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Postnatal depression in fathers
International Review of Psychiatry
Abstract
More than 10% of fathers suffer from psychiatric morbidity in the postnatal period. Depression amongst fathers is associated with having depressed partners, having an unsupportive relationship and being unemployed. Depression in fathers therefore occurs in highly vulnerable families and may have an important impact on the emotional development of the infant. Developing effective screening and treatment methods for these families is an important priority for future research
... None assessed symptoms of post-traumatic stress. The Edinburgh Postnatal Depression Scale (EPDS) (31) was assessed in all seven studies (35,(68)(69)(70)(71)(72)(73). Other measures assessed come from one Hong Kong study with Chinese fathers (71), validating the Beck Depression Inventory (BDI) (74) and 9-item Patient Health Questionnaire (PHQ-9) (32), one Vietnamese study (72) validating the 12-item General Health Questionnaire (GHQ-12) (75) and Zung's Self-rated Anxiety Scale (76), and one Swedish study assessing the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A) (77) (see Table 1). ...
... Time interval between index test and reference test (diagnostic interview) ranged from same-day completion to 8 weeks. Four studies conducted the diagnostic interview with a sub-sample of those completing the index test, sampling by index scores (68,69,71,73). Of these, two provided weighted estimates in recognition of verification bias (68,69). ...
... Of these, two provided weighted estimates in recognition of verification bias (68,69). Most studies reported that assessors of the diagnostic interview were blinded to the results of the index test (35,69,(71)(72)(73); the others were unclear. The only mention of acceptability found in the accuracy studies concerned higher levels of dropout for fathers compared to mothers prior to or during diagnostic interview (35,70) and a comment that the measures were "acceptable and comprehensible" to participants, with no data reported in relation to this (72). ...
Introduction: Five to 10 percentage of fathers experience perinatal depression and 5–15% experience perinatal anxiety, with rates increasing when mothers are also experiencing perinatal mental health disorders. Perinatal mental illness in either parent contributes to adverse child and family outcomes. While there are increasing calls to assess the mental health of both parents, universal services (e.g., maternity) and specialist perinatal mental health services usually focus on the mother (i.e., the gestational parent). The aim of this review was to identify and synthesize evidence on the performance of mental health screening tools and the acceptability of mental health assessment, specifically in relation to fathers, other co-parents and partners in the perinatal period.
Methods: A systematic search was conducted using electronic databases (MEDLINE, PsycINFO, Maternity, and Infant Care Database and CINAHL). Articles were eligible if they included expectant or new partners, regardless of the partner's gender or relationship status. Accuracy was determined by comparison of screening tool with diagnostic interview. Acceptability was predominantly assessed through parents' and health professionals' perspectives. Narrative synthesis was applied to all elements of the review, with thematic analysis applied to the acceptability studies.
Results: Seven accuracy studies and 20 acceptability studies were included. The review identified that existing evidence focuses on resident fathers and assessing depression in universal settings. All accuracy studies assessed the Edinburgh Postnatal Depression Scale but with highly varied results. Evidence on acceptability in practice is limited to postnatal settings. Amongst both fathers and health professionals, views on assessment are mixed. Identified challenges were categorized at the individual-, practitioner- and service-level. These include: gendered perspectives on mental health; the potential to compromise support offered to mothers; practitioners' knowledge, skills, and confidence; service culture and remit; time pressures; opportunity for contact; and the need for tools, training, supervision and onward referral routes.
Conclusion: There is a paucity of published evidence on assessing the mental health of fathers, co-mothers, step-parents and other partners in the perinatal period. Whilst practitioners need to be responsive to mental health needs, further research is needed with stakeholders in a range of practice settings, with attention to ethical and practical considerations, to inform the implementation of evidence-based assessment.
... The mental health of women during pregnancy and after birth and the need for identification of mental illness, such as postnatal depression (PND), is well described in the literature (Austin & Lumley, 2003;Ballard & Davies, 1996;Buist, Austin, & Hayes, 2009). Peripartum depression is defined as women being depressed antenatally and any time up to four weeks following the delivery of their baby (the symptomatology is not considered any different from other depressive conditions) (American Psychiatric Association, 2013). ...
... Peripartum depression is defined as women being depressed antenatally and any time up to four weeks following the delivery of their baby (the symptomatology is not considered any different from other depressive conditions) (American Psychiatric Association, 2013). Approximately 12 to 20% of women experience antenatal depression (Leigh & Milgrom, 2008), and about 10 to 15% of women experience postnatal depression (Austin & Lumley, 2003;Ballard & Davies, 1996). The forthcoming birth of a new baby and the life changes that occur following the birth of a baby can present parents with a range of new demands on mothers and fathers, and more recently the mental health of fathers is being considered (Davé, Petersen, Sherr, & Nazareth, 2010;Edward, Castle, Mills, Davis, & Casey, 2014). ...
... The forthcoming birth of a new baby and the life changes that occur following the birth of a baby can present parents with a range of new demands on mothers and fathers, and more recently the mental health of fathers is being considered (Davé, Petersen, Sherr, & Nazareth, 2010;Edward, Castle, Mills, Davis, & Casey, 2014). Fathers are also at risk of depression in the antenatal and postnatal periods, where it has been reported between 4 and 25% of men experience depression in the ante and postnatal periods (Ballard & Davies, 1996;Fletcher, Matthey, & Marley, 2006;Kim & Swain, 2007). ...
The forthcoming birth of a new baby and the life changes that occur can present parents with a range of challenges. While recognised in mothers, postnatal depression is not well researched in fathers; especially considering that up to 25% of men report experiencing depression in the ante and postnatal periods. The aim of this study was to test a self-screening tool and referral pathway pamphlet for expectant women and their partners. We used a single blinded randomised controlled study design. The sample, comprised 70 dyads, was randomised to either care as usual or to the self-screening tool and referral pathway pamphlet intervention. The self-screening tool included the Edinburgh Postnatal Depression Scale (EPDS). Other questionnaires used to survey the dyads were the Kessler Psychological Distress (Kessler-10) and the Maternity Social Support Scale (MSSS). The gender differences in the EPDS, Kessler-10 and MSSS scales are represented by differences of 1.0 points on EPDS, 1.0 points on Kessler-10, fathers were reporting less psychological distress than mothers in all cases. No difference was observed in perceived social support. The attrition between time-points was mostly men. Cultural and socio-demographic factors may affect generalisability of the findings. The self-screening tool and referral pathway pamphlet provided to dyads may have some benefit in assisting couples in the perinatal period to detect and seek help for early symptoms of distress.
... On the other hand, poor marital satisfaction, low social support and poor quality of life were found to be associated with paternal postpartum depression [17]. Having an unsupportive relationship, marital disharmony, being unemployed, young age, poorer social functioning and past history of psychiatric disorder were also found to be associated with paternal mental health problems during the perinatal period [7,[18][19][20]. Matthey et al. [21] stated that adjustment to parenthood was related to different variables at different times of the perinatal period [21]. ...
... Preliminary studies showed that the risk factors associated with paternal perinatal psychological distress and mental health problems included poor marital relationship, poor social network and insufficient information about pregnancy and childbirth, having an unsupportive relationship, past history of psychiatric disorder, young age, being unemployed and poor social function [17][18][19][20]. Poor marital satisfaction, low social support and poor quality of life were found to be associated with paternal postpartum depression [17]. ...
Introduction. Despite the fact that maternal perinatal mental health problems have been extensively studied and addressed to be a significant health problem, the literature on paternal perinatal mental health problems is relatively scarce. The present study aims at determining the prevalence of paternal perinatal depression and identifying the risk factors and the relationship between antenatal and postpartum depression. Methodology. 622 expectant fathers were recruited from regional maternal clinics. The expectant fathers were assessed using standardized and validated psychological instruments on 3 time points including early pregnancy, late pregnancy, and six weeks postpartum. Results. Results showed that a significant proportion of expectant fathers manifested depressive symptoms during the perinatal period. Paternal antenatal depression could significantly predict higher level of paternal postpartum depression. Psychosocial risk factors were consistently associated with paternal depression in different time points. Conclusions. The present study points to the need for greater research and clinical attention to paternal depression given that it is a highly prevalent problem and could be detrimental to their spouse and children development. The present findings contribute to theoretical basis of the prevalence and risk factors of paternal perinatal depression and have implications of the design of effective identification, prevention, and interventions of these clinical problems.
... This suggests that wealth and education represent different socioeconomic indicators and that having more resources may help buffer depressive symptoms. This interpretation is consistent with earlier work showing that economic contributions matter to Jamaican fathers [20] and unemployment, as a measure of socioeconomic status, was associated with higher rates of paternal depressive symptoms [37]. Social science research indicates that relative rather than absolute resource levels may matter [e.g., 38]; our measure of wealth did not assess how satisfied fathers were with their material resource standing or ability to provide resources to a new child, though evaluation of such perceptions would complement measures of absolute resource availability. ...
... The likely Jamaican sampling biases could also be pertinent, if more depressed men, also more likely in more challenging visiting relationships, are under-represented. What may matter more than relationship status, then, is relationship quality (across statuses), consistent with the significant negative relationship between better quality partnerships and lower depressive symptoms [37]. Interestingly, this observation parallels findings on Jamaican fathers' testosterone levels, in which fathers' relationship quality but not relationship status predicted their testosterone at 18-24 month postpartum [40]. ...
Background:
Approximately 10% of fathers in the Cultural West (i.e., US, Europe, and Australia) experience depression. We broaden the cultural scope of paternal depression research by investigating the prevalence and predictors of depressive symptoms among Jamaican fathers.
Methods:
The present research draws upon structured interviews with 3425 fathers of newborn children participating in a Jamaican birth cohort study-JA Kids-and represents one of the largest sample sizes of any study on postnatal depression among fathers worldwide. This sample of fathers participated from July to September 2011, and represents approximately 30% of all men who became fathers during that time in Jamaica. Fathers answered questions about sociodemographic background, relationship status and quality, social support, health, expectations and views of a partner's pregnancy, and the ten-item Edinburgh Postnatal Depression Scale (EPDS).
