess and build current capacity to engage-with safety and accountability at the forefront-fathers who use IPV.

Risk factors for postpartum depressive symptoms among fathers: A systematic review and meta-analysis

INTRODUCTION

The transition to parenthood is a major life change that may affect the mental well-being of both mothers and fathers and place them at an increased risk for depression. The objective of our study was to systematically review the literature and identify factors associated with postpartum depressive symptoms in fathers.

MATERIAL AND METHODS

Searches were conducted in PubMed, PsychInfo, Embase, and CINAHL to identify studies published until March 2020. Studies that reported factors associated with depression among fathers were included. The data from these studies were extracted independently by two authors with disagreements resolved by a third author and consensus. The odds ratio (OR) was used as a measure of association between the risk factor and the primary outcome: depression within the first 12 months following childbirth among fathers diagnosed using any method. Summary estimates were calculated using a random effects model. The associations between the risk factors and depressive symptoms were evaluated.

RESULTS

The search identified 1040 reports. After screening titles and abstracts, 62 full-text articles were assessed for eligibility and 25 studies involving 13 972 fathers were included in the systematic review. Fathers with a prior mental health illness episode had higher odds of developing depressive symptoms than those with no mental health history (eight studies, n = 3515, pooled OR 6.77, 95% CI 5.07-9.04; I²  = 0%). Other significant risk factors included relationship dissatisfaction (eight studies, n = 6924, pooled OR 1.53, 95% CI 1.29-1.81; I²  = 93%), maternal depression (seven studies, n = 6661, pooled OR 1.66, 95% CI 1.27-2.17; I²  = 88%), financial instability (five studies, n = 3052, pooled OR 2.24, 95% CI 1.44-3.48; I²  = 74%), paternal unemployment (three studies, n = 1505, pooled OR 6.61, 95% CI 1.94-22.54; I²  = 59%), low education level (two studies, n = 1697, pooled OR 3.56, 95% CI 1.06-11.97; I²  = 88%), and perceived stress (two studies, n = 692, pooled OR 1.06, 95% CI 1.02-1.11; I²  = 5%). Lack of support and low parenting self-efficacy were also associated with paternal postpartum depressive symptoms.

CONCLUSIONS

A history of paternal mental illness, maternal depression, and diverse psychosocial factors were associated with depressive symptoms among fathers postnatally. These findings can guide the development of family-level interventions for early identification and treatment and social media campaigns to promote help-seeking behaviors and engagement in preventive strategies.

Intimate Relationships and Depression: Searching for Causation in the Sea of Association

This article provides a critical review of existing research on intimate (marriage or marriage-like) relationship distress and risk for depression. Using the meta-framework of research triangulation, we seek to synthesize research evidence across several different methodologies and study designs and to draw the most reliable conclusion regarding a potential causal association between relationship distress and depression. Focusing on existing correlational (i.e., observational), genetically informed, and intervention (i.e., experimental) research on the association between relationship distress and depression, we conclude that the existing body of research evidence supports the claim that relationship distress is a causal risk factor for depression. A secondary aim of the article is to highlight a variety of effective methods that, when viewed from the perspective of triangulation, enhance the pursuit of causal inference, including propensity score matching, target trial emulation, directed acyclic graph approach, and Mendelian randomization.

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.

New parents' experiences of postpartum depression: a systematic review of qualitative evidence

OBJECTIVES

The objective of the review was to synthesize the evidence on new mothers' and fathers' experiences of postpartum depression (PPD).

INTRODUCTION

Postpartum depression is a form of clinical depression that affects women and, less frequently, men, typically during the first months after childbirth. It has been estimated that 10% to 20% of women and 10% of men suffer from PPD and it may have serious consequences for mothers, fathers and their children. Therefore, this review covers the experiences of both mothers and fathers.

INCLUSION CRITERIA

This qualitative review considered studies that included new mothers and fathers who had any number of children and who experienced PPD within a one-year postpartum period. The phenomenon of interest was the lived experience of new mothers and fathers with PPD. Qualitative studies including, but not limited to, phenomenology, grounded theory, ethnography, action research and feminist research were considered.

METHODS

The review systematically searched the following databases: MEDLINE, CINAHL, PsycINFO, Scopus and the Finnish database MEDIC. In addition, the search for unpublished articles included ProQuest Dissertations and Theses. The methodological quality of the included studies was assessed independently by two reviewers, and qualitative data were extracted from papers by two independent reviewers using a standardized data extraction tool. Qualitative research findings were pooled using the JBI methodology.

