Paternal perinatal stress is associated with children's emotional problems at 2 years

Mobile app-based intervention for paternal perinatal depression, anxiety, and stress: A randomised controlled trial

BACKGROUND

Paternal perinatal mental health significantly impacts family outcomes, yet fathers are often overlooked and underserved in mental health services. This study evaluates the efficacy of a mindfulness-based cognitive behaviour therapy intervention delivered via mobile app to address paternal perinatal depression, anxiety, and stress symptoms.

METHOD

A randomised controlled trial was conducted with perinatal fathers experiencing moderate depression, anxiety, or stress symptoms. Participants were assigned to either the Rover app mindfulness-based CBT intervention (n = 81) or an active control app, moodmonitor (n = 75). Primary outcomes were depression (EPDS), anxiety, and stress (DASS21); secondary outcomes included social support, parenting self-efficacy, and couple relationship quality. Post-test analysis occurred at four weeks, with an additional eight-week follow-up for the intervention group.

RESULTS

Contrary to hypotheses, no differences were found between groups for depression, anxiety, and stress symptoms. Both groups showed significant reductions in anxiety (intervention d = -1.7, control d = -1.94) and stress (intervention d = -2.9, control d = -2.8) and improved couple relationship quality. Rover users maintained improvements at 8-week follow-up. Fathers with severe baseline depression experienced greater reductions in depression using the Rover app (b = 5.36, p < 0.01).

LIMITATIONS

Low adherence to the intervention and moderate attrition over the study duration.

CONCLUSIONS

Although the intervention was acceptable to fathers, treatment adherence was low, highlighting the need for more engaging content. App-based interventions show potential benefits for paternal mental health, but user engagement must be improved. This study contributes to the growing literature on digital interventions for fathers' mental health and emphasizes the importance of including fathers in perinatal mental health research.

TRIAL REGISTRATION

Australian and New Zealand Clinical Trials Registry: ACTRN12621000275864.

Paternal Perinatal Depression, Anxiety, and Stress and Child Development: A Systematic Review and Meta-Analysis

Importance

This systematic review and meta-analysis comprehensively synthesizes the extant literature on the association of paternal perinatal mental distress (ie, depression, anxiety, and stress) with offspring development from birth to adolescence.

Objective

To provide a meta-analytic synthesis of the literature on the association between paternal perinatal depression, anxiety, and stress and offspring development during the first 18 years of life.

Data Sources

We searched MEDLINE Complete, Embase, PsycINFO, CINAHL Complete, and the gray literature for studies published up to November 2024.

Study Selection

Inclusion criteria included availability in English, a human sample, quantitative data, longitudinal design, and having a measure of paternal perinatal mental distress and offspring development.

Data Extraction and Synthesis

Of the 9572 studies identified, 48 cohorts (from 84 studies) with 674 effect sizes met criteria for quantitative synthesis (including 286 unpublished associations sourced from doctoral theses or through contact with authors of eligible studies). Univariate random-effects models were used to quantitatively synthesize the associations between paternal perinatal mental distress and offspring development. Study quality was assessed using the US National Institutes of Health quality assessment tool for observational, cohort, and cross-sectional studies. Data analysis was completed in January 2025.

Main Outcomes and Measures

The primary outcomes were global, social-emotional, adaptive, cognitive, language, physical, and motor development in offspring in the first 18 years of life.

Results

Paternal perinatal mental distress was associated with poorer global (r = -0.12; 95% CI, -0.22 to -0.01), social-emotional (r = 0.09; 95% CI, 0.07-0.11), cognitive (r = -0.07; 95% CI, -0.13 to -0.01), language (r = -0.15; 95% CI, -0.25 to -0.05), and physical development (r = 0.04; 95% CI, 0.00-0.08) in offspring. No evidence was found for adaptive and motor outcomes. Associations were generally stronger for postnatal than antenatal mental distress, suggesting that a father's mental state may exert a more direct influence on the developing child after birth.

Conclusions and Relevance

Evidence from this systematic review and meta-analysis indicates that paternal mental distress is a potentially modifiable predictor of child development. Reducing mental distress in fathers perinatally is thus an important target for preventative interventions aiming to support fathers during the transition to parenthood and promote the health and well-being of next-generation offspring.

