Differential predictors of birth-related posttraumatic stress disorder symptoms in mothers and fathers - A longitudinal cohort study

Childbirth-related posttraumatic stress symptoms: exploring the predictive potential of intrapartum hotspots

Childbirth-related posttraumatic stress symptoms (CB-PTSS) affect around 12% of postpartum individuals. While the subjective experience of childbirth is a key predictor of CB-PTSS, the specific defining characteristics of negative birth experiences remain poorly understood. This study aims to refine our understanding of negative birth experiences by investigating intrapartum hotspots, i.e. moments of extreme distress, and their association with CB-PTSS. In a cross-sectional study of N = 1,140 individuals who had given birth eight to ten weeks before, we examined the following: the types of hotspots, differences in hotspot-related distress, interpersonal difficulties during the hotspot, and CB-PTSS between the various types of hotspots and whether hotspot-related distress and interpersonal difficulties independently predicted CB-PTSS. Participants completed several items based on previous qualitative work [1] to assess the worst hotspot, hotspot-related distress, and interpersonal difficulties during the hotspot and the City Birth Trauma Scale to measure CB-PTSS, alongside relevant pregnancy- and birth-related questions. Medical interventions were the most frequently experienced worst hotspot and separation from the child was associated with the highest levels of hotspot-related distress, interpersonal difficulties, and CB-PTSS. Hotspot-related distress and interpersonal difficulties independently predicted CB-PTSS. Examining intrapartum hotspots poses a promising approach to define highly negative birth experiences.

Birthing partners - validation of a questionnaire to assess the well-being of support persons

BACKGROUND

There is little research on the well-being of the persons giving support during childbirth and how they feel when doing this. The aim of this study is to validate a questionnaire that assesses the well-being of those support persons during childbirth. This publication focuses on the validation of the questionnaire; the development is described in more detail in a previous publication.

METHODS

After the questionnaire had been developed, it was sent online to a sample for validation. Subsequently, the internal consistency was determined to assess the reliability and the correlation with an external criterion in order to assess the criterion validity. Known-groups validation was used to assess the construct validity of the questionnaire. Linear regressions were carried out to analyse which variables influence well-being.

RESULTS

The results show good reliability and high criterion validity. The known-groups analyses identified group differences between the different birth modes regarding the different domains of well-being of the support persons. Factors influencing well-being are whether it is a first time or repeated support, whether the birthing woman is a primiparous or multiparous woman and whether the birth is vaginal or operative.

CONCLUSION

Our results suggest that this questionnaire adequately captures important aspects of the well-being of support persons during childbirth. The questionnaire is designed for all birth experiences. In the case of negative experience it can be used to assess additional support and counselling and thus potentially promote the mental health of the support persons preventively.

Prepartum working conditions predict mental health symptoms 14 months postpartum in first-time mothers and their partners - results of the prospective cohort study "DREAM"

BACKGROUND

During the vulnerable transition to parenthood, (expectant) parents may be particularly susceptible to the negative effects of adverse working conditions. However, research on the influence of work-related factors on peripartum mental health issues is scarce. This study aims to enhance our understanding of work-related risk factors for the adjustment of parents in the transition to parenthood by investigating the role of prepartum precarious employment, abusive supervision, job insecurity, and job demand on postpartum mental health symptoms in first-time mothers and their partners.

METHODS

In the prospective-longitudinal cohort study "DREAM", N = 1,259 mothers and N = 811 male and female partners were asked about their working conditions during pregnancy and their mental health 14 months postpartum. We conducted several hierarchical multiple regression analyses with prepartum precarious employment, abusive supervision, job insecurity, and job demand (the latter three in joint regression analyses) as predictors of postpartum symptoms of depression, somatization, obsessive-compulsiveness, anxiety, and anger/hostility. In Model 1 we controlled for sociodemographic variables, and in Model 2 we also controlled for pre-existing symptoms of the respective mental health variable during pregnancy. Separate analyses were calculated for mothers and partners, and each mental health outcome.

RESULTS

Multiple regression analyses revealed that prepartum precarious employment and abusive supervision predicted mothers' and partners' mental health symptoms 14 months postpartum even after controlling for pre-existing symptoms. Prepartum job insecurity and job demand also predicted mental health symptoms 14 months postpartum but were no longer significant predictors in most models after controlling for pre-existing mental health symptoms. There were only minor differences regarding the considered mental health outcomes and between mothers' and partners' results.

