Paternal depression in the postnatal period and child development: a prospective population study

BACKGROUND

Depression is common and frequently affects mothers and fathers of young children. Postnatal depression in mothers affects the quality of maternal care, and can lead to disturbances in their children's social, behavioural, cognitive, and physical development. However, the effect of depression in fathers during the early years of a child's life has received little attention.

METHODS

As part of a large, population-based study of childhood, we assessed the presence of depressive symptoms in mothers (n=13,351) and fathers (n=12,884) 8 weeks after the birth of their child with the Edinburgh postnatal depression scale (EPDS). Fathers were reassessed at 21 months. We identified any subsequent development of behavioural and emotional problems in their children (n=10,024) at age 3.5 years with maternal reports on the Rutter revised preschool scales.

FINDINGS

Information was available for 8431 fathers, 11,833 mothers, and 10,024 children. Depression in fathers during the postnatal period was associated with adverse emotional and behavioural outcomes in children aged 3.5 years (adjusted odds ratio 2.09, 95% CI 1.42-3.08), and an increased risk of conduct problems in boys (2.66, 1.67-4.25). These effects remained even after controlling for maternal postnatal depression and later paternal depression.

INTERPRETATION

Our findings indicate that paternal depression has a specific and persisting detrimental effect on their children's early behavioural and emotional development.

Fatherhood in the twenty-first century

The twentieth century has been characterized by four important social trends that have fundamentally changed the social cultural context in which children develop: women's increased labor force participation, increased absence of nonresidential fathers in the lives of their children, increased involvement of fathers in intact families, and increased cultural diversity in the U.S.. In this essay, we discuss how these trends are changing the nature of father involvement and family life, and in turn affecting children's and fathers' developmental trajectories. We end with an eye toward the twenty-first century by examining how the children of today will construct their expectations about the roles of fathers and mothers as they become the parents of tomorrow. This life-span approach to fatherhood considers the broader sociohistorical context in which fatherhood develops, and emphasizes the urgent need to consider mothers, fathers, and family structure in future research as we seek to understand and model the effects of parenting on children's development.

Individual and combined effects of postpartum depression in mothers and fathers on parenting behavior

BACKGROUND

Pediatric anticipatory guidance has been associated with parenting behaviors that promote positive infant development. Maternal postpartum depression is known to negatively affect parenting and may prevent mothers from following anticipatory guidance. The effects of postpartum depression in fathers on parenting is understudied.

OBJECTIVE

Our purpose with this work was to examine the effects of maternal and paternal depression on parenting behaviors consistent with anticipatory guidance recommendations.

METHODS

The 9-month-old wave of data from a national study of children and their families, the Early Childhood Longitudinal Study, provided data on 5089 2-parent families. Depressive symptoms were measured with a short form of the Center for Epidemiologic Studies Depression Scale. Interviews with both parents provided data on parent health behaviors and parent-infant interactions. Logistic and linear regression models were used to estimate the association between depression in each parent and the parenting behaviors of interest. These models were adjusted for demographic and socioeconomic status indicators.

RESULTS

In this national sample, 14% of mothers and 10% of fathers exhibited levels of depressive symptoms on the Center for Epidemiologic Studies Depression Scale that have been associated with clinical diagnoses, confirming other findings of a high prevalence of postpartum maternal depression but highlighting that postpartum depression is a significant issue for fathers as well. Mothers who were depressed were approximately 1.5 times more likely to engage in less healthy feeding and sleep practices with their infant. In both mothers and fathers, depressive symptoms were negatively associated with positive enrichment activity with the child (reading, singing songs, and telling stories).

CONCLUSIONS

Postpartum depression is a significant problem in both mothers and fathers in the United States. It is associated with undesirable parent health behaviors and fewer positive parent-infant interactions.

Harsh parenting in relation to child emotion regulation and aggression

This study presents a model of harsh parenting that has an indirect effect, as well as a direct effect, on child aggression in the school environment through the mediating process of child emotion regulation. Tested on a sample of 325 Chinese children and their parents, the model showed adequate goodness of fit. Also investigated were interaction effects between parents' and children's gender. Mothers' harsh parenting affected child emotion regulation more strongly than fathers', whereas harsh parenting emanating from fathers had a stronger effect on child aggression. Fathers' harsh parenting also affected sons more than daughters, whereas there was no gender differential effect with mothers' harsh parenting. These results are discussed with an emphasis on negative emotionality as a potentially common cause of family perturbations, including parenting and child adjustment problems.

