Employment may Protect Fathers in the Setting of Maternal Teenage Pregnancy from Anxiety and Depression: Findings from the Australian Father's Study

Abstract

Objective: There is limited research on fathers in the setting of maternal teenage pregnancy. Most studies report data from regions of social disadvantage and low education. We report on the levels of anxiety, depression and quality of life of fathers in the setting of maternal teenage pregnancy in an area where the unemployment rate is low.
Methods: Observational study of 50 fathers in the setting of maternal teenage pregnancy and 100 fathers whose partners were not teenagers (control), living within the same metropolitan healthcare region with high employment rates. Fathers were enrolled within the larger Australian Father’s Study and were recruited from antenatal clinics and community settings. Researchers administered the Hospital Anxiety and Depression Scale, Satisfaction with Life Scale and demographic questionnaires.
Results: Fathers in the setting of maternal teenage pregnancy were significantly younger than control fathers (p<0.05). After adjusting for demographic variables, fathers in the setting of maternal teenage pregnancy did not have levels of anxiety, depression or quality of life that were significantly different to control fathers.
Conclusion: Fathers in the setting of maternal teenage pregnancy, when engaged in further education or employment have levels of anxiety, depression and quality of life comparable to control fathers.

Full text

Employment may Protect Fathers in the Setting of Maternal Teenage
Pregnancy from Anxiety and Depression: Findings from the Australian
Andrea G Atkinson1, Rodney W Petersen2 and Julie A Quinlivan3*
1Women’s and Newborns Health Service, Department of Obstetrics and Gynaecology, Joondalup Health Campus, Joondalup, WA, Australia
2Women’s and Babies Service, Women’s and Children’s Hospital, North Adelaide, SA, Australia
3Institute for Health Research, University of Notre Dame Australia, Fremantle, WA, Australia
*Corresponding author: Quinlivan JA, Institute for Health Research, University of Notre Dame Australia, Fremantle, WA, Australia, Tel: 08-9433-0698; E-mail:
Julie.Quinlivan@nd.edu.au
Rec date: Feb 1, 2016; Acc date: Feb 5, 2016; Pub date: Feb 12, 2016
Copyright: © 2016 Atkinson AG, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
Objective: There is limited research on fathers in the setting of maternal teenage pregnancy. Most studies report
data from regions of social disadvantage and low education. We report on the levels of anxiety, depression and
quality of life of fathers in the setting of maternal teenage pregnancy in an area where the unemployment rate is low.
Methods: Observational study of 50 fathers in the setting of maternal teenage pregnancy and 100 fathers whose
partners were not teenagers (control), living within the same metropolitan healthcare region with high employment
rates. Fathers were enrolled within the larger Australian Father’s Study and were recruited from antenatal clinics and
community settings. Researchers administered the Hospital Anxiety and Depression Scale, Satisfaction with Life
Scale and demographic questionnaires.
Results: Fathers in the setting of maternal teenage pregnancy were significantly younger than control fathers
(p<0.05). After adjusting for demographic variables, fathers in the setting of maternal teenage pregnancy did not
have levels of anxiety, depression or quality of life that were significantly different to control fathers.
Conclusion: Fathers in the setting of maternal teenage pregnancy, when engaged in further education or
employment have levels of anxiety, depression and quality of life comparable to control fathers.
Keywords: Teenage pregnancy; Teenage fathers; Education; Hospital
anxiety and depression scale; Satisfaction with life scale; Depression;
Anxiety; Quality of life
Background
Paternal depression is a signicant health problem. A recent meta-
analysis estimated it impacted upon one in ten families [1]. As with
maternal depression, its consequences can lead to poorer outcomes in
ospring [2]. Paternal depression can also cause nancial and
emotional stressors for the family as well as poor paternal infant
engagement [3]. ere is societal and political interest in strategies to
minimize the toll of paternal depression on families.
Depression in fathers is common in the setting of maternal teenage
pregnancy [4-7]. However, most reported studies have been conducted
in areas with low Relative Socioeconomic Area for Disadvantage scores
[8] where participation rates in employment and education in young
men are poor. Low socioeconomic status adversely impacts on the
incidence of depression [7].
Employment can be a protective factor against depression, acting as
a stabilising focus for vulnerable families [3,9,10]. Conversely, the
adverse cycle of unemployment and depression can adversely impact
on engagement of fathers with their children and increase paternal
stress and aggravation [3,9-11]. Education may also be a protective
factor in preventing depression in individuals from low socioeconomic
backgrounds [12,13]. However, the role of employment and education
as protective factors for fathers within the setting of maternal teenage
pregnancy has not been specically studied.
Our hypothesis was that employment and education could play a
protective role for fathers in the setting of maternal teenage pregnancy
by reducing rates of anxiety and depression and improving quality of
life. e aim of the study was to document levels of anxiety, depression
and quality of life in a geographic region where participation
opportunities in education and employment opportunities for young
men were high.
Methods
Type of study and ethics approval
e ndings in this manuscript were a predened sub-study of e
Australian Father’s Study, a longitudinal study of 1000 fathers that
explored father’s attitudes towards antenatal, birth and postnatal care
[14,15]. e Australian Father’s Study is collection of sub-studies of
men who are the acknowledged father in the setting of pregnancy. e
sub-studies address maternal teenage pregnancy, “y in y out (FIFO)”
workers, aboriginal background, migrant background and preterm
Reproductive System & Sexual
Disorders: Current Research Atkinson, et al., Reprod Syst Sex Disord 2016, 5:1
http://dx.doi.org/10.4172/2161-038X.1000161
Research Article Open Access
Reprod Syst Sex Disord
ISSN:2161-038X RSSD, an open access journal Volume 5 • Issue 1 • 1000161
Study
Father’
s

