A Mini-Review on Paternal Postpartum Depression

Postpartum depression has primarily been perceived as an issue that impacts mothers; however, research indicates an increasing prevalence of postpartum depression in fathers [1]. Parenthood requires fathers to adjust to new roles, new responsibilities, and new stressors particularly during the first postnatal year. These new demands can have a deleterious on paternal mental health and postpartum experiences and impairs mental health functioning [2]. Like mothers, fathers can develop depression postpartum. Unfortunately, fathers remain under screened, under diagnosed, and undertreated [3] for paternal postpartum depression. Paternal postpartum depression (PPD) is a clinically significant as the mental health of fathers can profoundly impact fathers individually and all other members in the family system [3]. Paternal PPD has been associated with working and short-term member loss [4], impairment in work functioning [5], emotional, social, cognitive, and behavioral development of their children, family dynamics, and marital satisfaction [6,7]. In fact, paternal postpartum depression rates in community-based samples have varied from four percent to [7] to as high as 50 percent [8]. The stigma associated with depression and mental health and cultural expectations of manhood [9] may lead to fathers underreporting or downplaying symptoms. The impact of paternal PPD if left untreated are far-reaching for fathers and their children; thus, it is imperative that clinicians and researchers possess the expertise to identify risk factors, screen properly for paternal postpartum depression and implement effective interventions for fathers confronting this issue.

A variety of studies documented the relationship between maternal depression and paternal depression during the pre and postnatal period [8,10-12]. In fact, researchers indicated the onset of paternal depression followed depression in the mother [10,12-13] with a 10% overall prevalence. Moreover, fathers with a history of depression and anxiety prior to the birth of their child were also at an increased risk of developing paternal PPD [7,14]. Other noteworthy risk factors include lack of social support, low level of marital or partner relationship satisfaction, difficult communication between parents, financial stress, under or unemployment, poor father-child bonding or attachment, difficulty adjusting to parenthood [15-18].

Various screening measures were presented in the research on PPD. The Edinburgh Postnatal Depression Scale (EPDS) is a self-report scale containing a 10-item scale, eight items address depressive symptoms and two explore anxiety [19]. This scale has been validated for use with mothers and fathers [1,20]. In fact, a meta-analysis study on paternal PPD identified 40 studies in which the EPDS was the screening tool [21]. Other assessment tools used for paternal PPD were the Hospital Anxiety and Depression Scale [22,23], Beck Depression Inventory [24], the Center for Epidemiologic Studies [25], General Health Questionnaire [26], and the Mental Health Index [27].

While the diagnostic criteria for postpartum depression associated with mothers is clear, there is not an official set of diagnostic criteria for postpartum depression in fathers [18]. In the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, maternal PPD is defined as a major depressive episode with a perinatal onset specifier. Symptoms of paternal PPD have been evaluated with measures used for maternal PPD. Associated symptoms for both mothers and fathers include loss of interest in activities, significant weight loss or gain, fatigue or loss of energy, insomnia or hypersomnia, inability to concentrate, feelings of worthlessness or guilt, severe anxiety, and thoughts of suicide or self-harm [28]. Fathers may also present with additional, less obvious symptoms including irritability, indecision, impulsivity, violent behavior, affective rigidity, avoidant behavior, and substance use [25,29] and remain symptomatic for a full year [30].

Fathers are more likely to experience the first onset of PPD within the first three to six months of childbirth [18,29-30]. Somatic symptoms such as indigestion, diarrhea, constipation, headaches, fluctuations in appetite, and insomnia may be more pronounced in fathers as well [18, 31]. Impairment in father-mother and father-child relationship are also noteworthy assessment areas. Disengaged parenting behaviors, lack of warmth, increased hostility, intimate partner violence, and child maltreatment are signs of depression [18, 32] were also documented as clinically significant indicators.

