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Prenatal and Postpartum Depression in Fathers and Its Association With Maternal Depression A Meta-analysis
Abstract
It is well established that maternal prenatal and postpartum depression is prevalent and has negative personal, family, and child developmental outcomes. Paternal depression during this period may have similar characteristics, but data are based on an emerging and currently inconsistent literature.
To describe point estimates and variability in rates of paternal prenatal and postpartum depression over time and its association with maternal depression.
Studies that documented depression in fathers between the first trimester and the first postpartum year were identified through MEDLINE, PsycINFO, EMBASE, Google Scholar, dissertation abstracts, and reference lists for the period between January 1980 and October 2009.
Studies that reported identified cases within the selected time frame were included, yielding a total of 43 studies involving 28 004 participants after duplicate reports and data were excluded.
Information on rates of paternal and maternal depression, as well as reported paternal-maternal depressive correlations, was extracted independently by 2 raters. Effect sizes were calculated using logits, which were back-transformed and reported as proportions. Random-effects models of event rates were used because of significant heterogeneity. Moderator analyses included timing, measurement method, and study location. Study quality ratings were calculated and used for sensitivity analysis. Publication bias was evaluated with funnel plots and the Egger method.
Substantial heterogeneity was observed among rates of paternal depression, with a meta-estimate of 10.4% (95% confidence interval [CI], 8.5%-12.7%). Higher rates of depression were reported during the 3- to 6-month postpartum period (25.6%; 95% CI, 17.3%-36.1%). The correlation between paternal and maternal depression was positive and moderate in size (r = 0.308; 95% CI, 0.228-0.384). No evidence of significant publication bias was detected.
Prenatal and postpartum depression was evident in about 10% of men in the reviewed studies and was relatively higher in the 3- to 6-month postpartum period. Paternal depression also showed a moderate positive correlation with maternal depression.
... Postpartum depression (PPD), also called postnatal depression, is a mood disorder that can occur in the mother and father after the birth of a child. It is estimated that postpartum depression affects about 1 in 7 women [1] and about 1 in 10 men [2]. The estimated time of onset of postpartum depression is from 2 to 8 weeks after delivery, but it should be noted that it can appear up to a year after the birth of the child [3]. ...
... Behavioral elements that may be noticed by third parties and considered alarm symptoms include persistent crying, lack of bonding with the child, and doubts about one's ability to care for oneself and the child [3]. Studies indicate that postpartum depression is not limited to women -it can also affect young fathers [2]. It manifests itself through feelings of depression, chronic fatigue, excessive stress, and anxiety, as well as changes in appetite and sleep quality. ...
... It manifests itself through feelings of depression, chronic fatigue, excessive stress, and anxiety, as well as changes in appetite and sleep quality. These are symptoms similar to those observed in mothers suffering from this condition [2,5]. The risk of postpartum depression in fathers is higher in the case of young people who have had depressive episodes and are experiencing conflicts in their relationships or financial problems. ...
Postpartum depression (PPD) is a severe mood disorder that affects approximately 1 in 7 women and 1 in 10 men, often occurring in the first year after childbirth. Its etiology is multifactorial, including hormonal changes, genetic predisposition, and environmental stressors, though its true prevalence is likely underestimated due to stigma and underreporting. Untreated PPD can have long-term consequences for maternal-child relationships, child development, and maternal health, including increased suicide risk. The condition remains underdiagnosed and undertreated due to stigma and systemic barriers to care. Zuranolone, an oral neuroactive steroid and positive allosteric modulator of GABA-A receptors, has recently garnered attention as a novel therapeutic option with the potential to target these underlying pathophysiological mechanisms. Aim of the study: The aim of this study is to provide a comprehensive review of the therapeutic efficacy, safety, and pharmacological characteristics of Zuranolone in the treatment of postpartum depression (PPD), with focusing particularly on its mechanism of action, pharmacokinetics and clinical trial outcomes. Materials and methods: A systematic literature review was conducted using PubMed and other medical databases. Keywords included "postpartum depression," "zuranolone," "GABA-A modulators,". Data from clinical trials, reviews, and pharmacological studies were analyzed. Conclusions: Zuranolone has provided significant efficacy with a very rapid onset of action in the reduction of symptoms in postpartum depression and long-term improvements observed over several weeks. Its mechanism of action, targeting GABAergic dysregulation, offers a novel therapeutic pathway for addressing postpartum psychiatric disorders. Future longitudinal studies are required to explore its long-term impact on maternal mental health.
... Studies have shown that fathers' prenatal and postnatal mental health has an important role in children's development and executive functions (Vänskä et al., 2017), children of depressed fathers are twice as likely to develop a psychiatric disorder by the age of 7 compared to children whose fathers are not depressed (Ramchandani et al., 2008), and fathers' mental health has negative effects on the overall development of children (Nishimura & Ohashi, 2010), with high rates of psychiatric disorders in school-age children. In this respect, the constant presence of children in such psychosocial conditions and home climate may lead to an increased risk of anxiety and depression, higher rates of emotional and behavioral disorders, hyperactivity, and delayed language skills (Paulson & Bazemore, 2010;Ramchandani et al., 2008). ...
... In addition, isolating the father from the baby's care and education processes (Davey et al., 2006) has a negative effect on father involvement. When the above studies are examined, it is clearly seen that they focus on the damage that poor mental health of the father after childbirth will cause on the family and children (Davey et al., 2006;Nishimura & Ohashi, 2010;Paulson & Bazemore, 2010;Ramchandani et al., 2008;Sejourne et al., 2012;Vänskä et al., 2017). On the other hand, there is no study on the possible effects of the father during the birth process on the pregnancy process, home climate, mother's well-being and child's temperament. ...
... This idea may cause us to attribute the source of most negative or undesirable behaviors in ourselves and our children to temperament, and therefore, we cannot find a solution to the negative behavior in question (due to the belief that temperament emerges only from genetic factors), that is, a kind of learned helplessness. In addition, it is seen in the literature that the effects of father's postpartum psychological health on mother, child and home climate have been examined (Davey et al., 2006;Nishimura & Ohashi, 2010;Paulson & Bazemore, 2010;Ramchandani et al., 2008;Sejourne et al., 2012;Vänskä et al., 2017). ...
Every baby brings its own temperament with it into the world. Although it is widely accepted by scientists that genetic factors are effective in the formation of temperament, this study aims to examine the possible effects of the pregnancy process on the temperament characteristics of children in line with the experiences of mothers and the role and effects of the father in the pregnancy process and to present a theoretical model explaining this process. The research, which was conducted in the Grounded Theory design, was conducted with a total of 237 mothers consisting of 3 different study groups. The study concluded, important evidence was found that temperament cannot be caused only by biological factors and that the mother's well-being during pregnancy also affects the child's temperament. The study also found that a father supporting the mother during pregnancy (father involvement) was the strongest factor positively influencing the mother's well-being and thus the child's temperament. Based on the research findings, Theoretical Model 1 for temperament formation and Theoretical Model 2 for the father's role in the pregnancy process were presented.
... During this period, fathers may experience challenges and vulnerability related to their mental health (Darwin et al., 2017;Philpott et al., 2020). Depressive symptoms in fathers that occur during pregnancy and the first year after birth is often referred to as paternal postpartum depression (PPD) (Cameron et al., 2016;Paulson & Bazemore, 2010). Meta-analyses of international studies indicate a prevalence of PPD of 8.4% to 10.4%, with the highest rates identified 3 to 6 months after birth (Cameron et al., 2016;Paulson & Bazemore, 2010). ...
... Depressive symptoms in fathers that occur during pregnancy and the first year after birth is often referred to as paternal postpartum depression (PPD) (Cameron et al., 2016;Paulson & Bazemore, 2010). Meta-analyses of international studies indicate a prevalence of PPD of 8.4% to 10.4%, with the highest rates identified 3 to 6 months after birth (Cameron et al., 2016;Paulson & Bazemore, 2010). PPD not only affects fathers' health, but is identified to have a negative impact on parenting 1 behavior, family relationships, and the health of mother and child, including the child's risk of distress (O'Brien et al., 2017;Ramchandani et al., 2008;Ramchandani et al., 2011). ...
... Relative to many other studies, we found a lower rate of PPD in our sample. In meta-analyses the rate of depression in fathers from pregnancy until one year postpartum is reported to be 8.4% to 10.4% (Cameron et al., 2016;Paulson & Bazemore, 2010). Notably, the meta-estimates include studies from countries on five continents, with the largest number of studies conducted in the United States of America and Asia. ...
Becoming a parent is a vulnerable life transition and may affect parents’ mental health. Depressive symptoms may occur in fathers, as well as mothers, during pregnancy and the postpartum period. The health service is expected to have a family perspective, aiming to support both parents. Despite this goal, mothers traditionally receive more support than fathers. Home visiting programs may provide enhanced guidance for new fathers and increased mental health support. The aim of this study was therefore to assess possible differences in level of depressive symptom in fathers receiving the New Families home visiting program compared with those receiving standard care from the Norwegian Child Health Service. A prospective nonrandomized controlled study with a parallel group design was performed. The Edinburg Postnatal Depression Scale (EPDS) was used to measure depressive symptoms in fathers (N = 197) at 28 weeks of their partners’ pregnancy (T1), at 6 weeks (T2), and 3 months postpartum (T3), in the intervention and the control group. The results indicate a prevalence of depressive symptoms (EPDS score ≥ 10) in Norwegian fathers of 3.1% at T1, 3.9% at T2, and 2.2% at T3 for the full sample. No significant EPDS score differences were found between the intervention and the control group at six weeks and three months postpartum. This suggests that the intervention had no clear impact on depressive symptoms during this time-period.
... Therefore, postpartum depression can be present in both women and men (1,2). The rate of depression during pregnancy and up to one year after birth was reported as 23.8% for mothers and 10.4% for fathers (3). ...
... Another study reported that the maternal depression rate in high-income countries was 10-20%, while it was above 20% in low-and middle-income countries (27). The wide variation in prevalence numbers may result from assessments conducted at different time points, using different methods, and variations in population characteristics, including socioeconomic backgrounds (3,27,28). Furthermore, the higher prevalence of depression in mothers compared to fathers in the present study, as well as in the literature, underscores the urgent need for targeted guidelines to support parental mental health, particularly for mothers, during this sensitive period. Disparities in maternal and paternal involvement in childcare may also contribute to maternal mental health outcomes. ...
... Vanhemmuuden hyvinvoinnin suhteen siirtymässä raskaudenajalta pikkulapsivaiheeseen äidit saavat yleensä isiä korkeampia arvoja muun muassa masentuneisuudessa sekä koetussa stressissä (Goodman, 2008;Paulson & Bazemore, 2010;Widarsson ym., 2013). Tutkimuksia, joissa olisi huomioitu isien ja äitien erot vanhemmuuden reflektiivisen kyvyn yhteyksissä erilaisiin vanhemmuuteen kytkeytyviin tekijöihin, on kuitenkin toistaiseksi vain vähän. ...
... Tarkasteltaessa masennusta jatkuvana muuttujana eri ikävaiheissa saivat äidit systemaattisesti korkeampia pisteitä kuin isät. Vaikka isien masentuneisuutta siirtymävaiheessa vanhemmuuteen on tutkittu selkeästi äitejä vähemmän, on aiemmissa tutkimuksissa havaittu masennuksen olevan myös isillä kohonnut vauvavaiheessa, mutta vähäisemmässä määrin kuin äideillä (Goodman, 2008;Paulson & Bazemore, 2010). ...
Johdanto: Vanhemmuuden reflektiivinen kyky voi toimia suojaavana tekijänä siirtymässä raskauden ajalta pikkulapsivaiheeseen. Siitä on kuitenkin on toistaiseksi vähän pitkittäistutkimuksia, joissa olisi erikseen huomioitu isät ja äidit. Tässä tutkimuksessa 1) vertasimme suomalaisia isejä ja äitejä reflektiivisen kyvyn keskiarvojen suhteen, sekä tutkimme 2) yhteyksiä sosioekonomisiin tausta muuttujiin ja hyvinvointiin, ja 3) reflektiivisen kyvyn pysyvyyttä raskauden ajalta kolmen kuukauden, vuoden ja kahden vuoden ikään. Menetelmät: Tutkittavat olivat 380 ensisynnyttäjää (76 isää ja 304 äitiä), jotka osallistuivat Families First -seurantatutkimukseen. Mittareina käytettiin standardoituja kyselylomakkeita. Tulokset: Äitien reflektiivinen kyky oli joiltain osin systemaattisesti korkeampaa kuin isien eri ikävaiheissa. Se yhdistyi äideillä raskauden aikana isejä selkeämmin sosioekonomisiin taustatekijöihin. Molemmilla vanhemmilla löytyi merkitseviä yhteyksiä reflektiivisen kyvyn ja oman hyvinvoinnin välillä, erityisesti vauvan ensimmäisen ikävuoden aikana. Vanhemmuuden reflektiivinen kyky oli perhekohtaisesti yhteydessä toisiinsa ja pysyvää, äideillä jo raskauden ajalta alkaen. Johtopäätökset: Varhaiset perheinterventiot kohdistuen vanhemmuuden reflektiiviseen ja hyvinvointiin kykyyn tulisi kohdentaa koko perheeseen, isien ja äitien esille tulleet erot huomioiden.
... It is important to note that these estimates only include depression and not other types of mental health problems during this period. Other studies that examined diagnosed mental health problems and above-threshold symptoms found that approximately 5-10% of fathers had perinatal depression, and approximately 5-15% experienced perinatal anxiety (10)(11)(12). ...
... Within Europe, there was Frontiers in Public Health 04 frontiersin.org a notable concentration of research from the United Kingdom (15), Sweden (12) and Italy (10). The scope of the reviews primarily focused on screening tools for paternal mental health during both the prenatal and postnatal periods, with one review additionally considering other co-parents and partners. ...