Results:
Analyses reveal that 9.1% (95% CI 8.1-10.1) of these Jamaican fathers of newborns had EPDS scores of 10 or higher, indicative of possible depression. Results suggest that educational attainment was not related to EPDS scores, though higher indices of material wealth (e.g., refrigerator and vehicle) were weakly, negatively related to EDS scores. Paternal age was also weakly negatively predictive of EDS scores. Whereas relationship status was unrelated to depressive symptoms, relationship quality negatively predicted depressive symptoms. Several other measures of social support (lacking a close circle of friends, fewer family, or friends to help in times of trouble) were also associated with higher EPDS scores.
Conclusions:
We interpret these findings in light of existing work on paternal depression, including the importance of social context and support.
... This suggests that wealth and education represent different socioeconomic indicators and that having more resources may help buffer depressive symptoms. This interpretation is consistent with earlier work showing that economic contributions matter to Jamaican fathers [20] and unemployment, as a measure of socioeconomic status, was associated with higher rates of paternal depressive symptoms [37]. Social science research indicates that relative rather than absolute resource levels may matter [e.g., 38]; our measure of wealth did not assess how satisfied fathers were with their material resource standing or ability to provide resources to a new child, though evaluation of such perceptions would complement measures of absolute resource availability. ...
... The likely Jamaican sampling biases could also be pertinent, if more depressed men, also more likely in more challenging visiting relationships, are under-represented. What may matter more than relationship status, then, is relationship quality (across statuses), consistent with the significant negative relationship between better quality partnerships and lower depressive symptoms [37]. Interestingly, this observation parallels findings on Jamaican fathers' testosterone levels, in which fathers' relationship quality but not relationship status predicted their testosterone at 18-24 month postpartum [40]. ...
... On the other hand, poor marital satisfaction, low social support and poor quality of life were found to be associated with paternal postpartum depression [17]. Having an unsupportive relationship, marital disharmony, being unemployed, young age, poorer social functioning and past history of psychiatric disorder were also found to be associated with paternal mental health problems during the perinatal period [7,[18][19][20]. Matthey et al. [21] stated that adjustment to parenthood was related to different variables at different times of the perinatal period [21]. ...
... Preliminary studies showed that the risk factors associated with paternal perinatal psychological distress and mental health problems included poor marital relationship, poor social network and insufficient information about pregnancy and childbirth, having an unsupportive relationship, past history of psychiatric disorder, young age, being unemployed and poor social function [17][18][19][20]. Poor marital satisfaction, low social support and poor quality of life were found to be associated with paternal postpartum depression [17]. ...
Introduction. Despite the fact that maternal perinatal mental health problems have been extensively studied and addressed to be a significant health problem, the literature on paternal perinatal mental health problems is relatively scarce. The present study aims at determining the prevalence of paternal perinatal depression and identifying the risk factors and the relationship between antenatal and postpartum depression. Methodology. 622 expectant fathers were recruited from regional maternal clinics. The expectant fathers were assessed using standardized and validated psychological instruments on 3 time points including early pregnancy, late pregnancy, and six weeks postpartum. Results. Results showed that a significant proportion of expectant fathers manifested depressive symptoms during the perinatal period. Paternal antenatal depression could significantly predict higher level of paternal postpartum depression. Psychosocial risk factors were consistently associated with paternal depression in different time points. Conclusions. The present study points to the need for greater research and clinical attention to paternal depression given that it is a highly prevalent problem and could be detrimental to their spouse and children development. The present findings contribute to theoretical basis of the prevalence and risk factors of paternal perinatal depression and have implications of the design of effective identification, prevention, and interventions of these clinical problems.
... There is not nearly the data available to understand the chronicity and severity of paternal depression, as most of the study of depression in fathers is focused on the antenatal and postpartum periods. Nevertheless, rates of depression during these periods have been found to be as high as 10 percent for men (Ballard & Davies, 1996), and, in general, men are considered to have about half the rate of depression as women during the ages most associated with childrearing (Wilson & Durbin, 2010). Nevertheless, the extent to which we understand the chronicity and continuity of depression in fathers remains limited. ...
Although childhood depressive disorders are relatively rare, the experience of depression in children's lives is not. Developmental contextual perspectives denote the importance of considering both depressive disorder and the experience of subclinical depressive symptoms in the child and the family to fully understand the implications of depressive experience for children's developmental well-being. This Element draws on basic emotion development and developmental psychopathology perspectives to address the nature of depressive experience in childhood, both symptoms and disorder, focusing on seminal and recent research that details critical issues regarding its phenomenology, epidemiology, continuity, etiology, consequences, and interventions to ameliorate the developmental challenges inherent in the experience. These issues are addressed within the context of the child's own experience and from the perspective of parent depression as a critical context that influences children's developmental well-being. Conclusions include suggestions for new directions in research on children's lives that focus on more systemic processes.
... Per molto tempo la letteratura sui disturbi psicologici perinatali si è limitata a considerare quasi esclusivamente i sintomi della madre, trascurando gli aspetti relazionali e familiari. L'esperienza clinica e i più recenti dati di ricerca[9,10,1,2,19,15,21], invece, hanno evidenziato che, in questo periodo, altri familiari manifestano segni di sofferenza emotiva e alterazioni comportamentali significative, in particolare il padre del bambino. Questi problemi sono spesso trascurati, nonostante si rivelino molto importanti, in quanto possono influenzare in modo significativo l'equilibrio familiare e di coppia[34,29], pregiudicando lo sviluppo di un attaccamento adeguato tra madre e neonato[37] e influenzando negativamente lo sviluppo psicosomatico e le future capacità cognitive e relazionali del bambino[30].40 ...
Secondo la teoria dell'attaccamento una funzione principale dell'essere genitori č fornire una "base sicura", cioč una particolare atmosfera di sicurezza e di fiducia all'interno della relazione con la figura di attaccamento. Questa necessitŕ si manifesta anche nella vita di coppia, in particolare durante la gravidanza e nel periodo successivo alla nascita di un figlio. Per studiare l'influenza di alcuni aspetti psicologici e comportamentali nelle madri e nei padri durante il periodo perinatale, gli autori hanno studiato un campione di 40 coppie valutate dal secondo trimestre di gravidanza al primo trimestre dopo il parto. In quattro occasioni a tutti i soggetti sono stati somministrati quattro questionari: il CES-D, il Symptom Questionnaire, l'Illness Behaviour Questionnaire e il Perinatal Couple Questionnaire. L'analisi statistica ha evidenziato che in questo periodo i padri manifestano alterazioni emotive con oscillazioni che sono correlate con la sofferenza materna. I padri le cui compagne hanno sofferto di disturbi affettivi durante il post-partum sono risultati piů depressi, ansiosi e irritabili, tendono a manifestare la loro sofferenza sotto forma di sintomatologia somatica e ad essere preoccupati per la propria salute e per il ruolo paterno. Gli interventi psicologici sui disturbi affettivi nel periodo perinatale dovrebbero perciň riguardare non solo la madre, ma entrambi i genitori. Nelle situazioni maggiormente a rischio, un aiuto psicoterapeutico finalizzato a ridurre la sintomatologia depressiva e ansiosa, le preoccupazioni ipocondriache e le difficoltŕ genitoriali puň favorire una migliore relazione di attaccamento non solo nei confronti del bambino, ma anche del proprio partner.
... 247 Research has also evaluated individual parenting programmes and services. 248 However, in line with previous research on women's use of postnatal services, men's use of existing services was not overwhelming. 249 A quarter of the men had used some type of parent or baby service, the most common being health visitor postnatal groups (see Table 3.5.1). ...
... Puis, petit à petit, des travaux sont apparus concernant la psychologie de la paternité en elle-même [87] ainsi que sur la psychopathologie des pères [88] . Ainsi, les études de Ballard et al. [89] montrent que les partenaires de femmes présentant une DPN ont plus de risque d'être déprimés eux aussi. Lovestone et Kumar [90] montrent que la moitié des partenaires de mères présentant un trouble grave du post-partum de type psychose puerpérale, qui sont vues en unité mère-enfant, présentent un diagnostic psychiatrique. ...
La psychiatrie périnatale est une discipline qui se situe à l'interface de trois disciplines : la psychiatrie de l'adulte, le développement psychologique fœtal et des premières années, et la psychopathologie du jeune enfant (de 0 à 5 ans). Elle est en lien naturel avec l'obstétrique et la pédiatrie, mais aussi avec l'ethnologie et la sociologie. Elle a pour objet les troubles mentaux et les aspects spécifiques des événements affectifs survenant chez l'un ou l'autre des parents (troubles thymiques de la grossesse et du post-partum, psychoses puerpérales, troubles de la personnalité, post-partum blues, déni de grossesse, etc.) durant la période périnatale, ainsi que la compréhension des mécanismes liant ces troubles, les troubles des interactions entre les parents et le fœtus, le nouveau-né puis le nourrisson, et les troubles du développement des jeunes enfants. Elle s'intéresse à l'étude de la parentalité et de son développement, et inclut une dimension de prévention des troubles de la parentalité et de leur impact sur le développement. Cette spécialité se doit donc d'inclure, encore plus que les autres champs de la psychiatrie, la prise en compte des dimensions familiale, environnementale, au sens de l'écologie du développement de Bronfenbrenner. La première méthode spécifique de soins périnataux fut sans doute l'hospitalisation conjointe mère-bébé. Cependant, la perspective actuelle est celle d'une évaluation et d'une observation conjointe du développement et des signes précoces de souffrance du bébé, menée parallèlement à celle (mais aussi distinctement de celle-ci) des dimensions de la santé mentale parentale, de leur capacité de caregiving (soins parentaux) et de la qualité globale des interactions parents-bébé.
... Post-natal psychiatric distress and morbidity (in both parents) is recognized in a wide variety of cultures and countries, although not all societies recognize it as a medical disorder (Oates et al., 2004). The commonest form of post-natal disorder is post-natal depression which is recognized to occur in both men and women (Ballard & Davies, 1996;Paulson & Bazemore, 2010). The prevalence of post-natal depression in women in the first six months after giving birth is about 25%, whereas for men, the figure is about 10%. ...
Both men and women are known to suffer from post-natal depression. However, there has been little attention paid to the psychodynamic genesis of post-natal depression in fathers. In this paper, I describe case histories of post-natal depression in two first time fathers and offer a formulation for understanding post-natal depression in such cases. I suggest a range of reasons for the failure to recognize this condition; and possible therapeutic interventions. © 2018 The Association for Psychoanalytic Psychotherapy in the NHS
... The early postnatal period is a crucial transitional period into parenthood (Matthey & Barnett 1999, Early 2001. A limited support during this period may result in postnatal depression (PND) for both fathers and mothers (Ballard & Davies 1996, Gao et al. 2009) and decreased parenting self-efficacy (PSE) in newborn care tasks (Coleman & Karraker 2000, Leerkes & Burney 2007, Salonen et al. 2009). Several previous inter- vention studies that provided educational support during this critical period have shown success; however, the focus remained only on primiparas ( Shaw et al. 2006, Ngai et al. 2009, Shorey et al. 2015a). ...
