Paternal Mental Health: Why Is It Relevant?

Maternal and paternal depressive symptoms and children's emotional problems at the age of 2 and 5 years: a longitudinal study

BACKGROUND

Maternal and paternal depressive symptoms are related to children's emotional problems, but their combined effect remains unclear. Here, we constructed four parental longitudinal depressive symptom trajectory groups and studied their associations with children's emotional problems at the age of 2 and 5 years.

METHODS

We did an assessment of maternal and paternal depressive symptoms (gestational week 32, as well as 3, 8 and 24 months postnatally) and children's emotional problems at ages two (N = 939) and five (N = 700) in the CHILD-SLEEP cohort. Three separate maternal and paternal depressive symptom trajectories based on latent profile analysis were combined to form four parental depressive symptom trajectory groups. We compared groups with a general linear model, with children's emotional (total, internalizing and externalizing) - problem scores serving as the dependent variables.

RESULTS

At both ages, combined parental depressive symptom trajectories were associated with children's emotional problems: effect sizes were medium for total and small for other domains. According to post hoc comparisons, children whose mothers or both parents had persistent depressive symptoms had significantly more total, externalizing and internalizing problems than did children who had neither parent nor only the father showing depressive symptoms. A higher (and persistent) level of maternal depressive symptoms was related to a higher level of these children's emotional problems, a pattern not evident with paternal depressive symptoms. In all analyses, the interaction effect was nonsignificant between parental trajectories and child gender.

CONCLUSIONS

Findings suggest that an absence of depressive symptoms in their fathers cannot compensate for the adverse effects of maternal depressive symptoms upon their children. Moreover, paternal depressive symptoms alone do not lead to increased risk for emotional problems in these 2- and 5-year-old children. In contrast, even subclinical levels of maternal depressive symptoms in late pregnancy are associated with increased risk for their children's experiencing internalizing and externalizing emotional problems.

The Long-Term Impact of Maternal Anxiety and Depression Postpartum and in Early Childhood on Child and Paternal Mental Health at 11-12 Years Follow-Up

BACKGROUND

Postpartum maternal anxiety and depression can affect child development and family functioning. However, the long-term impact of postpartum maternal anxiety and depression on child and paternal mental health is understudied. The present large-scale prospective cohort study is one of the first to investigate whether maternal anxiety and depressive symptoms postpartum and at child age 5-6 years separately and synergistically increase paternal anxiety and depressive symptoms and child emotional problems in early adolescence at age 11-12 years. Secondly, we investigated whether concurrent paternal anxiety and depressive symptoms at child age 11-12 years moderated the association between maternal anxiety and depressive symptoms in the postpartum period and at child age 5-6 years with child emotional problems at age 11-12 years.

METHODS

This study is part of the Amsterdam Born Children and Development (ABCD) cohort study, the Netherlands (N = 2.298). Maternal postpartum anxiety and depressive symptoms were assessed using the State-Trait Anxiety Inventory (STAI) and the Center for Epidemiologic Studies Depression Scale (CES-D) at 13 weeks postpartum. Maternal anxiety and depressive symptoms at child age 5-6 years and parental anxiety and depressive symptoms at 11-12 years were assessed using the Depression Anxiety Stress Scale (DASS-21). Child emotional problems were reported by the child and a teacher using the Strengths and Difficulties Questionnaire (SDQ). Multivariable linear regression was conducted, adjusted for demographic, perinatal/obstetric confounders, and affective symptoms of the other family members at 11-12 years.

RESULTS

Neither maternal anxiety nor depressive symptoms were related to paternal depressive symptoms at child age 11-12 years, while maternal postpartum depressive symptoms, depressive symptoms at 5-6 years and maternal anxiety at 5-6 years were positively related to paternal anxiety at 11-12 years. However, effect sizes were small. Only maternal postpartum depression was positively but weakly associated with more child emotional problems at 11-12 years. Although paternal concurrent affective symptoms were positively related to more child emotional problems in early adolescence, they did not moderate the association between maternal symptoms and child emotional problems.

CONCLUSIONS

Our results indicate that fathers and children seem to be affected only to a small extent by maternal postpartum anxiety or depression.

Prevalence, symptomatology, risk factors and healthcare services utilization regarding paternal depression in Germany: study protocol of a controlled cross-sectional epidemiological study

BACKGROUND

While postpartum depression is a well-researched disorder in mothers, there is growing evidence indicating that some fathers also develop depressive symptoms (paternal postpartum depression, PPD). A recent meta-analysis revealed a total prevalence of paternal depression during pregnancy and up to one year postpartum of 8.4%, with significant heterogeneity observed among prevalence rates. International studies suggest that PPD is characterized by additional symptoms compared to maternal postpartum depression. Furthermore, various risk factors of PPD have been identified. However, the prevalence, symptomatology, risk factors and healthcare situation of fathers affected by PPD in Germany are unknown.