... Dependent variable: Edinburgh Postnatal Depression Scale (EPDS); independent variable:work stress, marital relationship * p <0.05 The EPDS-J scores of fathers in Japan were highest in the last trimester of pregnancy and lowest at 3-5 months postpartum. According to a meta-analysis conducted by Paulson and Bazemore (2010), the prevalence of depression among fathers was 11% in the first and second trimesters of pregnancy, 12% in the third trimester, 7.7% in the first three months after childbirth, 25.6% (and the highest) in the first three-six months postpartum, 9% in the first six-twelve months postpartum, and 10.4% from gestation to one year postpartum. Our results were quite different from those of Paulson and Bazemore (2010), but their meta-analysis was more than a decade old and was possibly affected by different social conditions today. ...
... According to a meta-analysis conducted by Paulson and Bazemore (2010), the prevalence of depression among fathers was 11% in the first and second trimesters of pregnancy, 12% in the third trimester, 7.7% in the first three months after childbirth, 25.6% (and the highest) in the first three-six months postpartum, 9% in the first six-twelve months postpartum, and 10.4% from gestation to one year postpartum. Our results were quite different from those of Paulson and Bazemore (2010), but their meta-analysis was more than a decade old and was possibly affected by different social conditions today. Moreover, it examined paternal depression in Western countries but did not include Japanese cases. ...
Introduction: Paternal depression is not as widely recognized as maternal depression. Studies in Japan have examined the factors associated with paternal depression, but these have been limited to specific regions rather than conducted on a nationwide scale. This study aimed to examine changes in paternal perinatal depression from the last trimester of pregnancy to one year postpartum. Additionally, we explored the relationship between paternal perinatal depression and fathers' feelings toward their infants. Methods: This study used a longitudinal design. We initially planned to collect data from over 384 cases based on sample size calculations, and successfully collected data from 494 men in the first survey. However, more than half of the participants dropped out in the second and subsequent surveys, resulting in 201 men completing the longitudinal survey over a one-year period. Results: The mean Edinburgh Postnatal Depression Scale, Japanese version (EPDS-J) score in the last trimester of pregnancy was 9.274 (95% confidence interval [CI] 8.413-10.134), which was the highest throughout the study period. The mean EPDS-J score was lowest at 3-5 months postpartum, with a score of 7.682 (95% CI 6.816-8.547). At all time points, occupational stress and partner relationships were associated with EPDS-J scores. Conclusions: Reducing paternal perinatal depression requires controlling for occupational stress and maintaining good marital relationships. The findings suggest that addressing work-life balance is crucial for Japanese fathers to enhance their whole-family well-being. Keywords: fathers, marital relationship, occupational stress, perinatal depression
... This diminished engagement leads to poor communication and stimulation [57], potentially causing long-term detrimental effects on the infant's physical, cognitive, behavioral, and social development. Notably, fathers experience the highest rates of depression during 3 to 6 months postpartum [58]. Their critical role in a child's development underscores the importance of addressing paternal PPD. ...
... Numerous factors can be attributed to increasing prevalence that can be categorized into: paternal, maternal, infant, pandemicrelated stressors, interpersonal, and socioeconomic factors. Paternal factors attributed to an increase in depressive symptoms post-childbirth include a history of depression before conception of pregnancy [63][64][65][66][67] adverse childhood experiences [58], smoking, and intimate partner victimization violence [68]. Maternal factors negatively influencing their partners' mental health comprise depression in postnatal mothers [10,63] and previous unfavorable pregnancy outcomes [69]. ...
Postpartum depression (PPD) has been widely studied, assessed, and promptly intervened in new mothers. However, paternal postpartum depression gained attention not long ago. Postpartum depression in men could present over one year following the birth of the child, frequently presenting with symptoms like irritability, low mood, sleep disturbances, changes in appetite, fatigue, and loss of interest in everyday activities; amongst other symptoms of Major Depressive Disorder which may hinder them from taking care of themselves and the baby. Paternal PPD significantly impacts partner relationships causing maternal PPD, poor infant bonding, and therefore, affecting overall child development. The following narrative review is based on a literature search of articles published on paternal postnatal depression. The primary emphasis of this review has been to provide an overview of the current comprehension of paternal postpartum depression regarding prevalence, global incidence, and risk factors and to explore potential diagnostic tools for assessment and interventional strategies to treat this condition. Interestingly, pandemic-related stressors have been positively attributed to an increase in PPD prevalence post-pandemic. While more research is being conducted on this subject, research on the measurement characteristics of the diagnostic tools is highly recommended to implement well-defined criteria for early diagnosis of paternal PPD. The significant adverse consequences of PPD for not just the new mother, but also the infants, necessitate proper and timely diagnosis of PPD. Despite its severity, there have been no specific treatment modalities.
... Previous research have highlighted various pathways through which fathers can influence the emotional development of children, particularly in the context of maternal depression [17]. For instance, the presence of paternal depression may amplify the already detrimental effects of maternal depression, with studies showing more severe emotional difficulties in children when both parents are depressed, regardless of controlling for demographic variables [18]. Conversely, fathers who exhibit fewer depressive symptoms and engage in supportive parenting can serve as a protective 'buffer' against the negative effects of maternal emotional challenges [19]. ...
... Our study also found that maternal depressive symptoms did not significantly correlate with paternal depression symptoms. Although previous meta-analyses found significant correlation between maternal and paternal depressive symptoms during the prenatal and postpartum periods [18], such associations tend to diminish from age 2 to age 5 [43], which could explain the discrepancy between the current and past findings. Additionally, because we selected half of the mothers with a history of depression, the association may be weakened when one parent has high depressive symptoms meeting clinical diagnosis criteria, making this correlation less representative of the general population [44]. ...
Parents, including fathers, contribute to the early development of internalizing symptoms, which is observable and prevalent among young children. This longitudinal study examined the moderating role of paternal depressive symptoms/emotion dysregulation in the prospective associations between maternal depressive symptoms/emotion dysregulation and children’s internalizing problems (depressive and anxiety symptoms). Ninety-four preschoolers and their mothers and fathers participated. Parents completed online questionnaires when their children were four years old and one year later. Results indicated that higher paternal depressive symptoms were associated with an increase, while lower paternal symptoms were associated with a decrease, in the negative impact of maternal emotion dysregulation on children’s later depressive, but not anxiety, symptoms. We also tested the moderating role of paternal emotion dysregulation, these pathways were not significant. The findings enhance our understanding of the interaction between maternal and paternal psychological characteristics in contributing to children’s anxiety and depressive symptoms.
... It can be a key life stage when men are at increased risk of mental health difficulties and are in need of support. In the first postnatal year, it is estimated that~10% of fathers experience clinically significant depressive symptoms such as low mood, loss of interest or pleasure in activities, feelings of hopelessness, decreased energy, and changes in appetite and sleep (Cameron et al., 2016;Paulson & Bazemore, 2010). Although less well studied, symptoms of anxiety (e.g. ...
... We found that approximately one in four fathers were experiencing elevated depressive symptoms, including hopelessness, loss of interest, and difficulty experiencing positive feelings, with most fathers' scores falling in the mild to moderate range (21%) and a smaller percentage experiencing severe or extremely severe symptoms (5%). The proportion of fathers experiencing elevated depressive symptoms in this study is higher than what has been reported in previous studies of fathers during the first postnatal year where estimates have generally been around 10% (Cameron et al., 2016;Paulson & Bazemore, 2010). Symptoms of stress (e.g. ...
Fathers are at increased risk of mental health difficulties such as depression during the first postnatal year, however little is currently known about the extent to which fathers experience symptoms of anxiety and stress, and the factors associated with these symptoms. This study aimed to: (1) investigate the extent to which fathers accessing support to strengthen their coparenting relationship through a community health organisation experience depressive, anxiety and stress symptoms during the first postnatal year, and (2) examine associations between a broad range of individual, child, and family factors and fathers’ depressive, anxiety, and stress symptoms during the first postnatal year. This study involved secondary analysis of routinely collected data from 170 fathers of children aged 0–12 months who were enroled in a coparenting intervention programme delivered by a community health organisation in Melbourne, Australia. Elevated symptoms of stress were reported by ~28% of fathers, while elevated symptoms of depression and anxiety were reported by ~26% and 16% of fathers, respectively. Multiple regression analyses revealed evidence for associations between reduced parental self-efficacy and higher depressive and stress symptoms, while infant regulation difficulties and increased interparental conflict were associated with higher levels of stress. This study highlights that fathers are at risk of mental health difficulties during the first postnatal year. Findings demonstrate the importance of undertaking a broad assessment of fathers’ mental health during the first postnatal year and provide important insights into individual, child, and family factors that may represent optimal targets for prevention and early intervention.
... Consequently, pregnancy is also a time of increased vulnerability to psychological distress, including anxiety and depression [3]. Mental health disorders are the most common complication of pregnancy and child birth, affecting 20% of expectant mothers [3] and 10-15% of expectant fathers [4,5]. Perinatal mental health disorders have significant long-term implications for maternal and family wellbeing and child health and development [3,6]. ...
Objective
To identify social stressors and supports for expectant parents after prenatal diagnosis of congenital heart disease (CHD) and inform interventions to reduce distress.
Method
Parents of children diagnosed prenatally with CHD (N = 37) were purposively sampled across eight health systems. Qualitative data were collected using crowdsourcing methods and coded/analyzed using thematic analysis.
Results
Social stressors increasing distress after prenatal diagnosis were widely endorsed: (1) feelings of loneliness (most common: 68%), (2) well-meaning yet unhelpful comments, (3) loss of celebration of pregnancy, (4) information overload, and (5) untimely/insensitive discussions surrounding pregnancy termination. Social supports included: (1) emotional support and small acts of kindness, (2) hope/connection through the experiences of others, (3) informational support, (4) nurturing normalcy and the joy of pregnancy, and (5) connection through religion/spirituality.
Conclusion
Interpersonal relationships are vital for coping with prenatal diagnosis. Interventions to reduce distress after prenatal diagnosis should attend to common social stressors.
... Symptoms include depressed mood, loss of interest and pleasure in most activities, insomnia, feelings of worthlessness or guilt, suicidal ideation or recurrent thoughts of death, and others [2]. PPD is most prevalent within three to six months postpartum [3]. ...
Introduction: Postpartum depression (PPD) is a common mental health condition that affects new parents and is often associated with major depressive disorder (MDD). However, research focuses on maternal experiences, overlooking paternal PPD. Cortisol is a stress hormone that can cause dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, impacting the mental state, and serving as a biomarker of depression. This dysregulation could result in fathers experiencing PPD, as decreased levels of cortisol may hinder father-newborn bonding. PPD can develop over a year rather than within the first four weeks post-childbirth. 4% to 25% of new fathers experience PPD, with peak prevalence occurring within 3-6 months after childbirth. The Edinburgh Postnatal Depression Scale (EPDS) is a tool designed to screen for symptoms of PPD. This study examines the correlation between cortisol levels and PPD among fathers. Methods: A total of 100 fathers aged 18-45 will be recruited from urban hospitals in the Greater Toronto Area within 1 month postpartum. Participants will be screened using the EPDS, and blood samples will be collected to measure cortisol levels using an enzyme-linked immunosorbent assay (ELISA). This data will be collected at 1, 3, 6, and 12 months postpartum. Fathers with pre-existing psychiatric conditions, cortisol-altering medications, or significant health conditions will be excluded. Statistical analyses of the data will investigate the association between cortisol levels and paternal PPD. Results: The study expects a statistically significant negative difference in cortisol levels between fathers with PPD and those without, indicating a potential association between cortisol dysregulation and paternal PPD. The study may identify predictors (marital status, previous parenting experience, finances) influencing cortisol levels in fathers, providing insight into cortisol regulation and paternal well-being. Discussion: Findings will indicate cortisol as a biomarker for paternal PPD and assist in early interventions. It can also help with the readiness of healthcare providers to begin mental health services to fathers after delivery. Conclusion: This study investigates the link between low cortisol levels and paternal PPD, hypothesizing a positive correlation with EPDS. Findings may lead to early screening tools and targeted interventions aimed at improving paternal mental health.
... strong (range, 2.6-9.9), and very strong (over 10.0). Heterogeneity was assessed with the Q statistic [39], with its magnitude quantified with the I2 index [40]. An adaptation of Egger's test for our multivariate data based on residual data was used to evaluate the risk of publication bias, alongside funnel plots [41]. ...
The association between family violence and the COVID-19 pandemic remains complex. This meta-analysis aimed to determine trends in the observed changes in family violence comparing the pre-pandemic period to the pandemic period. A systematic search was performed in electronic databases to identify all relevant research reporting on COVID-19 and family violence. There was a statistically significant increase in family violence after the first lockdown. The odds ratio for the prevalence of physical and sexual violence together was 7.24 (95% CI = 4.74, 11.03 p < 0.001). A small marginal increase in the prevalence of various types of family violence leading to hospitalization was found, however, the result was not statistically significant (OR = 1.91, 95% CI = 0.91, 3.96, p = 0.09). A small significant increase in the prevalence of victims with a perception of increased violence during the pandemic lockdown was observed (proportion = 33%, 95% CI = 15.72%, 50.34%, p = 0.002). This meta-analysis found that during the COVID-19 lockdown, there was an increase in the prevalence of overall family violence, a small, non-significant, increase in the prevalence of hospitalizations due to family violence, as well as an increase in the perception of family violence by victims. These results are clinically relevant for implementing effective measures of violence prevention to safeguard vulnerable populations.
... Siihen verrattuna tässä tutkimuksessa äitien keskimääräiset kokonaispistemäärät olivat korkeammat. On havaittu, että isistä noin kymmenen pro senttia kärsii synnytyksen jälkeisestä masennuk sesta, erityisesti 3-6 kuukautta vauvan syntymän jälkeen (Paulson & Bazemore, 2010). Tässä tut kimuksessa kaikki isät jäivät alle kliinisen masen nuksen pistemäärän (Beck ym., 2004, s.14) sekä ensimmäisessä että toisessa mittauksessa. ...