Background:
Supportive educational programs during the perinatal period are scarce in Singapore. There is no continuity of care available in terms of support from community care nurses in Singapore. Parents are left on their own most of the time, which results in a stressful transition to parenthood. There is a need for easily accessible technology-based educational programs that can support parents during this crucial perinatal period.
Objective:
The aim of this study was to describe the study protocol of a randomized controlled trial on a technology-based supportive educational parenting program.
Methods:
A randomized controlled two-group pretest and repeated posttest experimental design will be used. The study will recruit 118 parents (59 couples) from the antenatal clinics of a tertiary public hospital in Singapore. Eligible parents will be randomly allocated to receive either the supportive educational parenting program or routine perinatal care from the hospital. Outcome measures include parenting self-efficacy, parental bonding, postnatal depression, social support, parenting satisfaction, and cost evaluation. Data will be collected at the antenatal period, immediate postnatal period, and at 1 month and 3 months post childbirth.
Results:
Recruitment of the study participants commenced in December 2016 and is still ongoing. Data collection is projected to finish within 12 months, by December 2017.
Conclusions:
This study will identify a potentially clinically useful, effective, and cost-effective supportive educational parenting program to improve parental self-efficacy and bonding in newborn care, which will then improve parents' social support-seeking behaviors, emotional well-being, and satisfaction with parenting. It is hoped that better supported and satisfied parents will consider having more children, which may in turn influence Singapore's ailing birth rate.
Trial registration:
International Standard Randomized Controlled Trial Number (ISRCTN): 48536064; https://www.isrctn.com/ISRCTN48536064 (Archived by WebCite at http://www.webcitation.org/6wMuEysiO).
... Fathers play an important role during pregnancy and the post-natal period, however, the role is not always well defined [21,22]. There is growing evidence fathers' mental health mirrors, to some extent, that of their partners in the early postnatal period [23]. Little is known, however, about expectant father's experience of pregnancy. ...
Introduction: Nausea and vomiting in pregnancy (NVP) are common. Whilst the impact on pregnant women has been well documented, there is less data on the impact on partners. This study evaluated awareness and impact of maternal NVP on expectant fathers.
Methods: Observational study of 300 expectant fathers. Institutional ethics approval and consent were obtained. Fathers were recruited from antenatal clinics and community settings. Researchers administered demographic, attitudinal and the Hospital Anxiety and Depression scale questionnaires during the third trimester. Expectant fathers were asked if their partner experienced NVP. If aware, they were asked to comment upon the impact on their lives.
Results: Participants were similar in demographics to those of the wider Australian community of expectant fathers. Most fathers were aware whether their partner experienced NVP (82%). Of these fathers, 20% reported no NVP, and 30%, 37% and 13% men reported maternal NVP was mild, moderate and severe, respectively. There was no correlation between paternal depression and maternal NVP, but a significant association was found between moderate and severe maternal NVP and paternal anxiety. In qualitative comments, five themes emerged: disruption on work, feelings of frustration and helplessness, concern over depression in their partner, concern for the developing baby and a sense of being manipulated in the third trimester of pregnancy.
Discussion: Most expectant fathers are aware of NVP in their partner. Moderate and severe maternal NVP are associated with significantly higher symptoms of paternal anxiety.
... Se si considera il periodo della gravidanza e del primo anno post-partum le percentuali rilevate di "depressione perinatale paterna" (dépression périnatale paternelle -DPP) variano dal 2% al 31%, con una media mondiale del 10.4% (Paulson, Bazemore, 2010 (1993) confrontando i risultati relativi a tre gruppi di padri hanno dimostrato che il gruppo di uomini le cui partner soffrivano di disturbi mentali post-partum accusavano una sintomatologia psichiatrica molto più elevata rispetto agli altri due gruppi. Altri studi hanno rilevato che dal 22% al 50% di padri depressi aveva una partner affetta da sintomatologia depressiva (Raskin, Richman, Gaines 1990;Ballard, Davies 1996). In uno studio canadese (Zelkowitz, Milet, 1997) dal confronto di 50 padri le cui partner erano affette da DPM con un gruppo di controllo di 50 padri sono emerse importanti differenze circa la prevalenza di disturbi psicologici: nel primo gruppo si registrò un 24% di diagnosi psichiatrica (comprendente disturbi depressivi, d'ansia, di somatizzazione e dell'adattamento) rispetto ad un 10% del gruppo di controllo. ...
... Risk factors for anxiety and depression in men during their transition to fatherhood can include factors such as an unsupportive marital relationship, paternal unemployment, immaturity, an unplanned pregnancy, 14,15 history of depression, young parental age and higher social deprivation, 16 poor social and emotional support, 17,18 having a partner with elevated depressive symptoms or depression, and poor relationship satisfaction. 19 Data on 3219 biological resident fathers who participated in a longitudinal study of children in Australia found that risk factors associated with psychological distress postnatally included poor job quality, poor relationship quality, maternal psychological distress, having a partner in a more prestigious occupation and low parental self-efficacy. ...
Review question/objective
This qualitative review seeks to identify first-time fathers’ needs and experiences in relation to their mental health and wellbeing during their transition to fatherhood. This will include resident first-time fathers who are either the biological or non-biological father.
The objectives are to explore first-time fathers’ experiences in relation to: Their mental health and wellbeing
Their perceived needs around mental health
The ways in which mental health problems are manifested, recognized and acted upon
The contexts and strategies that are perceived to support mental wellbeing
Perceived barriers and facilitators to accessing support for their mental health and wellbeing
... The early postnatal period is a crucial transitional period into parenthood (Matthey & Barnett 1999, Early 2001. A limited support during this period may result in postnatal depression (PND) for both fathers and mothers (Ballard & Davies 1996, Gao et al. 2009) and decreased parenting self-efficacy (PSE) in newborn care tasks (Coleman & Karraker 2000, Leerkes & Burney 2007, Salonen et al. 2009). Several previous intervention studies that provided educational support during this critical period have shown success; however, the focus remained only on primiparas (Shaw et al. 2006, Ngai et al. 2009, Shorey et al. 2015a. ...
AimsThe aim of this study was to describe a study protocol that evaluates the effectiveness of the Home-but not Alone' educational programme delivered via a mobile health application in improving parenting outcomes. Background
The development in mobile-based technology gives us the opportunity to develop an accessible educational programme that can be potentially beneficial to new parents. However, there is a scarcity of theory-based educational programmes that have incorporated technology such as a mobile health application in the early postpartum period. DesignA randomized controlled trial with a two-group pre-test and post-test design. Methods
The data will be collected from 118 couples. Eligible parents will be randomly allocated to either a control group (receiving routine care) or an intervention group (routine care plus access to the Home-but not Alone' mobile health application. Outcome measures comprise of parenting self-efficacy, social support, parenting satisfaction and postnatal depression. Data will be collected at the baseline (on the day of discharge) and at four weeks postpartum. DiscussionThis will be an empirical study that evaluates a theory-based educational programme delivered via an innovative mobile health application on parental outcomes. Results from this study will enhance parenting self-efficacy, social support and parenting satisfaction, which may then reduce parental risks of postnatal depression.
... nell'accudimento del neonato, a una maggiore tendenza a sculacciare i figli(Davis et al., 2011), a problemi infantili di adattamento e di comunicazione tra genitore e bambino (Jacob e Johnson, 1997), a disturbi del comportamento internalizzanti o esternalizzanti del figlio fino all'età di 4 anni e a comportamenti materni restrittivi o punitivi(Ballard et al., 1994). Il rischio sembra maggiore per i figli maschi(Ramchandani e Psychogiou, 2009). ...
Durante il periodo perinatale una funzione specifica del padre è quella di fornire una base sicura alla propria compagna, aiutandola a superare le difficoltà materiali e psicologiche e favorendo lo sviluppo di una buona relazione tra madre e bambino. La ricerca empirica ha evidenziato come in questo periodo gli stati emotivi dei genitori siano correlati e come anche il padre possa soffrire di disturbi affettivi simili alla depressione perinatale materna. I padri insicuri, troppo ansiosi, depressi, assenti o quelli che manifestano alterazioni del comportamento di malattia (somatizzazioni, disturbi funzionali, preoccupazioni ipocondriache) o problemi comportamentali (aggressività patologica, alcolismo, disturbi di dipendenza) possono non essere in grado di offrire una base sicura adeguata e rappresentano perciò una minaccia per l'equilibrio emotivo della compagna e per lo sviluppo del figlio. Gli studi sull'attaccamento familiare e sul ruolo del padre nei primi anni di vita dei figli hanno portato a risultati significativi che costituiscono una guida utile per l'organizzazione di interventi di prevenzione e trattamento dei disturbi affettivi perinatali che tengano conto di entrambi i genitori e delle esigenze specifiche del bambino e della sua famiglia.
... I disturbi depressivi minori, gli agiti comportamentali e la sindrome della couvade sarebbero più frequentemente conseguenti a conflitti di natura edipica, mentre alla base delle depressioni più gravi e delle reazioni psicotiche vi sarebbero problemi pre-edipici (legati al mancato superamento del legame simbiotico con la propria madre). nell'accudimento del neonato, a una maggiore tendenza a sculacciare i figli (Davis et al., 2011), a problemi infantili di adattamento e di comunicazione tra genitore e bambino (Jacob e Johnson, 1997), a disturbi del comportamento internalizzanti o esternalizzanti del figlio fino all'età di 4 anni e a comportamenti materni restrittivi o punitivi (Ballard et al., 1994). Il rischio sembra maggiore per i figli maschi (Ramchandani e Psychogiou, 2009). ...
... Preliminary studies showed that some risk factors associated with paternal antenatal psychological distress included poor marital relationship, poor social network and insufficient information about pregnancy and childbirth [10]. Having an unsupportive relationship, marital disharmony, being unemployed, young age, poorer social functioning and past history of psychiatric disorder were also found to be associated with paternal mental health problems during the perinatal period [2,[11][12][13]. Matthey et al. [14] argued that adjustment to parenthood was related to different variables at different times of the perinatal period. ...
