New Fathers' Perinatal Depression and Anxiety-Treatment Options: An Integrative Review

The risk factors of antenatal depression: A cross-sectional survey

AIMS AND OBJECTIVES

To investigate the prevalence of depression in the third trimester of pregnancy and identify the related demographic risk factors.

BACKGROUND

Antenatal depression as a disabling and treatable disease has a wide-ranging impact on perinatal women and has received extensive attention from researchers.

DESIGN

A cross-sectional survey was conducted at three public hospitals.

METHODS

Demographic questionnaire was developed from the literature review, and depression was assessed using the Edinburgh Postnatal Depression Scale. A binary logistic regression model was used to assess the association between depression and demographic predictors. STROBE checklist for cross-sectional studies was applied in this paper (see Appendix S1).

RESULT

A total of 773 pregnant women participated in the study. 29.6% of participants scored more than 9 points on Edinburgh Postnatal Depression Scale. In the final logistic model, living in rural area, marital satisfaction, assisted reproductive technology, lacking of prenatal health knowledge and life events were strongly significantly associated with antenatal depression. Moreover, living in an extended family, without Medicare insurance, unemployed, working as civil servants or healthcare workers, and lower household income also predicted antenatal depression. However, education level, smoking or drinking before pregnancy was found not to be associated with antenatal depression.

CONCLUSION

Our findings suggest that the prevalence of antenatal depression was high. Satisfied with the current marital status, pregnancy without assisted reproductive technology, knowledge of perinatal care and no life events recently were considered as the protective factors for antenatal depression.

RELEVANCE TO CLINICAL PRACTICE

Antenatal psychological interventions should focus on how to improve the marital satisfaction and the relationship with their family members. More attentions should be paid to the women who have had some life events recently or received assisted reproductive technology for pregnancy.

Child Health: Is It Really Assisted Reproductive Technology that We Need to Be Concerned About?

Concerns remain about the health of children conceived by infertility treatment. Studies to date have predominantly not identified substantial long-term health effects after accounting for plurality, which is reassuring given the increasing numbers of children conceived by infertility treatment worldwide. However, as technological advances in treatment arise, ongoing studies remain critical for monitoring health effects. To study whether the techniques used in infertility treatment cause health differences, however, remains challenging due to identification of an appropriate comparison group, heterogeneous treatment, and confounding by the underlying causes of infertility. In fact, the factors that are associated with underlying infertility, including parental obesity and other specific male and female factors, may be important independent factors to consider. This review will summarize key methodological considerations in studying children conceived by infertility treatment including the evidence of associations between underlying infertility factors and child health.

Effectiveness of a Technology-Based Supportive Educational Parenting Program on Parental Outcomes (Part 1): Randomized Controlled Trial

Background

Transitioning into parenthood can be stressful for new parents, especially with the lack of continuity of care from health care professionals during the postpartum period. Short hospital stays limit the availability of support and time parents need to be well equipped with parenting and infant care skills. Poor parental adjustment may, in turn, lead to negative parental outcomes and adversely affect the child’s development. For the family’s future well-being, and to facilitate a smoother transition into parenthood, there is a need for easily accessible, technology-based educational programs to support parents during the crucial perinatal period.

Objective

This study aimed to examine the effectiveness of a technology-based supportive educational parenting program (SEPP) on parenting outcomes during the perinatal period in couples.

Methods

A randomized, single-blinded, parallel-armed, controlled trial was conducted. The study recruited 236 parents (118 couples) from an antenatal clinic of a tertiary hospital in Singapore. Eligible parents were randomly assigned to the intervention group (n=118) or the control group (n=118). The SEPP is based on Bandura’s self-efficacy theory and Bowlby’s theory of attachment. Components of the intervention include 2 telephone-based educational sessions (1 antenatal and 1 immediately postnatal) and a mobile health app follow-up for 1 month. The control group only received routine perinatal care provided by the hospital. Outcome measures including parenting self-efficacy (PSE), parental bonding, perceived social support, parenting satisfaction, postnatal depression (PND), and anxiety were measured using reliable and valid instruments. Data were collected over 6 months at 4 time points: during pregnancy (third trimester), 2 days postpartum, 1 month postpartum, and 3 months postpartum. Outcomes were standardized using baseline means and SDs. Linear mixed models were used to compare the groups for postpartum changes in the outcome variables.