Interventions with a prevention focus in the form of education and support were viewed favorably in the research [33-35]. Fathers who participated in postpartum education particularly with a male facilitator reported lower levels of anxiety and depression at the conclusion of a six-week course [36]. Other effective approaches included cognitive behavior therapy, group therapy, psychodynamic therapy, and ongoing psychosocial assessment during the prenatal stage [2,37]. Interventions that focus on positive interactions between fathers and mothers [38], classes that increase father’s self-efficacy with infant care skills [39], and opportunities for fathers to share experiences with other fathers [40] yielded positive outcomes for fathers.

Paternal postpartum depression has received limited attention as much of the research has been focused on maternal postpartum depression; yet there is increasing recognition of the impact of postpartum depression on fathers and their families. This review highlighted key risk factors, screening and diagnostic considerations, and impact treatment options for fathers. Although fathers experience clinically significant symptoms routine screening and assessment during the postnatal period is inconsistent. It is hoped that researchers and practitioners will continue to focus on the experiences of fathers in this area.

None.

No conflict of interest.

1. Edward KL, Castel D, Mills C, Casey J, Cally Mills, Leigh Davis (2015) An integrative review of paternal depression. Am J Mens Health 9(1): 26-34.
2. Spector A Z (2006) Fatherhood and depression: A review of risks, effects, and clinical application. Issues Ment Health Nurs 27(8): 867-883.
3. Musser AK, Ahmed AH, Foli K J, Coddington JA (2013) Paternal postpartum depression: What health care providers should know. J Pediatr Health Care 27(6): 479-485.
4. Pio De Almeida, LS Jansen, K Kohler CA, Pinheiro RT, Da Silva RA, et al. (2012) Working and short-term memories are impaired in postpartum depression. J Affect Disord 136(3): 1238- 1242.
5. Melrose S (2010) Paternal postpartum depression: How can nurses begin to help? Contemp Nurse 34(2): 199-210.
6. Cockshaw W, Muscat T, Obst P, Thorpe K (2014) Paternal postnatal depressive symptoms, infant sleeping and feeding behaviors, and rigid parental regulation: A correlational study. J Psychosom Obstet Gynaecol 35(4): 124-131.
7. Ramchandani P, Stein A Evans J, O Connor T, Team AS (2005) Paternal depression in postnatal period and child development: A prospective population study. Lancet 365(9478): 2201-2205.
8. Goodman J (2004) Paternal postpartum depression, its relationship to maternal postpartum depression, and implications for family health. J Adv Nurs 45(1): 26-35.
9. Fisher SD (2016) Paternal mental health: Why is it relevant? Am J Lifestyle Med 11(3): 200-211.
10. Figueiredo B, Conde A (2011) Anxiety and depression in women and men from early pregnancy to 3- months postpartum. Arch Womens Ment Health 14(3): 247-255.
11. Paulson J, Bazemore S, Goodman J, Leiferman J (2016) The course and interrelationship of maternal and paternal perinatal depression. Arch Womens Ment Health 19(4): 655-663.
12. Wee K Y, Skouteris H, Pier C, Richardson B, Milgrom J (2011) Correlates of ant- and postnatal depression in fathers: A systematic review J Affect Disord 130(3): 358-377.
13. Veskrna L (2010) Peripartum depression: Does it occur in fathers and does it matter? Journal of Men’s Health 7(4): 420-430.
14. Gao L, Chan S W, Mao Q (2009) Depression, perceived stress, and social support among first-time Chinese mother and fathers in the postpartum period. Res Nurs Health 32(1): 50-58.
15. Bradley R, Slade P (2010) A review of mental health problems in fathers following the birth of a child. Journal of Reproductive and Infant Psychology 29(1): 19-42.
16. Buist A, Morse CA, Durkin S (2003) Men’s adjustment to fatherhood: Implications for obstetric health care. J Obstet Gynecol Neonatal Nurs 32(2): 172-180.
17. Davey SJ, Dziurawiec S, O Brient-Malone A (2006) Men’s voices: Postnatal depression from the perspective of male partners. Qual Health Res 16(2): 206-220.
18. Kim P, Swain JE (2007) Sad dads: Paternal postpartum depression. Psychiatry 4(2): 36-47.
19. Cox J, Holden J, Sagovsky R (1987) Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry 150: 782-786.
20. Matthey S, Barnett B, Kavanagh DJ, Howie P (2001) Validation of the Edinburgh Postnatal Depression Scale for men, and comparison of item endorsement with their partners. J Affect Disord 64(2-3): 175-184.
21. Pérez CF, Brahm R, Riquelme S, Rivera C, Jaramillo K, et al. (2017) Paternal post-partum depression: How has it been assessed? A literature reviews. Mental Health and Prevention Pp: 28-36.
22. Parfitt Y, Pike A, Ayers S (2013) The impact of parent’s mental health on parent-baby interaction: A prospective study. Infant Behav Dev 36(4): 599-608.
23. Parfitt Y, Ayers S, Pike A, Jessop DC, Ford E (2014) A prospective study of the parent-baby bond in men and women 15 months after birth. Journal of Reproductive and Infant Psychology 32: 441-456.
24. Pinheiro KAT, Coehlo FMDC, Quevedo LDA, Jansen K, Souza LDM, et al. (2011) Paternal postpartum mood: Bipolar episodes? Braz J Psychiatry 33(3): 283-286.
25. Paulson JF, Bazemore SD (2010) Prenatal and postpartum depression in fathers and its association with maternal depression. JAMA 303(19): 1961-1969.
26. Ngai FW, Ngu SF (2015) Predictors of maternal and paternal depressive symptoms at postpartum. J Psychosom Res