Tutkimuksen aihe: Perinataalikuolemalla tarkoitetaan yli 22-viikkoisen tai yli 500 grammaa painavan sikiön syntymistä kuolleena tai vastasyntyneen kuolemaa ensimmäisen viikon aikana. Tämän tutkimuksen tarkoitus on selvittää perinataalikuoleman jälkeen vanhempien kokemusta vauvan kuolemasta ja kuoleman vaikutuksista vanhempien elämään sekä traumaoireiden, masennusoireiden ja ahdistusoireiden ilmenemistä vauvansa menettäneillä vanhemmilla. Aineisto: Vauvansa menettäneet vanhemmat rekrytoitiin 12 kuukauden ajalla vuosina 2012–2013 Pirkanmaan sairaanhoitopiirin Tampereen yliopistollisen keskussairaalan synnyttäneiden osastolta 4A. Kaikki tutkimukseen halunneet seitsemän vanhempaa pääsivät mukaan. Vanhemmat haastateltiin, ja heitä pyydettiin täyttämään oirelomakkeet (BDI-II, GAD-7 ja IES-R) kolme ja kuusi kuukautta vauvan kuoleman jälkeen. Haastatteluaineiston analyysimenetelmänä käytettiin teoriaohjaavaa sisällönanalyysiä. Tutkimustulokset: Vauvan kuolema on traumaattinen tapahtuma, joka vaikuttaa vanhempiin kaikilla elämän osa-alueilla. Äidit kokivat isiä enemmän traumaoireita, ahdistusoireita ja masennusoireita. Johtopäätökset: Olemassaolevia suosituksia akuuttien kriisien psykologisesta työstä ja traumaperäisten stressireaktioiden ja -häiriöiden hoidosta tulisi aktiivisesti noudattaa vauvansa menettäneiden perheiden hoidossa. Traumaoireiden seulonnan avulla voitaisiin tunnistaa posttraumaattisen stressihäiriön (PTSD) riskissä olevat vanhemmat. Vauvansa menettäneille vanhemmille tulisi tarjota aktiivisesti psykologista tukea myös seuraavassa raskaudessa.
... Recent studies have estimated the prevalence of PPD in fathers to range from 4% to 25%, highlighting the substantial burden of this condition [1,2]. This wide variation in reported prevalence can be attributed to several factors, including differences in study populations, assessment methods, and cultural contexts. ...
The landscape of parental mental health is undergoing a profound transformation, challenging long-standing paradigms that have marginalized paternal psychological experiences. This comprehensive narrative review delves into the multifaceted realm of postpartum paternal depression, offering an unprecedented exploration of its complex etiology, manifestations, and far-reaching implications for individual, familial, and societal well-being.
... 6 A study found that about 10% of the spouses of first-time mothers showed significant prenatal and postnatal depression. 7 About two decades ago, the International Conference on Population and Development (ICPD) and the Fourth World Conference on Women discussed the role of spouses in the reproductive health of women. 8,9 However, although spouses strongly influence the reproductive health of women, they have received less attention from researchers, which has led to many direct and indirect negative effects. 10 In addition, other studies have found that the loss of paternal role function during breastfeeding will affect the growth of children. ...
Background
Based on the PRECEDE-PROCEED (Predisposing, Reinforcing, and Enabling Causes in Educational Diagnosis and Evaluation-Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development) model (PPM), we investigated the psychological status of the spouses of primiparous women to implement a health education program.
Methods
The study retrospectively analyzed 310 spouses of primigravid women who gave birth from March 2022 to March 2024. 154 spouses received regular education, and 156 spouses aslo received health education of PPM. Binary logistic regression analysis was performed to analyze the independent risk factors for negative emotions of the spouses of primigravid women during puerperium. Analysis of variance was performed to determine the differences in the effect of maternal breastfeeding on the growth and development of infants between the two models of health education.
Results
The health education group based on the PPM was defined as Group A, while the regular health education group was defined as Group B. The SAS (Anxiety self-assessment scale) and SDS (Depression self-assessment scale) of the spouses in Group A were significantly lower than those of the spouses in Group B three days postpartum. Health education intervention (OR = 0.239, P = 0.001), maternal psychological state (OR = 0.458, P = 0.004), and the education level of the spouses (OR = 0.480, P = 0.006) independently influenced the emergence of negative emotions in spouses. The SCL-90 (symptom checklist 90) scores of Group A were significantly lower than those of Group B but significantly higher than the national norm (P < 0.05).
Conclusion
The content of the program not only helps increase the adaptability and participation of the spouses in their role as fathers but also helps increase the effect of maternal breastfeeding on the growth and development of infants.
... As for the postpartum period, the two main CB-PTSD onset and maintenance factors identified by Ayers and her colleagues were a. depression and other co-morbid symptoms (anxiety, general psychological health, physical health), and b. stress and poor coping (Ayers et al., 2016). Postpartum depression affects fathers half as often as mothers (Paulson & Bazemore, 2010). More generally, the postpartum context may be very different for the two parents. ...
... This can lead to reduced support for their partner or deterioration of the marital relationship, which can be a risk factor for depression among women (Liu et al., 2021). Among couples, depression in one partner was reported to be correlated with depression in the other partner, and both men and women simultaneously suffer from depression in some cases (Paulson & Bazemore, 2010). Moreover, if paternal depression persists after childbirth, men's parenting skills may be impaired, potentially leading to child maltreatment (Takehara et al., 2017). ...
Objective: Changes in sleep are common among parents in the perinatal period. This study aimed to describe objective and subjective sleep quality in men during their partner's pregnancy and its association with depressive symptoms. Methods: We used cross-sectional data from a prospective observational study. Men in Japan with primiparous partners after 20 weeks of gestation were recruited. Objective and subjective sleep were measured using actigraphy and the Pittsburgh Sleep Quality Index, respectively, and depressive symptoms were measured using the Edinburgh Postnatal Depression Scale. This study was approved by the ethics committee of the principal investigator's institution. Results: A total of 15 men provided valid data for analysis. Actigraphy data showed that, on average, participants slept for 420.3 min per night, took 6.4 min to fall asleep, were awake for 11.3 min per night, and awoke 0.7 times during the night, with 97.4% sleep efficiency. There were no significant associations between sleep parameters and depressive symptoms, except for sleep latency (r = −0.59, p <.05). Conclusions: All participants had good sleep quality and few depressive symptoms, and there were no associations between overall sleep quality and depressive symptoms during pregnancy. This study provides baseline data for assessing changes in sleep after childbirth. Importantly, changes in sleep patterns after childbirth may stress fathers and lead to paternal depression. This illustrates the value of prenatal education, which covers postpartum sleep guidelines and information on infant care to help expectant fathers cope with sleep disruptions and adjust to fatherhood.
... This emphasizes the significance of interpersonal relationships in the dissemination of information [27]. Fathers engage in discussions about pregnancy-related experiences during casual hangouts or directly seek advice from family members and friends [28]. This practice is driven by the desire to connect, collaborate, and contribute to collective knowledge [19]. ...
Background
While the benefits of fathers’ engagement in pregnancy are well researched, little is known about first-time expectant fathers’ information-seeking practices in Southeast Asia regarding pregnancy. In addition, there is a notable gap in understanding their information-sharing behaviors during the pregnancy journey. This information is important, as cultural norms are prevalent in Southeast Asia, and this might influence their information-sharing behavior, particularly about pregnancy.
Objective
This study aims to explore and analyze the pregnancy-related information-sharing behavior of first-time expectant fathers in Southeast Asia. This study specifically aims to investigate whether first-time fathers share pregnancy information, with whom they share it, through what means, and the reasons behind the decisions to share the information or not.
Methods
We conducted semistructured interviews with first-time Southeast Asian fathers in Indonesia, a sample country in the Southeast Asian region. We analyzed the data using quantitative descriptive analysis and qualitative content theme analysis. A total of 40 first-time expectant fathers were interviewed.
Results
The results revealed that 90% (36/40) of the participants shared pregnancy-related information with others. However, within this group, more than half (22/40, 55%) of the participants shared the information exclusively with their partners. Only a small proportion, 10% (4/40), did not share any information at all. Among those who did share, the most popular approach was face-to-face communication (36/40, 90%), followed by online messaging apps (26/40, 65%). The most popular reason for sharing was to validate information (14/40, 35%), while the most frequent reason for not sharing with anyone beyond their partner was because of the preference for asking for information rather than sharing (12/40, 30%).
Conclusions
This study provides valuable insights into the pregnancy-related information-sharing behaviors of first-time fathers in Southeast Asia. It enhances our understanding of how first-time fathers share pregnancy-related information and how local cultural norms and traditions influence these practices. In contrast to first-time fathers in high-income countries, the information-sharing behavior of first-time Southeast Asian fathers is defined by cultural nuances. Culture plays a crucial role in their daily decision-making processes. Therefore, this emphasizes the importance of cultural considerations in future discussions and the development of intervention programs related to pregnancy for first-time Southeast Asian fathers. In addition, this study sheds light on the interaction processes that first-time fathers engage in with others, highlighting areas where intervention programs may be necessary to improve their involvement during pregnancy. For example, first-time fathers actively exchange new information found with their partners; therefore, creating features or platforms that facilitate this process could improve their overall experience. Furthermore, health practitioners should take a more proactive approach in engaging with first-time fathers, as currently there is a communication gap between them.
... and the estimate (r = .31) from a metaanalytic calculation on 43 studies involving 28,004 couples (Paulson & Bazemore, 2010). It is noteworthy that the 'cross-association' within the couple (Figure 1) indicates a bidirectional probability approximately four times higher of experiencing PDS if the partner is affected. ...
Background
Historically, perinatal depression has predominantly focussed on the mother-baby dyad, often neglecting the crucial role of fathers.
Aim
To determine the prevalence and associated factors of depressive symptoms in the immediate puerperium (PDS) in both mothers and fathers, individually and concurrently.
Method
This study employed a cross-sectional design. The presence of PDS was assessed using the Edinburgh Postnatal Depression Scale (EPDS), with a cut-off score of ⩾11 for mothers and ⩾9 for fathers. Logistic regression analyses were conducted to identify factors independently associated with PDS. Robustness of findings was verified through sensitivity analyses among participants without prior psychiatric conditions.
Results
Among 1,502 partnered mothers and fathers aged ⩾18 years who met the inclusion criteria, PDS were present in 13.0% of mothers, 10.5% of fathers and 3.5% of both parents. Mother-baby skin-to-skin contact and the father’s pregnancy planning were associated with a lower likelihood of PDS in mothers. For fathers, financial difficulties increased the likelihood of experiencing PDS threefold. The presence of PDS in mothers quadrupled the likelihood of PDS in fathers, and vice versa; their EPDS scores demonstrated a moderate correlation ( r s = .38). Among participants without prior psychiatric conditions, the odds of co-occurring PDS nearly tripled if the mother had a history of abortion or miscarriage. Fathers who had increased potentially addictive behaviours showed a six-fold increase in the likelihood of experiencing PDS.
Conclusions
Identifying depressive symptoms in both parents and incorporating fathers into clinical practice, research and health policy could enhance mental health outcomes in vulnerable populations.
... From a social psychology perspective, pregnancy can be seen as a specific and highly emotional state, and during a wife's pregnancy 63 , the husband may be influenced by the partner's negative emotions, possibly leading to "couvade syndrome", characterized by symptoms like loss of appetite, irritability, and sleep disturbances 64,65 . ...
Anxiety among pregnant women can significantly impact their overall well-being. However, the development of data-driven HCI interventions for this demographic is often hindered by data scarcity and collection challenges. In this study, we leverage the Empatica E4 wristband to gather physiological data from pregnant women in both resting and relaxed states. Additionally, we collect subjective reports on their anxiety levels. We integrate features from signals including Blood Volume Pulse (BVP), Skin Temperature (SKT), and Inter-Beat Interval (IBI). Employing a Support Vector Machine (SVM) algorithm, we construct a model capable of evaluating anxiety levels in pregnant women. Our model attains an emotion recognition accuracy of 69.3%, marking achievements in HCI technology tailored for this specific user group. Furthermore, we introduce conceptual ideas for biofeedback on maternal emotions and its interactive mechanism, shedding light on improved monitoring and timely intervention strategies to enhance the emotional health of pregnant women.
... As such, becoming a father incorporates feelings of both great expectations and joy, and fears and worries (Baldwin et al., 2018). Therefore, the transition can be difficult for some expectant fathers, where 13% have a severe fear of childbirth (FOC; Eriksson et al., 2005;, 5% to 10% have depression (Cameron et al., 2016;Paulson & Bazemore, 2010) and 3% to 25% have anxiety (Leach et al., 2016;Leiferman et al., 2021;Philpott et al., 2019). Expectant fathers with FOC report poorer physical and mental health than non-fearful expectant fathers , including greater levels of stress, anxiety, and depression (Leach et al., 2016;Philpott et al., 2017). ...
The aim of this mixed-method study was to identify support needs, as well as barriers and facilitators to seeking support in a sample of Swedish fathers with a fear of childbirth (FOC). Participants completed an anonymous quantitative online survey (N = 131), with three free-text items for those self-identifying as having an FOC (N = 71) and five individual in-depth interviews. Data analysis included descriptive and chi-square analyses for quantitative data, and manifest content analysis for qualitative data. Those with a severe FOC were more likely to report having on-going mental health difficulties (p = .039) and one fifth (21%) of the participants with severe FOC wanted to receive professional treatment, but only 8.1% received treatment. Most participants either preferred individual support or to receive support together with their partner. Fathers with severe FOC were more likely to report one or more barriers than those without FOC (p = .005), where unwanted social stigma was the single largest barrier. Qualitative findings identified one main category: Expectant fathers missing and wishing for support for FOC composed four generic categories: (1) support in developing an understanding of their fear, (2) coping by being aware of feelings, (3) professional support through trust and respect, and (4) needing individualized support. To encourage healthy fathers, clinical professionals should find ways to support fathers, such as by providing them with their own perinatal appointments, asking them about their feelings, as well as screening, diagnosing, and treating fathers with severe FOC.