Results

The intervention group showed significantly better outcome scores than the control group from baseline to 3 months postpartum for PSE (mean difference, MD, 0.37; 95% CI 0.06 to 0.68; P=.02), parental bonding (MD −1.32; 95% CI −1.89 to −0.75; P<.001), self-perceived social support (MD 0.69; 95% CI 0.18 to 1.19; P=.01), parenting satisfaction (MD 1.40; 95% CI 0.86 to 1.93; P<.001), and PND (MD −0.91; 95% CI −1.34 to −0.49; P<.001). Postnatal anxiety (PNA) scores of the intervention group were only significantly better after adjusting for covariates (MD −0.82; 95% CI −1.15 to −0.49; P<.001).

Conclusions

The technology-based SEPP is effective in enhancing parental bonding, PSE, perceived social support and parental satisfaction, and in reducing PND and PNA. Health care professionals could incorporate it with existing hands-on infant care classes and routine care to better meet parents’ needs and create positive childbirth experiences, which may in turn encourage parents to have more children.

Trial Registration

ISRCTN Registry ISRCTN48536064; http://www.isrctn.com/ISRCTN48536064 (Archived by WebCite at http://www.webcitation.org/6wMuEysiO).

Exploring the Transition to Fatherhood: Feasibility Study Using Social Media and Machine Learning

BACKGROUND

Fathers' experiences across the transition to parenthood are underreported in the literature. Social media offers the potential to capture fathers' experiences in real time and at scale while also removing the barriers that fathers typically face in participating in research and clinical care.

OBJECTIVE

This study aimed to assess the feasibility of using social media data to map the discussion topics of fathers across the fatherhood transition.

METHODS

Discussion threads from two Web-based parenting communities, r/Daddit and r/PreDaddit from the social media platform Reddit, were collected over a 2-week period, resulting in 1980 discussion threads contributed to by 5853 unique users. An unsupervised machine learning algorithm was then implemented to group discussion threads into topics within each community and across a combined collection of all discussion threads.

RESULTS

Results demonstrated that men use Web-based communities to share the joys and challenges of the fatherhood experience. Minimal overlap in discussions was found between the 2 communities, indicating that distinct conversations are held on each forum. A range of social support techniques was demonstrated, with conversations characterized by encouragement, humor, and experience-based advice.

CONCLUSIONS

This study demonstrates that rich data on fathers' experiences can be sourced from social media and analyzed rapidly using automated techniques, providing an additional tool for researchers exploring fatherhood.

Paternal psychological distress, parenting, and child behaviour: A population based, cross-sectional study

BACKGROUND

Child behaviour problems are common and can lead to later mental health problems. Poor maternal mental health and adverse parenting practices are known risk factors for child behaviour problems. Less is known about the association between paternal mental health and parenting, and child behaviour. We aimed to explore the association between paternal psychological distress and parenting (harsh discipline, low warmth, unreasonable expectations, and overinvolved/protectiveness) with children's internalising and externalising behaviour at 3 years of age.

METHODS

Cross-sectional surveys of 669 (80% response) fathers of 3-year-old children, nested within a randomised controlled trial. Main outcomes of behaviour (Child Behavior Checklist), parenting (Parent Behavior Checklist and overinvolved/protective parenting scale), and psychological distress (Kessler-6) were measured. Regression modelling examined the associations between paternal factors and child behaviour, adjusting for maternal mental health and parenting, as well as child and family variables.