CONCLUSIONS

Our study demonstrates that adverse working conditions are important risk factors for the adjustment of parents in the transition to parenthood, requiring more attention from research and practice. Precarious employment and abusive supervision appear to be particularly important factors affecting new parents' mental health. Future research should investigate the mechanisms behind these variables, including comparisons between mothers and their partners, and the role of stress-related biomarkers. Additionally, developing screening methods for clinical use to facilitate targeted preventive interventions is essential.

Posttraumatic stress disorder prevalence and childbirth: update meta-analysis after the introduction of the DSM-5 and COVID-19 pandemic

PURPOSE

Meta-analyses were previously performed to estimate PTSD prevalence in the postpartum period. Significant events that could impact this outcome occurred in the last decade, such as the publication of the DSM-5 in 2013 and the COVID-19 pandemic in 2020. This systematic literature review with a meta-analysis addressed studies published after 2014 to estimate PTSD prevalence after childbirth.

METHOD

The methodological guidelines recommended by PRISMA were followed. The meta-analysis estimate was the proportion of PTSD cases. The restricted maximum likelihood (REML) was the method adopted for estimation in addition to multilevel random effect models. Subgroup analyses were performed to assess the impact of interest variables.

RESULTS

The estimated prevalence was 0.10 (95%CI: 0.8-0.13; I2 = 98.5%). No significant differences were found regarding the introduction of the DSM-5 (p = 0.73) or COVID-19 (p = 0.97), but instead, between low- and middle-income countries, e.g., the Middle East presents a higher prevalence (p < 0.01) than European countries.

CONCLUSIONS

There is a potential increase in PTSD prevalence rates after childbirth in the last decade not associated with the pandemic or the current diagnostic classification. Most studies showed a methodological fragility that must be overcome to understand this phenomenon better and support preventive actions and treatment for puerperal women.

Childbirth as a traumatic event for attendant fathers

Background: Negative reactions such as post-traumatic stress disorder (PTSD) following childbirth have been increasingly reported in mothers, particularly following objectively and subjectively difficult childbirth experiences. A small body of research has examined fathers' reactions to childbirth, with mixed results.Objective: The study aimed to further these studies, investigating whether objective and subjective aspects of fathers' participation in childbirth were related to levels of PTSD and fear of childbirth symptoms, in the first year following childbirth.Method: In total, 224 fathers whose partners had given birth within the previous 12 months answered online questionnaires that examined participation in childbirth, subjective appraisals, levels of fear of childbirth, and PTSD symptoms. Data were analysed using structural equation modelling, examining both direct and indirect effects.Results: Approximately 6% of fathers reported symptoms consistent with probable PTSD. Negative cognitions mediated the path between an emergency caesarean and PTSD. Fear of childbirth was related to emergency caesareans and lack of information from the medical team.Conclusions: Future studies should examine the level of fathers' participation, their subjective appraisal of childbirth, and fear of childbirth, when assessing fathers' reactions to childbirth.

The Social Context of Pregnancy, Respectful Maternity Care, Biomarkers of Weathering, and Postpartum Mental Health Inequities: A Scoping Review

Background: Mental health disorders are the number one cause of maternal mortality and a significant maternal morbidity. This scoping review sought to understand the associations between social context and experiences during pregnancy and birth, biological indicators of stress and weathering, and perinatal mood and anxiety disorders (PMADs). Methods: A scoping review was performed using PRISMA-ScR guidance and JBI scoping review methodology. The search was conducted in OVID Medline and Embase. Results: This review identified 74 eligible English-language peer-reviewed original research articles. A majority of studies reported significant associations between social context, negative and stressful experiences in the prenatal period, and a higher incidence of diagnosis and symptoms of PMADs. Included studies reported significant associations between postpartum depression and prenatal stressors (n = 17), socioeconomic disadvantage (n = 14), negative birth experiences (n = 9), obstetric violence (n = 3), and mistreatment by maternity care providers (n = 3). Birth-related post-traumatic stress disorder (PTSD) was positively associated with negative birth experiences (n = 11), obstetric violence (n = 1), mistreatment by the maternity care team (n = 1), socioeconomic disadvantage (n = 2), and prenatal stress (n = 1); and inverse association with supportiveness of the maternity care team (n = 5) and presence of a birth companion or doula (n = 4). Postpartum anxiety was significantly associated with negative birth experiences (n = 2) and prenatal stress (n = 3). Findings related to associations between biomarkers of stress and weathering, perinatal exposures, and PMADs (n = 14) had mixed significance. Conclusions: Postpartum mental health outcomes are linked with the prenatal social context and interactions with the maternity care team during pregnancy and birth. Respectful maternity care has the potential to reduce adverse postpartum mental health outcomes, especially for persons affected by systemic oppression.