Comparison of skin-to-skin (kangaroo) and traditional care: parenting outcomes and preterm infant development

OBJECTIVE

To examine whether the kangaroo care (KC) intervention in premature infants affects parent-child interactions and infant development.

METHODS

Seventy-three preterm infants who received KC in the neonatal intensive care unit were matched with 73 control infants who received standard incubator care for birth weight, gestational age (GA), medical severity, and demographics. At 37 weeks' GA, mother-infant interaction, maternal depression, and mother perceptions were examined. At 3 months' corrected age, infant temperament, maternal and paternal sensitivity, and the home environment (with the Home Observation for Measurement of the Environment [HOME]) were observed. At 6 months' corrected age, cognitive development was measured with the Bayley-II and mother-infant interaction was filmed. Seven clusters of outcomes were examined at 3 time periods: at 37 weeks' GA, mother-infant interaction and maternal perceptions; at 3-month, HOME mothers, HOME fathers, and infant temperament; at 6 months, cognitive development and mother-infant interaction.

RESULTS

After KC, interactions were more positive at 37 weeks' GA: mothers showed more positive affect, touch, and adaptation to infant cues, and infants showed more alertness and less gaze aversion. Mothers reported less depression and perceived infants as less abnormal. At 3 months, mothers and fathers of KC infants were more sensitive and provided a better home environment. At 6 months, KC mothers were more sensitive and infants scored higher on the Bayley Mental Developmental Index (KC: mean: 96.39; controls: mean: 91.81) and the Psychomotor Developmental Index (KC: mean: 85.47; controls: mean: 80.53).

CONCLUSIONS

KC had a significant positive impact on the infant's perceptual-cognitive and motor development and on the parenting process. We speculate that KC has both a direct impact on infant development by contributing to neurophysiological organization and an indirect effect by improving parental mood, perceptions, and interactive behavior.

Fathers and Mothers at Play With Their 2- and 3-Year-Olds: Contributions to Language and Cognitive Development

Father-child and mother-child engagements were examined longitudinally in relation to children's language and cognitive development at 24 and 36 months. The study involved a racially/ethnically diverse sample of low-income, resident fathers (and their partners) from the National Early Head Start evaluation study (n=290). Father-child and mother-child engagements were videotaped for 10 min at home during semistructured free play, and children's language and cognitive status were assessed at both ages. Fathers' and mothers' supportive parenting independently predicted children's outcomes after covarying significant demographic factors. Moreover, fathers' education and income were uniquely associated with child measures, and fathers' education consistently predicted the quality of mother-child engagements. Findings suggest direct and indirect effects of fathering on child development.

Incorporating recognition and management of perinatal and postpartum depression into pediatric practice

Every year, more than 400,000 infants are born to mothers who are depressed, which makes perinatal depression the most underdiagnosed obstetric complication in America. Postpartum depression leads to increased costs of medical care, inappropriate medical care, child abuse and neglect, discontinuation of breastfeeding, and family dysfunction and adversely affects early brain development. Pediatric practices, as medical homes, can establish a system to implement postpartum depression screening and to identify and use community resources for the treatment and referral of the depressed mother and support for the mother-child (dyad) relationship. This system would have a positive effect on the health and well-being of the infant and family. State chapters of the American Academy of Pediatrics, working with state Early Periodic Screening, Diagnosis, and Treatment (EPSDT) and maternal and child health programs, can increase awareness of the need for perinatal depression screening in the obstetric and pediatric periodicity of care schedules and ensure payment. Pediatricians must advocate for workforce development for professionals who care for very young children and for promotion of evidence-based interventions focused on healthy attachment and parent-child relationships.

Depression in men in the postnatal period and later child psychopathology: a population cohort study

OBJECTIVE

Postnatal depression in women is associated with adverse effects on both maternal health and children's development. It is unclear whether depression in men at this time poses comparable risks. The present study set out to assess the association between depression in men in the postnatal period and later psychiatric disorders in their children and to investigate predisposing factors for depression in men following childbirth.