Background:
There is emerging evidence of the significance of paternal mental health problems among the expectant fathers during the antenatal and postnatal period. The present study aims at determining the prevalence of paternal perinatal anxiety and identifying its risk factors among the fathers.
Methods:
A total of 622 expectant fathers were recruited in Hong Kong. The expectant fathers were assessed using standardized and validated psychological instruments on three time points including early pregnancy, late pregnancy and 6 week postnatal. Independent samples t-test, one way ANOVA, Pearson's correlation and multiple linear regression were used to examine the effect of hypothesized risk factors. Hierarchical multiple regression and mixed effect model were also conducted with potential confounding factors controlled for.
Results:
Results showed that a significant proportion of expectant fathers experienced anxiety during the perinatal period. Low self-esteem and poor social support were found to be risk factors of paternal anxiety across pregnancy to postnatal period. Work-family conflict could significantly predict paternal anxiety in the pregnancy period.
Conclusions:
The present study points to the need for greater research and clinical attention to paternal anxiety, given that it is a highly prevalent problem and could be detrimental to their partner's well-being and children development. The present findings contributes to the theoretical understanding of the prevalence and risk factors of paternal perinatal anxiety and have implications for the design of effective identification, prevention, and interventions of these clinical problems.
... In una sintesi della letteratura sul tema, Ballard & Davies (1996) ...
... Sono pochissime le ricerche che hanno indagato il mondo emotivo dei padri nel periodo più precoce, quello che va dall'inizio della gravidanza al primo semestre di vita del proprio figlio, dopo l'evento nascita. Ultimamente, però, nella letteratura scientifica si è cominciato a parlare di depressione post-partum dei padri [1]. Ci sono ricerche che attestano la preva-lenza di depressione paterna nei neo padri intorno al 5%, fino addirittura ad indicare un 10% di neopadri con sintomi de pres sivi, all'interno di un campione di 5089 famiglie [2]. ...
... Based on a hospital sample of 312 men Boyce et al. (2007) showed that new Australian fathers if his partner is experiencing depression. Several studies and reviews have found a signifi cant correlation between paternal and maternal perinatal depression (Areias et al., 1996;Ballard & Davies, 1996;Deater-Deckard, Pickering, Dunn, Golding, & the ALSPAC Study Team, 1998;Goodman, 2004;Matthey et al., 2000;Morse et al., 2000;Paulson & Bazemore, 2010;Ramchandani et al., 2008;Soliday et al., 1999). Possible shared-environment factors that may contribute to this co-morbidity include partner relationship dysfunction (Matthey et al., 2000), infant-related problems (Dudley, Roy, Kelk, & Bernard, 2001), socioeconomic instability (Gao, Chan, & Mao, 2009), and family structure (Deater-Deckard et al., 1998). ...
Although much research has been devoted to determining the nature and best treatment for maternal perinatal depression, paternal perinatal depression (PPND) has received comparatively little attention. The aim of the present literature review is to find empirical evidence to guide the development of a broad and preliminary intervention model for PPND. The nature of PPND is informed by a psycho-social conceptualisation of the disorder. PPND is often associated with significant morbidity within the fathers family, including depression in his partner, maladjustment to parenthood and future psychological problems in his children. Existing treatments developed for mothers with PND and perinatal parent education for fathers are informative. A multi-level intervention model for fathers with PPND is proposed for discussion.
... Luoma et al. (2012) examined 194 fathers right after birth and found that 21% of the fathers and 24% of the mothers scored above the cutoff point for depressive symptoms, thereby suggesting that depressive feelings may affect fathers as well as mothers. In addition, research also has indicated that depressive symptoms or depression in men are frequently associated with poor relationship satisfaction, low social support (Wee, Skouteris, Pier, Richardson, & Milgrom, 2011) and being unemployed (Ballard & Davies, 1996), and immaturity or unplanned pregnancy (Schumacher, Zubaran, & White, 2008). ...
There is a growing knowledge of the predictors of depressive or anxious feelings during pregnancy among prospective fathers, and the present study investigates how paternal adverse childhood experiences relate to anxious and depressive feelings during pregnancy. Participants were recruited to “The Little in Norway Study (LIN-study)” (2010) at different well-baby clinics in Norway; 976 fathers consented to participate in the study, of which 881 had valid data for adverse childhood experiences. The study reports on the relationship between the Adverse Childhood Experience Scale (ACE Scale; R.F. Anda, A. Butchart, V.J. Felitti, & D.W. Brown, 2010) and depressive feelings, using the Edinburgh Postnatal Depression Scale (EPDS; M. Eberhard-Gran & K. Slinning, 2007), and pregnancy-related anxiety, using the Pregancy-Related Anxiety Scale-Revised (PRAQ-R; A.C. Huizink, E.J. Mulder, D.M.P.G. Robles, & G.H. Visser, 2004). Data collection was comprised of five time points during pregnancy: Time 1 (T1; Weeks 8–34) and four follow-up time points; Time 2 (T2: Weeks 20–25), Time 3 (T3: Weeks 26–31), Time 4 (T4: Weeks 32–34), and Time 5 (T5: Week 36). Fathers’ with higher ACE scores reported more pregnancy-related anxiety than did fathers with lower scores at all time points in pregnancy, except at T5 (36 weeks), while also reporting more depressive feelings during pregnancy. Health providers and community centers should pay more attention to fathers’ mental health during pregnancy, as the whole family system needs to be considered during pregnancy to provide optimal healthcare. Adverse childhood experiences among fathers-to-be may increase depressive and anxious feelings during pregnancy.
... Depressioner av olika svårighetsgrad och med olika varaktighet både under graviditeten och efter förlossningen förekommer hos både kvinnor och män; bland nyförlösta kvinnor med en omfattning av 10-15% (Cooper & Murray, 1998;Cox, Holden & Sagovsky, 1987;Wickberg, 1996) och bland blivande och nyblivna fäder 5-12% (Ballard & Davies, 1996;Frost, 1997;Morse, Buist, & Durkin, 2000). I vissa parförhållanden förekommer depression hos båda föräldrarna. ...
Institutionen för psykologi Lunds Universitet Korttidspsykoterapi med sex kvinnor och sex män i samband med graviditets-och post partumperioden analyserades med narrativ ansats och med anknytningsteori och affektteori som grund. Syftet med studien var att skaffa kunskap om psykiska besvär hos blivande och nyblivna föräldrar och att undersöka om korttidspsykoterapi med kvinnor och män i samband med barnafödandet i förebyggande syfte kunde avlasta dem. Anknytningsmönster och affektiva tillstånd kartlades genom att, i den narrativa analysen, använda Adult Attachment Interview (AAI) respektive Affect Consciousness Interview (ACI). De perceptgenetiska testen DMT och PORT användes för att få en oberoende uppfattning om kvinnornas och männens anknytningsmönster och affektiva tillstånd. Samtliga kvinnor och män företedde brister i eget anknytningsmönster; traumatiska livshändelser avslöjades och "skam-förödmjukelse" var den affekt som dominerade psykoterapiberättelserna både i början och slutet av terapin. Det fanns en tydlig skillnad i medvetenhet om och förmåga att uttrycka affekten i slutet av psykoterapin jämfört med i början av terapin. Antagandet om att det tematiska innehållet i psykoterapiberättelserna skulle domineras av parförhållandet, den egna identiteten, förhållandet till det kommande eller nyfödda barnet och till egna föräldrar bekräftades. Resultaten visade att korttidspsykoterapi i samband med barnafödandet möjliggjorde en "reflekterande funktion" i relation till det tematiska innehållet i terapin, det egna anknytningsmönstret och livshändelser samt höjde den affektiva medvetenhetsnivån vilket bör öka möjligheten till och gynna förut-sättningen för anknytningen till och det affektiva samspelet med barnet. Nyckelord: korttidspsykoterapi, graviditet, post partum, kvinna, man, anknytning, affekt, perceptgenes. Att bli förälder till ett barn, inte nödvändigtvis det första, ställer individen inför exis-tentiella spörsmål och inför förändringar i vardagslivet. Ansvaret för en annans liv och kravet att alltid finnas till hands för barnet, som har rätt att kräva trygghet, förståelse, bekräftelse och om-sorg av sin förälder (Stern, Bruschweiler-Stern & Freeland, 1999) väcker till liv erfarenheter i relationen till egna föräldrar och deras inbördes relation – från tidig barndom och under hela uppväxten (Anzieu, 2000; Barrows, 2002; Clyman, 1992; Fraiberg, 1990; Siddiqui, Hägglöf & Eisemann, 2000). Klinisk erfarenhet har visat hur föräldrablivandet och ett barns födelse Tack till de kvinnor och män som ville lämna sina berättelser till forskningsändamål för att, som flera av dem uttryckte det, kunna hjälpa andra i liknande belägenhet i samband med att de väntar eller just har fått ett barn. Tack till psykolog Stefan Persson, Mödra-och Barnhälsovården i Göteborg, för ett gott samarbete kring en av männen i studien.
... Postpartum Depression has devastating effects on mothers, and also on partners (Ballard & Davies, 1996;Boath, Pryce & Cox, 1998;Meighan, Davis, Thomas & Droppleman, 1999;Osfield, 2000) and may indeed have adverse consequences on the behaviour and development of young children (Cox, 1987;Whiffen & Gotlieb, 1989;Beck, 1992;Lauch, Esser & Schmidt, 1998;Sinclair & Murray, 1998;Rigby, Sanderson, Desforges, Lindsay, & Hall, 1999, Craig, 2003. Furthermore, according to Cox (1987), at the end of one year postnatally only fifty percent of women have recovered from PND and children of depressed mothers may show behaviour disturbances at three years or cognitive defects at four years. ...
... It is also considered as 'the birth of the family' (Lewis, 1989). The family environment is critical for the parents, the development of the child, and the whole family as a unit (Ballard & Davis, 1996;Belsky & Kelly, 1994;Belsky, Lang, & Rovine, 1985;Cowan & Cowan, 1995;Hay & Kumar, 1995;Knauth, 2000;Scrandis, 2005). Parenthood is socially constructed around philosophies of family life and gender roles. ...