Childbirth-related posttraumatic stress symptoms - examining associations with hair endocannabinoid concentrations during pregnancy and lifetime trauma

Evidence has linked alterations of the endocannabinoid system with trauma exposure and posttraumatic stress disorder (PTSD). Childbirth-related PTSD symptoms (CB-PTSS) affect about every eighth woman and can negatively influence the entire family. While aetiological models of CB-PTSD include psychological risk factors such as maternal trauma history and negative subjective birth experience (SBE), they lack biological risk indicators. We investigated whether lifetime trauma and CB-PTSS were associated with long-term endocannabinoid concentrations during pregnancy. Further, we tested endocannabinoids as mediators between lifetime trauma and CB-PTSS and whether SBE moderated such mediational paths. Within the prospective cohort study DREAMHAIR, 263 expectant mothers completed trauma assessments and provided hair samples for quantification of long-term endocannabinoid levels (anandamide [AEA], 2-arachidonoylglycerol [1-AG/2-AG], and N-acyl-ethanolamides [NAE]) prior to their anticipated birth date. Two months postpartum, CB-PTSS and SBE were measured. Regression models controlling for relevant confounders showed no association between lifetime trauma and hair endocannabinoids during pregnancy, yet higher number of lifetime trauma events and lower hair AEA were significantly associated with CB-PTSS, with the latter finding not remaining significant when Bonferroni corrections due to multiple testing were applied. While hair AEA did not mediate the association between lifetime trauma and CB-PTSS, the effect of lower hair AEA on CB-PTSS was stronger upon negative SBE. Results suggest greater lifetime trauma and reduced maternal hair AEA during pregnancy may be associated with increased risk for CB-PTSS, particularly upon negative SBE. Findings confirm lifetime trauma as a CB-PTSS risk factor and add important preliminary insights on the role of endocannabinoid ligand alterations and SBE in CB-PTSS pathology.

Maternal postpartum depressive symptoms: The predictive role of objective and subjective birth experience and hair glucocorticoids

BACKGROUND

Having a negative childbirth experience is a known risk-factor for developing postpartum depression (PPD). Alterations of the hypothalamus-pituitary-adrenal (HPA)-axis have been discussed as a potential underlying mechanism. However, research on the association between negative birth experiences and long-term integrated glucocorticoids (GCs) is lacking. This study aimed to examine whether objective and subjective birth experience predicted long-term GCs and PPD symptoms.

METHODS

Measures of objective and subjective birth experience, PPD symptoms, and hair strands for the assessment of hair cortisol concentrations (HairF), hair cortisone concentrations (HairE), and HairF/HairE ratio, were provided eight weeks after childbirth by 235 mothers participating in the study DREAMHAIR.

RESULTS

A negative objective birth experience predicted a higher HairF/HairE ratio but was not associated with HairF or HairE. The subjective birth experience did not explain additional variance in hair GCs but was a significant predictor for PPD symptoms. A higher HairF/HairE ratio predicted PPD symptoms when controlling for prepartum depressive symptoms and number of lifetime traumatic events.

LIMITATIONS

Analyses were based on a relatively homogeneous sample and women reported in general positive birth experiences and low levels of depressive symptoms. Therefore, results should be applied to the broader population with caution.

CONCLUSIONS

Our results suggest that negative objective birth experience is associated with an altered HairF/HairE ratio, which in turn, seems to be a promising biomarker to identify women at risk for developing PPD. A negative subjective birth experience may be less critical for alterations of the HPA-axis but remains an essential risk factor for PPD.

[Fathers and peripartum mental illness: the neglected parent?]