METHOD

A population-based cohort of 10,975 fathers and their children from the Avon Longitudinal Study of Parents and Children (ALSPAC) was recruited in the prenatal period and followed for 7 years. Paternal depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale and later child psychiatric disorder (DSM-IV) with the Development and Well-Being Assessment.

RESULTS

Depression in fathers in the postnatal period was significantly associated with psychiatric disorder in their children 7 years later (adjusted OR 1.72, 95% CI 1.07-2.77), most notably oppositional defiant/conduct disorders (adjusted OR 1.94, 95% CI 1.04-3.61), after adjusting for maternal depression and paternal educational level. A history of severe depression and high prenatal symptom scores for depression and anxiety were the strongest predictors of paternal depression in the postnatal period.

CONCLUSIONS

Depression in fathers in the postnatal period is associated with later psychiatric disorders in their children, independently of maternal postnatal depression. Further research into the risks associated with paternal psychopathology is required because this could represent an important opportunity for public health intervention.

Evolution and proximate expression of human paternal investment

In more than 95% of mammalian species, males provide little direct investment in the well-being of their offspring. Humans are one notable exception to this pattern and, to date, the factors that contributed to the evolution and the proximate expression of human paternal care are unexplained (T. H. Clutton-Brock, 1989). The nature, extent, and influence of human paternal investment on the physical and social well-being of children are reviewed in light of the social and ecological factors that are associated with paternal investment in other species. On the basis of this review, discussion of the evolution and proximate expression of human paternal investment is provided.

Fathers' role in the etiology, prevention and treatment of child anxiety: A review and new model

Fathers have been neglected in investigations of the development, prevention, and treatment of anxiety and anxiety disorders in children and adolescents. This review provides a historical background of what is known about fathers' roles in the etiology of anxiety problems and provides evidence from bottom-up, top-down, and cross-sectional correlation studies of the connections between fathers' and their children's anxiety. Treatment and prevention programs are discussed in terms of the limited findings regarding fathers' involvement in treatment for children's and adolescents' anxiety problems. Finally, a model is presented to show the unique ways in which mothers and fathers are involved in the development of anxiety disorders in their children. Future directions for research in this area are highlighted.

Maternal employment and time with children: dramatic change or surprising continuity?

Despite the rapid rise in mothers' labor force participation, mothers' time with children has tended to be quite stable over time. In the past, nonemployed mothers' time with children was reduced by the demands of unpaid family work and domestic chores and by the use of mother substitutes for childcare, especially in large families. Today employed mothers seek ways to maximize time with children: They remain quite likely to work part-time or to exit from the labor force for some years when their children are young; they also differ from nonemployed mothers in other uses of time (housework, volunteer work, leisure). In addition, changes in children's lives (e.g., smaller families, the increase in preschool enrollment, the extended years of financial dependence on parents as more attend college) are altering the time and money investments that children require from parents. Within marriage, fathers are spending more time with their children than in the past, perhaps increasing the total time children spend with parents even as mothers work more hours away from home.

Mothering, fathering, and infant negativity as antecedents of boys' externalizing problems and inhibition at age 3 years: differential susceptibility to rearing experience?

To examine the effects of infant negative emotionality and of mothering and fathering during the toddler years on 3-year-old boys' externalizing problems and inhibition, as well as explore the proposition that children vary in their susceptibility to rearing influence, 125 first-born, Caucasian boys from maritally intact families were studied. Results revealed that when infant negativity is measured with objective, replicable, and discriminantly valid procedures, no relation obtains between it and externalizing problems (nor inhibition). Moreover, as hypothesized on the basis of prior work, parenting was a stronger predictor of externalizing problems and inhibition in the case of children who were highly negative as infants. Mothering proved a stronger predictor of externalizing problems and fathering of inhibition, with more negative mothering in the 2nd and 3rd year forecasting higher CBCL-externalizing scores and less negative fathering in the 2nd and 3rd year and more positive fathering in the 2nd year forecasting more inhibition at age 3 Implications of these findings for studies of parental influence are considered.