Objective: The study aimed to explore the experiences of first-time Maltese parents between pregnancy and the first six months in the postnatal period. Background: Parents’ interaction with their children appears to have an important and lasting effect on children’s cognitive and behavioural development. While both women and men anticipate equal involvement in child care, it is generally the woman who assumes primary responsibility when the new baby arrives. Methods: The qualitative paradigm was used to conduct the study by means of a semi-structured interview schedule. Data was collected at 28 weeks gestation, at 6 weeks postnatally and at 6 months postnatally. Twenty-six first-time parents (13 couples) participated in the study and were recruited by purposive sampling. Gender theory was used as the theoretical framework to guide this study. Interpretative phenomenological analysis was used during the analysing phase. Results: Two main super-ordinate themes were revealed from this study: ‘Pregnancy as a time of preparation’ and ‘The postnatal period as a time of critical change in the lifeworld of the couple’. Conclusion: Findings showed that competent and timely support by trained professionals could equip future couples for the art of parenting and could help parents to resolve challenges before they escalate into problems. This study encourages cross-cultural research on this topic so as to shed light on differences and similarities of contemporary early parenting challenges and outcomes.
... A study of 4109 families found that mothers and fathers reporting depressive symptoms were less likely to read, tell stories, or sing to their infant than parents reporting no depressive symptoms (Paulson, Dauber, & Leiferman, 2006). Maternal depression has been linked to reduced time spent in reading activities (Kiernan & Huerta, 2008), while paternal depression has been associated with less involvement, engagement, responsiveness, and warmth in parenting (Ballard & Davies, 1996). High levels of both maternal and paternal stress have also been associated with less involvement in childrearing and play activities with preschool-aged children (McBride & Mills, 1993). ...
Parent involvement in play, learning, and everyday home activities is important for promoting children's cognitive and language development. The aims of the study were to (a) examine differences between mothers' and fathers' self-reported involvement with their children, (b) explore the relationship between child, parent and family factors, and parent involvement, where parental self-efficacy (PSE) mediates these associations, and (c) assess whether the nature of the relationships between child, parent and family factors, PSE, and parent involvement differed for mothers and fathers. Participants were 851 Australian mothers and 131 fathers of children aged 0–4 years. Few differences between mothers' and fathers' involvement were found after accounting for employment status. Path analysis revealed that the relationships between parent well-being, child temperament, and parent involvement were mediated by PSE for both mothers and fathers. Directions for future research and the practical implications of these findings for supporting mothers and fathers to strengthen their involvement in home activities with their children are discussed.
In order to reach the WHO’s Sustainable Development Goals relating to maternal and infant health, maternal mental health preconditional needs to be addressed. The purpose of the thesis project was to explore how Shanghai women and health care providers perceive mental health problems during the perinatal period in urban China, in the light of the two-child policy. Method: Data collections were conducted in Shanghai, urban China. In Study I, thirty-seven women were interviewed regarding their judgement and decision-making whether to have a second child after the introduction of the two-child policy. Qualitative systematic text condensation analysis was used to describe their decision-making factors. Study II involved 15 interviews with key health care informants and their perceptions of the current situation of perinatal mental health care in urban China. Qualitative content analysis was used to describe their responses. In Study III, sixteen women were interviewed about their insights on perinatal mental health problems. Thematic analysis of the semi-structured interviews was conducted. Study IV was a web survey study of 487 women. The topics discussed related to women’s perinatal and current mental health status, help-seeking behavior for mental health care, disclosure opportunities and preferences, and the kind of help they would expect and request. Descriptive and comparative statistics were performed. Results: Urban Chinese women’s decision-making regarding having a second child in reference to the two-child policy include women’s status, career, challenges of two children, one-child generation, restriction of reproductive freedom, and the expectation of governmental support. The outcomes highlight the impact of the child policy societal, economic, and on perinatal health changes (I). Key health care informants described how mental health was influenced by tradition affecting the perception of mental health in both society and the individual. The health care experts, policy makers, and public health professionals stressed the required resources and reflected in the lack of professional training, limited staff, and resources available to provide adequate care for patients with mental health problems (II). Intergenerational transition, maternal mental health, and transition into motherhood capture the Shanghai women’s position of being in between the traditional and modern Chinese role of motherhood. The urban Chinese woman in a modern society with a professional life expects to have access to high-tech medicine and all aspects of a cosmopolitan lifestyle (III). A total of 487 women confirmed the results in a survey and emphasized the trust in friends, husband, and community health care centers, but all of these were overshadowed by online resources. Women from the one-child generation reported less mental well-being compared to the older generation. The vast majority of the participating women (82.2%) would seek help from online resources and over 70% of the participants would seek help primarily at community health centers. The majority of the women trusted their friends and husband as their first contact to share their mental health problems with. The mother-in-law was the person the women trusted least. Conclusion: The findings provide an enhanced understanding of mental health problems in the perinatal period on local level, and provide suggestions for improved perinatal mental health care for urban Chinese women. The public health concern and cause for action to reach out to the young mothers of the one-child generation are evident. Hesitation to seek care due to lack of knowledge or lack of trust in the health care system are identified as obstacles for young women to seek care. These results are relevant in the current discourse surrounding the reduction of the fertility rate in China, despite the introduction of the two-child policy. This thesis illustrates the need to continue understanding perinatal mental health and the contribution of the new child policy on a societal and family level.
According to existing literature on Perinatal Psychiatric Services, husbands have not often been involved in the treatment of their spouses with Perinatal Psychiatric disorders, especially in India, despite the advantages as an adjunctive form of therapy. The current study aimed at evaluating the effectiveness of brief psychoeducation on the attitude of husbands of women with postpartum psychiatric disorder through a biopsychosocial based informative and supportive model of intervention. A 3 session based Brief Psychoeducation Program (BPP) was developed for the targeted population and its effectiveness was evaluated through quasi-experimental research design. Using Community Attitude towards Mentally Ill Scale (CAMI) assessment of the outcome variable was done at 3 levels i.e., Pre (baseline), Post (immediately after the intervention) and Follow-up post (1 month after the intervention). A total of 21 participants were recruited meeting the study criteria. Friedmans test and descriptive statistics were used to analyze the data. Results indicated the transformation in the attitude of the participants in all the 4 domains of the scale from pre-intervention to post-intervention phase. The study has a strong implication for mental health professionals in this area at both clinical (medical and psychiatry settings) and nonclinical settings.
Background:
Much of the research on parenting and its influence on child development has emphasised the mother's role. However, increasing evidence highlights the important role of fathers in the development, health and well-being of their children. We sought to explore the association between paternal involvement in early child-rearing and depressive symptoms in 9 and 11 year-old children.
Methods:
We used data from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort recruited in the southwest of England. The outcome was depressive symptoms measured using the short Moods and Feelings Questionnaire (sMFQ) score. The main exposure was father involvement measured through factor analysis of fathers' responses on their participation in, understanding of, and feelings about their child's early upbringing. Scores on factor 1 measured fathers' emotional response to the child; scores on factor 2 measured the frequency of father involvement in domestic and childcare activities; scores on factor 3 measured fathers' feelings of security in their role as parent and partner.
Results:
Children of fathers with high scores on factors 1 and 3 had 13% (OR 0.87, 95%CI 0.77-0.98, p = 0.024) and 9% (OR 0.91, 95%CI 0.80-1.03, p = 0.129) respectively lower adjusted odds of depressive symptoms at 9 and 11 years. For factor 2, there was weak evidence of a 17% increase in odds of depressive symptoms associated with 1 unit higher factor scores at both ages (OR 1.17, 95%CI 1.00-1.37, p = 0.050).
Limitations:
In these observational data, the possibility of residual confounding in the association between the exposure and the outcome cannot be ruled out.
Conclusion:
Positive psychological and emotional aspects of father involvement in children's early upbringing, but not the quantity of direct involvement in childcare, may protect children against developing symptoms of depression in their pre-teen years.
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.
Interventions targeting parents’ mental health in the perinatal period are critical due to potential consequences of perinatal mental illness for the parent, the infant, and their family. To date, most programs have targeted mothers. This systematic review explores the current status and evidence for intervention programs aiming to prevent or treat paternal mental illness in the perinatal period.
Electronic databases were systematically searched to identify peer-reviewed studies that described an intervention targeting fathers’ mental health in the perinatal period. Mental health outcomes included depression, anxiety, stress as well as more general measures of psychological functioning.
Eleven studies were identified. Three out of five psychosocial interventions and three massage technique interventions reported significant effects. None of the couple-based interventions reported significant effects. A number of methodological limitations were identified, including inadequate reporting of study designs, and issues with the timing of interventions. The variability in outcomes measures across the studies made it difficult to evaluate the overall effectiveness of the interventions.
Father-focused interventions aimed at preventing perinatal mood problems will be improved if future studies utilise more rigorous research strategies.
Objectives This paper presents the most recent data published internationally dealing with the importance of strengthening the father's role in the pre, peri and post- natal period and results from a study realized with fathers-to-be attending prevention services of Consultorio Famigliare (CF) in the Health Welfare District of Varese. Materials and methods A questionnaire with 30 multiple-choice questions was given to all the couples attending the CF in Somma Lombardo Sample: 62 fathers-to-be completed the survey, representing 52% of the total population attending the CF in year 2007. Mean age of fathers in the sample is 34 ys, 75% in the sample completed secondary school and 95% was waiting for the birth of their first child. Results Data have been analysed in relation with: a) information, b) behaviours, c) selfefficacy, d) emotions, e) experiences of solidarity and self-help among men and male friends. Data reveals that fathers are actively involved and want to play a primary role in occasion of the birth of their child, but, at the same time, have to face some emotional challenges that they are not able to share with their partner and male friends. Conclusions It is necessary to sustain the father's role with ad hoc programs but right now these kind of actions are rare and scarcely provided by socio-sanitary services and agencies dealing with new parents.
This study focuses on mothers' perceptions of fathers' attitudes toward consumption decisions related to the introduction of the first child in the family. Two interviews were conducted with each respondent, pre- and post-natal, using the long interview method; in this paper we focus on pre-natal data. Data revealed that men, according to their partner's perceptions, used consumption as a virtual umbilical cord, although levels of consumption involvement varied from co-involvement for most purchases, to limited involvement, and/or involvement for 'large' items, particularly travel systems and technical items. This research also revealed that men partook in highly masculinized forms of "nesting," and in general shunned pregnancy book reading; although some did engage in "research" activities such as searching the internet for product safety information. We conclude from this study that the transition into parenthood can be difficult for men due to their lack of a physical connection to the pregnancy, a perception that the baby industry is not designed for them, the continuance of male stereotypes in the media, and also the time available to men to become involved in consumption activities immediately prior to a baby's birth.