Paternal bonding in pregnancy and early parenthood: a qualitative study in first-time fathers

The birth of an infant marks a period of profound change in first-time parents. Parental love and warmth, however, already begin to develop during pregnancy. Also for fathers, the development of bonding to the infant may be a unique process. The current qualitative study aimed to explore views and experiences of first-time fathers on the origins and development of paternal bonding during pregnancy and early childhood. In total, 30 in-depth semi-structured interviews were conducted with expectant fathers (second or third trimester of pregnancy; n = 10) and fathers of infants (0-6 months postpartum; n = 11) and toddlers (2-3 years of age; n = 9). Two major themes were uncovered from the data: feelings of bonding and facilitators of bonding. The first theme was supported with three subthemes: 1) from abstract to concrete, 2) positive emotions, and 3) uncertainties and worries. The second theme, facilitators of bonding, was supported with four subthemes: 1) experiencing the foetus, 2) meeting the child, 3) interaction, and 4) communication. Similar to previous studies, our results suggested that, in most fathers, paternal bonding originates in pregnancy and that it evolves over time. Seeing or feeling the child, both during pregnancy and postpartum, as well as interacting or communicating with the child, appears to facilitate fathers' feelings of bonding. Involving fathers in pregnancy, childbirth, and parenting may be essential for their bonding process.

A Preliminary Investigation of Associations Between Traumatic Events Experienced During Pregnancy and Salivary Diurnal Cortisol Levels of Brazilian Adolescent Mothers and Infants

INTRODUCTION

Interpersonal violence against women is a major global health problem that may have intergenerational effects. This study investigated associations between maternal experiences of interpersonal violence and other traumatic events and maternal and infant salivary diurnal cortisol in a cohort of adolescent mothers in São Paulo, Brazil.

METHOD

Adolescent mothers (14-19 years) participating in a home-visiting intervention were interviewed retrospectively about lifetime and pregnancy violence and trauma exposure. Mothers collected saliva at waking and before bedtime from themselves (n = 23) and their infants (n = 32) at 12 months postpartum. Multivariable regression models were used to examine associations between trauma history variables and salivary diurnal cortisol.

RESULTS

Adjusting for the intervention group, infant sex, maternal age, non-supplement medication use, and sample collection time, we found that higher-than-average lifetime trauma exposure was associated with maternal evening cortisol (b = 0.472, p-value = 0.028). Lifetime assaultive violence exposure was also associated with maternal evening cortisol (b = 0.196, p-value = 0.02). Maternal exposure to traumatic events in pregnancy was positively associated with bedtime cortisol levels of infants (b = 0.21, p = 0.01). Trauma variables were not associated with maternal or infant morning cortisol levels.

CONCLUSION

Results suggest that maternal trauma history influences both maternal and infant postnatal cortisol regulation as indexed by evening cortisol levels. These results are consistent with models of fetal programming; however, future studies should investigate potential postnatal psychobiological pathways. Lifetime trauma exposure may also become embedded in the maternal hypothalamic-adrenal-pituitary axis regulation. Future studies are needed to consider other biological pathways in the intergenerational transmission of trauma.

Perinatal risk factors and subclinical hypomania: A prospective community study

BACKGROUND

Perinatal risk factors are implicated in the development of psychopathology, but their role in bipolar disorder (BD) and hypomania is unclear. Using data from a prospective community cohort, this is the first study to investigate the association between a range of perinatal risk factors, hypomanic symptoms, and 'high-risk' for BD in the general population.

METHODS

Parent report of perinatal events were available for 26,040 eighteen-month-olds from the Twins Early Development Study. Subsequent self-report hypomania was measured at ages 16 (Hypomania Checklist-16; N = 2943) and 26 (Mood Disorders Questionnaire; N = 7748). Participants were categorised as 'high-risk' for BD using established classifications. Linear and logistic regressions were conducted within a generalised estimating equations framework to account for relatedness in the sample.