Parental 'affectionless control' as an antecedent to adult depression. A risk factor delineated

The view that depressives perceive themselves as having been exposed to an insufficiency of parental care and to parental overprotection was confirmed in a case-control study of 125 neurotic depressives, using a subjective measure of perceived parental characteristics, the Parental Bonding Instrument (PBI). An interaction effect was noted, with the depressives scoring the same-sexed parent more deviantly. A discriminant analysis established that low parental care scale scores were the best discriminators, with raw care scores of less than 10 being highly sensitive in discriminating depressives from controls. Sixty-seven percent of the patients and 37% of the controls scored one or both parents to the "affectionless control" (low care--high protection) PBI quadrant, representing a relative risk of 3.4. It is concluded that the PBI delineates and quantifies a risk factor to certain grades of depressive experience.

The relations among depression in fathers, children's psychopathology, and father–child conflict: A meta-analysis

Research on parental depression is beginning to recognize the importance of studying fathers in relation to maladaptive outcomes in their offspring. Paternal depression is hypothesized to correlate with internalizing and externalizing psychopathology in children and adolescents and to compromise adaptive parent-child relationships (e.g., increased conflict). In the present paper, meta-analytic procedures were applied to this literature to address the magnitude and direction of covariation between paternal depression and children's functioning. In addition, we tested whether variation in findings could be accounted for by study characteristics. Results indicated that paternal depression was significantly related to offspring internalizing and externalizing psychopathology and father-child conflict. Larger effects for internalizing symptoms were associated with the use of community samples and symptom rating scales of internalizing problems.

The role of fathers in child and adolescent psychopathology: make room for daddy

This review summarizes research concerning the relation between paternal factors and child and adolescent psychopathology. When compared with mothers, fathers continue to be dramatically underrepresented in developmental research on psychopathology. However, findings from studies of children of clinically referred fathers and nonreferred samples of children and their fathers indicate that there is substantial association between paternal characteristics and child and adolescent psychopathology. Findings from studies of fathers of clinically referred children are stronger for fathers' effects on children's externalizing than internalizing problems. In most cases the degree of risk associated with paternal psychopathology is comparable to that associated with maternal psychopathology. Evidence indicates that the presence of paternal psychopathology is a sufficient but not necessary condition for child or adolescent psychopathology.

Parental Socialization of Emotion Expression: Gender Differences and Relations to Child Adjustment

The present study examined gender differences in children's submissive and disharmonious emotions and parental attention to these emotions. Sixty children and their mothers and fathers participated when children were 4 and 6 years old. Children's emotion expression and parental responses during a game were coded. Girls expressed more submissive emotion than boys. Fathers attended more to girls' submissive emotion than to boys' at preschool age. Fathers attended more to boys' disharmonious emotion than to girls' at early school age. Parental attention at preschool age predicted later submissive expression level. Child disharmonious emotion predicted later externalizing symptoms. Gender differences in these emotions may occur as early as preschool age and may be subject to differential responding, particularly by fathers.

Parent-child connectedness and behavioral and emotional health among adolescents

BACKGROUND

This study sought to examine teen perceptions of mother-child and father-child connectedness, with focus on valuing parental opinions and perception of parental communication and caring, and associations with behavioral and emotional health.

METHODS

A population-based sample of 4746 students in public schools completed the 2001 Project EAT (Eating Among Teens) survey.

RESULTS

Overall, the majority of girls and boys reported valuing their parents' opinion when making serious decisions and believing that their parents cared about them. Yet, one fourth of girls and boys felt unable to talk to their mother about problems, and over half of girls and one third of boys felt unable to talk to their father. Valuing friends' opinions over parents' opinions, and perceiving low parental communication and caring were associated with unhealthy weight control, substance use, suicide attempts, body dissatisfaction, depression, and low self-esteem. Of significant concern, compared to their peers who reported feeling that their mother cared quite a bit or very much, youths who reported feeling as though their mother cared very little or not at all about them reported particularly high prevalence rates of unhealthy weight control behaviors (63.49% girls, 25.45% boys); suicide attempts (33.51% girls, 21.28% boys); low self-esteem (47.15% girls, 24.56% boys); and depression (63.52% girls, 33.35% boys).

