Depression in Fathers During Pregnancy and After Childbirth
Time to read: 4 minutes
Depression has a lower prevalence in men than in women although this lower incidence may be due to the gender biases in seeking help.
“Only relatively recently has the influence of fathers on children been recognized as vital for adaptive psychosocial and cognitive development.
Given that paternal depression can have direct or indirect effects on children, it is important to recognize and treat symptoms among fathers early, and the first step in doing that is arguably increasing awareness among fathers about increased risks.” – Underwood et al., 2017
Studies show that approximately 9% of men in the general population have depression. [1]
During pregnancy, rates differ between 2-19% for antenatal paternal depression and 12-19% for women. The rates of postnatal paternal depression range between 3-12% compared to 13-18% for women. [2]
We have previously covered the impact of maternal stress on child development.
While perinatal depression in women is associated with hormonal fluctuations and psychosocial factors, paternal depression is associated with a wide range of biological and psychosocial factors that have an impact on brain structure and function. Negative child outcomes such as emotional or behavioural issues play a significant part. [2]
In a large contemporary longitudinal study in New Zealand of approximately 7,000 children, researchers are studying what risk factors have an impact on a child’s wellbeing. To this end, a recently published study in JAMA Psychiatry analysed the risk of depression and the risk factors associated with depression in the father antenatally and postnatally. [2]
WHO AND WHAT WAS STUDIED?
The study was a longitudinal cohort study consisting of 3,523 New Zealand men with a mean age of 33-years old .
Subjects recruited were evenly distributed among socioeconomic and ethnic groups.
Researchers performed face-to-face interviews during their partner’s pregnancy and then 9-months after childbirth.
Depression was monitored using the Edinburgh Postnatal Depression Scale (depression defined as >12) and the 9-item Patient Health Questionnaire (depression defined as >9).
Interviews also recorded employment status, health, smoking status, family support, family stress, neighborhood integration, and warmth/hostility values at time of pregnancy. (confounding variables)
WHAT WERE THE FINDINGS?
Antenatal Depression Factors
The study showed that antenatal depression symptoms were recorded in 82 fathers (2.3%) and that it was strongly associated with:
- An increased perception of stress
- A fair-to-poor health rating during their partner’s pregnancy
Postnatal Depression Factors
Postnatal depression symptoms were recorded in 153 fathers (4.3%) and this was strongly associated with:
- An increased perception of stress at 9 months
- A fair-to-poor health rating at 9 months.
- Unemployment
- A previous history of depression
Furthermore, men with antenatal depression were more likely to have a partner with antenatal depression.
Men with postnatal depression were more likely to have a partner with antenatal or postnatal depression.
STRENGTHS AND LIMITATIONS
Selection bias: 7.8% of participants who were not assessed postnatally were significantly different from those who completed both interviews.
Confounding: This study did not include any analysis of whether fathers were receiving medication for depression, which is a confounding factor.
Recall bias: The measurement of pre-pregnancy and early pregnancy factors is susceptible to recall bias.
External validity: The results cannot be generalised to first and second trimesters of pregnancy.
However, the large sample, with high participation rates and a good spread across ethnic backgrounds gives the study added value and will help to raise awareness of paternal depression.
THE BIG PICTURE
Fathers who have higher levels of stress as well as poorer health were more at risk of developing paternal depression.
Paternal depression had a significant impact on both mother and child and therefore, based on these findings, pre-childbirth discussions about mental health that include both the mother and the father, should be considered for those men classified as high-risk.
“Expectant fathers should seek support if they experience unemployment and/or relationship or family difficulties following the birth of their child.
Men who have a history of mental health problems or who are stressed or unwell during their partner’s pregnancy should be assessed for paternal post natal depression symptoms (PPDS). Men should also be encouraged to give up smoking during their partner’s pregnancy and continue not to smoke after the birth of their child.” – Underwood et al., 2017
The ‘Growing Up in New Zealand’ is a longitudinal study of approximately 7,000 New Zealand children. [3]
The study hopes to be able to better understand what risk factors are important during the early stages of human development and how best to approach these issues.
In the ‘Growing Up in New Zealand’ cohort, two recent publications have shown that the reported rates of maternal depression are 11.5% antenatal and 8.0 % postnatal. [4], [5]
Along with this study, these three publications show that there are common and separate risk factors for perinatal depression in men and women.
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