A couple's sex life can be complex; entailing an interplay of biological, relational, psychological, social and cultural factors that fluctuate over the course of the relationship. Despite all this change, however, no other time in the sexual relationship may be as dynamic as the transition to parenthood. Although the impact of sexual functioning on the relationship can be quite profound, there is a continued apprehension amongst both healthcare providers and expectant parents to discuss aspects of sexuality during pregnancy. As such, pertinent information is not frequently disseminated to expectant parents and, all too often, couples are caught off-guard by the number of challenges they face related to their sexual functioning during this time of transition. The current chapter will be an integrative literature review on the dynamic nature of the sexual relationship during the transition to parenthood, its many potential determinants, and implications for treatment during each stage of the transition process. Our focus will be on the period just prior to conception through postpartum. In addition, as a considerable amount of the transition literature has centered mainly on the female partner, we will pay particular attention to factors influencing the male partner and couple functioning as a whole. We also address issues relevant to special contextual factors (e.g., planned vs. unplanned pregnancy) and problems (e.g., infertility). Throughout, we emphasize the limitations in the current knowledge base and barriers to communication between providers and the soon-to-be parents.
Background
To become a parent is an emotionally life-changing experience. Paternal depression during the postnatal period has been associated with emotional and behavioral problems in children. The condition has predominantly been related to mothers, and the recognition of paternal postnatal depression (PND) has been paid less attention to. PND in fathers may be difficult to detect. However, nurses in pediatric services meet a lot of fathers and are in a position to detect a father who is suffering from PND. Therefore, the aim of this study was (a) to explore Child Health Center nurses’ experiences of observing depression in fathers during the postnatal period; and (b) to explore hindrances of observing these fathers.
Methods
A qualitative descriptive study was conducted. Ten nurses were interviewed in 2014. A thematic data analysis was performed and data were analyzed for meaning.
Results
Paternal PND was experienced as being vague and difficult to detect. Experiences of fathers with such problems were limited, and it was hard to grasp the health status of the fathers, something which was further complicated when routines were lacking or when gender attitudes influenced the daily work of the nurses.
Conclusion
This study contributes to an increased awareness of hindrances to the recognition of PND in fathers. The importance to detect all signals of paternal health status in fathers suffering from PND needs to be acknowledged. Overall, more attention needs to be paid to PND in fathers where a part of the solution for this is that they are screened just like the mothers.
Mental health and wellbeing is a public health priority in the UK. The transition to parenthood can be a stressful time bringing new challenges, which can significantly affect the mental wellbeing of both mothers and fathers. While the importance of maternal mental health is widely recognised, fathers' mental health needs are less well understood. Poor mental health in fathers can have an adverse effect on the child's health and development. Health visitors can play a key role in improving fathers' mental health during this crucial time. This paper is the second of a two-part series on fatherhood, which explores the importance of improving mental health and wellbeing in fathers in the postnatal period.
Fathers' postnatal mental health is associated with emotional and behavioral outcomes for children in early childhood. The aim of this study was to examine whether parenting behavior mediated the relationship between fathers' postnatal psychological distress and emotional-behavioral outcomes for children at age 5. The sample consisted of 2,025 fathers participating in Growing Up In Australia: The Longitudinal Study of Australian Children. Data collected when the children were aged 0 to 12 months and 4 to 5 years were used. Results revealed that the relationship between fathers' postnatal distress and children's outcomes was mediated by parenting hostility (angry and frustrated reactions toward the child such as yelling), and this remained significant after controlling for fathers' concurrent mental health and mothers' postnatal mental health. These findings underscore the important contribution of fathers' postnatal mental health to later parenting behavior and child outcomes. Implications for policy and practice focused on improving mental health and parenting support to fathers in the early childhood period is discussed.
The aim of this project was to review current research regarding postnatal depression in fathers and to present potential screening and referral options. The search was limited to scholarly (peer reviewed) journals and all articles were retrieved with date limits. Initial search parameters were the following: antenatal depression OR pregnancy depression OR postnatal depression OR perinatal depression AND father* OR men OR paternal. The search yielded 311 abstracts returned. With reference to the inclusion criteria and primary and secondary outcomes intended for the focus of this review, N = 63 articles were retrieved and read in full by the researchers. These articles were included in the final integrative review. Depression in fathers following the birth of their child was associated with a personal history of depression and with the existence of depression in their partner during pregnancy and soon after delivery. Based on the review the authors suggest routine screening and assessment of both parents should occur across the pregnancy and postnatal period. The use of the Edinburgh Postnatal Depression Scale for screening of depression in men needs to be linked to referral guidelines for those individuals who require further investigation and care.
Behavior-state matching and synchrony in interactions were assessed in 48 depressed and nondepressed mother–infant dyads when the infants were 3 months old. Attentive/affective behavior states were coded for the infants and mothers on a negative to positive scale. The depressed mothers and their infants matched negative behavior states more often and positive behavior states less often than did the nondepressed dyads. The total percentage of time spent in matching behavior states was less for the depressed than for the nondepressed dyads. Cross-spectral analyses of the mothers' and the infants' behavior-state time series suggested only a trend for greater coherence or synchrony in the interactions of the nondepressed dyads. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Married, middle-class women who met diagnostic criteria for depression and a comparable group of nondepressed women were videotaped interacting with their infants at home at 2, 4, and 6 months. When depression was defined in terms of 2-month diagnosis, there were no differences between depressed and comparison mothers or babies in either positive or negative interaction during feeding, face-to-face interaction, or toy play. However, women whose depressions lasted through 6 months were less positive with their infants across these 3 contexts than women whose depressions were more short-lived, and their babies were less positive during face-to-face interaction. These data highlight the need to distinguish between transient and protracted depression in evaluating depression effects on the mother–infant relationship and infant outcome. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
[discuss] the research on paternal responsiveness or sensitivity, particularly to very young infants / consider the development of father–infant attachments, evaluating the proposition that there is a preference hierarchy among attachment figures in which mothers typically are preferred over fathers / describe research on the differences and similarities between maternal and paternal behavior / [consider] paternal influences on [infant] development . . . and patterns of indirect effects (PsycINFO Database Record (c) 2012 APA, all rights reserved)
24 women (mean age 24 yrs) who had received ultrasound examinations and psychological interviews during the 3rd trimester of pregnancy were subsequently divided into a group of 12 Ss who had reported pregnancy problems (marital difficulties and ambivalence about the child) and another group of 12 Ss who had not. Ss were then observed at 3–5 mo postpartum in interactions with their infants and were given the Beck Depression Inventory, the State-Trait Anxiety Inventory, the Nowicki-Strickland Internal–External Control Scale for Adults, measures of mothers' and infants' temperament, and a maternal developmental expectations and childrearing attitudes scale. The mothers who had experienced pregnancy problems were more depressed, anxious, and externalizing postpartum and expressed more punitive childrearing attitudes. These depressed mothers and their infants showed less optimal interaction behaviors. Results suggest that postpartum depression can be predicted from a simple set of questions regarding the mother's negative feelings about her marriage and her expectant child during the prenatal period. (19 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The study was based on an index group of 49 mothers who had had depressive disorders in the post-natal year, and 49 control mothers who had been free from any psychiatric disorder since delivery. Nineteen months after childbirth, the interaction between mother and child was assessed by blind assessors using defined observational methods. Compared with controls, index mother-child pairs showed a reduced quality of interaction (e.g. mothers showed less facilitation of their children, children showed less affective sharing and less initial sociability with a stranger). Similar but reduced effects were seen in a subgroup of index mothers and children where the mother had recovered from depression by 19 months. Social and marital difficulties were associated with reduced quality of mother-child interaction.
Tested the general hypothesis that depressed persons, as a group, are less socially skillful than nondepressed individuals. Social skill was defined as the complex ability both to emit behaviors that are positively reinforced and not to emit behaviors that are punished by others. The interpersonal behaviors of 8 depressed and 11 nondepressed undergraduates in 2 groups were compared. All verbal interchanges among group members were coded. Results were cross-validated in both groups and were generally consistent in showing depressed Ss to be lower than controls on a number of operational measures of social skill (i.e., activity level, interpersonal range, rate of positive reactions emitted, and action latency). (32 ref.)
• The Schedule for Affective Disorders and Schizophrenia (SADS) was developed to reduce information variance in both the descriptive and diagnostic evaluation of a subject. The SADS is unique among rating scales in that it provides for (1) a detailed description of the features of the current episode of illness when they were at their most severe; (2) a description of the level of severity of manifestations of major dimensions of psychopathology during the week preceding the evaluation, which can then be used as a measure of change; (3) a progression of questions and criteria, which provides information for making diagnoses; and (4) a detailed description of past psychopathology and functioning relevant to an evaluation of diagnosis, prognosis, and overall severity of disturbance. This article reports on initial scale development and reliability studies of the items and the scale scores.
The difficulties inherent in obtaining consistent and adequate diagnoses for the purposes of research and therapy have been pointed out by a number of authors. Pasamanick12 in a recent article viewed the low interclinician agreement on diagnosis as an indictment of the present state of psychiatry and called for "the development of objective, measurable and verifiable criteria of classification based not on personal or parochial considerations, but on behavioral and other objectively measurable manifestations."Attempts by other investigators to subject clinical observations and judgments to objective measurement have resulted in a wide variety of psychiatric rating scales.4,15 These have been well summarized in a review article by Lorr11 on "Rating Scales and Check Lists for the Evaluation of Psychopathology." In the area of psychological testing, a variety of paper-and-pencil tests have been devised for the purpose of measuring specific
The primary objective of this paper is to examine role attitude-behavior congruence for seven family roles. Findings based on questionnaire data from 1154 married men and women indicate that: (1) there exists a substantial number of husbands and wives experiencing role attitude-behavior incongruence; (2) of the individuals in the incongruent role attitude-behavior group, more women than men express egalitarian attitudes toward the performance of family roles; (3) both sexes tend to express egalitarian or role sharing attitudes, but women enact the majority of duties related to all roles with the exception of the provider role, which is mainly performed by men. Thus, the general conclusion is that where role attitude-behavior incongruence exists, both married men and women express egalitarian role attitudes but this egalitarianism is not generally reflected in role behaviors.