METHODS/DESIGN

This study comprises a controlled, cross-sectional epidemiological survey administered via postal questionnaires. The primary objective is to compare the prevalence of depressive symptoms in fathers with a 0-12-month-old infant to the prevalence of depressive symptoms in men without recent paternity. Two structurally differing regions (concerning birthrate, employment status, socioeconomic structure, and nationality of inhabitants) will be included. A random sample of 4600 fathers (2300 in each region) in the postpartum period and 4600 men without recent paternity matched by age, nationality and marital status will be assessed regarding depressive symptoms using the PHQ-9. Contact data will be extracted from residents' registration offices. As secondary objectives, the study aims to provide insights into symptoms and risk factors of PPD in fathers and to assess the current healthcare situation of fathers with PPD in Germany. In an add-on study, genetic and epigenetic mechanisms of PPD will be explored.

DISCUSSION

This study will conduct the first direct comparison between fathers in the postpartum period of one year after childbirth and a matched sample of men without a newborn child. Besides closing this research gap, the findings will provide prevalence estimates as well as insights into specific symptomatology, risk factors, and the current healthcare situation regarding fathers with PPD in Germany. The results will identify low-threshold approaches as a relevant issue for healthcare. Moreover, the findings should inform the development of PPD-specific screening instruments and healthcare offers addressing fathers with PPD.

TRIAL REGISTRATION

German Clinical Trials Register (DRKS): DRKS00013339 ; Trial registration date: August 20, 2018; Universal Trial Number (UTN): U1111-1218-8185.

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.

Impact of paternal deployment to the conflicts in Iraq and Afghanistan and paternal post-traumatic stress disorder on the children of military fathers

BACKGROUND

Little is known about the social and emotional well-being of children whose fathers have been deployed to the conflicts in Iraq/Afghanistan or who have post-traumatic stress disorder (PTSD).AimsTo examine the emotional and behavioural well-being of children whose fathers are or have been in the UK armed forces, in particular the effects of paternal deployment to the conflicts in Iraq or Afghanistan and paternal PTSD.

METHOD

Fathers who had taken part in a large tri-service cohort and had children aged 3-16 years were asked about the emotional and behavioural well-being of their child(ren) and assessed for symptoms of PTSD via online questionnaires and telephone interview.

RESULTS

In total, 621 (67%) fathers participated, providing data on 1044 children. Paternal deployment to Iraq or Afghanistan was not associated with childhood emotional and behavioural difficulties. Paternal probable PTSD were associated with child hyperactivity. This finding was limited to boys and those under 11 years of age.

CONCLUSIONS

This study showed that adverse childhood emotional and behavioural well-being was not associated with paternal deployment but was associated with paternal probable PTSD.Declaration of interestN.T.F. is a trustee of the Warrior Programme, a charity supporting ex-service personnel and their families. She is also a member of the Independent Group Advising on the Release of Data (IGARD). S.W. is a trustee of Combat Stress, a charity supporting ex-service personnel and their families, and President of the Royal Society of Medicine. S.W. is partially funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Emergency Preparedness and Response at King's College London in partnership with Public Health England (PHE), in collaboration with the University of East Anglia and Newcastle University.

Engaging Fathers in the Promotion of Healthy Lifestyle Behaviors

Parental engagement is an important component in lifestyle behavior change interventions for children as parents are uniquely positioned to establish a healthy environment and model healthy eating and physical activity habits for their children. Despite both mothers and fathers being important agents of behavioral change for their children, fathers are typically underrepresented in programming interventions. Physical activity may be an important strategy for fathers to become involved in lifestyle change with their children as, compared to mothers, fathers traditionally tend to be comfortable engaging in physical activity with their children.

Paternal Physical Activity: An Important Target to Improve the Health of Fathers and their Children

Although the transition to fatherhood is joyful and fulfilling for many men, becoming a father also exposes men to a series of new challenges and responsibilities that can negatively affect their well-being. As such, effective strategies that foster positive physical and mental health in fathers are required. Given the established links between regular physical activity and optimal health, strategies to reduce the substantial decline in physical activity typically observed during the early fatherhood may be particularly fruitful. In this commentary, we discuss the potential mediating role of physical activity on a series of important outcomes for fathers, including paternal and child health and the quality of the father-child relationship. We also present an argument that high-quality research studies testing physical activity interventions that meaningfully engage fathers are urgently required.