 78: 156-161.

27. Condon J, Corkindale C, Boyce P, Gamble E (2013) A longitudinal study of father-to-infant attachment: Antecedents and correlates. Journal of Reproductive and Infant Psychology 31(1): 15-30.
28. American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington DC: Author.
29. Biebel K, Alikhan S (2016) Paternal postpartum depression. Journal of Parent & Family Mental Health 1(1): 1-4.
30. Matthey S, Barnett B, Ungerer J, Waters B (2000) Paternal and maternal depressed mood during the transition to parenthood. J Affect Disord 60(2): 75-85.
31. Schumacher M, Zubaran C, White G (2008) Bringing birth-related paternal depression to the fore. Women and Birth 21(2): 65-70.
32. Wilson S, Durbin E (2010) Effects of paternal depression on fathers’ parenting behaviors: A meta- analytic review.

Clin Psychol Rev 30: 167-180.

33. Areias M, Kumar R, Barros H, Figueiredo E (1996) Correlates of postnatal depression in mothers and fathers. Br J Psychiatry

169(1): 36-41.

34. Castle H, Slade P, Barranco-Wadlow M, Rogers M (2008) Attitudes to emotional expression, social support, and postnatal adjustment in new parents. Journal of Reproductive and Infant Psychology 26(3): 180- 194.
35. Morse CA, Buist A, Durkin S (2000) First-time parenthood: Influences on pre- and postnatal adjustment in fathers and mothers. J Psychosom Obstet Gynaecol 21(2): 109-120.
36. Tohotoa J, Maycock B, Hauck YL, Dhaliwal S, Howat P, Burns S, Binns CW (2012) Can father inclusive practice reduce paternal postnatal anxiety and depression scale. BMC Pregnancy and Childbirth 12: 75.
37. Fletcher R, Vimpani G, Russell G, Sibbritt D (2008) Psychosocial assessment of expectant fathers. Arch Womens Ment Health 11(1): 27-32.
38. Dennis CL, Letourneau N (2007) Global and relationship-specific perceptions of support and the development of postpartum depressive symptomatology. Soc Psychiatry Psychiatr Epidemiol 42: 389-395.
39. Genesoni L, Tallandini M (2009) Men’s psychological transition to fatherhood: An analysis of the literature, 1989-2008. Birth 36: 305-317.
40. Chin R, Hall P, Daiches A (2011) Fathers’ experiences of their transition to fatherhood: A metasynthesis. Journal of Reproductive and Infant Psychology 29(1): 4-18.