CONCLUSIONS

Adolescents' perceptions of low parental caring, difficulty talking to their parents about problems, and valuing their friends' opinions for serious decisions were significantly associated with compromised behavioral and emotional health. Interventions aimed at improving the parent-child relationship may provide an avenue toward preventing health risk behaviors in youth.

Maternal postpartum behavior and the emergence of infant–mother and infant–father synchrony in preterm and full-term infants: The role of neonatal vagal tone

Relations between maternal postpartum behavior and the emergence of parent-infant relatedness as a function of infant autonomic maturity were examined in 56 premature infants (birthweight = 1000-1500 g) and 52 full-term infants. Maternal behavior, mother depressive symptoms, and infant cardiac vagal tone were assessed in the neonatal period. Infant-mother and infant-father synchrony, maternal and paternal affectionate touch, and the home environment were observed at 3 months. Premature birth was associated with higher maternal depression, less maternal behaviors, decreased infant alertness, and lower coordination of maternal behavior with infant alertness in the neonatal period. At 3 months, interactions between premature infants with their mothers and fathers were less synchronous. Interaction effects of premature birth and autonomic maturity indicated that preterm infants with low vagal tone received the lowest amounts of maternal behavior in the postpartum and the least maternal touch at 3 months. Infant-mother and infant-father synchrony were each predicted by cardiac vagal tone and maternal postpartum behavior in both the preterm and full-term groups. Among preterm infants, additional predictors of parent-infant synchrony were maternal depression (mother only) and the home environment (mother and father). Findings are consistent with evolutionary perspectives on the higher susceptibility of dysregulated infants to rearing contexts and underscore the compensatory mechanisms required for social-emotional growth under risk conditions for parent-infant bonding.

Attachment representations in mothers, fathers, adolescents, and clinical groups: a meta-analytic search for normative data

This meta-analysis on 33 studies, including more than 2,000 Adult Attachment Interview (AAI) classifications, presents distributions of AAI classifications in samples of nonclinical fathers and mothers, in adolescents, in samples from different cultures, and in clinical groups. Fathers, adolescents, and participants from different countries show about the same distribution of AAI classifications as nonclinical mothers do. The distribution of nonclinical mothers is as follows: 24% dismissing, 58% autonomous, and 18% preoccupied mothers. About 19% of the nonclinical mothers are unresolved with respect to loss or trauma of other kinds. Mothers from low socioeconomic status show more often dismissing attachment representations and unresolved loss or trauma. Autonomous women and autonomous men are more often married to each other than can be expected by chance, and the same goes for unresolved men and women. Clinical participants show highly deviating distributions of AAI classifications, with a strong overrepresentation of insecure attachment representations, but systematic relations between clinical diagnosis and type of insecurity are absent.

Involving men to improve maternal and newborn health: A systematic review of the effectiveness of interventions

BACKGROUND

Emerging evidence and program experience indicate that engaging men in maternal and newborn health can have considerable health benefits for women and children in low- and middle-income countries. Previous reviews have identified male involvement as a promising intervention, but with a complex evidence base and limited direct evidence of effectiveness for mortality and morbidity outcomes.

OBJECTIVE

To determine the effect of interventions to engage men during pregnancy, childbirth and infancy on mortality and morbidity, as well as effects on mechanisms by which male involvement is hypothesised to influence mortality and morbidity outcomes: home care practices, care-seeking, and couple relationships.

METHODS

Using a comprehensive, highly sensitive mapping of maternal health intervention studies conducted in low- and middle-income countries between 2000 and 2012, we identified interventions that have engaged men to improve maternal and newborn health. Primary outcomes were care-seeking for essential services, mortality and morbidity, and home care practices. Secondary outcomes relating to couple relationships were extracted from included studies.

RESULTS

Thirteen studies from nine countries were included. Interventions to engage men were associated with improved antenatal care attendance, skilled birth attendance, facility birth, postpartum care, birth and complications preparedness and maternal nutrition. The impact of interventions on mortality, morbidity and breastfeeding was less clear. Included interventions improved male partner support for women and increased couple communication and joint decision-making, with ambiguous effects on women's autonomy.