RESULTS

Prenatal alcohol exposure (β = 0.08, SE = 0.04, p = .0002) and number of alcohol units consumed (β = 0.09, SE = 0.02, p < .0001) were associated with hypomanic symptoms at age 16, and number of alcohol units (OR = 1.13, 95 % CI:1.06-1.21, p = .0003) and maternal stress (OR = 1.68, 95 % CI:1.21-2.34, p = .002) were associated with 'high-risk' for BD age 16. Prenatal tobacco exposure (β = 0.10, SE = 0.04, p < .0001) and number of cigarettes smoked (β = 0.10, SE = 0.01, p < .0001) were associated with hypomanic symptoms and 'high-risk' for BD at age 26, although these result were attenuated controlling for parental psychiatric history.

LIMITATIONS

Familial confounding could not be fully adjusted for. Rater reports include some biases.

CONCLUSIONS

These findings show perinatal risk factors to be associated with subclinical hypomania and 'high-risk' for BD. Future work should explore the mechanisms underlying these longitudinal associations, which could shed light on prevention and intervention efforts.

Paternal Postpartum Depression and Associated Factors Among Partners of Women Who Gave Birth in Seka Town, Southwest Ethiopia

Despite epidemiologic studies demonstrating the increased incidence of paternal postpartum depression, their emotional health is overlooked throughout their partner's pregnancy and postpartum period as postpartum depression has been traditionally construed as a disease of women. Traditional masculinity norms also result in a lack of recognition and barriers to the treatment of depression in men. This study is aimed to determine the prevalence and factors of paternal postpartum depression among fathers whose wives gave birth. A community-based cross-sectional study was conducted from July 7 to 17, 2023. The 288 sample size was estimated using a single population proportion formula and selected by random sampling technique. The data were exported from Kobo Toolbox and analyzed using SPSS version 26. Candidate variables were identified in bivariate at p < .25 for the multivariate analysis. A p < .05 and adjusted odds ratio (AOR) were used to determine the significance. A total of 280 partners participated making a 97.22% response rate. Paternal postpartum depression was 19.6%(95% confidence interval [CI] = [15.4%, 24.3%]). It was significantly associated with history of depression (AOR = 4.4, 95% CI = [1.7, 10.9]), unplanned pregnancy (AOR = 4.7, 95% CI = [1.9, 11.3]), alcohol consumption (AOR: 3.0, 95% CI = [1.3, 7.4]), infant sleeping problem (AOR: 3.0, 95% CI = [1.1, 8.9]), and mode of delivery (AOR: 3.0, 95% CI = [1.3, 7.6]). This study concluded that paternal postpartum depression was high. The researchers recommended the inclusion of men's mental health services like screening into women's postnatal health care.

Children's screen time and psychosocial symptoms at 5 years of age - the role of parental factors

BACKGROUND AND OBJECTIVES

Electronic media (e-media) has become a universal part of young children's daily lives. Previous studies have found an association between increased screen time and children's psychosocial symptoms. We investigated whether parents' psychological distress and parenting style dimensions explain the association between children's screen time and psychosocial symptoms. Moreover, we investigated whether parents' mental well-being and parenting style dimensions moderate this association.

METHODS

We used data from the Finnish CHILD-SLEEP birth cohort study. Parents and the child were assessed when the child was 5 years old (N = 671). The measure of screen time included program viewing from TV and other devices. Child's psychosocial problems and parents' depression, stress and parenting style dimensions were assessed by self-reports.

RESULTS

A high level of screen time in children was associated with attention and concentration difficulties, hyperactivity and impulsivity symptoms as well as internalizing and externalizing symptoms among 5-year-olds. For the most part, the associations remained significant despite controlling for parents' mental health, parenting style dimensions and multiple background factors, especially associations relating to attention and concentration difficulties and hyperactivity symptoms were robust. Maternal stress and depression moderated the association between children's screen time and psychosocial symptoms, indicating a more pronounced association among stressed or depressed mothers.

CONCLUSION

There is an independent association between children's screen time and psychosocial symptoms which is especially pronounced among those children whose mothers had poorer mental well-being. In clinical practice, the length of screen time should be inquired already at a young age and parents should be offered guidance to reduce the possible ill effects of excessive screen time, as well as help with their own mental health problems.