To the Editor—
Although we welcome discussion of the relative merits of different research criteria for Psy chiatric diagnosis, the article by Drs Overall and Hollister in the Archives (36:1198-1205, 1979) "Comparative Evaluation of Research Diagnostic Criteria for Schizophrenia" troubles us for several reasons. First of all, the authors do not address the issue of the different purposes of various sets of research diagnostic criteria. Whereas the purpose of the actuarial approach taken by Drs Overall and Hollister is to simulate competent or expert clinical practice, the purpose of the Washington University criteria, research diagnostic criteria (RDC), and DSMIII criteria is to improve usual clinical practice by incorporating into the criteria distinctions that have been shown by research study to have some validity in terms of such variables as course, response to specific therapy, familial pattern, etc. Given this difference in purpose, it is hardly adequate to approach the evaluation
This article reports the development of an instrument to measure initial adjustment to school, and its use to explore the differences between children with and without nursery experience. Those with nursery experience proved to have a better grounding for cognitive work in infant school, but there was no significant difference on emotional or social criteria of adjustment to school.
There is evidence for an association between postpartum depression and a number of indices of adverse child outcome. In infants of mothers with postpartum depression, deficits have been found in their early interactions and their cognitive functioning. A high rate of insecure attachment is also apparent. There is also evidence for a longer term association: cognitive development in the four-year-olds of mothers who have had a postpartum depression appears compromised (at least in boys from lower socio-economic backgrounds), and there is an association with behavioural disturbance. Longitudinal analyses reveal that the impaired patterns of early interaction occurring between mother and infant in the context of the maternal mood disorder may be an important determinant of some of these adverse child outcomes. With respect to cognitive development, there is evidence of a sensitive developmental period, although its precise parameters are uncertain. Observational and experimental studies are needed to elucidate the process by which maternal and infant behaviour becomes disturbed. The explanatory potential of treatment studies has been little exploited and that of sibling studies not at all. Such enquiry could contribute much to elucidating the relative contributions of genetic and environmental factors to the association between postpartum depression and adverse child outcome
The CES-D scale is a short self-report scale designed to measure depressive symptomatology in the general population. The items of the scale are symptoms associated with depression which have been used in previously validated longer scales. The new scale was tested in household interview surveys and in psychiatric settings. It was found to have very high internal consistency and adequate test- retest repeatability. Validity was established by pat terns of correlations with other self-report measures, by correlations with clinical ratings of depression, and by relationships with other variables which support its construct validity. Reliability, validity, and factor structure were similar across a wide variety of demographic characteristics in the general population samples tested. The scale should be a useful tool for epidemiologic studies of de pression.
The father's role in infancy is currently undergoing a major re-evaluation. Evidence from cross-cultural, historical, comparative and biological sources indicates that the father is capable of playing an active role in infant development. A series of observational studies of father-infant interaction in the newborn period were described. The results indicated that fathers are interested and involved with newborn infants and as nurturant as mothers in their interactions with their infants. While mothers spent more time than fathers in feeding and caretaking activities, fathers and mothers did not differ in their caretaking competence as indexed by their sensitivity to infant cues in the feeding situation. The implications of these findings for the father's role in infancy were discussed and the desirability of introducing greater institutional support systems for fathers was noted.
The development of a questionnaire to be completed by parents for use in screening preschool children is described. Ninety per cent of children attending a psychiatric clinic were identified when the criteria were a score of 11 or more points on the behaviour scale and/or inability to speak in 3-word phrases, and/or speech which was very difficult to understand. The questionnaire could be used as a basis for collecting information systematically about preschool children, and as a screening device for identifying children with behaviour difficulties and developmental delay.
This manual is a guide to a particular method of standardising the elements of this diagnostic process with a view to achieving comparability between clinicians. The most important part of the book is therefore the glossary of definitions of symptoms. Everything else depends upon it. It is useless to try to determine whether a symptom is present unless it is quite clear what its specific characteristics are and how it can be distinguished from other symptoms. If the clinician knows these differential definitions, the rest is a matter of technique. If he does not, no amount of technical skill will give his judgments value.
24 depressed and 24 nondepressed mothers (mean age 27.2 yrs) were videotaped in 3 face-to-face interactions with their 3-mo-old infants to investigate whether infants of depressed Ss, who became depressed postpartum, would behave like infants of nondepressed Ss, who were invited to "look depressed." For the 1st interaction, Ss were asked to play with their infants; for the 2nd interaction, Ss were instructed to look and act depressed with their infants; and for the 3rd interaction, Ss were again asked to play with their infants (reunion). The videotapes were then coded by a naive research assistant. Results show that infants of nondepressed Ss exhibited more frequent positive facial expressions; less frequent negative facial expressions; and more frequent vocalizations, protests, and wary looks than infants of depressed Ss. Activity level and heart rate were higher for infants of nondepressed Ss than infants of depressed Ss. Data suggest that infants are able to detect the affective qualities of their mothers' displays and appropriately modify their affective displays in response. Findings also suggest that depression or depressed affect emerges in infants as a function of early interactions with their depressed mothers. (16 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
A large group of infants of primiparous women who were at high risk for postnatal depression (N=188) and a smaller group of those at low risk (N=43) were assessed in the neonatal period using the Neonatal Behavioural Assessment Scale. Poor motor scores and high irritability were strongly predictive of the onset of maternal depression by eight wéeks postpartum. These effects obtained after taking account of both maternal mood in the neonatal period and maternal perceptions of infant temperament. Poor motor scores and high levels of infant irritability in the neonatal period also predicted less optimal infant behaviour in face‐to‐face interactions with the mother at two months postpartum. Neonatal behaviour did not predict the persistence of depression, nor did it predict the quality of maternal behaviour in interaction with the infant.
RÉSUMÉ
Le rôle des facteurs infantiles dans la dépression post‐ natale et les interactions mère‐enfant.
Un groupe important de nourrissons de mères primipares à haut risque de dépression du postpartum (N=188) et un plus petit groupc de mères à faible risque (N=43) ont été examinées durant la période néonatale à l'aide de la Neonatal Behavioural Assessement Scale. Des scores moteurs médiocres et un degréélevé d'irritabilité ont été fortement prédictifs d'un début de dépression maternelle à huit semaines de post‐partum. Ces effets étaient obtenus en tenant compte à la fois de l'humeur maternelle dans la période néonatale et la perception maternelle du comportement de leur enfant. Des scores moteurs médiocres et un niveau élevé de l'irritabilité chez lc nourrisson durant la période néonatale prédisait également un comportcment infantile moins optimal dans l'interaction de face à face avec la mère deux mois après la naissance. Le comportement à la naissance ne prédisait pas la persistance de la dépression, ni la qualité du comportement maternel dans l'interaction avec son nourrisson.
ZUSAMMENFASSUNG
Der Einfluβ kindlicher Faktoren auf postnatale Depressionen und Mutter‐Kind Interaktionen
Eine große Gruppe von Säuglingen erstgebärender Mütter, die ein hohes Risiko für eine postnatale Depression hatten (N=188) und eine kleinere Gruppe solcher mit niedrigem Risiko (N=43) wurden in der Neugeborenenperiode mit Hilfe der Neonatal Behavioural Assessment Scale untersucht. Schlechte motorische Scores und hochgradige Empfindlichkeit waren wichtige Parameter für den Beginn einer mütterlichen Depression bis fünf Wochen postpartum. Diese Einfüsse blieben auch bestehen, nachdem man sowohl die Stimmung der Mutter in der Nconatalpcriode als auch ihre Einschätzungen des kindlichen Temperaments berücksichtigt hattc. Schlechte motorische Scores und hochgradige Empfindlichkeit des Kindes in der Neonatalperiode waren kein optimaler Parameter für das kindliche Verhalten bei Blickkontakt‐Interaktionen mit der Mutter im Alter von zwei Monaten post partum. Das Verhalten in der Neonatalperiode besagte nichts über das Fortbestehen der Depression, noch besagte es etwas über die Art des mütterlichen Verhaltens bei Interaktionen mit dem Kind.
RESUMEN
Papel de los factores del recién nacido en la depresión postnatal y en las interacciones madre‐lactante ;
Un gran grupo de lactantes de mujeres primíparas de alto riesgo para la depresión postnatal (N=188) y un grupo más pequcño con bajo riesgo (N=43) fueron evaluados en el período neonatal utilizando la Neonatal Behavioural Assessment Scale. Los puntajes motores pobres y la alta irritabilidad fueron fuertemenie predictivos del inicio de una depresión materna a las ocho semanas postpartum. Estos efectos se obtuvieron después de tener en cuenta la manera de ser de la madre (su estado de ánimo) en el período neonatal y las percepciones maternas del temperamento del lactante. Los puntajes motores pobres y los altos niveles de irritabilidad el lactante en el período neonatal tambíen predijeron un comportamiento del lactante menos óptimo en su interacción con la madre a los dos meses del postparto. El comportamiento neonatal no predijo la persistencia de la depresión, ni la cualidad del comportamiento materno en su interacción con el lactante.
Abstract— The speech of depressed and well mothers during play with their infants at two months was compared on dimensions of structure and semantics. No differences between maternal groups were found on measures of complexity and syntax. However, the speech of depressed women expressed more negative affect, was less focused on infant experience, and tended to show less acknowledgement of infant agency. Speech style of depressed women also varied according to infant gender. Regression analyses indicated that the quality of maternal communication with the infant, and particularly the focus of speech, mediated the association between depression and infant cognitive development in the first 18 months.
This paper describes the further development of a new rating scale for use by teachers, the Prosocial Behaviour Questionnaire (PBQ). The PBB is designed For use in the investigation of positive aspects of children's behaviour in primary school (ages 5–11 years). Tests of internal and external reliability and of validity are reported. It is concluded that the PBQ is a useful research instrument, However, teachers need training in its use and should be aware of the possible “halo” effects on their ratings of the child's sex. reading ability, aggressiveness and deviant behaviour
Although some depressed mothers are withdrawn, others are highly engaged and intrusive. There are correspondences between the behavior of depressed mothers and their infants.