CONCLUSION

Interventions to engage men in maternal and newborn health can increase care-seeking, improve home care practices, and support more equitable couple communication and decision-making for maternal and newborn health. These findings support engaging men as a health promotion strategy, although evidence gaps remain around effects on mortality and morbidity. Findings also indicate that interventions to increase male involvement should be carefully designed and implemented to mitigate potential harmful effects on couple relationship dynamics.

Paternal transmission of stress-induced pathologies

BACKGROUND

There has been recent interest in the possibility that epigenetic mechanisms might contribute to the transgenerational transmission of stress-induced vulnerability. Here, we focused on possible paternal transmission with the social defeat stress paradigm.

METHODS

Adult male mice exposed to chronic social defeat stress or control nondefeated mice were bred with normal female mice, and their offspring were assessed behaviorally for depressive- and anxiety-like measures. Plasma levels of corticosterone and vascular endothelial growth factor were also assayed. To directly assess the role of epigenetic mechanisms, we used in vitro fertilization (IVF); behavioral assessments were conducted on offspring of mice from IVF-control and IVF-defeated fathers.

RESULTS

We show that both male and female offspring from defeated fathers exhibit increased measures of several depression- and anxiety-like behaviors. The male offspring of defeated fathers also display increased baseline plasma levels of corticosterone and decreased levels of vascular endothelial growth factor. However, most of these behavioral changes were not observed when offspring were generated through IVF.

CONCLUSIONS

These results suggest that, although behavioral adaptations that occur after chronic social defeat stress can be transmitted from the father to his male and female F1 progeny, only very subtle changes might be transmitted epigenetically under the conditions tested.

Coping strategies in mothers and fathers of preschool and school-age children with autism

Despite the theoretical and demonstrated empirical significance of parental coping strategies for the wellbeing of families of children with disabilities, relatively little research has focused explicitly on coping in mothers and fathers of children with autism. In the present study, 89 parents of preschool children and 46 parents of school-age children completed a measure of the strategies they used to cope with the stresses of raising their child with autism. Factor analysis revealed four reliable coping dimensions: active avoidance coping, problem-focused coping, positive coping, and religious/denial coping. Further data analysis suggested gender differences on the first two of these dimensions but no reliable evidence that parental coping varied with the age of the child with autism. Associations were also found between coping strategies and parental stress and mental health. Practical implications are considered including reducing reliance on avoidance coping and increasing the use of positive coping strategies.

Are discrepancies among child, mother, and father reports on children's behavior related to parents' psychological symptoms and aspects of parent-child relationships?

Examined whether parents' symptoms and qualitative and quantitative aspects of parent-child relationships make unique contributions to mothers' and fathers' reports of, and mother-child, father-child, and father-mother discrepancies on, children's behavior. Participants were 100 children, aged 10-12, and their mothers and fathers. Parents' symptoms and parent-child relationships made unique contributions to both parents' ratings of externalizing behavior. Although parent-child relationship variables were related to both parents' ratings of internalizing behavior, only parents' symptoms made unique contributions. On mother-child and father-child discrepancies, differences emerged between mother and father, and internalizing and externalizing behaviors. Both fathers' and mothers' symptoms contributed to father-mother discrepancies on both behavior types, with parent-child relationships contributing unique variance to discrepancies on internalizing behavior. Results highlight the importance of each informant's symptoms and relationship variables in understanding informant discrepancies.

Disclosure and secrecy in adolescent-parent relationships

Beliefs about parents' legitimate authority and adolescents' obligations to disclose to parents and actual disclosure and secrecy in different domains were examined in 276 ethnically diverse, lower middle-class 9th and 12th graders (Ms=14.62 and 17.40 years) and their parents (n=249). Adolescents were seen as more obligated to disclose prudential issues and less obligated to disclose personal than moral, conventional, and multifaceted issues; parents viewed adolescents as more obligated to disclose to parents than adolescents perceived themselves to be. Adolescents disclosed more to mothers than to fathers, particularly regarding personal issues, but mothers overestimated girls' disclosure. Greater trust, perceived obligations to disclose, and, for personal issues, more parental acceptance and psychological control predicted more disclosure and less secrecy.