... Fathers of preterm infants might also be vulnerable to higher levels of stress and anxiety (Sandnes et al., 2024), with both being significant risk factors for depression (Vismara et al., 2016). It is important to note that the mental health of mothers and that of fathers in the NICU are linked to each other; for example, maternal depression can be a significant predictor of paternal depression, and vice versa (Edward et al., 2015;Glasser & Lerner-Geva, 2019;Musser et al., 2013;Paulson & Bazemore, 2010). This is important because high levels of anxiety and depression can lead to decreased parental sensitivity in understanding their babies' communicative signals (Zelkowitz et al., 2011), which can lead to insecure attachment patterns (Evans et al., 2012), and consequently more long-term psychosocial, behavioral, and cognitive problems for the child (Groh et al., 2017). ...
BACKGROUND
Preterm birth contributes to adverse mental health outcomes of parents dealing with a premature neonate. The main objective of this study is to determine whether music therapy (MT) songwriting during the infants’ stay in the neonatal intensive care unit (NICU) is superior to standard care in reducing the risk of postpartum depression in high-risk parents of preterm children throughout the hospital treatment. The secondary objectives include assessment of effectiveness of MT in other aspects of mental health (anxiety level, perceived stress, mental wellbeing, coping, resilience). Furthermore, this trial will evaluate the medical and social factors that may be associated with the effects of MT songwriting.
PARTICIPANTS AND PROCEDURE
The study design is a sequential mixed method study with a dominant status QUAN to qual. The quantitative trial was designed as a parallel, multicenter, pragmatic, randomized controlled trial. The qualitative study is a descriptive phenomenological study that seeks to understand the lived experiences of participants exposed to songwriting. Participants are parents of premature infants hospitalized in NICU (106 families) in 5 hospitals, in Colombia and Poland. Intervention: 3 MT songwriting sessions per week across 3 weeks. Primary outcome: the risk of postnatal depression; secondary outcomes: anxiety level, mental wellbeing, resilience, stress, coping.
RESULTS
The results will be analyzed quantitatively and qualitatively.
CONCLUSIONS
This study will provide a report on the effectiveness of MT songwriting on mental health in at-risk parents of preterm infants.
... Research into paternal mental health following childbirth has focused primarily on major depressive disorder (Bradley & Slade, 2011). Recent estimates indicate that depression is common in fathers, with approximately 10% of fathers experiencing major depressive disorder at some point in the time span of their partner's pregnancy up through 12 months post-delivery (Giallo et al., 2012;Paulson & Bazemore, 2010). Further, up to 1 in 6 fathers report experiencing significant anxiety during the perinatal period (Leach et al., 2016). ...
... PPD is most prevalent in the first 3-6 months after giving birth, although it can also sneakily appear over a year as opposed to the typical 4 weeks. It affects about 8-10% of men [4][5][6] . ...
Postpartum depression (PPD) is a significant mental health disorder that has received little attention (both clinically and experimentally) and is underdiagnosed. PPD is most associated with mothers after giving birth. However, it may also affect fathers for unknown reasons. Poverty, a family history of depression, and hormonal changes are all risk factors for PPD in fathers. Although not much is known about paternal PPD, research indicates that it is often 8.7% prevalent in the first year, peaking between 3 and 6 months after childbirth (9.2%).
... Symptoms were found to usually appear 1 to 2 weeks after delivery; however, in some, the disease developed within 3 to 6 months of delivery [23]. Postpartum depression in men can manifest differently than in women. ...
Pregnancy-related stress affects not only the woman but also her partner. The issue of postpartum depression in women is increasingly discussed, apart from its occurrence in men, which can develop up to 12 months after giving birth. Risk factors for depression in young fathers are numerous and include hormonal fluctuations, socioeconomic conditions, and co-occurrence of other diseases. Emerging depressive symptoms are nonspecific and can be missed even by experienced medical personnel. Currently, screening tests use questionnaires that do not consider male risk factors. Perhaps the development of more personalized diagnostic methods would enable early identification of men at risk and include preventive measures. The proposed treatment methods of postpartum depression, such as sertraline or cognitive-behavioral therapy, enable patients to recover and provide appropriate support. The disease can cause long-term consequences that negatively affect the development and functioning of the child’s psyche. Behavioral disorders and emotional problems are observed in children whose fathers had postpartum depression. Moreover, partner relationships deteriorate and the father-child bond is impaired. Further research should focus on identifying risk factors in men from different social classes, considering environmental, personal, and ethnic characteristics, and on the effectiveness of postpartum depression treatment in men. This article aims to review the incidence, causes, diagnosis, and management of male postpartum depression.
... Research findings indicate that the prevalence of paternal depression may vary ranging from 9.76% during the antenatal period to about 8.75% within the first year following birth (Paulson & Bazemore, 2010). However, a recent survey conducted by Atif et al. has reported a significantly higher prevalence of postnatal depression (23.5%) among Pakistani men (Atif et al., 2022). ...
Background
Perinatal mental health issues affect approximately 10% of women in high-income countries and 30% in low- or middle-income countries. This review aims to determine the prevalence of perinatal depression among mothers and fathers in Pakistan and identify associated risk factors.
Methods
We conducted a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We included quantitative studies on the prevalence or incidence of maternal and paternal perinatal depression, including antenatal or postnatal depression in Pakistan, with or without associated risk factors. We performed an electronic search, dual-title/abstract and full-text screening, and data extraction. Analysis was conducted on Revman and JBI SUMARI software. The quality of the included studies was assessed with the NHLBI tool. This review updated a previously published review that included 43 studies, with the last search date of 31st May 2019, now extended to literature published up to June 30, 2023.
Results
Consistent with the previous review, our analysis of 61 studies indicated a pooled prevalence of 37% (95% confidence interval (CI): 30.6–43.6) for maternal antenatal depression. Postnatal depression at different time points, revealed rates of 34.2% (95% CI: 22.7–46.7), 40.9% (95% CI: 0–97.4), and 43.1% (95% CI: 24.4–62.9) at 3, 6 and 12 months, respectively. Paternal postnatal depression was observed at 40.5% (95% CI: 14.9–69) based on two studies. Risk factors for maternal perinatal depression include multiparity, contraceptive failure, inadequate antenatal care, pregnancy-induced hypertension, previous psychiatric illness, passive smoking, drug abuse, low socio-economic status, marital problems, family hardships, recent bereavement, housing difficulties, food insecurity, husband's illiteracy, his unemployment, and being blamed for child disability.
Conclusion
The findings reveal a high prevalence of perinatal depression among mothers with very limited evidence of fathers residing in Pakistan, emphasising the need for prospective studies addressing mental health challenges.
Registration
This review is registered on PROSPERO (CRD42023442581).
... Consistent with extant research on maternal depression [14], maternal internalizing problems manifested in two ways in the present study: a low-symptom profile characterized by symptoms that slowly decreased over time and a clinical profile characterized by clinically significant elevations in internalizing problems that, notably, persisted up to 2 years postpartum. Results converge with past research on rates of maternal depression (e.g., 23.8%; [78]) and suggest that approximately one in five mothers (21.2% in the present study) experience clinical elevations in broad internalizing problems across pregnancy and the postpartum period. Further, results also suggest that elevations in depressive and anxiety symptoms observed during this period can be attributed to core psychopathology rather than physical symptoms typically associated with the pregnancy-postpartum transition (e.g., appetite and sleep changes). ...
There is an increased risk for depression and anxiety across the perinatal period (i.e., spanning pregnancy and the first year postpartum); however, limited research has examined elevations in core negative affectivity underlying internalizing disorders more broadly. The current study sought to characterize trajectories of core internalizing problems among both mothers and fathers across the perinatal period and explored whether modifiable risk and protective factors buffered risk for elevated symptoms during this key developmental transition. A community sample of mixed-sex couples (N = 159) completed assessments during pregnancy and at four postpartum timepoints. Using growth mixture modeling, we found that 21.2% of mothers demonstrated clinical elevations in core internalizing symptoms that persisted up to 2 years postpartum. In contrast, 7.8% of fathers demonstrated clinical elevations in core internalizing symptoms across this period, with an additional 29.0% of fathers demonstrating subthreshold symptom elevations. Concerns related to pregnancy and childbirth and paternal (partner) internalizing problems during pregnancy conferred risk for elevated symptoms in mothers, whereas psychological flexibility, emotional intimacy, and the quality of received support were identified as protective factors for fathers. Results highlight the importance of repeated screening for internalizing problems and suggest that promoting a strong interparental relationship is critical for emotional health and well-being across the perinatal period.
... Our findings revealed a postpartum depression prevalence of 32.4% among nonbiological fathers in same-sex partnerships, substantially higher than the previously reported rate of approximately 10% among heterosexual fathers (Paulson & Bazemore, 2010). This marked disparity may be attributed to several factors: minority stress from societal discrimination and internalized homophobia; role ambiguity due to a lack of societal role models; legal barriers in certain jurisdictions; and insufficient social support from families of origin and society at large. ...
This study investigated postpartum depression in nonbiological fathers in same-sex partnerships and the factors influencing their mental health. A survey of 500 participants revealed that 32.4% of nonbiological fathers exhibited clinical symptoms of depression. Minority stress, work-family conflict, and socioeconomic factors were identified as the primary predictors of depressive symptoms. The findings underscore the necessity for targeted support and interventions for this group.
... The prevalence of paternal PD was 9.7 % among Japanese fathers [52]. A meta-analysis of 43 studies showed that approximately 10 % of men globally had experienced AD [53]. Another meta-analysis that included 74 studies with 41,480 participants found a meta-estimate of paternal depression of 8.4 % [54]. ...
Background
Paternal antenatal depression and postpartum depression are associated with adverse health outcomes in mothers and infants; however, their prevalence among Chinese fathers remains controversial. This meta-analysis aimed to summarize the prevalence of antenatal depression and postpartum depression in Chinese fathers.
Methods
We conducted a systematic meta-analysis on the prevalence of antenatal depression and postpartum depression among Chinese fathers by searching 11 databases. Pooled estimates and 95 % confidence intervals were calculated. The choice between a random-effects model and a fixed-effects model was based on an assessment of heterogeneity among the studies as well as assumptions regarding the similarity of the studies in terms of clinical characteristics, quality, design, and conduct. Subgroup and meta-regression analyses were conducted based on the scale used to measure antenatal depression and postpartum depression, the region where the study was completed, the time of the study, the study design, the number of children, publication language, the study site, and quality assessment.
Results
This meta-analysis included 28 studies with 8795 participants. The prevalence of antenatal depression among Chinese fathers was 11 % (95 % CI: 5%–17 %, P < 0.01) using a random-effects model. Heterogeneity was I² = 91 %. Publication language moderated the prevalence of paternal antenatal depression (the amount of heterogeneity accounted for was 92.13 %). The prevalence of postpartum depression among Chinese fathers was 16 % (95 % CI: 13%–18 %, P < 0.01), using a random-effects model. The heterogeneity was I² = 94 %. The prevalence of paternal postpartum depression was moderated by the scale used to measure postpartum depression (39.17 % heterogeneity) and the region where the study was completed (33.15 % heterogeneity). Moreover, Egger's test (t = 4.542, P < 0.001) indicated publication bias in studies on postpartum depression among Chinese fathers. However, after applying the trimming correction, the pooled prevalence of postpartum depression had a P value of <0.05, indicating that despite the publication bias, the results remain reliable and unaffected in terms of effect size.
Conclusion
The prevalence of antenatal depression and postpartum depression among Chinese fathers was similar to those reported in low- and middle-income countries. Fathers should receive regular screening, effective prevention, and appropriate treatment. However, interpreting these results requires consideration of the limitations of the study.
... Postnatal depression is a debilitating disorder generating suffering for around 12 to 17% of mothers [1,2] and between 8 and 13% of fathers [3,4]. The mental health condition usually occurs during the first year after the child is born and is characterized by a range of depressive symptoms, including sadness and tearfulness, anhedonia, difficulty sleeping, worry, self-blame, and thoughts of self-harm. ...
Background
New mothers and fathers are at risk of developing postnatal depressive problems. To understand how postnatal depressive symptoms unfold over time, analyses at the within-person level are necessary. Inspecting postnatal depressive problems at the symptom level provides a novel perspective, ultimately offering insight into which symptoms contribute to the elevation of other symptoms over time.
Methods
Panel graphical vector-autoregression (GVAR) models were applied to analyze the within-person temporal and contemporaneous relations between depressive symptoms across the postnatal period in new mothers and fathers (at T1; Nmothers = 869, Nfathers = 579). Depressive symptoms were assessed at 6-, 12-, and 18-months postpartum, using the Edinburgh Postnatal Depression Scale.
Results
The results revealed that for mothers, sadness was a key symptom predicting symptom increases in multiple other depressive symptoms and itself (autoregressive effect) over time. Furthermore, anxiousness and feeling scared predicted each other across the postnatal period in mothers. For fathers, the most central predicting symptom in the overall network of symptoms was being anxious, while self-blame and being overwhelmed had strong self-maintaining roles in the fathers’ symptomatology, indicating that these could be key features in fathers experiencing postnatal depressive problems. The pattern of symptoms that mothers and fathers experienced within the same time window (contemporaneous associations), shared many of the same characteristics compared to the temporal structure.
Conclusions
This study suggests that across the postnatal period, from 6- to 18-months postpartum, depressive symptoms in mothers and fathers contribute differently to the pattern of depressive problems, highlighting sadness as a key feature in maternal symptomatology and anxiousness components in paternal symptomatology.
The author describes pregnancy as a state of absolute hospitality in which the woman opens herself up to an unknown stranger. She takes the view that pregnancy is the most radical form of relatedness of oneʼs self and the other. The importance that a woman attributes to this bizarre two in one body experience is a function of her own history. This is based on unconscious sources and conscious experiences that have influenced her since her own infancy period and have culturally shaped her. In the view of the author, the quality of this experience and the complex feelings contained therein shape the intersubjective core of the self. For most mothers mixed feelings predominate; however, such a healthy maternal ambivalence cannot automatically be accepted in societies in which motherhood is idealized by culturally bound images.