Fathers also play an important role during pregnancy and the postpartum period, both for the partner and for the child. With changes in society and increasing early involvement in the care of infants, the father-child relationship has become increasingly more important in recent years. There is growing evidence that fathers can also suffer from mental illnesses during their partner's pregnancy and especially after the birth of a child. As the transition to the role of a father is a major change in a man's life, the birth of a child can be a life event that contributes to a first time mental illness or triggers a new episode of an already existing illness. For example, birth complications can also traumatize the attendant fathers and result in trauma sequelae. Peripartum anxiety disorders and depression probably affect approximately 5% of all men and can among other things have a negative impact on the development of exposed children. Specific screening or even treatment services for affected men are still very rare and little research has been performed. Much less is known about the prevalence, risk factors, and treatment of other mental illnesses in fathers, and there is still a great need for research in this respect.

Understanding Attrition in Text-Based Health Promotion for Fathers: Survival Analysis

BACKGROUND

Web-based interventions targeting parents with health and parenting support frequently report high rates of attrition. The SMS4dads text messaging program, developed in Australia, has delivered texts to over 10,000 fathers. The brief text messages, which are sent 3 times per week from 16 weeks of gestation to 48 weeks after birth, include regular reminders that participants can leave the program by texting back "STOP" to any message. Although acceptance of the program is high, almost 1 in 5 ask it to be removed. Analyzing the factors influencing attrition from digital parenting programs such as SMS4dads may assist in developing more effective interventions.

OBJECTIVE

This study aimed to examine factors associated with attrition in a text-based intervention targeting fathers.

METHODS

Demographic characteristics, requests to complete a psychological scale, individual message content, participant feedback, and automatically collected data registering clicks on links embedded in the texts were examined to identify attrition factors among 3261 participants enrolled in SMS4dads from 4 local health districts in New South Wales, Australia, between September 2020 and December 2021.

RESULTS

Participants who were smokers, recorded risky alcohol consumption, had a lower education level, or signed up prenatally had 30% to 47% higher hazard of dropout from the program, whereas participant age, Aboriginal or Torres Strait Islander status, rurality, and psychological distress score (as Kessler Psychological Distress Scale [K10] category) were not associated with dropout. Primary reasons for dropping out reported by 202 of 605 respondents included "other reasons" (83/202, 41.1%), followed by "not helpful" (47/202, 23.3%) and "too busy" (44/202, 21.8%). Program features such as repeated requests to complete a psychological scale (K10) and the content of individual messages were not linked to increased dropout rates. Analysis of a sample (216/2612) of inactive participants who had not engaged (clicked on any embedded links) for at least 10 weeks but who had not opted out identified a further 1.5% of participants who would opt to leave the program if asked.

CONCLUSIONS

Identifying which features of the participant population and of the program are linked to dropout rates can provide guidance for improving program adherence. However, with limited information from feedback surveys of those exiting early, knowing which features to target does not, by itself, suggest ways to increase engagement. Planning ahead to include robust measures of attrition, including more detailed feedback from participants, could provide more effective guidance. A novel element in this study was seeking feedback from inactive participants to estimate dropout from this group and thereby provide an overall dropout rate of 20%. The retention rate of 80%, relatively high compared with other web-based parenting programs for fathers, suggests that tailoring the content to specifically address fathers' role may be an important consideration in reducing fathers' disengagement.

The impact of mode of delivery on parent-infant-bonding and the mediating role of birth experience: a comparison of mothers and fathers within the longitudinal cohort study DREAM

BACKGROUND

The association between mode of delivery (MOD) and parent-infant-bonding has only been studied in mothers and findings have been inconclusive. The aim of this study was to prospectively investigate how MOD relates to postpartum parent-infant-bonding in both mothers and fathers and whether these associations are mediated by birth experience.

METHODS

This study is part of the prospective cohort study "Dresden Study on Parenting, Work, and Mental Health" (DREAM). Our sample comprised N = 1,780 participants who completed quantitative questionnaires during pregnancy as well as 8 weeks and 14 months postpartum. MOD was dummy coded, contrasting spontaneous vaginal delivery against vaginal delivery induced by drugs, operative vaginal delivery, planned, and unplanned cesarean section. Parent-infant bonding and birth experience were assessed using validated scales. A moderated mediation analysis based on ordinary least square (OLS) regression and bootstrapped estimates was conducted, considering relevant confounding variables.

