Paternal Postpartum Depression

Three main points:

Paternal postpartum depression is common (prevalence in some studies is equal to postpartum depression in
mothers)
Depression in fathers associated with psychiatric diagnoses (eg, oppositional defiant/conduct disorder and
anxiety disorders), behavioral problems, hyperactivity, and lower cognitive function (in preterm infants).
Possible reasons why: less likely to engage with their children, are more likely to use aggressive or harsh
discipline, less parent-to-child reading, marital conflict
The Edinburg Postnatal Depression Scale (EPDS) is a suitable screening tool even for paternal postpartum
depression.
Prevalence and risk factors
The estimated prevalence of postpartum depression for mothers ranges from 8 to 15 percent based on the
study
Numerous research studies report that depression in mothers is correlated with: impaired feeding, slower
cognitive development, disruptive behaviors, and higher rates of depression in the child later in life.
Postpartum depression is also common in fathers.
Meta-analysis in JAMA (2010):

The prevalence of paternal depression during the first three postpartum months was 8 percent.

The prevalence of paternal depression 6 to 12 months after birth was 10 percent.

The correlation between paternal and maternal depression was positive and moderate in size (r =
0.308; 95% CI, 0.228-0.384).

Directionality is not clear; but other studies seem to show that maternal depression happens
earlier
Risk factors for postnatal paternal depression:

Prenatal anxiety or depression

Lifetime history of severe depression

Marital discord

Maternal prenatal depression

Other children in the family

Impact on infant outcomes
We care about and screen for maternal postpartum depression because it affects outcomes in children. But
why should we start caring more about paternal postpartum depression? Well, it may also adversely affect
child development.
Avon Longitudinal Study of Parents and Children (Lancet 2005)

A study of children (n >10,000) evaluated at age 3.5 years found that behavioral problems and
hyperactivity occurred in more children whose fathers had suffered postpartum depression (even after
controlling for maternal depression and other risk factors).

The increased risk for behavioral problems was associated with depression in fathers during the
infant's early months also remains after controlling for later paternal depression. Suggests that paternal
depression in the early months of a child's life (not just when theyre 2 years old) might be a particular
risk factor for adverse development.

Follow-up of the same children at age seven years found that psychiatric diagnoses (eg,
oppositional defiant/conduct disorder and anxiety disorders) were more common in offspring of
depressed fathers than offspring of nondepressed fathers (12 versus 6 percent) independent of maternal
postnatal depression.
Early Childhood Longitudinal Study, Birth Cohort (J Dev Behav Pediatr 2016)


Study looked at the impacts of both prematurity and parental depressive symptoms on childrens
early cognitive function.

Preterm infants are at risk for low cognitive function associated with perinatal complications,
parent's education, socioeconomic status, and family well-being.

Depressive symptoms in parents were assessed at 9 months after birth by the Center for
Epidemiologic Studies Depression Scale

Cognitive function in children was assessed at 24 months by selected questions from the Bayley
Scales of Infant Development (measures early communication skills, memory, expressive, and receptive
vocabulary, comprehension, and problem solving abilities).

At 9 months, 14% of mothers and 12% of fathers had depressive symptoms (not diagnosed
depression, just depressive symptoms). Incidence was higher in fathers of preterm infants (20%) and
especially high in nonresident fathers of preterm infants (40%).

In turn, children of fathers with higher depressive symptoms had lower cognitive function at age
of 24 months, even after adjustment for maternal depressive symptoms and childrens biological and
social risk factors. These associations were not found for mothers.

Possible reasons why there was an association with lower cognitive function:
Direct pathways:

Fathers less likely to engage with their children, are more likely to use aggressive or
harsh discipline.

Another study showing that depression in fathers associated with less parent-to-child
reading and diminished expressive vocabulary development which could affect cognitive
function
Indirect pathways:

If depression in fathers leads to marital conflict or compromises maternal effect or

involvement.
Lack of cognitively stimulating activities, physical care, paternal warmth, and caregiving
activities associated with a higher likelihood of infant cognitive delay.