The methodological recommendations have been developed with the aim of grading, systematizing and identifying key areas for the implementation of individual measures or a comprehensive corporate program for reproductive health promotion in working individuals at the employer level, including taking into account international experience.
The guidelines describe seven key subprograms aimed at early diagnosis and timely treatment of urinary tract diseases, assessment of reproductive health, improving literacy in sex education and behavior, reducing the negative impact of industrial and external environmental factors on reproductive health, increasing commitment to measures to combat risk factors for noncommunicable diseases, providing support during menopause in women and andropause in men, and creating conditions in the workplace conducive to maintaining a strong family. The guidelines are intended for healthcare and public health organization specialists, heads of state authorities of constituent entities of the Russian Federation in the field of health protection, specialists of regional centers for public health and medical prevention, as well as for heads of organizations in various economic sectors. The materials presented in the guidelines can also be used by medical workers of various specialties (paramedics, general practitioners (family doctors), obstetrics and gynecology doctors, dermatology and venereology specialists, medical prevention doctors, occupational pathology physicians and urologists).
Objectives
The project aimed to assess health visitors’ concordance with evidence-based criteria regarding identification and support of postnatal depression in mothers receiving the health visiting service.
Introduction
Timely identification is critical to support mothers at risk of postnatal depression. Undetected and untreated postnatal depression can result in severe consequences for the mother's health, infant health and development, and well-being of the family as a whole. Due to their unique role of universal home visiting, health visitors are ideally placed to identify and support mothers, and evidence-based practice is key to positive outcomes.
Methods
A baseline audit was carried out using evidence-based audit and feedback informed by the JBI Model for EBHC and guided by the seven-phase implementation framework, involving 12 health visitors and 60 health visiting records from one health board in Wales, UK. The first step involved project development and generating evidence. A baseline audit was completed and a training program on perinatal and infant mental health was implemented. Finally, a post-implementation audit was completed involving 6 health visitors and 30 health visiting records.
Results
Receiving training in perinatal and infant mental health resulted in an improvement in baseline audit results. Health visitor concordance with best practice guidelines increased, with three of the six criteria in the post-implementation audit reaching 100% concordance, and two other criteria increasing to 83% and 93%, respectively.
Conclusion
The implementation project achieved improvements in concordance with best practice recommendations for identifying and supporting mothers experiencing, or at risk of experiencing, postnatal depression.
Spanish abstract
http://links.lww.com/IJEBH/A293
Using a qualitative approach, this study examined disclosure patterns of women who have experienced symptoms of postpartum depression (PPD). PPD is a mental illness that new parents are at risk of developing. If left unresolved, PPD can have severe, negative impacts on the development of the baby and the well-being of the parent. Unfortunately, due to the stigmatized nature of the illness, parents are sometimes reluctant to bring up their struggles with this illness and seek help. Eighteen women who had experienced PPD within the past 5 years were recruited and participated in an interview where they were asked questions regarding their disclosure behaviors. Using communication privacy management theory, the data were examined to explain disclosure patterns. Findings were discovered using a thematic analysis. Themes of disclosure processes, disclosure considerations, boundary maintenance, and effects of disclosure were prompted by the theory, and several subthemes were discovered in the data. This study highlights the challenges that many mothers face when trying to disclose their mental health difficulties to others, like family members, coworkers, and health-care professionals in the postpartum stage.
Background
Postpartum anxiety and depression are common in new parents. While effective interventions exist, they are often delivered in person, which can be a barrier for some parents seeking help. One approach to overcoming these barriers is the delivery of evidence-based self-help interventions via websites, smartphone apps, and other digital media.
Objective
This study aims to evaluate the effectiveness of technology-based distal interventions in reducing or preventing symptoms of postpartum depression or anxiety in male and female birth and adoptive parents, explore the effectiveness of technology-based distal interventions in increasing social ties, and determine the level of adherence to and satisfaction with technology-based distal interventions.
Methods
A systematic review and series of meta-analyses were conducted. Three electronic bibliographic databases (PsycINFO, PubMed, and Cochrane Library) were searched for randomized controlled trials evaluating technology-based distal interventions for postpartum depression or anxiety in birth and adoptive parents. Searches were updated on August 1, 2023, before conducting the final meta-analyses. Data on trial characteristics, effectiveness, adherence, satisfaction, and quality were extracted. Screening and data extraction were conducted by 2 reviewers. Risk of bias was assessed using the Joanna Briggs Institute quality rating scale for randomized controlled trials. Studies were initially synthesized qualitatively. Where possible, studies were also quantitatively synthesized through 5 meta-analyses.
Results
Overall, 18 articles met the inclusion criteria for the systematic review, with 14 (78%) providing sufficient data for a meta-analysis. A small significant between-group effect on depression favored the intervention conditions at the postintervention (Cohen d=–0.28, 95% CI –0.41 to –0.15; P<.001) and follow-up (Cohen d=–0.27, 95% CI –0.52 to –0.02; P=.03) time points. A small significant effect on anxiety also favored the intervention conditions at the postintervention time point (Cohen d=–0.29, 95% CI –0.48 to –0.10; P=.002), with a medium effect at follow-up (Cohen d=–0.47, 95% CI –0.88 to –0.05; P=.03). The effect on social ties was not significant at the postintervention time point (Cohen d=0.04, 95% CI –0.12 to 0.21; P=.61). Effective interventions tended to be web-based cognitive behavioral therapy programs with reminders. Adherence varied considerably between studies, whereas satisfaction tended to be high for most studies.
Conclusions
Technology-based distal interventions are effective in reducing symptoms of postpartum depression and anxiety in birth mothers. Key limitations of the reviewed evidence include heterogeneity in outcome measures, studies being underpowered to detect modest effects, and the exclusion of key populations from the evidence base. More research needs to be conducted with birth fathers and adoptive parents to better ascertain the effectiveness of interventions in these populations, as well as to further assess the effect of technology-based distal interventions on social ties.
Trial Registration
PROSPERO CRD42021290525; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=290525
Pregnancy and childbirth are experienced as traumatic by around a third of all mothers, 12% of whom suffer from post-traumatic stress and 1.3–5% from post-traumatic stress disorder. Of pregnant women and women who have recently given birth, 10–15% are affected by postpartum depression (PPD). A common cause is psychological trauma during pregnancy and childbirth.
PPD can be significantly improved by treating the trauma. The EX.TRACT method, which combines acupuncture with trauma exposure and psychotherapy in five treatment steps, is very helpful here.
The treatment of prolonged pain during pregnancy and after childbirth also influences the psychological disorder.
In a preliminary medical history discussion, the central traumatizing situation is determined, which is then used as an image or imagination in the acupuncture therapy. The physical complaints are also discussed.
In the acupuncture session, the overall constitution and the physical complaints are treated first, which in this case report was with a combined treatment of acupuncture, osteopathy and manual therapy.
The patient then has to imagine the traumatic situation several times. The resulting physical discomfort and aversive feelings such as fear, anger and rage, sadness, disgust and exhaustion are largely eliminated immediately using appropriate acupuncture points.
The aim of the therapy is to erase the negative feelings in the limbic system so that the event is only stored in the episodic memory and the symptoms caused by the traumatic situation are eliminated.
The case report presents a patient who was physically injured and emotionally traumatised by childbirth. The prolonged birthing process ended in a vaginal injury and need for surgery after haemorrhage, leaving her unable to care for the baby.
A combined treatment of acupuncture, osteopathy and manual therapy was used for the physical pain. The psychological trauma and PPD were successfully treated with the EX.TRACT method in three treatment sessions.
Introduction
Fatherhood is a significant transition in a man’s life, introducing new challenges. Yet men’s experiences of this period remain poorly understood. Occupational therapists possess skills and knowledge to support individuals during transition. This study explored the experiences of men during the transition to fatherhood over the first postnatal year.
Method
Underpinned by an occupational therapy theoretical perspective, a systematic review was conducted. Following searches of databases: AMED, CINAHL, Medline and PsycINFO, qualitative studies meeting selection criteria were retrieved and quality assessed. Data was extracted and synthesised using an established meta-ethnographic approach.
Findings
Seven articles were included in the review. Four interconnected themes: (1) A New Occupational Identity, (2) Relationship Changes, (3) Challenges and Impact, (4) Unmet Occupational Needs, and four subthemes: Roles and Responsibilities, and Adjusting Priorities (theme 1); An Emotional Journey and Exhaustion (theme 3) were identified.
Discussion
Fathers’ postnatal transitional experiences were reflective of a journey of adjustment and growth. Experiences indicated the requirement for greater support of fathers throughout the antenatal and postnatal transition. Occupational therapists have the skills to work with fathers to balance occupations, manage fatigue and adjust to new roles. Further research should focus on understanding experiences of men in under-represented groups.
Objective
This prospective study aimed to assess couples’ psychological status during the perinatal period to identify those at risk for postpartum depression.
Methods
Conducted at Lyon University Hospital from March to July 2022, the study enrolled pregnant women without progressive psychiatric disorders or obstetric risk factors, and their partners. Participants completed the Edinburgh Postnatal Depression Scale (EPDS) at three points: during the 9th month of pregnancy, immediate postpartum, and 6–8 weeks after delivery. A score ≥10 on the EPDS indicated depression risk. A score ≥10 on the EPDS indicate depression risk. The primary endpoint was EPDS scores throughout the perinatal period.
Results
Ninety-five couples participated; 96% of patients and 68% of partners completed pre-delivery questionnaires, 81% and 71% during maternity stay, and 64% and 46% postpartum, respectively. Overall, 15% of patients and 1% of partners had EPDS scores >10 in the postpartum period. Psychiatric history and emergency cesarean sections were associated with higher immediate postpartum EPDS scores in patients [Beta 3.7 points, 95% CI 0.91; 6.4 and Beta 5.2 points, 2.2; 8.1, respectively]. Episiotomy was associated with higher EPDS scores in partners. No significant association between the different factors studied and the EPDS score was found at 6–8 weeks postpartum in patients nor their partners.
Conclusions
While specific risk factors for persistent perinatal depression in couples were not identified, a notable proportion of patients exhibited high EPDS scores. Screening all couples during prepartum and postpartum periods is crucial, regardless of identified risk factors.
Parenting behavior comprises a variety of adult-infant and adult-adult interactions across multiple timescales that require an extensive reorganization of individual priorities and physiology. The state transition from non-parent to parent is facilitated by combinatorial hormone action on specific cell types that are integrated throughout interconnected and brain-wide neuronal circuits. In this review we take a comprehensive approach to integrate historical and current literature on each of these topics across multiple species, with a focus on rodents. New and emerging molecular, circuit based and computational technologies have recently been used to address outstanding gaps in our current framework of knowledge on infant-mediated behavior, mainly in murine models. This work is raising fundamental questions about the interplay between instinctive and learned components of parenting and the mutual regulation of parenting and anti-parenting behaviors in health and disease. Whenever possible, we point to how these technologies have helped gain novel insights, while opening new avenues of research into studies of parenting. We hope this review will serve as an introduction for those new to the field, a comprehensive resource for those already studying parenting, and a guidepost for designing future studies.
Background
Exposure to early childhood adversities, such as family violence, parental depression, or low-income, undermine parent-child relationship quality and attachment leading to developmental and mental health problems in children. Addressing impacts of early childhood adversity can promote children’s development, giving them the best start in life. Parental reflective function (RF), or parents' ability to understand their own and children's mental states, can strengthen parent-child relationships and attachment and buffer the negative effects of early adversity. We developed and tested ATTACH™ (Attachment and Child Health), an effective RF intervention program for parents and their preschool-aged children at-risk from early adversity. Pilot studies revealed significantly positive impacts of ATTACH™ from in-person (n = 90 dyads) and online (n = 10 dyads) implementation. The two objectives of this study are to evaluate: (1) effectiveness, and (2) implementation fidelity and uptake of ATTACH™ Online in community agencies serving at-risk families in Alberta, Canada. Our primary hypothesis is ATTACH™ Online improves children’s development. Secondary hypotheses examine whether ATTACH™ Online improves children’s mental health, parent-child relationships, and parental RF.
Methods
We will conduct an effectiveness-implementation hybrid (EIH) type 2 study. Effectiveness will be examined with a quasi-experimental design while implementation will be examined via descriptive quantitative and qualitative methods informed by Normalization Process Theory (NPT). Effectiveness outcomes examine children’s development and mental health, parent-child relationships, and RF, measured before, after, and 3 months post-intervention. Implementation outcomes include fidelity and uptake of ATTACH™ Online, assessed via tailored tools and qualitative interviews using NPT, with parents, health care professionals, and administrators from agencies. Power analysis revealed recruitment of 100 families with newborn to 36-month-old children are sufficient to test the primary hypothesis on 80 complete data sets. Data saturation will be employed to determine final sample size for the qualitative component, with an anticipated maximum of 20 interviews per group (parents, heath care professionals, administrators).
Discussion
This study will: (1) determine effectiveness of ATTACH™ Online and 2) understand mechanisms that promote implementation fidelity and uptake of ATTACH™ Online. Findings will be useful for planning spread and scale of an effective program poised to reduce health and social inequities affecting vulnerable families.
Trial registration
Name of registry: https://clinicaltrials.gov/.
Registration number: NCT05994027
The paper describes results of the study of fathers' depressed mood during the postpartum period. It was hypothesized that the most important factors in the development of depressed mood in men would be those linked to current situation and not those related to men's individual characteristics. Thus, men whose partners were depressed would reveal more depressive symptoms. It was also expected that depressed mood in men would be related to low social support, negative economic situation of a family, low quality of marital relationship and prenatal expectations concerning life with an infant. Eighty couples were asked to complete a set of questionnaires including the EPDS. The responses revealed that depression was present not only in mothers but also in fathers. The multivariate analyses confirmed initial assumptions—the most important correlates of depressed mood in men were as follows: the level of women's depression, the high discrepancy between prenatal expectations and experiences related to family and social life after childbirth, and low satisfaction with the marital relationship. Fathers' neuroticism and age were not related to depression.