RESULTS

Compared to spontaneous vaginal delivery, all categories of MOD predicted more negative birth experiences in both parents. A more positive birth experience predicted stronger parent-infant-bonding at 8 weeks, but not at 14 months postpartum. Mothers who delivered via cesarean section (planned or unplanned) reported stronger parent-infant-bonding at 8 weeks and 14 months postpartum. In fathers, only unplanned cesarean section was associated with stronger parent-infant-bonding at 8 weeks postpartum. At 8 weeks postpartum, birth experience mediated the association between a vaginal delivery induced by drugs and a planned cesarean section and mother-infant-bonding and between a vaginal delivery induced by drugs, an operative vaginal delivery, and planned cesarean section and father-infant-bonding. At 14 months postpartum, birth experience mediated the association between a vaginal delivery induced by drugs, operative vaginal delivery, and planned cesarean section and parent-infant-bonding in both parents.

CONCLUSIONS

The results emphasize the importance of the birth experience for parent-infant-bonding in both mothers and fathers. Further research should address the mechanisms by which parents with an unplanned cesarean section establish stronger parent-infant-bonding compared to parents whose baby was delivered via spontaneous vaginal delivery, despite their overall more negative birth experiences.

Hair glucocorticoids during pregnancy in the context of trauma exposure and their predictive value for the development of childbirth-related posttraumatic stress disorder symptoms

BACKGROUND

Childbirth-related posttraumatic stress disorder (CB-PTSD) is gaining attention as a mental disorder with negative sequela for mothers and their offspring. Maternal trauma history is a well-known vulnerability factor for CB-PTSD symptoms (CB-PTSS). Furthermore, alterations of the hypothalamus-pituitary-adrenal axis have been linked to both trauma exposure and PTSD development. Hence, we investigated whether trauma history was associated with long-term glucocorticoid (GC) levels during pregnancy and their predictive role for CB-PTSS. Further, we examined whether GCs act as a mediator in the relationship between trauma history and CB-PTSS and whether this was moderated by the subjective birth experience.

METHODS

212 women participating in the prospective cohort study DREAM_HAIR provided hair samples for quantification of long-term integrated cortisol and cortisone levels prior to their anticipated birth date accompanied by measures of trauma history. CB-PTSS and subjective birth experience were assessed two months postpartum.

FINDINGS

Trauma history predicted elevated hair cortisol and hair cortisone during the third trimester of pregnancy, however associations did not remain significant when Bonferroni correction due to multiple testing was applied. Trauma history also predicted higher CB-PTSS. Hair GC levels during pregnancy neither predicted CB-PTSS two months after birth nor mediated the relationship between trauma history and CB-PTSS. The subjective birth experience moderated the relationship of hair cortisol and cortisone with CB-PTSS.

CONCLUSION

Our data suggest that a history of trauma contributes to a higher risk to develop CB-PTSS and elevated long-term GC levels during the third pregnancy trimester. Further, the predictive role of hair cortisol and cortisone levels for CB-PTSS may depend on subjective birth experience. This highlights the need to consider the latter in future investigations when examining the role of stress-related biomarkers in more severely affected samples.

Depressive Symptoms in Expecting Fathers: Is Paternal Perinatal Depression a Valid Concept? A Systematic Review of Evidence

BACKGROUND

Since the identification of Couvade syndrome in the late 1950s, little attention has been dedicated to the issue of depression in expecting fathers.

OBJECTIVE

To quantify the extent of depression in expecting fathers and find out if they match their pregnant partners' depression.

METHODS

We conducted a PubMed and ClinicalTrials.gov search using paternal depression and all its variants as terms. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement to include eligible studies.

RESULTS

We identified a grand total of 1443 articles, of which 204 were eligible. The total number of fathers/expecting fathers involved was 849,913. Longitudinal studies represented more than half of the included studies; more than three-quarters of the studies used the Edinburgh Postnatal Depression Scale (EPDS). The average occurrence of paternal depression was around 5%, which confers the entity some clinical dignity. Depression tends to occur more in expecting women and new mothers than in expecting partners or new fathers, while the co-occurrence in the same couple is quite low.

LIMITATIONS

The methodological heterogeneity of the included studies prevents us from meta-analyzing the obtained data. The validity of the instruments used is another issue.

CONCLUSIONS

Paternal depression is distinct from maternal depression and occurs at lower rates (about half). The very existence of a paternal depression clinical entity is beyond any doubt. Future research should address methodological heterogeneity.