birth. FIFO workers are workers who live in one region of Australia
and y to their worksite wherein they lodge on site for a period of one
to four weeks and then y home and repeat this in a cycle.
ey represent a signicant part of the Australian workforce
especially in industries such as mining, oil and gas where the worksites
are in isolated rural locations. e Australian Father’s Study also
recruited a large cohort of fathers who reected the general
demographic features of the wider population of Australia fathers with
a pregnant partner in terms of age, ethnicity, religious belief and parity.
ese were comparison fathers for the substudies.
e Australian Father’s Study has institutional ethics committee
approval (Primary ethics committee: Joondalup Health Campus) and
Australian and New Zealand national trial registration
(ACTRN12613001273774) located at the web address: https://
www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=365323.
Study population
All individuals in the present study on fathers in the setting of
maternal teenage pregnancy were recruited from the North
Metropolitan Health Service in Western Australia. Individual informed
consent was obtained from each male participant aer permission to
approach the father had been verbally obtained from the pregnant
woman.
Fathers in the setting of maternal teenage pregnancy were dened as
men who were the acknowledged father of the baby in a setting where
the pregnant woman was aged less than 20 years (maternal teenage
pregnancy fathers). Of note, these fathers were not all themselves
teenagers, as their mean age was 2.1 years older than the pregnant
mother.
e comparison group was expectant fathers recruited from the
same metropolitan health service region, whose pregnant partner was
not a teenager (comparison fathers). is group of fathers had
demographic features similar to the wider population of expectant
Australian fathers in terms of age, religious belief, years of education,
employment and rst time fatherhood status [16].
All fathers were recruited from a geographic region with low
unemployment, and a high Relative Socioeconomic Index for
Disadvantage as the recruiting postcodes fell into the 50-100th centiles
[8].
Questionnaires
Research sta rst approached the pregnant mother to obtain verbal
consent to approach the father of her unborn baby. is was a
requirement of the ethics committee. Research sta then approached
the nominated father. Following written consent, fathers completed a
demographic questionnaire, the Hospital Anxiety and Depression
Scale (HADS) [17,18] and Satisfaction with Life Scale (SWLS) [19,20].
e HADS is a widely used tool to identify emotional distress in
non-psychiatric patients [17,18]. It does not identify specic mental
disorders but is a more general measurement of mental distress and
consists of subscales for anxiety and depression. Fourteen questions
(half relate to anxiety and half to depressive symptoms) are interpreted
in a range from normal to severe. It excludes symptoms of physical
feeling or sensation, therefore avoiding potential confounding by
somatic symptoms [17,18].
e SWLS is a ve-item questionnaire that measures global
evaluation of satisfaction with one’s life [19,20].SWLS does not specify
the context of pregnancy and fatherhood. It assesses overall
contentment with life as a subjective measure based on personal
standards. SWLS has reliable test-retest validity for the purpose of
comparison with delivery and postnatal data [19,20].
Inclusion and exclusion criteria
Fathers were recruited via the pregnant mother who identied the
man as the father of her unborn baby. If the mother declined to
provide consent, the father was excluded. Fathers where pregnancy was
complicated by a known fetal anomaly or with insucient English
literacy skills were also excluded from this sub-study.
Sample size
We assumed 50% of fathers in the setting of maternal teenage
pregnancy compared to 30% of comparison fathers would report
anxiety or depressive symptomatology. is assumption was based
upon outcomes from a 2005 study from western Melbourne in
Victoria, Australia [4].
A sample of 45 teenage group fathers provided 80% power with an
error of 0.05 to detect this dierence. e study recruited 50 fathers in
the setting of maternal teenage pregnancy to ensure a sucient sample,
assuming incomplete data might be obtained from some
questionnaires. Twice the number of fathers was enrolled for the
comparison group.
Statistical analysis
Data was entered onto a dataset using Minitab® (version 16,
University of Melbourne). A descriptive analysis was used for the
quantitative data. In order to analyze for dierences in responses
between fathers in the setting of maternal teenage pregnancy and
comparison fathers, the signicance (p) of the dierences was
determined by the Fisher Exact test. A p-value of 0.05 was set for
rejection of the null hypothesis. Student T-test was used to compare
continuous data.
Results
Of the teenage mothers approached, 86% gave permission to speak
to the acknowledged father of their baby. Of the fathers in the setting
of maternal teenage pregnancy subsequently approached by research
sta, 80% consented to participate in the trial. is gave an overall
consent rate of 69%.
e demographic characteristics of the study participants are
summarized in Table 1. Fathers in the setting of maternal teenage
pregnancy were signicantly younger and more likely born in Australia
than the comparison group fathers (92% versus 68%, p<0.0001).
A higher prevalence of fathers in the setting of maternal teenage
pregnancy were of Aboriginal or Torres Strait Islander descent (18%
versus 3%, p<0.0001). Signicantly more fathers in the setting of
maternal teenage pregnancy did not cohabit with the mother (28%
versus 10%, p=0.008) and no longer had an ongoing relationship with
the mother (28% versus 10%, p=0.008).
Citation: Atkinson AG, Petersen RW, Quinlivan JA (2016) Employment may Protect Fathers in the Setting of Maternal Teenage Pregnancy from
Anxiety and Depression: Findings from the Australian Father’s Study. Reprod Syst Sex Disord 5: 161. doi:10.4172/2161-038X.1000161
Page 2 of 5
Reprod Syst Sex Disord
ISSN:2161-038X RSSD, an open access journal Volume 5 • Issue 1 • 1000161