The impact of maternal depression and adversity on mother-infant face-to-face interactions at 2 months, and on subsequent infant cognitive development and attachment, was examined in a low-risk sample of primiparous women and their infants. The severe disturbances in mother-infant engagement characteristic of depressed groups in disadvantaged populations were not evident in the context of postpartum mood disorder in the present study. However, compared to well women, depressed mothers were less sensitively attuned to their infants, and were less affirming and more negating of infant experience. Similar difficulties in maternal interactions were also evident in the context of social and personal adversity. Disturbances in early mother-infant interactions were found to be predictive of poorer infant cognitive outcome at 18 months. Infant attachment, by contrast, was not related to the quality of 2-month interactions, but was significantly associated with the occurrence of adversity, as well as postpartum depression.
Maternal depression is a prevalent symptom among lowincome mothers with infants. Depressed mothers are more likely than nonde pressed mothers to show hostile and intrusive behavior toward their infants, and infants of depressed mothers are more likely to exhibit slowed development and unstable, avoidant attachment behaviors.
A crucial problem in psychiatry, affecting clinical work as well as research, is the generally low reliability of current psychiatric diagnostic procedures. This article describes the development and initial reliability studies of a set of specific diagnostic criteria for a selected group of functional psychiatric disorders, the Research Diagnostic Criteria (RDC). The RDC are being widely used to study a variety of research issues, particularly those related to genetics, psychobiology of selected mental disorders, and treatment outcome. The data presented here indicate high reliability for diagnostic judgments made using these criteria.
The Schedule for Affective Disorders and Schizophrenia (SADS) was developed to reduce information variance in both the descriptive and diagnostic evaluation of a subject. The SADS is unique among rating scales in that it provides for (1) a detailed description of the features of the current episodes of illness when they were at their most severe; (2) a description of the level of severity of manifestations of major dimensions of psychopathology during the week preceding the evaluation, which can then be used as a measure of change; (3) a progression of questions and criteria, which provides information for making diagnoses; and (4) a detailed description of past psychopathology and functioning relevant to an evaluation of diagnosis, prognosis, and overall severity of disturbance. This article reports on initial scale development and reliability studies of the items and the scale scores.
The authors describe four cases in which men developed emotional illnesses related to their wives' pregnancies. In all of the cases, the patients had experienced sibling rivalry at a significant time in their lives. This factor seemed to be more important dynamically in understanding their feelings about fatherhood than previously proposed factors, such as envy of the wife's childbearing capacity, dependence on the wife, and neurotic conflict with the oedipal father. The authors suggest that in men with neuroses, the issue of sibling rivalry is an important determinant of reactions to fatherhood.
Synopsis
The Camberwell Psychiatric Register was searched for contacts by the 2257 women resident in the register catchment area who were known to have had a child in 1970. Of these, 99 women (and 39 of their husbands) were found to have had a ‘new episode’ of psychiatric illness in the two years before or the two years after the birth of their child. The distribution of these ‘new episodes’ relative to the time of childbirth was then studied. In the women, both functional psychoses and depressive illnesses showed a sharp rise in the new episode rate in the three months immediately after delivery. There was also a suggestion of a secondary rise, less dramatic but more sustained, from the 10th to the 24th month after delivery. There was no comparable rise in the husbands. Women whose children were illegitimate had high new episode rates throughout the four-year study period, but not particularly so in the puerperium itself.
A large sample of primiparous women was screened for depression after childbirth. Those identified as depressed, women with a previous history of depression and a control group were followed up to 18 months, when their infants were assessed on measures of cognitive, social and behavioral development. Infants of postnatally depressed mothers performed worse on object concept tasks, were more insecurely attached to their mothers and showed more mild behavioural difficulties. Postnatal depression had no effect on general cognitive and language development, but appeared to make infants more vulnerable to adverse effects of lower social class and male gender.
In a study comparing depressive disorders detected in a field survey (n = 90) with patients referred to a specialist treatment setting (n = 63), the clinical features and demographic correlates of 'cases' of affective disorders proved to be similar. However, those in treatment settings appeared to have more people achieving definite case status. Hospital-referred cases were also more likely than community cases to be older and single, and this difference persisted even after controlling for chronicity of symptoms.
SYNOPSIS
One hundred and thirty men and women attending psychiatric hospitals with depressive disorders were interviewed at the time of their initial contact. After a mean four month interval, 119 were reassessed in order to test the hypothesis that initial levels of social support predict clinical improvement even when other potential risk factors such as age, sex, diagnosis and severity of depression are controlled. Severity and duration of the episode emerged as the only significant background predictors of recovery. The explained variance in recovery from depression due to social support was equal in men and women, and was not diminished by the background clinical predictors. According to subset analyses however, the aspects of personal relationships and perceived support that predict recovery in men and in women appear to be different. The available multiple regression models of outcome favoured a main effect of social support and provided persuasive if inconclusive evidence for a statistical interaction effect with sex. The implications for further research and for theory are discussed.
Ninety-two women and their first-born children took part in a longitudinal survey of maternal mental health. When the children were four years old, their mothers were interviewed by means of the Behavioural Screening Questionnaire, and the children's problems were rated by a psychiatrist, who was unaware of the mothers' psychiatric histories or of assessments of their current health. As expected, mothers who were concurrently depressed reported significantly more behavioural difficulties in their children. Marital disharmony during pregnancy and a history of paternal psychiatric problems were also associated with later childhood behavioural difficulties. Children who scored below average on the McCarthy scales of cognitive abilities were also reported by their mothers to have more behavioural problems, but the children's behavioural difficulties at four showed no clear links with post-natal depression.
This study examined the association of postpartum depression with specific infant characteristics. Twenty-five diagnosed depressed and 25 nondepressed mothers and their 2-month-old infants participated in the study. The mothers completed measures of infant temperament and difficulty associated with infant care, and the infants were assessed using the Bayley Scales of Infant Development. Group comparisons indicated that, compared with the infants of the nondepressed mothers, the infants of the depressed women were less competent cognitively and expressed more negative emotions during the testing. The depressed mothers perceived their infants as more difficult to care for and more bothersome than did the nondepressed mothers, but did not attribute these difficulties to the temperament of their infants. These findings suggest that postpartum depression is associated with an identifiable pattern of infant behavior that may exacerbate depressed women's mood.
The use of different diagnostic classifications of psychiatric disorder in the United States and the United Kingdom, together with associated changes in the operational definitions of disorder, has placed additional barriers in the way of U.S./U.K. comparative studies. However, the parallel development of two general population studies, one in Edinburgh and one in St. Louis, MO, has enabled a comparative analysis with limited objectives, to be undertaken. This paper presents results based upon matched samples of women from these studies. The findings revealed current overall prevalence, and the socio-demographic determinants of prevalence, to be similar in the two city samples. The results additionally indicate the consequence of applying diagnostic criteria appropriate to different ranges of psychiatric syndromes for the estimation of prevalence in general population samples.
Ninety four women and their first born children took part in a longitudinal study of maternal mental health during pregnancy and after delivery. The children's cognitive functioning was assessed at age 4 using the McCarthy scales, without knowledge of the mothers' psychiatric history or current health. As expected girls performed slightly better than boys and children from middle class and professional families did better than children from working class homes, as did children whose mothers had achieved at least one A level at school. Significant intellectual deficits were found in the children whose mothers had suffered with depression, but only when this depression occurred in the first year of the child's life. Marital conflict and a history of paternal psychiatric problems were independently linked with lower cognitive test scores; together with a working class home background these were the only factors that contributed to the deleterious effect of maternal postnatal depression.
To determine whether the "depressed" behavior (e.g., less positive affect and lower activity level) of infants noted during interactions with their "depressed" mothers generalizes to their interactions with nondepressed adults, 74 3-6-month-old infants of "depressed" and nondepressed mothers were videotaped in face-to-face interactions with their mothers and with nondepressed female strangers. "Depressed" mothers and their infants received lower ratings on all behaviors than nondepressed mothers and infants. Although the infants of "depressed" versus nondepressed mothers also received lower ratings with the stranger adult, very few differences were noted between those infants' ratings when interacting with their mother versus the stranger, suggesting that their "depressed" style of interacting is not specific to their interactions with depressed mothers but generalizes to their interactions with nondepressed adults as early as 3 months of age.
Twenty-one married couples, recruited from childbirth classes (mean age 29.6 years), were administered questionnaires measuring 20 different moods during the third trimester of pregnancy (prepartum period), during the postpartum period, and at 6 months after birth (follow-up period). In each questionnaire period individual questionnaires were filled out daily by both the mother and father for 10 consecutive days. The results indicated that the postpartum period, compared with the prepartum and follow-up periods, is an emotionally unique time but not a period marked by depression. The moods that were rated as being experienced more strongly by men and women during the postpartum period were associated with anxiety and concern for one's ability to cope such as "nervousness," "worried," "helpless," and "anxious" or positive emotions such as "enthusiastic" and "happy." It is concluded that men and women in this sample tend to experience the postpartum period in an emotionally similar way.
A model of maternal postpartum depression was tested in which difficult infant temperament was construed as a stressor and supportive interpersonal relationships were construed as a protective resource. It was hypothesized that both infant temperamental difficulty and level of social support would affect maternal depression through the cognitive mediation of perceived self-efficacy in the parenting role. Participants were 55 married women who were assessed during pregnancy and again 3 months postpartum. Infant temperament was assessed through observation, maternal crying records, and the Revised Infant Temperament Questionnaire. Results of a path analysis indicated that infant temperamental difficulty was strongly related to the mothers' level of postpartum depression, both directly and through the mediation of parenting self-efficacy. Consistent with predictions, social support appeared to exert its protective function against depression primarily through the mediation of self-efficacy. Both practical implications for identifying women at risk for postpartum depression and theoretical implications for understanding the mechanisms through which stressful events and social support affect adjustment are discussed.
This study investigates whether three-year-old children whose mothers had been depressed after their birth showed more behaviour disturbance than children of mothers who were not depressed at that time. Ninety-one of 103 mothers who took part in an earlier prospective study of postnatal depression were reinterviewed three years later to determine their present mental state, and to assess their child's behaviour, using Richman's Behavioural Screening Questionnaire.
No relationship was found between a prolonged postnatal depression and behaviour disturbance in the child, but children whose mothers had brief postnatal depressive episodes showed more behaviour disturbance than those whose mothers had not been depressed since childbirth.
Although there is an extensive literature on mental illness associated with motherhood, the related area of mental illness associated with fatherhood is only beginning to develop.
This paper reviews the literature, presents four new cases, interprets causes in terms of psychoanalytic developmental theory, and speculates on methods of prevention and treatment, including therapeutic abortion if the wife is willing.