Childhood maltreatment and health in the UK Biobank: triangulation of outcome-wide and polygenic risk score analyses

BACKGROUND

Childhood maltreatment is common globally and impacts morbidity, mortality, and well-being. Our understanding of its impact is constrained by key substantive and methodological limitations of extant research, including understudied physical health outcomes and bias due to unmeasured confounding. We address these limitations through a large-scale outcome-wide triangulation study.

METHODS

We performed two outcome-wide analyses (OWAs) in the UK Biobank. First, we examined the relationship between self-reported maltreatment exposure (number of maltreatment types, via Childhood Trauma Screener) and 414 outcomes in a sub-sample of 157,316 individuals using generalized linear models ("observational OWA"). Outcomes covered a broad range of health themes including health behaviors, cardiovascular disease, digestive health, socioeconomic status, and pain. Second, we examined the relationship between a polygenic risk score for maltreatment and 298 outcomes in a non-overlapping sample of 243,006 individuals ("genetic OWA"). We triangulated results across OWAs based on differing sources of bias.

RESULTS

Overall, 23.8% of the analytic sample for the observational OWA reported at least one maltreatment type. Of 298 outcomes examined in both OWAs, 25% were significant in both OWAs and concordant in the direction of association. Most of these were considered robust in the observational OWA according to sensitivity analyses and included outcomes such as marital separation (OR from observational OWA, ORo = 1.25 (95% CI: 1.21, 1.29); OR from genetic OWA, ORg = 1.06 (1.03, 1.08)), major diet changes due to illness (ORo = 1.27 (1.24, 1.29); ORg = 1.01 (1.00, 1.03)), certain intestinal diseases (ORo = 1.14 (1.10, 1.18); ORg = 1.03 (1.01, 1.06)), hearing difficulty with background noise (ORo = 1.11 (1.11, 1.12); ORg = 1.01 (1.00, 1.01)), knee arthrosis (ORo = 1.13 (1.09, 1.18); ORg = 1.03 (1.01, 1.05)), frequent sleeplessness (ORo = 1.21 (1.20, 1.23); ORg = 1.02 (1.01, 1.03)), and low household income (ORo = 1.28 (1.26, 1.31); ORg = 1.02 (1.01, 1.03)). Approximately 62% of results were significant in the observational OWA but not the genetic OWA, including numerous cardiovascular outcomes. Only 6 outcomes were significant in the genetic OWA and null in the observational OWA; these included diastolic blood pressure and glaucoma. No outcomes were statistically significant in opposite directions in the two analyses, and 11% were not significant in either OWA.

CONCLUSIONS

Our findings underscore the far-reaching negative effects of childhood maltreatment in later life and the utility of an outcome-wide triangulation design with sensitivity analyses for improving causal inference.

Prenatal paternal anxiety symptoms predict child DHEA levels and internalizing symptoms during adrenarche

Introduction

This study examined (1) whether measures of paternal anxious and depressive symptoms collected prenatally and during a follow-up assessment when the child was in middle childhood, predict child neuroendocrine outcomes, and (2) whether neuroendocrine outcomes are intermediate factors between paternal mental health and child cognitive/behavioral outcomes. Middle childhood coincides with increased autonomy as the child transitions into grade school, and with adrenarche, as the maturing adrenal gland increases secretion of dehydroepiandrosterone (DHEA) and its sulfated metabolite (DHEA-S), hormones that are implicated in corticolimbic development which regulate emotions and cognition.