RESULTS

Thirteen papers that considered mothers' (n = 199) experiences of PPD were included in the review. A total of 98 findings were extracted and aggregated into 14 categories, and from them, four synthesized findings were developed: i) Depressed mothers feel unable to control their own lives due to low resilience; ii) The ambivalent feelings depressed mothers experience towards their babies, partners and in-laws cause distress and suffering; iii) Depressed mothers experience anger and despair if they perceive imbalances between their support needs and the support they get from healthcare providers and significant others; and iv) Depressed mothers experience hopelessness and helplessness resulting from their new-found motherhood and financial worries. Two papers that considered fathers' (n = 20) experiences of PPD were included in the review. A total of 19 findings were extracted and aggregated into six categories, and from them, two synthesized findings were developed: i) Depressed fathers experience disappointment arising from perceived imbalances between their support needs and the support they get from their partner and significant others; and ii) Depressed fathers are more imbalanced after childbirth than fathers who are not suffering from PPD, so they feel unable to control their own lives due to low resilience.

CONCLUSIONS

The qualitative studies concerning new parents' experiences of PPD have focused on the mother's perspective, and studies of the father's perspective, especially of the father's own experiences of PPD, are scarce. Both mothers and fathers do not receive enough support from their significant others. In addition, mothers want more support from health professionals. Because PPD has a great influence on the well-being of mothers and fathers, as well as children, it is important to understand what parents undergo after childbirth.

Postpartum depression in mothers and fathers: a structural equation model

BACKGROUND

Post-partum depression (PPD) is a growing mental health concern worldwide. There is little evidence in the Chinese context of the relationship between paternal PPD and maternal PPD. Given the growing global concerns this relationship requires further exploration.

METHODS

A survey was conducted with 950 total couples from March 2017 to December 2018. The study was conducted using a standardized questionnaire that included basic demographic information, information on the relationship between the mother-in-law and daughter-in-law, marital satisfaction (both maternal and paternal), and PPD symptoms. Structural Equation Modelling (SEM) analysis was used to explore the underlying mechanism for PPD symptoms in mothers and fathers.

RESULTS

In 4.4% of the couples both the wife and the husband showed depressive symptoms. Maternal marital satisfaction showed a significant mediating effect on paternal PPD (B = -0.114, p < 0.01), and there was a direct effect of maternal PPD on paternal PPD (B = 0.31, p < 0.001).

CONCLUSIONS

This is the first study to investigate the possible correlation between maternal PPD, mother-in-law and daughter-in-law relationship satisfaction, maternal marital satisfaction, paternal marital satisfaction, and paternal PPD. It is important for future PPD interventions to target both maternal and paternal mental health, as well as the mechanisms identified that can lead to PPD.

Prenatal Attachment and Perinatal Depression: A Systematic Review

Pregnancy is a period of complex bio-psychological changes, during which the development of an attachment bond to the fetus takes on a central role. Depressive symptoms are common during this period. Both symptoms of depression and low levels of prenatal attachment are related to negative outcomes in caregivers and infants. Following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement, this systematic review analyzes and systematizes 41 studies concerning the association between prenatal attachment and perinatal depression. The majority of the studies reported a significant association between the two. Specifically, prenatal depressive symptoms were found to be negatively associated with prenatal attachment. Furthermore, lower levels of prenatal attachment were related to higher postnatal depressive symptoms, although fewer studies assessed this association. While these results were found across different populations, conflicting findings emerged, suggesting they should be interpreted with caution, particularly in male samples and in non-normative pregnancies (e.g., high-risk pregnancies, medically assisted pregnancies, and pregnancies with previous perinatal losses). These results are clinically important for the perinatal screening process and for implementing preventive and treatment programs. However, future studies are needed to further confirm and generalize these results.

Life situation and support during pregnancy among Thai expectant mothers with depressive symptoms and their partners: a qualitative study

Background

Expectant parents may have positive and negative emotions during pregnancy and receive support from different sources. Studies on life situation and support among couples have rarely been conducted. This study aims to explore life situation and support during pregnancy among expectant mothers with depressive symptoms and their partners.