Depression has been extensively studied for mothers but not for fathers. This study examines the sociodemographic correlates of symptoms of depression and how depression is associated with father involvement using the Composite International Diagnostic Interview–Short Form (CIDI-SF) for major depression. The study uses a sample of 2,139 resident fathers in the Fragile Families and Child Wellbeing 12-Month Father Survey. Results indicate that symptoms of major depression differ by race, marital status, and employment status but not by age and educational status. Major depression also differs significantly based on drug and alcohol use and criminal justice experience. Results of ordinary least squares regression models indicate that major depression is negatively associated with father–child activities (engagement), positively associated with paternal aggravation/stress in parenting, and negatively associated with both the quality of the mother-father relationship and coparental relationship supportiveness. Findings are important for identifying fathers for whom interventions would be valuable.
Because of the pressure for timely, informed decisions in public health and clinical practice and the explosion of information in the scientific literature, research results must be synthesized. Meta-analyses are increasingly used to address this problem, and they often evaluate observational studies. A workshop was held in Atlanta, Ga, in April 1997, to examine the reporting of meta-analyses of observational studies and to make recommendations to aid authors, reviewers, editors, and readers.
Twenty-seven participants were selected by a steering committee, based on expertise in clinical practice, trials, statistics, epidemiology, social sciences, and biomedical editing. Deliberations of the workshop were open to other interested scientists. Funding for this activity was provided by the Centers for Disease Control and Prevention.
We conducted a systematic review of the published literature on the conduct and reporting of meta-analyses in observational studies using MEDLINE, Educational Research Information Center (ERIC), PsycLIT, and the Current Index to Statistics. We also examined reference lists of the 32 studies retrieved and contacted experts in the field. Participants were assigned to small-group discussions on the subjects of bias, searching and abstracting, heterogeneity, study categorization, and statistical methods.
From the material presented at the workshop, the authors developed a checklist summarizing recommendations for reporting meta-analyses of observational studies. The checklist and supporting evidence were circulated to all conference attendees and additional experts. All suggestions for revisions were addressed.
The proposed checklist contains specifications for reporting of meta-analyses of observational studies in epidemiology, including background, search strategy, methods, results, discussion, and conclusion. Use of the checklist should improve the usefulness of meta-analyses for authors, reviewers, editors, readers, and decision makers. An evaluation plan is suggested and research areas are explored.
In a study of the postpartum affective experiences of couples, mothers and fathers completed questionnaires on coping, marital satisfaction, stress, positive and negative affect, and depression one month pre- and then one month postpartum. More than one-fourth of both mothers and fathers reported elevated depressive symptoms, which correlated significantly between parents. Prepartum coping, stress, and affect significantly predicted postpartum affect. Research and clinical applications of the findings are discussed.
Objective: Funnel plots (plots of effect estimates against sample size) may be useful to detect bias in meta-analyses that were later contradicted by large trials. We examined whether a simple test of asymmetry of funnel plots predicts discordance of results when meta-analyses are compared to large trials, and we assessed the prevalence of bias in published meta-analyses. Design: Medline search to identify pairs consisting of a meta-analysis and a single large trial (concordance of results was assumed if effects were in the same direction and the meta-analytic estimate was within 30
Excessive infant crying, or infantile colic, is a common and often stress-inducing problem for parents that can ultimately result in child abuse. From previous research it is known that maternal depression is related to excessive crying, but so far little is known about the influence of paternal depression.
In a prospective, population-based study, we obtained information on both maternal and paternal depressive symptoms at 20 weeks of pregnancy by using the Brief Symptom Inventory. Parental depressive symptoms were related to excessive crying in 4426 two-month-old infants. The definition of excessive crying was based on the widely used Wessel's criteria (ie, crying >3 hours for >3 days in the past week).
After adjustment for depressive symptoms of the mother and relevant confounders, we found a 1.29 (95% confidence interval: 1.09-1.52) higher risk of excessive infant crying per SD of paternal depressive symptoms.
Our findings indicate that paternal depressive symptoms during pregnancy might be a risk factor for excessive infant crying. This finding could be related to genetic transmission, interaction of a father with lasting depressive symptoms with the infant, or related indirectly through contextual stressors such as marital, familial, or economic distress.
We compared the prevalence of depression in the postpartum period and its relationship with perceived stress and social support in first-time mothers and fathers. A cross-sectional study was conducted in mainland China with a convenience sample of 130 pairs of parents. Measures taken at 6-8 weeks after delivery included the Edinburgh Postnatal Depression Scale, the Perceived Stress Scale, and the Social Support Rating Scale. Eighteen (13.8%) of the mothers and 14 (10.8%) of the fathers were suffering from depression. No signficant differences were found in their prevalence rates. Perceived stress, social support, and partner's depression were significantly associated with depression. These findings suggest counseling, support, and routine screening for depression should be provided to both mothers and fathers.
We compared the screening accuracy of a short, five-item version of the Mental Health Inventory (MHI-5) with that of the 18-item MHI, the 30-item version of the General Health Questionnaire (GHQ-30), and a 28-item Somatic Symptom Inventory (SSI-28). Subjects were newly enrolled members of a health maintenance organization (HMO), and the criterion diagnoses were those found through use of the Diagnostic Interview Schedule (DIS) in a stratified sample of respondents to an initial, mailed GHQ. To compare questionnaires, we used receiver operating characteristic analysis, comparing areas under curves through the method of Hanley and McNeil. The MHI-5 was as good as the MHI-18 and the GHQ-30, and better than the SSI-28, for detecting most significant DIS disorders, including major depression, affective disorders generally, and anxiety disorders. Areas under curve for the MHI-5 ranged from 0.739 (for anxiety disorders) to 0.892 (for major depression). Single items from the MHI also performed well. In this population, short screening questionnaires, and even single items, may detect the majority of people with DIS disorders while incurring acceptably low false-positive rates. Perhaps such extremely short questionnaires could more commonly reach use in actual practice than the longer versions have so far, permitting earlier assessment and more appropriate treatment of psychiatrically troubled patients in primary care settings.
Examined the prevalence of depression in a heterogeneous sample of 360 pregnant women. Subjects were assessed with respect to both depressive symptomatology and diagnostic status during pregnancy and after delivery. At both assessments, approximately 25% of the sample reported elevated levels of depressive symptomatology. In contrast, 10% of the women met diagnostic criteria for depression during pregnancy, and 6.8% were depressed postpartum. However, only half of the cases of postpartum depression were new onset (3.4%); the remaining women receiving a diagnosis in the postpartum had also been depressed during pregnancy. Finally, depression during pregnancy was related to different sociodemographic variables than was postpartum depression, suggesting that depression at these two times may be associated with different psychological or etiological factors.
Investigated the hypothesis that postpartum depression is a function of disruption of parents' prepartum functioning by the subsequent demands of infant caretaking. 78 primiparous middle SES married couples (mean age 25.5 yrs) completed a battery of questionnaires, including the Beck Depression Inventory, at 8 wks prepartum and 8 wks postpartum, assessing indicators of stress related to childcare. Results indicate that when the level of prepartum depression was controlled, the reported experience of positively reinforcing events was negatively related to postpartum depression for women. For men, the degree to which their infant's behavior was viewed as better than the average was negatively related to postpartum depression. The strongest predictor of depression in both men and women was prepartum depression level. It is concluded that the findings were consistent with the social stress and behavioral theories' interpretation of postpartum depression. (17 ref)
Comparing women's and men's emotional reactions to childbirth can clarify the impact on mental health of childbirth as a life event.
Fifty-four first-time mothers attending obstetric services in Oporto, Portugal, and 42 of their husbands or partners participated in a longitudinal study of their mental health. All subjects were given a semi-structured clinical interview (SADS) at 6 months antenatally and at 12 months postnatally and sub-samples were interviewed at 3 months postnatally. At all these times all the mothers and fathers also completed a translated version of a self-rating scale for depression, the Edinburgh Postnatal Depression Scale (EPDS).
More women than men had past histories of depression but their rates of depression did not differ significantly during pregnancy. In the first 3 months postnatally, nearly a quarter of the women at risk were found to have become depressed (major, minor and intermittent) in contrast with less than 5% of the men. In the next nine months men were more prone to become depressed than previously and their conditions tended to follow an earlier onset of depression in their spouses.
Comparisons of EPDS and SADS ratings showed that the translated EPDS was a valid instrument for women but it was less satisfactory when applied to men.
The course of postnatal depression was examined in first-time mothers and fathers with emphasis on the role of personality and parental relationships as risk factors.
157 couples were assessed at four points: antenatally and at 6, 12 and 52 weeks postnatally. Various measures of mood and personality were administered at each of these assessment points.
Examination of the factors associated with depressed mood suggested that a woman's relationship with her own mother was important in the early postpartum stage, and also her level of interpersonal sensitivity and neuroticism. For the father, his relationship with either his mother or father and his level of neuroticism were associated with his mood level early on. By the end of the first year couple morbidity increased, with rates of distress being at their highest for both parents, and factors associated with depressed mood being linked to partner relationship variables, at least for mothers. At most time points, antenatal mood and partner relationship were significant predictor variables for the postnatal mood of both mothers and fathers. Limitations: The sample had a relatively high level of education and this should be taken into account when considering the generalisation of findings to less educated populations. At the time of conducting this study, the Edinburgh Postnatal Depression Scale (EPDS) had only been validated for use in the first few months postpartum, and thus we used another scale to measure the mother's mood at the other assessment points (the Beck Depression Inventory). Current research would suggest that the EPDS is valid both antenatally and at other times in the first year postpartum.
Whilst there was some consistency for mothers and fathers in the variables that predict their postpartum adjustment, these being antenatal mood and partner relationship, there is also evidence that adjustment to parenthood was related to different variables at different times. Early adjustment was related to the couple's relationship with their own parents, as well as their own personality. Later adjustment was related to the couple's functioning and relationship.
The consequences of unintended first pregnancy on the mental health of cohabitating couples (N = 124) were examined in the third trimester of pregnancy and at four months postpartum. Results indicated that the influence of unintended pregnancy on parental depressive symptoms is complex and via different mechanisms for men and women. Pregnancy viewed as unintended by males and intended by their partners appeared to pose the greatest risk for postpartum depressive symptoms, particularly in women.
Although anxiety disorders are documented in the literature for new mothers (but less so for fathers), rates of postpartum caseness tend to include only those with depression when diagnostic interviews or self-report measures validated on such interviews are used. This methodology therefore underestimates the true percentage of women and men who experience significant psychological difficulties postpartum. This has implications for assessment, treatment and screening for postnatal mood disorders.
Two studies were conducted on a total of 408 women and 356 men expecting their first child. They were recruited antenatally, and interviewed at 6 weeks postpartum using the Diagnostic Interview Schedule. DSM-IV criteria were applied to determine the presence since birth of depression (major or minor), panic disorder, acute adjustment disorder with anxiety (meeting the criteria for generalised anxiety disorder except for the duration criterion), and phobia.
The inclusion of diagnostic assessment for panic disorder and acute adjustment disorder with anxiety increased the rates of caseness by between 57 and 100% for mothers, and 31-130% for fathers, over the rates for major or minor depression. Inclusion of assessment for phobia further increased the rates of disorder in both samples. Couple concordance rates were between 6.6 and 11.1%, with no significant difference between rates for depressive or depressive and anxious caseness. For women, a previous history of an anxiety disorder appears to be a greater risk factor for a postnatal mood disorder (i.e. depression or anxiety) than a history of a depressive disorder.
These results clearly show the need to assess for both depression and anxiety in new and expectant parents, and we believe the term 'postnatal mood disorder' (PMD), rather than postnatal depression, more accurately reflects significant adjustment difficulties in new parents.
Uncertainties exist about prevalence and correlates of major depressive disorder (MDD).
To present nationally representative data on prevalence and correlates of MDD by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria, and on study patterns and correlates of treatment and treatment adequacy from the recently completed National Comorbidity Survey Replication (NCS-R).
Face-to-face household survey conducted from February 2001 to December 2002.
The 48 contiguous United States.
Household residents ages 18 years or older (N = 9090) who responded to the NCS-R survey.
Prevalence and correlates of MDD using the World Health Organization's (WHO) Composite International Diagnostic Interview (CIDI), 12-month severity with the Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR), the Sheehan Disability Scale (SDS), and the WHO disability assessment scale (WHO-DAS). Clinical reinterviews used the Structured Clinical Interview for DSM-IV.
The prevalence of CIDI MDD for lifetime was 16.2% (95% confidence interval [CI], 15.1-17.3) (32.6-35.1 million US adults) and for 12-month was 6.6% (95% CI, 5.9-7.3) (13.1-14.2 million US adults). Virtually all CIDI 12-month cases were independently classified as clinically significant using the QIDS-SR, with 10.4% mild, 38.6% moderate, 38.0% severe, and 12.9% very severe. Mean episode duration was 16 weeks (95% CI, 15.1-17.3). Role impairment as measured by SDS was substantial as indicated by 59.3% of 12-month cases with severe or very severe role impairment. Most lifetime (72.1%) and 12-month (78.5%) cases had comorbid CIDI/DSM-IV disorders, with MDD only rarely primary. Although 51.6% (95% CI, 46.1-57.2) of 12-month cases received health care treatment for MDD, treatment was adequate in only 41.9% (95% CI, 35.9-47.9) of these cases, resulting in 21.7% (95% CI, 18.1-25.2) of 12-month MDD being adequately treated. Sociodemographic correlates of treatment were far less numerous than those of prevalence.
Major depressive disorder is a common disorder, widely distributed in the population, and usually associated with substantial symptom severity and role impairment. While the recent increase in treatment is encouraging, inadequate treatment is a serious concern. Emphasis on screening and expansion of treatment needs to be accompanied by a parallel emphasis on treatment quality improvement.
In a sample of 200 postpartum couples the symptom profile of mothers with RDC generalised anxiety disorder was independent of the symptom profile of RDC minor or major depression. Amongst fathers however there was a strong positive correlation between the symptom profiles of anxiety and depression. This would suggest that postpartum anxiety is a separate disorder amongst mothers but not fathers. The prevalence rate of the disorder amongst mothers exceeds 6%, it is hence a common problem in need of further investigation.