Comparison fathers
N=100
Maternal teenage
pregnancy setting
fathers N=50
P-value
Age
Mean (sd) 31.8 (3.1) 21.2 (1.2) <0.0001
Country of birth
Australia 68% 92% <0.0001
Elsewhere 32% 8%
Aboriginal or Torres Strait Islander 3% 18% <0.0001
Relationship status
Living with partner in ongoing relationship 82% 32% <0.0001
Not living with partner but in an ongoing relationship 8% 40%
Not living with partner and not in an ongoing relationship 10% 28%
Education
<12 years 7% 14% <0.0001
12 years 40% 74%
>12 years 53% 12%
Employed
No 5% 12% 0.76
Yes 95% 88%
Fly In, Fly Out worker
Yes 20% 14% 0.5
No 80% 86%
Hours employed
0-15 9% 35% <0.0001
15-40 23% 61%
40+ 68% 4%
Smoker 21% 38% 0.009
First time father
Yes 52% 96% <0.0001
No 48% 48%
Pregnancy planning
Natural – planned 70% 22% <0.0001
IVF – planned 11% 0%
Unplanned 19% 78%
Table 1: Demographics of expectant fathers.
76% of fathers in the setting of maternal teenage pregnancy had
received 12 years of education though signicantly fewer had achieved
more than 12 years (12% versus 53% p<0.0001), an outcome probably
attributable to their younger age and therefore more limited years of
Citation: Atkinson AG, Petersen RW, Quinlivan JA (2016) Employment may Protect Fathers in the Setting of Maternal Teenage Pregnancy from
Anxiety and Depression: Findings from the Australian Father’s Study. Reprod Syst Sex Disord 5: 161. doi:10.4172/2161-038X.1000161
Page 3 of 5
Reprod Syst Sex Disord
ISSN:2161-038X RSSD, an open access journal Volume 5 • Issue 1 • 1000161