Methods

Twenty-seven expectant mothers, in the last trimester of pregnancy with depressive symptoms (Edinburgh Postnatal Depression Scale score ≥ 7) from seven public antenatal care clinics in Sakonnakhon, a north-eastern province of Thailand, and their partners were interviewed. In total, 54 semi-structured interviews were subjected to content analysis.

Results

Four categories emerged: (1) Having obstacles in life, (2) Facing life transition, (3) Enhancing confidence, and (4) Dissatisfaction with support. The informants described obstacles regarding economy, fear of health problems, getting an abnormal child and partners’ behaviours. They received support from family members and social networks, but some were dissatisfied with the support from the healthcare. For example, expectant fathers wished to receive more health information and be more involved.

Conclusions

Healthcare professionals should be aware of the influence of cultural and contextual factors when providing antenatal care to expectant parents. Male involvement in the care must not be neglected.

Paternal depressive symptoms during the early postpartum period and the associated factors following the implementation of the two-child policy in China

AIM

To evaluate the prevalence of paternal depressive symptoms during the first three days of childbirth, as well as the associated factors, following the implementation of the two-child policy in China in 2015, which allows couples to have two children in the Chinese mainland.

METHODS

A cross-sectional study was conducted among 318 fathers. Paternal depressive symptoms and self-efficacy of fathers were screened using the Edinburgh Postnatal Depression Scale and the General Self-Efficacy Scale, respectively. In addition, basic information of all parents and neonates was collected. Univariate analysis, binary logistic regression analysis, and principal component analysis (PCA) were used to identify the relationship between paternal depressive symptoms and its associated factors.

RESULTS

Twenty-two percentage of fathers had depressive symptoms during the first three days of childbirth. Binary logistic regression analysis revealed that older fathers, those who slept for more than 8 h per night, or were dissatisfied with their living conditions were more susceptible to developing the symptoms. On the contrary, protective factors such as the educational level of fathers, planned pregnancy, prenatal guidance, having the second-born child, and higher self-efficacy were found to reduce the development of paternal depressive symptoms. PCA showed that the main components that influenced the paternal depressive symptoms were parental age and parity.

CONCLUSIONS

The prevalence of paternal depressive symptoms during the postpartum period did not increase significantly after the implementation of the two-child policy in China. However, focusing on the associated factors is necessary in order to manage postpartum depression during the early postpartum period.

Men's experience of first fatherhood discovery: a descriptive study based on free hierarchical evocation by associative networks

Objective and Background: Men's experiences of first-fatherhood discovery differ widely with various circumstances; they were examined according to the intended/unintended occurrence of partner's pregnancy.Methods: An Associative Network study targeted 44 first-time fathers and analysed their reactions to a stimulus-sentence 'In the first days after pregnancy announcement … 'Results: Word-associations formed 19 themes and 5 metathemes. The main metathemes were Emotional (30%), Cognitive (27%) and Relational (23%). Negative emotions were more frequent in unintended vs. intended pregnancies. Subthemes Chock, Feeling of unreality, Emotion control, Guilt, Denial, or Regret prevailed in unintended pregnancies. The major theme in all pregnancies was Personal advancement but subthemes Physical and psychological preparation and Responsibility prevailed in intended pregnancies vs. Acceptation and Personal progress in unintended pregnancies. Themes Relationships (with partner and others) were more frequently mentioned in unintended pregnancies vs. theme Logistics in intended pregnancies. Overall, the participants expressed opposed conflicting emotions but a desire for real involvement in pregnancy, birth, and child-raising.Conclusion: The participants proved interested and concerned. Fathers's presence and support should be solicited, accounted for, and valued by mothers-to-be and health professionals in all pregnancies. Involving fathers since pregnancy is essential for mental equilibrium, child-parent attachment, child and parent development, and family relationships.

[Prevalence and associated factors of depression symptoms in fathers of children aged 6 months to 17 years in Québec]

OBJECTIVES

In fathers, depression symptoms experienced during pregnancy and after childbirth represent a depression risk factor during the child first months. Since depression can have a huge impact on their subsequent involvement with the child, this issue is worrisome and requires consideration. Until now, however, few studies have dealt with paternal depression and its determinants beyond the perinatal period.

METHOD

This study uses data from a representative provincial survey conducted with 1342 fathers of children aged 6 months to 17 years. It documents the prevalence of moderate and severe depression symptoms with the CES-D scale as well as associated factors.