Rosenthan's (1979) concept of fail-safeN has thus far been applied to probability levels exclusively. This note introduces a fail-safeN for effect size.
This study investigated psychological correlates of depression in fathers and mothers in the first postnatal year, using a mixed, mainly clinically referred sample and a cross-sectional design. The Edinburgh Postnatal Depression Scale (EPDS) was used for depression screening for mothers, and the EPDS, Beck Depression Inventory (BDI) and General Health Questionnaire (GHQ) for fathers. A total of 75 mothers (47.5%) had EPDS scores > 12, and 45 fathers (48.9%) exceeded the threshold on one or more of the three screening instruments. Most of the variance in paternal and maternal depression was accounted for by neuroticism. However, while mothers appeared primarily influenced by their own personality, perinatal and infant-related factors, fathers appeared more influenced by mothers' personality difficulties and unresolved past events, and mothers' current mental health and infant-related problems, as well as the state of the marital/ de facto relationship. The BDI and EPDS seemed to measure more severe pervasive forms of paternal depression than the GHQ, and the EPDS appeared to tap some items more specifically associated with perinatal psychological risk than the BDI. Depression in one partner was moderately correlated with depression in the other. High rates of paternal depression and anxiety in mothercraft settings suggest the need to routinely assess the mental state of both parents in these settings, and to include fathers in postnatal depression intervention programmes. The mother's negative perceptions of her infant's temperament are significantly associated with maternal and paternal depression, suggesting an important focus for intervention.
The effect of psychosocial factors on the emotional well-being of mothers following childbirth were examined within the cultural contexts of Britain and Greece. These mothers had already completed questionnaires during pregnancy and were contacted a second time in the postpartum period. At 4–6 weeks postpartum a sample of 165 Greek mothers and 101 British mothers and their partners completed the Edinburgh Postnatal Depression Scale. The relationship between mothers' EPDS scores and measures of emotional well-being in pregnancy (CCEI), social support, life events, fathers' EPDS score, and father's perception of change in partner was examined in each culture. No difference in the distribution of EPDS scores in each culture was found. Social support and life events were found to predict postnatal depression in both cultures. Additionally, in Greece, emotional well-being in pregnancy made a separate contribution to prediction. The major difference between the two cultures was in the relationship between mothers and their partners. Greek fathers were more emotionally and physically distanced from their partners during pregnancy, birth and early parenthood and perceived their partners as being more changed by the transition to parenthood. These differences were not reflected in differences in emotional well-being possibly because they accord with social expectation in each culture.
Background
The occurrence of postnatal depression in fathers has begun to receive attention in the international research literature. The Edinburgh Postnatal Depression Scale (EPDS) assessment tool has been validated for men. However, identification of such men has been hindered by the use of assessment tools that may not be sensitive to the particular depressive symptoms experienced by men. So far the problem of male depressive symptoms has not been included in research on men's postnatal depressions.
We examined maternal and paternal characteristics at 1 month postpartum as risk and protective factors for children's internalizing and externalizing problems at 2–3 years of age. In a sample of 70 couples and their children, fathers' depressive symptoms at 1 month postpartum predicted children's internalizing and externalizing problems at 2–3 years of age, and the interaction of fathers' and mothers' depressive symptoms predicted subsequent internalizing problems. Mothers' postpartum symptoms did not predict either type of children's behavior problems at age 2–3. When entered in the regression equations, mothers' depressive symptoms when the children were age 2–3 years accounted for all of the effects of paternal and maternal postpartum depressive symptoms. No evidence was found for the protective effects of marital satisfaction or social support, or for low levels of depressive symptoms in a spouse. We highlight directions for future risk and resilience research related to parental postpartum depression.
Maternal postpartum depression (PPD) has been shown to negatively influence mother–infant interaction; however, little research has explored how fathers and father–infant interaction are affected when a mother is depressed. This study examined the influence of maternal PPD on fathers and identified maternal and paternal factors associated with father–infant interaction in families with depressed as compared with nondepressed mothers. A convenience sample of 128 mother–father–infant triads, approximately half of which included women with significant symptoms of PPD at screening, were recruited from a screening sample of 790 postpartum women. Mothers and fathers completed measures of depression, marital satisfaction, and parenting stress at 2 to 3 months' postpartum and were each videotaped interacting with their infants. Results indicate that maternal PPD is associated with increased paternal depression and higher paternal parenting stress. Partners of depressed women demonstrated less optimal interaction with their infants, indicating that fathers do not compensate for the negative effects of maternal depression on the child. Although mother–infant interaction did not influence father–infant interaction, how the mother felt about her relationship with the infant did, even more so than maternal depression. The links between maternal PPD, fathers, and father–infant interaction indicate a need for further understanding of the reciprocal influences between mothers, fathers, and infants.
In recent years the trend for fathers in Western postindustrial countries to attend childbirth has increased. This study examined the interaction between fathers' information-seeking coping predispositions and their level of attendance at antenatal classes with respect to their experiences of attending childbirth. Associations between fathers' childbirth experiences, their relationship with their baby, and level of depressive symptomatology at 6 weeks postpartum were also examined.
A quantitative methodology was employed in which 78 fathers completed several questionnaires, some within 6 days of childbirth and others at 6 weeks postpartum.
Fathers who were characterized as high blunters (avoiders) of threat information, from antenatal classes reported that experiencing childbirth was less fulfilling than fathers with similar coping styles who did not attend classes. Fathers' reports of fulfillment and delight while attending childbirth were negatively related to their level of depressive symptomatology at 6 weeks postpartum. Levels of distress were associated with subsequent depressive symptoms, but their effect was removed when preexisting depressive symptoms were partialled out. Fathers whose children were born by cesarean delivery used significantly more negative adjectives to describe their baby at 6 weeks postpartum compared with those born by vaginal delivery. More married fathers attended antenatal classes and reported lower levels of depressive symptomatology than unmarried fathers.
Although fathers' attendance at antenatal classes may have positive consequences for them and their partner, for some fathers, attendance at classes may be associated with less positive reports of experiencing childbirth. The way in which men experience childbirth may have some influence on their subsequent emotional well-being.
Maternal depression is associated with adverse child development, but little is known about the effects of paternal depression. This pilot study estimated the prevalence of paternal depression and mood state, and assessed the relationship between paternal mood and infant temperament. The participants in the study were 98 fathers of newborn babies. Fathers were initially screened for depressed mood (Hospital anxiety and depression scale, and Edinburgh postnatal depression scale), and at 6 months parental mood, infant temperament, couple relationship quality, alcohol use, adverse life events, parenting, and demographics were recorded. Infant fussiness was analysed in relation to paternal mood and other contextual factors using multiple regression. Of the 98 fathers, 48 (49%) completed depression-screening measures. Of these 48 fathers, 4 (8%) reported depressive symptoms above the cut-off for case definition. A total of 48% (N=19) completed measures at follow-up. In the adjusted model, higher paternal depression scores, more traditional attitudes towards fathering, and increased recent life events were related to higher infant fussiness scores; and better couple relationship quality was related to lower fussiness scores. This study showed that 1 in 12 fathers had depressed mood, and lower mood was associated with negative infant temperament. Since the findings of this feasibility study were based on a small sample size the association of paternal mood and child development merits further study using a larger sample of fathers.
Thesis (Ph.D.)--University of Massachusetts Amherst, 2006. Includes bibliographical references (p. 110-115). Printout.
To evaluate the time to onset, duration, and risk factors for major and minor depression in pregnant women attending the Centers for Prenatal Care.
The presence of depressive symptoms and their severity were evaluated at monthly intervals in 154 pregnant women, using the Primary Care Evaluation of Mental Disorders and the Hospital Anxiety and Depression Scale. Comparisons between women with major and minor depression and nondepressed women were performed using the one-way analysis of variance with Bonferroni post-hoc analysis for continuous variables and with Fisher exact test for categorical variables.
Major depression was diagnosed in 19 women (12.3%) and minor depression in 28 (18.1%), whereas the remaining 107 did not show any depressive symptoms. Depression was later in onset and had a longer duration in women with major depression (mean+/-standard deviation 5.6+/-2.8 months and 2.3+/-1.7 months, respectively) than in women with minor depression (3.5+/-2.2 months and 1.6+/-0.7, respectively; P=.007 and P=.04). The risk of developing major depression was predicted at the beginning of pregnancy by the presence of previous depressive episodes (odds ratio [OR] 9.5, 95% confidence interval [CI] 2.5-29.2) and conflicts with husband/partner (OR 7.8, 95% CI 1.02-62.7), whereas the risk of developing minor depression was predicted by being a housewife (OR 7.2, 95% CI 2.3-22.1), presence of previous depressive episodes (OR 4.7, 95% CI 1.4-15.3) and whether the pregnancy was unwanted (OR 2.4, 95% CI 1.0-5.7).
Our study confirms that major and minor depression frequently affect pregnant women, particularly those with a history of depression, and they have different risk factors and onset and duration times. In most women, these disorders are present in a mild form (short duration and mild severity).
III.
To examine the effects of early maternal and paternal depression on child expressive language at age 24 months and the role that parent-to-child reading may play in this pathway.
The 9-month and 24-month waves from a national prospective study of children and their families, the Early Childhood Longitudinal Study - Birth Cohort (ECLS-B), provided data on 4,109 two-parent families. Depressive symptoms were measured with a short form of the Center for Epidemiologic Studies Depression Scale (CES-D). Parents reported on positive parent-infant interactions, child expressive vocabulary, and demographic and health information at child age 9 and 24 months. Linear regression was used to estimate associations between depression, parenting, and child vocabulary. Structural equation modeling was used to test the hypothesis that parent reading behavior mediates the parent depression to child vocabulary pathway. These models were adjusted for demographic indicators.
As previously reported from this national sample, 14% of mothers and 10% of fathers exhibited elevated levels of depressive symptoms at 9 months. For both mothers and fathers, depression at 9 months was negatively associated with contemporaneous parent-to-child reading. Only for fathers, however, was earlier depression associated with later reading to child and related child expressive vocabulary development. A model describing this pathway demonstrated a significant indirect pathway from depression to vocabulary via parent reading to child.
Depression is a significant problem among both mothers and fathers of young children, but has a more marked impact on the father's reading to his child and, subsequently, the child's language development.
Depressive symptoms were assessed in 86 couples during pregnancy and after childbirth. Although 59.3% (N = 51) of the couples contained at least one symptomatic spouse during the transition to parenthood, both spouses were symptomatic in only 11.1% (N = 4) of the affected couples during pregnancy and 12.5% (N = 4) after childbirth.
This cross-sectional descriptive study investigated the type and frequency of physical and psychological symptoms experienced by pregnant and postpartal women and their spouses. The sample of 70 married couples included 23 pairs in an early pregnancy group, 24 in a late pregnancy group, and 23 in a postpartum group. Both spouses completed a symptoms checklist of 20 physical and 3 psychological symptoms and the Beck Depression Inventory. Findings indicate that both spouses experienced some physical and psychological symptoms during pregnancy and the postpartum, although the women reported many more symptoms than did the men. Women in the late pregnancy group reported the highest number of physical symptoms; those in the postpartum group, the lowest number. No differences, however, in reports of psychological symptoms were found among the three groups of women. No significant differences in reports of either physical or psychological symptoms were found among the three groups of men.
The development of a 10-item self-report scale (EPDS) to screen for Postnatal Depression in the community is described. After extensive pilot interviews a validation study was carried out on 84 mothers using the Research Diagnostic Criteria for depressive illness obtained from Goldberg's Standardised Psychiatric Interview. The EPDS was found to have satisfactory sensitivity and specificity, and was also sensitive to change in the severity of depression over time. The scale can be completed in about 5 minutes and has a simple method of scoring. The use of the EPDS in the secondary prevention of Postnatal Depression is discussed.
Paternal competence was compared for 79 experienced fathers (one or more children) and 93 inexperienced (first-time) fathers at early postpartum, 1, 4, and 8 months following birth. No differences in paternal competence by previous experience in the father role were found at any test period, nor did the trajectories of change differ between the two groups. Paternal competence means at 4 and 8 months did not differ, but were significantly higher than 1-month means. During the 8-month period, 30% to 61% of the variance in experienced men's paternal competence was explained; the range for inexperienced men was 31% to 49%. Depression was a major predictor for experienced fathers at 1, 4, and 8 months; partner relationships were predictive at 1 and 4 months. Sense of mastery and family functioning were consistent predictors for inexperienced fathers, who also reported greater anxiety and depression than experienced fathers at 4 and 8 months after birth.
In the first study to systematically examine postnatal depression in fathers, we examined depression in 200 postnatal couples, using a two-stage design. The prevalence of depression ascertained by the 13-item Edinburgh Postnatal Depression Scale (EPDS), using a cut-off score for 'caseness' of 13 or more in an unselected postnatal sample, was 27.5% in mothers at six weeks postpartum, 25.7% in mothers at six months postpartum, 9.0% in fathers at six weeks postpartum, and 5.4% in fathers at six months postpartum. The prevalence did not differ significantly in either mothers or fathers from a control group of parents with children between three and five years of age. As expected, mothers had a significantly higher prevalence of psychiatric 'caseness' at both six weeks and six months postpartum than fathers. Fathers were significantly more likely to be cases if their partners were also cases. The hypothesis that different aetiological factors would be important in brief and persistent disorders in mothers was upheld.
A meta-analysis of 44 studies was conducted to determine the magnitude of the relationship between postpartum depression and each of the following predictor variables: prenatal depression, history of previous depression, social support, life stress, child care stress, maternity blues, marital satisfaction, and prenatal anxiety. Effect sizes were calculated three ways: unweighted, weighted by sample size, and weighted by quality index score. Moderate to large significant effect sizes were revealed between these eight predictor variables and postpartum depression. The mean r effect size indicator range for each predictor variable was as follows: prenatal depression (.49 to .51), child care stress (.48 to .49), life stress (.36 to .40), social support (.37 to .39), prenatal anxiety (.30 to .36), maternity blues (.35 to .37), marital satisfaction (.29 to .37), and history of previous depression (.27 to .29).
