Paternal Postpartum Depression

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 inappropriate use of health
care resources. Children of mothers depressed during the early postpartum period were also
found to have higher rates of depression (42%) as adolescents compared with children of
nondepressed mothers (12.5%).
Postpartum depression is also common in fathers.
A meta-analysis in JAMA of 19 observational studies (n = 3293 fathers) found that 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 [63].
These prevalence rates may exceed the rate of depression during non-postpartum periods (4
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 it seems like maternal
depression happens earlier.

Risk factors for postnatal paternal depression include [65,66]:

Prenatal anxiety or depression
Lifetime history of severe depression
Marital discord
Maternal prenatal depression
Other children in the family

Paternal postpartum depression may adversely affect child development.

Avon Longitudinal Study of Parents and Children (Lancet 2005)

As an example, 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 associated with depression in fathers during the infant's early
months also remains after controlling for later paternal depression, suggesting that
paternal depression in the early months of a child's life might be a particular risk factor
for adverse development.

Not just during the later months

Stronger in boys than in girls

Subsequent 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 [66].

A longitudinal study of a nationally representative cohort (Early Childhood Longitudinal

Study, Birth Cohort) of 5350 children born in 2001.

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

The cohort included 450 very preterm infants and 900 moderate/late preterm
infants.

Depressive symptoms in parents were assessed at 9 months after birth by a

standardized depression scale (CESD 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: 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-tochild reading and later expressive vocabulary development
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.

The initial data collection wave, at 9 months, likely missed cases of depression
that resolved in the early postnatal period; we did not have data to ascertain whether
depressive symptoms were present before or during pregnancy, which may have biased
our findings, particularly if prenatal depressive symptoms have a causal relationship with
postnatal depressive symptoms10 or childrens cognitive function

Clinically, our findings underscore the 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.

A quick self-report screen

1) "Since your new baby was born, have you felt down, depressed, or hopeless?"
and 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.
Validated questionnaires include the Edinburg Postnatal Depression Scale,12,13 the Center
for Epidemiologic Studies Depression Scale,14 and the PPD Screening Scale.15

The EPDS is a reliable and valid measure of mood in fathers. Lot of studies validating it in
paternal postpartum depression.

One study: 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 cutoff 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) 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
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.

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 parentto-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