RESULTS

Findings show prevalence rates ranging from 3% to 10% depending on depression symptom severity and children age. Associated factors include problematic use of alcohol, no employment, stress related to balancing work and family, domestic violence environment, and low revenue and social support.

CONCLUSION

These results are interpreted in light of the role and involvement fathers keep in their child's life. They also stress the importance of identifying depression symptoms in this population beyond the perinatal period while monitoring the symptom intensity.

'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.

A prospective study of postnatal depressive symptoms and associated risk factors in first-time fathers

BACKGROUND

Recent studies show that paternal depression negatively impacts children's behavioral and emotional development. This study determined the prevalence of depressed mood in first-time fathers at 2 and 6 months postpartum and identified associated risk factors.

METHODS

A prospective cohort study with 622 men who completed sociodemographic and psychosocial questionnaires during their partner's third trimester of pregnancy. Fathers completed measures again at 2 and 6 months postpartum and partners completed the depressed mood measure at all three timepoints. A cutoff of ≥10 for the Edinburgh Postnatal Depression Scale identified depressed mood status.

RESULTS

The prevalence of depressive symptoms in fathers was 13.76% at 2 months and 13.60% at 6 months postpartum. Men who were depressed during their partner's pregnancy were 7 times more likely to be depressed at 2 months postpartum. Depressed mood status at both the antenatal and 2 month postpartum assessment was associated with increased risk of depressed mood at 6 months postpartum. Older age, poor sleep quality at study entry, worse couple adjustment, having a partner experiencing antenatal depressive symptoms and elevated parental stress were associated with depressive symptoms at 2 months postpartum. Poor sleep quality, financial stress and a decline in couple adjustment were independently associated to depressive symptoms at 6 months postpartum.

LIMITATIONS

This sample was fairly well-educated and predominately middle-class. Depressive symptoms were assessed using a self-report questionnaire.

CONCLUSIONS

The psychosocial risk factors identified provide opportunities for early screening and targeted prevention strategies for fathers at risk for depression during the transition to parenthood.

Postpartum fatigue and depression: A systematic review and meta-analysis

BACKGROUND

New parents are vulnerable to fatigue and depressive symptoms. Many studies have reported significant positive correlations between the two in postpartum parents, but the size of correlations varies considerably between studies. The relationship between postpartum fatigue and depression is yet to be systematically synthesized and meta-analyzed.

METHODS

A PROSPERO registered systematic review and meta-analysis (CRD42017065240) was conducted on the correlation between fatigue and depression within the first two years postpartum in parents. Moderation analysis was used to examine the influence of demographic and measurement factors on the effect sizes.

RESULTS

Thirty-five eligible papers were identified (34 on mothers, 1 on fathers). The meta-analytic summary effect size for simultaneously measured fatigue and depressive symptoms among women in the postpartum period was r = 0.52, 95% CI [0.45, 0.59], p < .001. There was a high degree of heterogeneity in the strength of the correlation between studies. This heterogeneity was not accounted for by demographic (e.g., infant age, maternal age, population type) or methodology (e.g., measurement) related moderators.

LIMITATIONS

Studies not reporting or providing correlation between fatigue and depression were not included. Unable to assess some moderators due to limited sample size.

CONCLUSIONS

There is a strong correlation between fatigue and depressive symptoms among women in the first two years after child-birth, but a high degree of heterogeneity in correlation strength exists between studies. Careful assessment of both fatigue and depression when either symptom is reported could facilitate accurate differential diagnosis and prioritizing treatment in postpartum women. Further implications for assessment, treatment, and future research are discussed.

Paternal Postnatal Depression Among Fathers of Newborn in Saudi Arabia

Paternal postnatal depression (PPND) is not a commonly recognized phenomenon. The aim of the study was to identify the Edinburgh Postnatal Depression Scale (EPDS) cutoff for Saudi fathers, to estimate PPND prevalence and to determine the risk factors of PPND among fathers of newborn in Saudi Arabia. A cross-sectional study of fathers with babies born up to 6 months prior to the survey was conducted. Fathers were screened using EPDS and demographic questionnaire. The fathers were selected using systematic random sampling from visitors to the birth registration office. A subsample of participants from the postnatal wards in a tertiary care was invited for additional evaluation by a psychologist using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for major depressive disorders. Receiver operating characteristic curve was utilized to identify fathers with depression; a cutoff of 8/9 was optimal to achieve sensitivity 77.8% and specificity 81.3%. Adjusted prevalence of PPND was reported with corresponding Wilson 95% confidence interval. Two hundred and ninety fathers completed the EPDS and demographic questionnaire. Of 72 invited participants, 57 (79.16%) attended the diagnostic interview. The average age of fathers was 34.97 ± 8.56 years, the average maternal age was 29.18 ± 7.41 years, average age of the newborn was 43.13 ± 35.88 days. PPND adjusted prevalence was 16.6% (95% CI [8.5, 25.6]). Paternal mental health needs equal attention during and postdelivery of newborn. Fathers should receive perinatal and postnatal mental health assessment to prevent behavioral problems in their children and disruption of relationship with their spouse.