It's About Time: The Circadian Network as Time-Keeper for Cognitive Functioning, Locomotor Activity and Mental Health

A variety of organisms including mammals have evolved a 24h, self-sustained timekeeping machinery known as the circadian clock (biological clock), which enables to anticipate, respond, and adapt to environmental influences such as the daily light and dark cycles. Proper functioning of the clock plays a pivotal role in the temporal regulation of a wide range of cellular, physiological, and behavioural processes. The disruption of circadian rhythms was found to be associated with the onset and progression of several pathologies including sleep and mental disorders, cancer, and neurodegeneration. Thus, the role of the circadian clock in health and disease, and its clinical applications, have gained increasing attention, but the exact mechanisms underlying temporal regulation require further work and the integration of evidence from different research fields. In this review, we address the current knowledge regarding the functioning of molecular circuits as generators of circadian rhythms and the essential role of circadian synchrony in a healthy organism. In particular, we discuss the role of circadian regulation in the context of behaviour and cognitive functioning, delineating how the loss of this tight interplay is linked to pathological development with a focus on mental disorders and neurodegeneration. We further describe emerging new aspects on the link between the circadian clock and physical exercise-induced cognitive functioning, and its current usage as circadian activator with a positive impact in delaying the progression of certain pathologies including neurodegeneration and brain-related disorders. Finally, we discuss recent epidemiological evidence pointing to an important role of the circadian clock in mental health.

[Association of postpartum depression with postpartum posttraumatic stress disorder in Korean mothers: a longitudinal survey]

Purpose

This study aimed to determine the level of postpartum posttraumatic stress disorder (PTSD) and postpartum depression (PPD) in Korean mothers with healthy babies and to explore the factors related to postpartum PTSD.

Methods

This study used a longitudinal survey design to explore the levels and association of PPD and PTSD. Two hundred women were recruited during pregnancy and the data were collected via online survey from 166 mothers (84% retained) who gave birth to healthy babies, at two postpartum periods: Fear of childbirth was assessed at the 1st week; and spousal support, PPD, and postpartum PTSD were surveyed at the 4th week postpartum. Descriptive statistics, t-test, one-way analysis of variance, Chi square test, and multiple regression were done.

Results

The mean age of mothers was 33.12 (±3.97) years old. Postpartum PTSD was low (8.95±6.49) with 1.8% (n=3) at risk (≥19). PPD was also low (6.68±5.28) and 30.1% (n=50) were identified at risk (≥10). The comorbid rate of PPD with PTSD was 6%. Mothers who did not have a planned pregnancy had higher scores of PPD (t=-2.78, p=.008), whereas spousal support and PPD had negative relationship (r=-.21, p=.006). The overall explanatory power for postpartum PTSD was 55.2%, of which PPD was the only significant variable (β=.76, t=13.76, p<.001).

Conclusion

While only 1.8% was at risk of postpartum PTSD at 4 weeks postpartum, PPD prevalence was 30.1% and PPD was the only influential factor of postpartum PTSD. Assessment and counseling of PPD are required as well as screening for postpartum PTSD. More research is also needed on postpartum PTSD in Korean women.

Physical and mental health changes in the five years before and five years after childbirth: A population-based panel study in first-time mothers and fathers from Germany

BACKGROUND

The transition to parenthood is characterized by far-reaching changes in life. However, little prospective-longitudinal evidence from general population samples exists on changes of general physical and mental health in the years around the birth of a child among mothers and fathers.

METHODS

Using data from the German Socio-Economic Panel Study (SOEP), this study examined continuous and discontinuous short- and long-term changes of general physical and mental health from five years before until five years after the birth of the first child in women (N = 1,912) and men (N = 1,742). Whether a child was born was assessed annually throughout the study. Physical and mental health was assessed biannually from 2002 to 2018 with the SF-12v2.

RESULTS

Multilevel analyses revealed that women experienced a considerable decrease of physical health during pregnancy, which remitted after delivery. On average, women's mental health increased in the last year before and first year after delivery. These mental health improvements were stronger in older vs. younger mothers and remained largely stable in the years after childbirth. In contrast, little evidence for changes of general physical or mental health in (expectant) fathers was found.

LIMITATIONS

Physical and mental health was assessed with a short questionnaire only (SF-12v2).

CONCLUSIONS

On average, women's mental health tends to improve before and after the birth of the first child. Men seem to be much less affected by the birth of a child than many previous studies suggest.