RESULTS

In adjusted analyses, paternal psychological distress (b = 0.43, 95% confidence interval [CI] [0.26-0.60], p < 0.001), harsh discipline (b = 0.20, 95% CI [0.13-0.27], p < 0.001), and maternal mental health (b = 0.08, 95% CI [0.03-0.12], p = 0.001) were associated with externalising symptoms. However, only paternal psychological distress, harsh discipline, and being a boy were associated with borderline/clinical levels of externalising problems (all p < 0.05). Paternal psychological distress, harsh discipline, overinvolved parenting, maternal mental health, and difficult child temperament were associated with internalising symptoms (all p < 0.05). However, only paternal harsh discipline and overinvolved parenting were associated with borderline/clinical internalising problems.

CONCLUSIONS

Paternal mental health and parenting are independently associated with child behaviour. Treatments for children with behavioural problems should also address paternal mental health and parenting.

Focus on fathers: paternal depression in the perinatal period

Aims:

This report aims to present a concise overview and synthesis of current research findings regarding paternal depression in the perinatal period.

Methods:

A literature search was conducted, primarily via PubMed and PsychNET, for English-language research studies and meta-analyses using combinations of the terms ‘perinatal’, ‘pregnancy’, ‘postpartum’, ‘depression’ AND ‘fathers’ OR ‘paternal’. Peer-reviewed articles were considered, and a representative sample of literature, with an emphasis on recent publications from a broad range of populations was summarized for each of the following sub-sections: prevalence, risk factors, impact on the infant/child, and healthcare costs.

Results:

Reported prevalence has ranged from 2.3% to 8.4%, with a significant degree of heterogeneity in rates, due to differences in multiple aspects of the methodology (timing, instruments, etc.). Nevertheless, rates of maternal depression remain higher than paternal depression, and higher rates of one are associated with higher rates of the other. The primary risk factors for paternal depression are maternal depression and the father’s history of severe depression, or symptoms of depression or anxiety prenatally. Biological mechanisms may underlie paternal depression, with changes reported in testosterone, cortisol and prolactin levels during this period. Paternal depression has been related to children’s behavioral, emotional and social function at 36 months and psychiatric disorders at 7 years, adjusting for maternal depression. Healthcare costs may also be impacted by paternal postpartum depression, with higher father–child dyad costs found after controlling for potential confounders.

Conclusions:

Focusing on fathers’ emotional well-being in the perinatal period is important in itself, as well as for their wives and children. Programs recommending screening for maternal perinatal mood and anxiety disorders should include inquiry regarding the father’s emotional state, and if his distress is reported it should be clarified and followed-up by support and intervention as necessary.

Early Childhood Mental Health: Starting Early with the Pregnant Mother

Perinatal mental health has important implications for maternal and child outcomes. Most women with psychiatric disorders during pregnancy go undiagnosed and untreated, despite widespread initiatives for early identification. Universal screening for psychiatric disorders, particularly depression and anxiety, has been implemented in obstetric and primary care settings. However, there is little evidence regarding the effectiveness on psychiatric symptom reduction or prevention of adverse outcomes in children. Recently, comprehensive screening and follow-up programs integrated within obstetric or primary care settings have shown promising results in improving maternal mental health outcomes. Further work is needed to determine best clinical and most cost-effective practices.

Perinatal and infant mental health in Australia: moving forward towards REAL prevention and early intervention - can we do it?

OBJECTIVES

Australia has been at the forefront of appropriate early intervention. Prevention of mental illness in infants by early identification and intervention in the mental health of their mothers has stalled since the cessation of funding through the National Perinatal Depression Initiative (NPDI, 2009-2015). Whilst screening for maternal mental illness has been widely implemented throughout Australia during the last two decades, services are now diminishing and great opportunities to ride the crest of a wave for appropriate mental illness intervention are receding. Reviews of history and interventions internationally may help guide future directions.

CONCLUSIONS

Advocacy through across-agency and across-political-party support has been markedly successful for perinatal and infant mental health in the United Kingdom. A solid foundation exists in Australia. Australian psychiatrists have the ability to continue to change the face of prevention and early intervention.