The Experience of Men Whose Partners Have Postpartum Depression [Formula: see text]

BACKGROUND: The correlation of paternal depressive symptomatology to maternal postpartum depression can approach 50%. Paternal depression during a female partner's postpartum time period can include feelings of fear, confusion, frustration, anger, helplessness, and lack of support. There are only a few published studies that address the interaction between paternal and maternal mental health during the postpartum period. AIMS: The purpose of this study was to gain insight into the experiences of men whose partners had postpartum depression as a foundation for intervention and program development. METHOD: This qualitative study used a descriptive phenomenological approach. A purposive sample of 10 men who lived with a partner diagnosed with postpartum depression was recruited via flier postings in mental health clinics, a perinatal mental health email listserv, and word-of-mouth. Single, audiotape-recorded interviews were completed. Qualitative data analysis was used to reduce initial coding to final themes that described participant experiences. RESULTS: The participants described efforts to provide support and care for their families; their efforts not to make things worse; their fears, anxieties, and physical responses; and the isolation associated with not knowing how to ask for help. The five themes included needing to support partners, maintaining stability, experiencing mutual symptoms, feeling isolated, and providing insight for others. CONCLUSIONS: Depression is known to have a negative effect on all members of a family. It is imperative that fathers' experiences are understood in order to fill this gap in caring for families.

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

BACKGROUND

Postpartum depression negatively affects the whole family and its prevalence in Sweden ranges between 6-10% for fathers and 13-16% for mothers. However, only mothers in Sweden are currently routinely screened.

AIM

The aim of this study was to determine if a postpartum depression screening for fathers in Stockholm County could be cost-effective.

METHODS

National Swedish databases were used to find registry data and a literature review was undertaken to identify the model data inputs associated with postpartum depression in Sweden. The generated evidence was used to build a Markov model in TreeAge. One-way and probabilistic sensitivity analyses were performed to account for parameter uncertainties. Alternative scenario analyses were further undertaken to test the assumptions in the base case analysis.

RESULTS

A postpartum screening for depression in fathers is cost-effective in base case and alternative scenarios. The results indicate that the screening program is associated with lower costs and higher health effects. The results were sensitive to variables of quality adjusted life years for the depressed fathers, probabilities of remission in treatment and no treatment groups and start age and productivity losses. The probabilistic sensitivity analysis resulted in a 70% probability of the postnatal depression screening intervention being cost-effective.

LIMITATIONS

The current study only uses secondary data; therefore future research should assess the cost-effectiveness of screening fathers for depression.

CONCLUSION

The postpartum screening intervention for fathers could be cost-effective compared to no screening. Future research should replicate the potential cost-effectiveness for screening fathers for postpartum depression.

Promoting Postpartum Mental Health in Fathers: Recommendations for Nurse Practitioners

The transition to fatherhood can challenge the mental health of first-time fathers and heighten their risk for postpartum depression (PPD). Paternal PPD not only affects the individual, but relationships with partners and children as well. This scoping review explores paternal PPD, highlighting the factors for and impacts of paternal PPD, the experiences of first-time fathers during the postnatal period, including their knowledge gaps and learning preferences. Drawing on the scoping review findings, recommendations are made for postnatal programs to improve the inclusion of new fathers amid describing how nurse practitioners can promote men's mental health in the postpartum period.