Problems with this study: Data collected at 9 months, which likely missed cases of depression
that resolved in the early postnatal period

Main takeaway point: Need to identify and manage postnatal depressive symptoms in both
parents, and especially for nonresident fathers and fathers of infants born preterm who may be
experiencing clinical levels of depressive symptoms beyond the initial phase after their childs birth.
Screening
A quick self-report screen

1) "Since your new baby was born, have you felt down, depressed, or hopeless?"

2) "Since your new baby was born, have you had little interest or little pleasure in doing things?"

One Yes answer constitutes a positive screen.

Questionnaires include the Edinburg Postnatal Depression Scale, the Center for Epidemiologic Studies
Depression Scale, and the PPD Screening Scale.
The EPDS is a reliable and valid measure of mood in fathers. Several studies validating it in paternal
postpartum depression.
One study from 2001: Screening for depression or anxiety disorders in fathers requires a two point lower
cut-off than screening for depression or anxiety in mothers (7/8), and we recommend this cut-off to be 5/6.

2.3% of fathers endorsed question 9 (I have been so unhappy that I have been crying)
compared to 44.1% of mothers

Treatment:

For mild to moderate, postpartum, unipolar major depression, suggest psychotherapy. This
approach is especially useful for lactating patients who want to avoid neonatal exposure to
antidepressants. However, pharmacotherapy is a reasonable alternative if psychotherapy is not
successful, or is declined or not available, or if the patient has previously responded to antidepressants.

Cochrane review (2007)

Although the methodological quality of the majority of trials was, in general, not strong, the
meta-analysis results suggest that psychosocial and psychological interventions are an effective
treatment option for women suffering from postpartum depression.
Psychosocial and psychological interventions include psychoeducational strategies, cognitive
behavioural therapy, interpersonal psychotherapy, psychodynamic therapy, non-directive
counselling, various supportive interactions, and tangible assistance, delivered via telephone, home
or clinic visits, or individual or group sessions in the postpartum by a health professional or lay
person.
(1) Psychosocial interventions (e.g. non-directive counselling, support groups)
(2) Psychological interventions (e.g. interpersonal psychotherapy, cognitive behavioural therapy)
versus standard care or usual care
Treatment goes beyond the father

Study in the Pediatrics journal (2015) that shows that the association between depression in
fathers during the postnatal period and subsequent child behavior is explained predominantly by the
mediating role of family factors, such as depression in the mother and couple conflict

What this might suggest is that the reason there is an association between paternal depression
and behavioral problems in the kid is that you have a home where the mom is depressed and there is
marital conflict.

What this tells you is that we should be assessing the family environment and functioning and
then target appropriate interventions to enhance the couple and family relationships. Consider referring
to targeted parenting programs to help parents understand their childrens needs and to prevent child
psychopathology

Doesnt sound too revolutionary and the hard part is finding those targeted parenting programs
and having the mom/dad go to them. Because what good is screening, if we dont have the resources to
help people we identify as having problems?

Three main points:

Prevalence of paternal depression during the first three postpartum months is about 8 percent. Moderate
positive correlation between paternal and maternal depression
Depression in fathers (not mothers) of preterm infants was associated with significantly lower cognitive
function in the child at 2 years. Paternal postpartum depression associated with psychiatric diagnoses (eg,
oppositional defiant/conduct disorder and anxiety disorders), behavioral problems, and hyperactivity in their
children. Possible reasons why: less likely to engage with their children, are more likely to use aggressive or
harsh discipline, less parent-to-child reading, marital conflict
The EPDS is a suitable screening tool for fathers in the postpartum period, albeit cutoffs are different to
those applicable in women. It is important to note the EPDS does not diagnose depression but can alert the
clinician to the need for a full diagnostic interview
References:
Postnatal Depressive Symptoms Among Mothers and Fathers of Infants Born Preterm: Prevalence and
Impacts on Childrens Early Cognitive Function
Prenatal and Postpartum Depression in Fathers and Its Association With Maternal Depression A Metaanalysis
Paternal Depression in the Postnatal Period and Child Development: Mediators and Moderators

Validation of the Edinburgh Postnatal Depression Scale for men, and comparison of item endorsement with
their partners
Paternal depression in the postnatal period and child development: a prospective population study
An Integrative Review of Paternal Depression