Control and social gratification at work and in other social roles have been shown to be predictive of depression in general adult populations, yet the potential importance of these factors in the postpartum period has not been explored. This study examines the influence of self-reported social gratification, support, and control at work and in the parenting role on depressive symptomatology for both men and women in the postpartum period. A model including perceptions of control, social gratification, and support in these two life domains is tested at 6 months postpartum in a sample of 108 first-time parents. When this model is compared to a parallel model using information obtained 6 months before the birth, strong support for the increased significance of these variables in the postpartum period is found. The need to include work and role-related variables in a comprehensive stress-diathesis model of postpartum depression for both men and women is discussed.
Correlates and predictors of mood disturbances at 3 days and 6 weeks postpartum were assessed in Irish mothers and their partners.
The Edinburgh Postnatal Depression Scale (EPDS) and the Highs Scale were used to assess 370 mothers and their partners. Socio-demographic, clinical and obstetric data were collected at patients' first antenatal visit. Factors associated with EPDS scores of > or = 13 and Highs score of > or = 8 were examined.
On the EPDS 11.4% of mothers scored > or = 13 at 3 days postpartum and 11% at 6 weeks, while 18.3% of mothers scored > or = 8 on the Highs Scale at 3 days and 9% at 6 weeks. Scores on the EPDS and Highs Scale were interrelated. Factors associated with EPDS scores of > or = 13 at 6 weeks were single status, unemployment, unplanned pregnancy, public status and bottlefeeding. The best predictors of EPDS > or = 13 at 6 weeks were mothers' scores on the EPDS and the Highs Scale at 3 days. Three per cent of partners scored > or = 13 on the EPDS at 3 days postpartum and 1.2% at 6 weeks.
Factors associated with mothers' mood disturbance were readily identifiable and collected routinely at antenatal intake. Mothers' mood within 3 days of delivery was the best predictor of later postnatal depression. Paternal mood disturbance was rare. Certain women may be at increased risk for postnatal mood disturbance and may be amenable to early identification and intervention.
To review the literature investigating the effects of parental affective illness on children over the past decade.
A computerized search of articles published over the past 10 years was completed. Articles were reviewed and relevant studies are presented.
Over the course of the past 10 years a number of longitudinal studies have confirmed that children of affectively ill parents are at a greater risk for psychiatric disorders than children from homes with non-ill parents. Life table estimates indicate that by the age of 20 a child with an affectively ill parent has a 40% chance of experiencing an episode of major depression. Children from homes with affectively ill parents are more likely to exhibit general difficulties in functioning, increased guilt, and interpersonal difficulties as well as problems with attachment. Marital difficulties, parenting problems, and chronicity and severity of parental affective illness have been associated with the increased rates of disorder observed in these children.
The presence of depression in parents should alert clinicians to the fact that their children also may be depressed and therefore in need of services. J. Am. Acad. Child Adolesc.
The objective of the study was to examine moods and adjustment through the transition to parenthood as an issue affecting the couple; to examine not only the postpartum but also the pregnancy experience and to explore how each partner's experiences interact with those of the other. A longitudinal repeated measures design was utilized with 327 healthy couples with a first-time pregnancy who were from Melbourne, Victoria in 1995-98. Each partner was interviewed on four occasions: mid- and late pregnancy, early postpartum and 4 months postnatally. Twenty per cent of mothers and 12% of fathers were significantly distressed at mid-pregnancy (Time 1) and this persisted until the early postpartum (Time 3) phase. Young age (particularly in women), negative mood, poor relationship functioning, gender role stress (particularly performance failure regarding work and sex in males) and low social support predicted distress in mid-pregnancy (Time 1). Negative mood in partner and self, and poor relationship functioning at mid-pregnancy predicted vulnerability to postnatal distress (Time 3 and/or Time 4). The incidence of distress in couples during mid- and late pregnancy is of concern and highlights the importance of considering the total transition to parenthood, not only the onset of postnatal distress. The analyses of predictors of postnatal distress from prenatal variables suggest that a 'contagion of distress' may operate in some couples. The standard management provided for couples experiencing pregnancy may be inadequate for many couples. These findings suggest that it is important to consider the mood and relationship quality of both partners and to offer intervention services as early as possible to offset possible progression into postnatal depression.
Differences in postpartum depressive symptomatology (PPDS) among an international sample of 892 women from nine countries representing five continents were explored.
Edinburgh Postnatal Depression Scale (EPDS) and Beck Depression Inventory (BDI) were used to assess PPDS among a convenience sample that completed the two questionnaires twice, yielding a total of four sets of scores per subject. Women sampled were primiparae with no obstetrical complications, and had a healthy baby. Depression history and therapy were ruled out as exclusion criteria.
Mean scores for EPDS and BDI varied across sites at both time points (P value<.001). European and Australian women had the lowest levels of PPDS, USA women fell at the midpoint, and women from Asia and South America had the highest depressive symptom scores. The moderate concordance between the EPDS and BDI suggested that the measures have complementary uses for screening and assessment.
Utility of EPDS and BDI for yielding profiles of postpartum women's depressive symptomatology was demonstrated. Further research to validate depressive symptom measures with diverse international populations is indicated.
The Edinburgh Postnatal Depression Scale (EPDS) has been validated and used extensively in screening for depression in new mothers, both in English speaking and non-English speaking communities. While some studies have reported the use of the EPDS with fathers, none have validated it for this group, and thus the appropriate cut-off score for screening for depression or anxiety caseness for this population is not known.
Couples were recruited antenatally and interviewed at six weeks postpartum. EPDS scores and distress caseness (depression or anxiety disorders) for 208 fathers and 230 mothers were determined using the Diagnostic Interview Schedule.
Analyses of the EPDS for fathers using distress caseness (depression or anxiety disorders) as the criterion shows that a cut-off of 5/6 has optimum receiver operating characteristics. Furthermore acceptable reliability (split-half and internal consistency) and validity (concurrent) coefficients were obtained. For mothers the optimum cut-off screening value to detect distress caseness was 7/8. Item analysis revealed that fathers endorsed seven of the ten items at lower rates to mothers, with the most significant being that referring to crying.
The EPDS is a reliable and valid measure of mood in fathers. Screening for depression or anxiety disorders in fathers requires a two point lower cut-off than screening for depression or anxiety in mothers, and we recommend this cut-off to be 5/6.
The extent of heterogeneity in a meta-analysis partly determines the difficulty in drawing overall conclusions. This extent may be measured by estimating a between-study variance, but interpretation is then specific to a particular treatment effect metric. A test for the existence of heterogeneity exists, but depends on the number of studies in the meta-analysis. We develop measures of the impact of heterogeneity on a meta-analysis, from mathematical criteria, that are independent of the number of studies and the treatment effect metric. We derive and propose three suitable statistics: H is the square root of the chi2 heterogeneity statistic divided by its degrees of freedom; R is the ratio of the standard error of the underlying mean from a random effects meta-analysis to the standard error of a fixed effect meta-analytic estimate, and I2 is a transformation of (H) that describes the proportion of total variation in study estimates that is due to heterogeneity. We discuss interpretation, interval estimates and other properties of these measures and examine them in five example data sets showing different amounts of heterogeneity. We conclude that H and I2, which can usually be calculated for published meta-analyses, are particularly useful summaries of the impact of heterogeneity. One or both should be presented in published meta-analyses in preference to the test for heterogeneity.
To compare maternal and paternal psychological responses following birth of a healthy baby; and to explore predictors of parental psychological distress.
A prospective, longitudinal, population-based cohort study.
A Norwegian district general hospital.
One hundred and twenty-seven mothers and 122 fathers were included.
Eligible consenting parents were enrolled. The assessments, which were performed zero to four days after birth, at six weeks and at six months, included General Health Questionnaire-28 (GHQ-28), State Anxiety Inventory and Impact of Event Scale. The response rates at the three occasions were 97%, 85% and 71%.
Symptoms of intrusion, avoidance, arousal and psychological distress including anxiety, depression, social dysfunction and somatisation.
Clinically important psychological distress was reported by 37% of the mothers and 13% of the fathers a few days after childbirth (P < 0.001). Severe intrusive stress symptoms were reported by 9% and 2% of mothers and fathers, respectively (P = 0.002). Level of intrusive stress was the outcome that differed most clearly between mothers and fathers at all three points of time. Being a single parent, multiparity and a previous traumatic birth were significant independent predictors of acute maternal psychological distress. After six weeks and six months, the level of psychological distress including symptoms of depression fell to levels found in the general population.
Childbirth does not seem to trigger long term psychological distress in most parents. Clinically important psychological distress occurred more frequently in mothers than in fathers. Acute maternal psychological distress was predicted by being a single parent, being multiparous, and having a previous traumatic birth.
Little is known as to whether negative experiences associated with infertility and IVF treatment persist after successful treatment. The aim of the study was to compare couples who have conceived after IVF and couples who have conceived naturally regarding personality factors and emotional responses to pregnancy.
Fifty-seven women pregnant after IVF and 55 male partners and 43 women who had conceived naturally and 39 male partners were recruited from university IVF clinics and antenatal clinics in Stockholm. The subjects were interviewed about their socio-demographic background. They completed scales of personality traits, anxiety, emotional responses to pregnancy, marital adjustment and reactions to recalled infertility while in pregnancy week 13 (range 11-17).
The results showed that the IVF women had more muscular tension and were more anxious about loosing the pregnancy than the control women. The IVF women with high infertility distress were more anxious about loosing the pregnancy and less ambivalent than the women with lower distress. The IVF men had more somatic anxiety, indirect aggression, guilt, and were more detached and more anxious about loosing the pregnancy and less ambivalent than the control men. The IVF men with high infertility distress were more anxious about the baby not being normal than the men with lower infertility distress.
The women and men who had conceived after IVF differed on a number of personality dimensions and emotional responses to the pregnancy from that of the women and the men who had conceived naturally. The results suggest that IVF couples may need additional emotional support in early pregnancy.
To assess factors affecting first-time fathers' transition to parenthood.
A longitudinal repeated measures study in which participants were interviewed in mid-pregnancy and completed assessments in late pregnancy, in early postpartum, and at 4 months postpartum. SELLING AND PARTICIPANTS: Two hundred twenty-five first-time fathers were recruited from a major obstetric hospital in Melbourne, Victoria, from 1995 to 1998, via their partners.
Men were seen separately from their spouses, and questionnaires assessing parity history, social support, marital satisfaction, anger, anxiety, and gender role stress were completed at each time. Prenatal and postnatal distress were measured by the Edinburgh Postnatal Depression Scale.
Men's peak period of distress was at the first assessment in pregnancy, where there was an overrepresentation of younger men, who were employed part-time and in shorter relationships. For most of the men, their anxieties decreased steadily postpartum. Lower relationship satisfaction was associated with distress, as was gender role stress, both antenatally and postpartum. Distress was also seen to affect men's attachment to their infants.
Although most men deal effectively with the transition to fatherhood, a small group of distressed men may have continued problems in their role as a parent and partner. If more attention can be paid to their anxieties antenatally, it might benefit the men, their partners, and their infants.
Much attention has been paid to the problem of postpartum depression in women. However, there is some indication that men also experience depression after the birth of a child, and that paternal depression is linked to maternal depression.
The purpose of this integrative review was to examine current knowledge about postpartum depression in fathers. Specific aims were (1) to examine the incidence of paternal depression in the first year after the birth of a child, (2) to identify the characteristics and predictors of paternal postpartum depression, (3) to describe the relationship between maternal and paternal postpartum depression, and (4) to discuss the influence of paternal depression on the family and infant.
A literature search from 1980 to 2002 was carried out using the CINAHL, PsychInfo, and Medline electronic databases. Twenty research studies were identified that included incidence rates of paternal depression during the first year postpartum. These were further examined and synthesized regarding onset, severity, duration, and predictors of paternal depressive symptoms, and for information about the relationship between maternal and paternal depression.
During the first postpartum year, the incidence of paternal depression ranged from 1.2% to 25.5% in community samples, and from 24% to 50% among men whose partners were experiencing postpartum depression. Maternal depression was identified as the strongest predictor of paternal depression during the postpartum period. The implications of parental depression for family health were discussed.
Postpartum depression in men is a significant problem. The strong correlation of paternal postpartum depression with maternal postpartum depression has important implications for family health and well-being. Consideration of postpartum depression in fathers as well as mothers, and consideration of co-occurrence of depression in couples, is an important next step in research and practice involving childbearing families.
In comparison to its female counterpart, the transition of men to parenthood has been relatively neglected in previous research. The present paper argues that men may have gender-specific risk factors for perinatal psychological distress and may manifest distress in ways different from women. The prime objective of this research was to document changes in psychological, relationship and lifestyle parameters in a cohort of first time fathers from pregnancy to the end of the first postnatal year. The present paper reports on these changes.
Three hundred and twelve men were assessed at 23 weeks of pregnancy and followed up at 3, 6 and 12 months postnatally, using a battery of self-report questionnaires covering psychological symptom levels, lifestyle variables and relationship/sexual functioning. Two hundred and four men completed all four assessments.
The men exhibited highest symptom levels in pregnancy with general, through small, improvement at 3 months and little change thereafter. Lifestyle variables showed small changes over the first postnatal year. Sexual functioning appeared to deteriorate markedly from pre-pregnancy levels with only minimal recovery by the end of the first year. The results highlight that the majority of men anticipated return of sexual activity to pre-pregnancy levels; however, this failed to eventuate.
Pregnancy, rather than the postnatal period, would appear to be the most stressful period for men undergoing the transition to parenthood. The results suggest that the most important changes occur relatively early in pregnancy. Thereafter, lack of change (rather than change) is the most noteworthy feature. These men appeared to be ill-prepared for the impact of parenthood on their lives, especially in terms of the sexual relationship. Further research to determine the timing and trigger of stress in pregnancy is recommended.