Paternal Perinatal Depression Assessed by the Edinburgh Postnatal Depression Scale and the Gotland Male Depression Scale: Prevalence and Possible Risk Factors

Several studies have used the Edinburgh Postnatal Depression Scale (EPDS), developed to screen new mothers, also for new fathers. This study aimed to further contribute to this knowledge by comparing assessment of possible depression in fathers and associated demographic factors by the EPDS and the Gotland Male Depression Scale (GMDS), developed for “male” depression screening. The study compared EPDS score ≥10 and ≥12, corresponding to minor and major depression, respectively, in relation to GMDS score ≥13. At 3–6 months after child birth, a questionnaire was sent to 8,011 fathers of whom 3,656 (46%) responded. The detection of possibly depressed fathers by EPDS was 8.1% at score ≥12, comparable to the 8.6% detected by the GMDS. At score ≥10, the proportion detected by EPDS increased to 13.3%. Associations with possible risk factors were analyzed for fathers detected by one or both scales. A low income was associated with depression in all groups. Fathers detected by EPDS alone were at higher risk if they had three or more children, or lower education. Fathers detected by EPDS alone at score ≥10, or by both scales at EPDS score ≥12, more often were born in a foreign country. Seemingly, the EPDS and the GMDS are associated with different demographic risk factors. The EPDS score appears critical since 5% of possibly depressed fathers are excluded at EPDS cutoff 12. These results suggest that neither scale alone is sufficient for depression screening in new fathers, and that the decision of EPDS cutoff is crucial.

Protocol for the Northern babies longitudinal study: predicting postpartum depression and improving parent-infant interaction with The Newborn Behavioral Observation

INTRODUCTION

Postpartum depression (PPD) is a prevalent disorder. Studying the factors related to PPD will help to identify families at risk and provide preventive interventions. This can in turn improve the developmental trajectories for the children. Several previous studies have investigated risk factors for PPD. However, few studies have focused on cognitive vulnerability factors. The first aim of the present study is to explore a range of protective and risk factors, including cognitive factors, for PPD, parent-infant interactions and child development. The second aim of the study is to evaluate the effectiveness of The Newborn Behavioral Observation (NBO) as a universal preventive intervention delivered in routine practice. The NBO is a brief relationship-enhancing intervention that may reduce depressive symptomatology in mothers.

METHODS

The study is a longitudinal observational study with an intervention. The observational study uses a prospective cohort design, whereas the intervention study has a non-randomised cluster-controlled design comparing a group receiving NBO with a group receiving standard care. The intervention group will receive three NBO sessions within the first 4 weeks postdelivery. Between 2015 and 2018, approximately 200 families will be recruited in the municipality of Tromsø, Norway. Parents are recruited during pregnancy, and assessments will be performed during gestational weeks 16-22, 24-30 and 31, and at 6 weeks, 4 months and 6 months postdelivery. Predictor variables include several cognitive vulnerability factors including early maladaptive schemas, implicit attitudes and cognitive processing of emotionally valenced infant facial information.

ETHICS AND DISSEMINATION

The Regional Committee for Medical and Health Research Ethics in Northern Norway has approved the project. The research team has collaboration with local health services and can assist participants who need more extensive follow-up. Results from the project will be disseminated in international and national peer-reviewed journals, and at courses and conferences.

TRIALS REGISTRATION NUMBER

NCT02538497; Pre-results.

Swedish child health nurses treat fathers more equally in 2014 than 2004, but mothers remain their primary focus

AIM

This study focused on Swedish child health nurses' attitudes and the support they provided to fathers and mothers, highlighting changes from 2004 to 2014.

METHOD

In 2014, 363 child health nurses in Stockholm County completed a 23-item questionnaire, similar to the questionnaire by Massoudi et al. in 2004, on their attitudes and the support they gave to fathers and mothers. Analyses were completed using chi-square tests of nurses' attitudes and support to fathers and mothers, and the results from the 2004 and 2014 studies were compared.

RESULTS

In 2014, the vast majority of nurses fully agreed that it was important to have close contact with both parents, but more than two-thirds did not feel they had the same competencies for mothers and fathers and three quarters found it complicated to support both parents. The majority viewed fathers more equally in 2014 than in 2004 and although they did provide more support to both parents, mothers in 2014 still received more support than fathers.

CONCLUSION

While Swedish child health nurses viewed fathers as more equal to mothers in 2014 than 2004, mothers still received the majority of the parenting support.