opportunity. ere were no signicant dierences in levels of
employment or in employment as a y in, y out (FIFO) worker.
e prevalence of smoking in fathers in the setting of maternal
teenage pregnancy was higher (38% versus 21%, p<0.009) as was the
rate of unplanned pregnancy (78% versus 19%, p<0.0001).
Table 2 demonstrates no signicant dierence in overall HADS and
subscale depression and anxiety scores between the two groups.
Similarly dierences in mean scores for the SWLS were not signicant
with a mean score of 27.5 for the control group and 27.6 for the
teenage group fathers.
Comparison
fathers
N=100
Maternal
teenage
pregnancy
setting
fathers
N=50
P-value
HADS
Total score ≥ 14
N (%)
22% 28% 0.42
Anxiety subscale score ≥8
N (%)
19% 16% 0.82
Depression subscale score ≥8
N (%)
10% 14% 0.59
Satisfaction with life scale
Total score
Mean (sd)
27.5 (4.9) 27.6 (4.7) 0.79
Table 2: Anxiety, depression and quality of life in expectant fathers.
A secondary analysis was undertaken of the fathers in the setting of
maternal teenage pregnancy comparing those who were themselves
teenagers compared to the fathers who were 20 years and older. No
signicant dierence was found in overall HADS score (32% versus
26%, p=0.75), depression sub-scale (16% versus 16%, p=1.00), anxiety
subscale (16% versus 13%, p=0.93), or quality of life scores (27.7 versus
27.6, p=0.86).
Discussion
is study found that fathers in the setting of maternal teenage
pregnancy who live within a geographic region of higher Relative
Socioeconomic Index for Disadvantage and where youth education
and employment opportunities are high have levels of anxiety,
depression and quality of life similar to comparison fathers. In
contrast, a previous study from Western Melbourne, Australia in a
setting where the Relative Socioeconomic Index for Disadvantage was
low and rates of youth participation in employment and education
were poor, reported signicantly higher levels of psychosocial
pathology [4].
In line with previous reports, we documented lower rates of co-
habitation with partners, higher rates of being Australian-born and of
being of Aboriginal or Torres Strait Islander descent. ere were
signicantly higher rates of unplanned pregnancy and smoking.
e fathers recruited for our study lived in a region where
unemployment levels were below the national average, particularly due
to employment opportunities through the mining industry. Rates of
FIFO employment were similar between the two groups (18% for
fathers in the setting of maternal teenage pregnancy and 16% for
comparison fathers) and represented a signicant proportion of overall
employment. Our results suggest that in a setting where employment
opportunities are high, and socioeconomic status is maintained, the
eect of stressful life events such as unplanned maternal teenage
pregnancy may be ameliorated in the father so that age does not
become a dening risk variable. Employment thus acts as a buer
against psychosocial pathology.
is environment also promotes quality of life. e SWLS scores
were high in both fathers in the setting of maternal teenage pregnancy
and comparison fathers. Although the two groups showed diverse
demographics, their quality of life scores were similar in the antenatal
period.
Unfortunately, rates of maternal teenage pregnancy are higher in
regions where youth education and employment opportunities are
more limited. erefore, rates of psychosocial pathology are likely to
remain high in these regions. Co-morbidities of unplanned pregnancy,
relationship fragmentation and smoking still need to be addressed,
even in areas of higher socioeconomic opportunity.
Overall, the study reinforces that the provision of education and
employment opportunities to young men in the setting of maternal
teenage pregnancy is a vital social intervention to buer these young
men and the family against psychosocial pathology.
Study Limitations
is study has a number of limitations. Firstly, fathers could only be
approached through the pregnant woman, so those cases where the
father was unknown or where a severe relationship breakdown had
occurred were not able to be included in the study. Secondly, the study
did not explore family income, paternal networks and father’s needs
and desires for pregnancy. ese variables might impact upon
outcomes. Finally, the trial is not randomized and it may be that other
factors ameliorated the impact on psychosocial pathology and quality
of life that were not measured. e study advantages were the high
participation rate and compliance in questionnaire completion.
Conclusion
Fathers in the setting of maternal teenage pregnancy, when living in
a region with education and employment opportunities, have levels of
anxiety, depression and quality of life comparable to comparison
fathers. is study highlights the vital need to provide education and
employment opportunities for vulnerable fathers.
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Citation: Atkinson AG, Petersen RW, Quinlivan JA (2016) Employment may Protect Fathers in the Setting of Maternal Teenage Pregnancy from
Anxiety and Depression: Findings from the Australian Father’s Study. Reprod Syst Sex Disord 5: 161. doi:10.4172/2161-038X.1000161
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ISSN:2161-038X RSSD, an open access journal Volume 5 • Issue 1 • 1000161

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Citation: Atkinson AG, Petersen RW, Quinlivan JA (2016) Employment may Protect Fathers in the Setting of Maternal Teenage Pregnancy from
Anxiety and Depression: Findings from the Australian Father’s Study. Reprod Syst Sex Disord 5: 161. doi:10.4172/2161-038X.1000161
Page 5 of 5
Reprod Syst Sex Disord
ISSN:2161-038X RSSD, an open access journal Volume 5 • Issue 1 • 1000161