Paternal Postpartum Depression

What Health Care Providers Should Know

Anna K. Musser, MS, RN, CPNP; Azza H. Ahmed, DNS, RN, IBCLC, PNP; Karen J. Foli, MSN, PhD, RN; Jennifer A. Coddington, DNP, MSN, RN, CPNP


J Pediatr Health Care. 2013;27(6):479-485. 

In This Article

Effects of Paternal PPD

Relationship Between Maternal and Paternal PPD

Maternal PPD is a risk factor for paternal PPD, and the incidence of paternal PPD has been correlated with maternal PPD (Goodman, 2004; Paulson & Bazemore, 2010; Nazareth, 2011). In an integrative literature review conducted by Goodman (2004), the incidence of paternal PPD during the first postpartum year ranged from 1.2% to 25% in community samples; however, this incidence increases to 24% to 50% among men whose partners were experiencing PPD. Maternal PPD was the strongest predictor of paternal PPD (Goodman, 2004). This causal relationship is unclear, but male partners of depressed women reportedly feel less supported and experience fear, confusion, frustration, helplessness, anger, a disrupted family, and uncertainty about the future (Schumacher et al., 2008).

A lack of social support has been recognized as a risk factor for maternal PPD. This lack of support also may play an important role in the development of paternal PPD. Dennis and Letourneau (2007) found that depressed women were more likely to be dissatisfied with the support from their partners, believe that communication was poor, perceive their partner as uncaring, and report a decline in the affection and closeness within their relationship. A woman's inability to rely on her partner for help with the infant and household chores was another risk factor for maternal PPD. These risk factors for maternal PPD may be exacerbated when the father is also depressed, because he may be more likely to withdraw from the relationship (Kim & Swain, 2007). Mothers experiencing PPD also may increase the risk for PPD in fathers because fathers are not receiving the support they need during this time of transition (Goodman, 2004; Nazareth, 2011).

Consequences for Infants and Children

The effects of maternal PPD on infants and children are well documented. Recently, more research has been conducted concerning the effects of paternal PPD on infant and child development and well-being. Findings document a higher risk for increased family stress, lack of bonding, increased incidence of spanking, and later child psychopathology such as emotional issues, conduct disorder, and hyperactivity (Davis, Davis, Freed, & Clark, 2011; Paulson et al., 2009; Ramchandani et al., 2005; Ramchandani, Stein, et al., 2008; Ramchandani, O'Connor, et al., 2008; van den Berg et al., 2009). This research underscores the need for screening and management of paternal PPD by the PNP to prevent negative consequences for infants and children.

The risk for negative parenting outcomes increases when both parents are depressed (Melrose, 2010). Fathers may play an important role in "buffering" their children from the effects of maternal PPD; however, this buffer is lost when the father also has PPD (Melrose, 2010). When both parents are depressed, they are more likely to view their child negatively, describe their child as below average or average, and perceive more health problems in their children (Melrose, 2010). Paulson, Dauber, and Leiferman (2006) conducted a study focusing on both the individual and combined effects of maternal and paternal PPD on parenting behaviors. The study found that the greatest negative effects on parenting behaviors occurred when both parents were depressed: infants were less likely to be put to sleep on their backs and to have been breastfed, and they were more likely to be put to bed with a bottle. Fathers also were less likely to play outside and sing songs to their babies when both parents were depressed (Paulson, Dauber, and Leiferman, 2006).

Davis and colleagues (2011) examined the association between depression in fathers of 1-year-old children and parenting behaviors. In this study, depressed fathers were more likely to report spanking their child and were less likely to report reading aloud to their child. Interestingly, 77% of these depressed fathers reported speaking with their child's health care provider during the previous year (Davis et al., 2011). These encounters may serve as opportune times for the PNP to screen for depression and refer fathers for appropriate treatment and to provide anticipatory guidance concerning positive parenting behaviors.

In a population-based study by Ramchandani, Stein, Evans, O'Connor, and the Avon Longitudinal Study of Parents and Children (ALSPAC) Study Team (2005), fathers were screened for PPD at 8 and 21 months, and child behaviors were assessed at 3.5 years, according to three problem areas: emotional issues, conduct, and hyperactivity. Findings revealed that paternal PPD was associated with high scores in all three categories, with boys scoring higher than girls. After controlling for social class, degree of education, and maternal depression, scores still remained high for conduct problems and hyperactivity (Ramchandani et al., 2005).

Paternal PPD also appears to have long-term effects on children. The effects on later childhood psychopathology were studied by Ramchandani, Stein, O'Connor, Heron, Murray, and Evans (2008). This population cohort study used ALSPAC family data collected from the prenatal time through 7 years. The study found paternal depression at 8 weeks postpartum to be strongly associated with a psychiatric diagnosis in children at 7 years. Twelve percent of children diagnosed with attention deficit hyperactivity disorder, oppositional defiant/conduct disorder, or any anxiety or depressive disorder had depressed fathers during the postpartum period compared with 6% of children whose fathers were not depressed. Oppositional defiant/conduct disorder was the most prevalent diagnosis. Based on this literature, paternal PPD may be more specifically related to behavioral and social problems, which suggests a link between antisocial behavior and the father's possible role of socializing children (Ramchandani, Stein, et al., 2008).

Ramchandani, O'Connor, and colleagues (2008) compared the longitudinal effects of both prenatal and postnatal paternal depression on infants and children. This longitudinal cohort study also used data from ALSPAC. Fathers who were depressed both prenatally and during the postpartum period were more likely to have children diagnosed with emotional, conduct, hyperactivity, and pro-social problems at both 3.5 and 7 years. Consistent with their earlier study, boys were at a higher risk of developing conduct problems at 3.5 years (Ramchandani, O'Connor, et al., 2008).

Paulson, Keefe, and Leiferman (2009) assessed maternal and paternal depression and the subsequent language development of their child at 24 months as part of the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B). Families were assessed at 9 and 24 months for parental depression, positive parenting interactions, child expressive vocabulary, and demographic and health information. Depression in both mothers and fathers at 9 months was associated negatively with parent-to-child reading. Early depression for fathers was associated with later reading to their children and later expressive vocabulary development (Paulson et al., 2009).

A study by van den Berg and colleagues (2009) that included infants only examined the link between paternal PPD and excessive infant crying in a population cohort of fathers. At 20 weeks' gestation, fathers completed a self-report questionnaire to assess psychiatric symptoms. Infant crying behavior information was then obtained at 2 months (van den Berg et al., 2009).