Untreated perinatal paternal depression: Effects on offspring

Transition to parenthood represents an important life event which increases vulnerability to psychological disorders. Aim of this article is to analyze all studies which investigated the effects of untreated perinatal paternal depression in offspring. We searched pertinent, peer-reviewed articles published in English (January 1980 to April 2016) on MEDLINE, PsycINFO, and Science.gov. Twenty-three studies met the inclusion criteria. Most of the reviewed studies suffer from methodological limitations, including the small sample, the lack of a structured psychiatric diagnosis, and inclusion bias. Despite such limitations, paternal depression seems to be associated with an increased risk of developmental and behavioural problems and even psychiatric disorders in offspring. In particular, in infants and toddlers such problems vary from increased crying to hyperactivity and conduct problems to psychological and developmental impairment, and poor social outcomes. School-age children of depressed fathers have a doubled risk for suffering from specific psychiatric disorders. Hence, facilitating access to vigorous and evidence based treatments is a public health opportunity for improving the quality of life of depressed parents and their children. Evidences emerging from this review actually suggest that the traditional gender-focused approach to perinatal mood disorders should be completed by a family-centred approach, in order to improve the effectiveness of perinatal mental health programs.

Prevalence of paternal depression in pregnancy and the postpartum: An updated meta-analysis

BACKGROUND

Research in paternal prenatal and postpartum depression has nearly doubled since prevalence rates were last meta-estimated in October 2009. An updated meta-analysis allows additional questions to be answered about moderators that influence risk.

METHODS

Studies reporting paternal depression between the first trimester and one-year postpartum were obtained for the period from January 1980 to November 2015. In total 74 studies with 41,480 participants were included, and data was extracted independently by two authors. Moderator analyses included measurement method, timing of assessment, study location, publication year, age, education, parity, history of depression, and maternal depression.

RESULTS

The meta-estimate for paternal depression was 8.4% (95% confidence interval [CI], 7.2-9.6%) with significant heterogeneity observed among prevalence rates. Prevalence significantly varied based on publication year, study location, measurement method, and maternal depression. Prevalence was not conditional on paternal age, education, parity, history of paternal depression, and timing of assessment.

LIMITATIONS

Analyses were limited by variability in assessment measures, countries from which studies were available, extant data for the first trimester and 6- to 9-month postpartum, and method of reporting sociodemographic information.

CONCLUSIONS

Paternal depression was present in 8% of men in the included studies. Future screening policies and interventions should consider moderating risk factors for depression throughout the transition to parenthood.

Paternal Depression Rates in Prenatal and Postpartum Periods and Affecting Factors

The objective of this study was to determine the paternal depression rates and affecting factors in prenatal and postpartum periods. The study, which was descriptive and cross-sectional, was conducted with 92 volunteer couples that suited the criteria for the sample. These participants were selected from couples that applied to the gynecology clinic of a private hospital between September 2014 and April 2015 and who were in their 37th-40th weeks of pregnancy. Data collection was planned in two interviews; the first one was done between the 37th and 40th weeks of the pregnancy, and the second was conducted between the 4th and 6th weeks after the birth. Interviews were completed with 84 couples. In this study, it was determined that there was no relationship between average paternal and maternal scores on the Edinburgh Postnatal Depression Scale (EPDS) in prenatal and postpartum periods. It was found that the average score of the Family-Work Conflict Scale increased and couples' marriage harmony decreased as the EPDS average score for fathers increased. In addition, it was found that the EPDS average score for fathers that wanted the pregnancy was less compared to fathers that did not want the pregnancy, and the difference between the two groups was statistically meaningful.

Fathers’ depressive symptoms in the postnatal period: Prevalence and correlates in a population-based Swedish study

Aims: The aim of this study was to investigate the prevalence and correlates of depression in new fathers. Methods: A population-based sample of 885 Swedish fathers and their partners completed a questionnaire, including the Edinburgh Postnatal Depression Scale at three months postpartum. Correlates of depressive symptoms were analysed with univariate and multiple variable regression models. Results: Symptoms of depression were found in 6.3% of the fathers and 12.0% of the mothers, and the point prevalence of major depression in fathers was 1.3%. The strongest correlates of depressive symptoms in fathers were problems in the partner relationship, a low educational level, previous depression, stressful life events and low partner support. The cross-sectional design could affect the magnitude of the results, and causal inferences cannot be made. Conclusions: Although the rate of depressive symptoms is lower in fathers than in mothers at three months postpartum, the associated factors are similar to those found in studies of mothers. The first visits at the child health centre could include a discussion with both parents about normal transition problems; balancing work, personal and family needs; and distress. When signs of distress or partner relationship difficulties are picked up, this should be followed up and support interventions offered.