Methods

Participants were recruited from a subsample of a large prospective birth cohort study (3D study). We conducted a follow-up study when children were 6-8 years old (N = 61 families, 36 boys, 25 girls). Parental symptoms of anxiety, stress and depression were assessed via validated self-report questionnaires: prenatally using an in-house anxiety questionnaire, the Perceived Stress Scale (PSS) and the Center for Epidemiologic Studies Depression (CES-D), and at the follow up, using the Beck Anxiety and Beck Depression Inventories. Children provided salivary hormone samples, and their pituitary gland volume was measured from structural Magnetic Resonance Imaging (MRI) scans. Child behaviors were measured using the Strengths and Difficulties Questionnaire and cognitive outcomes using the WISC-V. Multiple regression analyses were used to test whether paternal mental health symptoms assessed prenatally and during childhood are associated with child neuroendocrine outcomes, adjusting for maternal mental health and child sex. Indirect-effect models assessed whether neuroendocrine factors are important intermediates that link paternal mental health and cognitive/behavioral outcomes.

Results

(1) Fathers' prenatal anxiety symptoms predicted lower DHEA levels in the children, but not pituitary volume. (2) Higher prenatal paternal anxiety symptoms predicted higher child internalizing symptoms via an indirect pathway of lower child DHEA. No associations were detected between paternal anxiety symptoms measured in childhood, and neuroendocrine outcomes. No child sex differences were detected on any measure.

Conclusion

These results highlight the often-overlooked role of paternal factors during pregnancy on child development, suggesting that paternal prenatal anxiety symptoms are associated with child neuroendocrine function and in turn internalizing symptoms that manifest at least up to middle childhood.

Longitudinal associations between paternal mental health and child behavior and cognition in middle childhood

Introduction

Paternal mental health has been associated with adverse consequences on offspring psychosocial development, and family environmental factors may partly explain those associations. To clarify this, we need comprehensive prospective studies, particularly in middle-childhood when the child enters school and is expected to make use of behavioral and cognitive skills as part of their interactions and learning.

Method

Using data from a sub-sample of the prospective 3D birth cohort study comprised of mother-father-child triads, and a follow-up of the parents and the children at 6-8 years of age (n = 61; 36 boys, 25 girls), we examined whether paternal anxious and depressive symptoms measured during the pregnancy period (i.e., prenatally) or concurrently when the child was assessed at 6-8 years old were associated with children's cognition/behavior.

Results

In contrast to our hypotheses, we found that greater prenatal paternal depressive symptoms predicted fewer child behavioral difficulties; and that greater concurrent childhood paternal depression or anxiety symptoms were associated with higher child full-scale IQ, controlling for the equivalent maternal mental health assessment and parental education. Father parenting perception did not mediate these associations, nor were they moderated by maternal mental health at the concurrent assessment, or paternal ratings of marital relationship quality.

Discussion

These findings suggest that higher symptoms of paternal mental health symptoms are associated with fewer child behavioral difficulties and higher cognitive performance in middle childhood. Potential clinical implications and future research directions are discussed.

Factor structure of the Edinburgh Postnatal Depression Scale in a large population-based sample of fathers

BACKGROUND

Paternal perinatal distress is receiving increasing attention. The Edinburgh Postnatal Depression Scale (EPDS) is the predominant screening tool for paternal perinatal distress. Research using the large Avon Longitudinal Study of Parents and Children (ALSPAC) cohort demonstrated that a three-factor EPDS structure is appropriate among mothers, with anhedonia, anxiety and depression factors emerging consistently across perinatal timepoints.

METHOD

We employed confirmatory factor (CFA; n = 6170 to 9848) analysis to determine if this structure was appropriate for ALSPAC fathers, and the extent of invariance between mother and father groups.

RESULTS

At 18-weeks gestation, and 8-weeks, 8-months and 21-months postpartum, the three-factor model had consistently superior fit to other proposed models. Consistent with interpretation of a total distress score, factors were highly correlated. The model exhibited configural invariance in both the first (8-months) and second (21-months) post-partum years. Metric and scalar invariance were not supported, however, non-invariance was largely attributable to item 9 canvassing "crying".

LIMITATIONS

While the study employs a large cohort, the data collection in 1991 to 1992 in the United Kingdom may not account for the diverse gender roles, family structures and societal changes seen since that time.

CONCLUSIONS

Interpretation of the EPDS as representing perinatal distress, reflecting anhedonia, anxiety and depression aspects, is appropriate for mothers and fathers. The experience of distress has nuanced gender-based differences. Implications for EPDS interpretation and cut-off scores among fathers are discussed.