Abstract and Introduction
Paternal postpartum depression (PPD) is a clinically significant problem for families that is currently underscreened, underdiagnosed, and undertreated. Maternal PPD is a well-known condition and has been extensively researched. In comparison, PPD in fathers and its potential effects on the family are not widely recognized. Studies have shown the importance of optimal mental health in fathers during the postpartum period. Negative effects of paternal PPD affect marital/partner relationships, infant bonding, and child development. To promote optimal health for parents and children, pediatric nurse practitioners must stay up to date on this topic. This article discusses the relationship of paternal PPD to maternal PPD; the consequences, signs, and symptoms; and the pediatric nurse practitioner's role in assessing and managing paternal PPD.
Paternal postpartum depression (PPD) is a clinically significant problem for families that is currently underscreened, underdiagnosed, and undertreated. Estimates of the incidence of paternal PPD in the literature vary widely, ranging from 4% to 25% of new fathers within the first 12 postpartum months (Goodman, 2004; Paulson, Dauber, & Leiferman, 2006; Ramchandani, Stein, Evans, O'Connor, & ALSPAC Study Team, 2005). This wide statistical variation may be due to the relative newness of this topic, inconsistent research methods, lack of standardized guidelines, and clinical heterogeneity (Paulson & Bazemore, 2010). Despite varying statistics, paternal PPD is proving to be public health concern because it is associated with increased community care costs such as primary care, psychologist contacts, mental health groups, and outpatient hospital services or utilization (Edoka, Petrou, & Ramchandani, 2011).
Current literature does not reveal a specific definition of paternal PPD; however, several studies used the maternal PPD definition to build on for defining parental PPD (Pilyoung & Swain, 2007; Schumacher, Zubaran, & White, 2008). The Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR) defines maternal PPD as a major depressive episode with onset occurring within 4 weeks of delivery, depressed or sad mood, marked loss of interest in virtually all activities, significant weight loss or gain, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness or guilt, diminished ability to think or concentrate, and recurrent thoughts of death (American Psychiatric Association, 2000). These symptoms, as well as other behaviors, may be present in depressed new fathers (Paulson & Bazemore, 2010; Pilyoung & Swain, 2007). Many studies consider paternal PPD to be depression occurring within the first 12 postpartum months, with the highest rates found at 3 to 6 months postpartum (Goodman, 2004; Nazareth, 2011; Paulson & Bazemore, 2010).
Research describes the negative effects of compromised paternal mental health, especially during the postpartum period. Paternal PPD can negatively affect infant care and bonding, is stressful to the family unit, and has been linked to later child psychopathology such as conduct and emotional disorders, hyperactivity, and anxiety and depression, as well as language delays (Paulson & Bazemore, 2010; Paulson, Keefe, & Leiferman, 2009; Ramchandani et al., 2005; Ramchandani, Stein, et al., 2008; Ramchandani, O'Connor, et al., 2008; Schumacher et al., 2008; van den Berg et al., 2009).
Traditionally, care for postpartum depression has been directed toward mothers. In the past decade, increased attention in the literature has been paid to paternal PPD, including its diagnosis, prevalence, and effects on child behavior. The body of knowledge describing the characteristics of paternal PPD, risk factors, comorbidities, effects on infants and children, and links to maternal PPD is growing. It is important for pediatric nurse practitioners (PNPs) to have up-to-date knowledge on this subject because they can play a critical role in diagnosis and management. To our knowledge, no literature currently exists that summarizes PPD and addresses the role of the PNP in its assessment and management. Therefore the purpose of this article is to highlight the relationship of paternal PPD with maternal PPD, the consequences for the family unit, signs and symptoms, and the PNP's role in assessing and managing paternal PPD.
J Pediatr Health Care. 2013;27(6):479-485. © 2013 Mosby, Inc.