High Rate of Prenatal, Postpartum Depression Found in Fathers

Deborah Brauser

May 19, 2010

May 19, 2010 — More than 10% of fathers experience prenatal and postpartum depression, with the highest rates found 3 to 6 months after birth, according to results from a new multinational meta-analysis reported May 19 in the Journal of the American Medical Association theme issue on mental health.

Because recent national data place the 12-month prevalence of depression among men in the general population at 4.8%, "this suggests that paternal prenatal and postpartum depression represents a significant public health concern," write the study authors.

Although maternal prenatal and postpartum depression is well established, "information on paternal depression has been thin and inconsistent," coprincipal investigator James F. Paulson, PhD, of the Department of Pediatrics at Eastern Virginia Medical School in Norfolk, told attendees during a media briefing.

"The prevalence, risk factors, and effects of depression among new fathers is not well understood and has received little attention from researchers and clinicians," added Dr. Paulson.

Depression Rates of More Than 28,000 Fathers Examined

Although past studies have shown incidence rates of 10% to 30% for maternal depression, which can often lead to negative family and child development outcomes, studies focusing on paternal depression are troubled by "clinical heterogeneity and prevalence estimates that vary considerably," the investigators write.

For this analysis, the investigators sought to evaluate estimates of paternal prenatal and postpartum depression, its rate variabilities, and its association with maternal depression.

"In addition to looking at the rates, we really wanted to look at whether there was a link between mothers' and fathers' depression," said Dr. Paulson. "Could we tie these 2 together and understand them as a family systems issue?"

Of 256 potential studies identified from the MEDLINE, PsychINFO, EMBASE, Google Scholar, and Dissertation Abstracts International databases, the investigators chose 43 studies from 16 countries.

"The majority of these were conducted after 2004," explained Dr. Paulson, who noted that 17 originated in the United States and 26 were international.

All together, the analysis included 28,004 fathers older than 18 years. "The sample was overwhelmingly first-time parents," added Dr. Paulson. "However, we did not have enough information to separate out marital status."

Significant Paternal Depression Rates

Results showed an overall meta-estimate of 10.4% for paternal depression between the first trimester and 1 year post partum (95% confidence interval [CI], 8.5% – 12.7%).

Of these fathers, the 3- to 6-month postpartum period showed the highest depression rates at 25.6% (95% CI, 17.3% – 36.1%), whereas the first 3 postpartum months showed the lowest rates at 7.7% (95% CI, 5.3% – 11.1%).

However, "the small number of studies measuring paternal depression during [the 3- to 6-month] period suggests cautious interpretation," the investigators write.

"Still, it begs the question: what's going on in this time period?" added Dr. Paulson. "And what can we learn more about what happens in families post partum and particularly how men are experiencing new fatherhood?"

The estimated correlation between paternal and maternal depressive symptoms "was positive and moderate in size" (r = 0.308; 95% CI, 0.228 – 0.384), the study authors report.

"In other words, as one partner's depression severity went up, so did the other," said Dr. Paulson. "That's not to say that there's any established direction of effect. It may be that mom's depression is leading the way, or dad's is, or there's some mix family to family. Or there may be other factors associated with it, such as child temperament, crying, or colic."

In addition, the US studies reported a higher average rate of prenatal and postpartum depression at 14.1% (95% CI, 10.9% – 18.0%) than did the international studies at 8.2% (95% CI, 5.9% – 11.1%).

"The observation that expecting and new fathers disproportionately experience depression suggests that more efforts should be made to improve screening and referral, particularly in light of the mounting evidence that early paternal depression may have substantial emotional, behavioral, and developmental effects on children," the study authors write.

"We clearly need to acknowledge that this is a problem," said Dr. Paulson. "Medical professionals need to help convey this information, and we need to screen for it as vigorously as we can."

He added that the association between paternal and maternal depression suggests that "if clinicians see depression in one partner that should prompt them to ask about depression in the other." Plus, intervention efforts that focus on the couple and family rather than on just the individual may be needed, although, he added, "this may be easier said than done."

Possible barriers include prenatal and postpartum depression "commonly viewed as a disorder of motherhood" and the need to "update the construct of depression in men" to understand that irritability, anger, and withdrawal are actually common depressive symptoms in men, he said.

Dr. Paulson told Medscape Psychiatry that his team is about to start recruiting participants for a new National Institute of Health–funded study that will examine mothers and fathers from the first trimester of pregnancy through 6 months post partum, focusing on how depression in both parents is related to relational factors (such as marital satisfaction, intimacy, and conflict), as well coparenting issues.

"We're hoping this will help us understand all this a little better from a family systems perspective and how it plays out over time. That will take us into the leading edge of looking at how parents together might affect child development and child outcomes," he said.

Need to Recognize Disorder's Existence

"This meta-analysis was really well done," Richard M. Glass, MD, deputy editor of JAMA and clinical professor of psychiatry at the University of Chicago, told Medscape Psychiatry.

"I think its most basic takeaway is that there is such a thing as postpartum and prenatal depression in fathers as well as mothers. So recognizing that it exists and needs attention is an important point," added Dr. Glass.

He noted that a depressed father is less likely to have positive bonding with the infant, which can possibly have effects on its development. "While that's clearly true for mothers, there's also some emerging evidence that it's also going to be true for fathers."

However, "there still isn't much [real] evidence so far on the effects on the child from paternal depression. As mentioned, that's still emerging and still needs further research," concluded Dr. Glass.

The study authors and Dr. Glass have disclosed no relevant financial relationships.

JAMA. 2010;303:1961-1969.

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