Sage Journals: Discover world-class research

Abstract

The aim of this project was to review current research regarding postnatal depression in fathers and to present potential screening and referral options. The search was limited to scholarly (peer reviewed) journals and all articles were retrieved with date limits. Initial search parameters were the following: antenatal depression OR pregnancy depression OR postnatal depression OR perinatal depression AND father* OR men OR paternal. The search yielded 311 abstracts returned. With reference to the inclusion criteria and primary and secondary outcomes intended for the focus of this review, N = 63 articles were retrieved and read in full by the researchers. These articles were included in the final integrative review. Depression in fathers following the birth of their child was associated with a personal history of depression and with the existence of depression in their partner during pregnancy and soon after delivery. Based on the review the authors suggest routine screening and assessment of both parents should occur across the pregnancy and postnatal period. The use of the Edinburgh Postnatal Depression Scale for screening of depression in men needs to be linked to referral guidelines for those individuals who require further investigation and care.

Keywords

depression father paternal postnatal pregnancy screening

Introduction

The World Health Organization (WHO) has reported that 450 million people globally are affected by mental illness (WHO, 2007), with gender being implicated as a critical determinant. In 2000, depression was reported as the leading cause of disability as measured by years lived with the disability and the fourth leading contributor to the global burden of disease measured as Disability Adjusted Life Years (Mathers, Boerma, & Ma Fat, 2008). More recently, depression has been identified as the second cause of Disability Adjusted Life Years s in the age category 15 to 44 years for both sexes combined (WHO, 2011). It is estimated that 51.8% of females and 48.2% of males in the United States experience depression (Kessler et al., 2003) at some time in their lives. In Australia, female depression rated higher than male depression prevalence where data were derived from a national sample of 10,641 people 18 to 75+ years of age (Wilhelm, Mitchell, Slade, Brownhill, & Andrews, 2003). Around a fifth (19%) of individuals in the United Kingdom had some indication of anxiety or depression with a higher proportion of women than men and a higher proportion of those aged between 40 and 59 or aged 80 and older (Beaumont & Lofts, 2013).

The mental health of women and the need for identification of mental illnesses such as depression during pregnancy and after the birth (postnatal depression [PND]) of their child is well described in the literature. What is often not considered is the mental health of fathers in the pre- and postnatal periods. Fathers are at risk of depression at this time, expressly if their partner becomes depressed, yet they are usually not the focus of screening (Ramchandani et al., 2011). Currently, the focus of care in the majority of maternity services is on the mother and infant. This integrative review aims to identify literature on PND in fathers and to present potential screening and referral options available to clinicians.

Objectives

The authors aimed systematically to search, critically appraise, and summarize the literature on PND in fathers and to review current screening options, impact on the family unit, and interventions available for fathers experiencing PND.

Method

Search Outcomes

The primary outcomes of interest were the following: screening, assessment, and referral of PND in fathers; paternal depression; and effects of paternal depression. Secondary outcomes of interest include adverse events of the depression.

Databases Searched

A search of the literature was undertaken using the following databases: Academic Search Complete, CINAHL Plus with full text, Health Source, Nursing/Academic, Medline complete, Psychology and Behavioural Sciences Collection, and SocINDEX with Full Text. The search was limited to scholarly (peer-reviewed) journals, and all articles were retrieved with no time limit. Initial search parameters were the following: antenatal depression OR pregnancy depression OR postnatal depression OR perinatal depression AND father* OR men OR paternal.

Inclusion Criteria

The inclusion criteria for this integrative review included articles written in English, paternal PND, and screening, assessment, and referral of PND in fathers.

Exclusion Criteria

The exclusion criteria used for this review included the following: articles not written in English, articles focusing exclusively on maternal PND, articles not subject to peer review, and editorials and other non-peer-reviewed material.

Quality Appraisal

The quality of the research was assessed with reference to the Critical Appraisal Skills Program qualitative research checklist and the Critical Appraisal Skills Program: Cohort Studies is a methodological checklist (Taylor et al., 2000).

Synthesis

Data were extracted by two of the researchers. Extracted data were collated and synthesized.

Results

The search yielded 311 abstracts. With reference to the inclusion criteria and primary and secondary outcomes intended for the focus of this review, 63 articles were retrieved and read in full by the researchers (see Figure 1).

Figure 1.

PRISMA of abstracts returned.

Prevalence and Risk Factors

In the 1990s, PND in fathers was generally considered rare (Lane et al., 1997). More recently, paternal PND is gaining recognition as a significant problem that negatively affects the family unit. There are also increasing amounts of research demonstrating that the prevalence of PND in fathers is not as rare as first thought and that there are risk factors for the development of PND in fathers that health care professionals should be aware of.

Maternal depression has been identified as the strongest predictor of paternal depression during the postnatal period (Goodman, 2004). Depression in fathers following the birth of their child is also associated with a personal history of depression (Gao, Chan, & Mao, 2009) where a history of severe depression and high prenatal symptom scores for depression and anxiety have been determined as the strongest predictors of paternal depression in the postnatal period (Ramchandani, Stein, et al., 2008).

The literature suggests a detailed assessment of fathers during the postnatal period, especially when their female partners are depressed, to allow for timely and appropriate treatment and/or interventions (Schumacher, Zubaran, & White, 2008). Paulson, Dauber, and Leiferman (2006) explored the individual and combined effects of PND in mothers and fathers and parenting behavior. In their study, a national sample of 8,865 cases was further narrowed down to include only those biological mothers with corresponding resident father data, yielding a final sample size of 5,089. Of these, 14% of mothers and 10% of fathers exhibited levels of depressive symptoms that were associated with clinical diagnoses such as depression with or without anxiety. Escriba-Aguir and Artazcoz (2011) reported similar rates of PND in their longitudinal study (n = 687 mothers and n = 669 fathers) with 9.3% of mothers and 3.4% of fathers diagnosed with depression at 3 months and 4.4% of mothers and 4.0% of fathers diagnosed with depression at 12 months postpartum.

Many studies report the onset of paternal depression often followed depression in the mother (Dudley, Roy, Kelk, & Bernard, 2001; Edmondson, Psychogiou, Vlachos, Netsi, & Ramchandani, 2010; Figueiredo & Conde, 2011; Hanington, Heron, Stein, & Ramchandani, 2012; Pinheiro et al., 2006; Veskrna, 2010; Wee, Skouteris, Pier, Richardson, & Milgrom, 2011) with approximately 10% prevalence overall. Furthermore, studies in this review revealed an association for paternal depression with having an unsupportive relationship and being unemployed (Ballard & Davies, 1996; Davé, Nazareth, Sherr, & Senior, 2005). Other factors associated with an elevated risk of paternal PND include a personal history of depression and/or anxiety, maternal depression during pregnancy, older age, low levels of marital satisfaction, financial/life stressors, a feeling of incongruity between expectations of parenthood and the realities, lack of outside social supports for parenting, poor social functioning, dissatisfaction with partner support, poor communication between the parents, gender of the child for some cultures, adaptation impaired paternal/newborn bonding, and/or feelings of exclusion from maternal/newborn bonding (Bradley & Slade, 2011; Buist, Morse, & Durkin, 2003; Davé et al., 2005; Davey, Dziurawiec, & O’Brien-Malone, 2006; Kim & Swain, 2007; Mao, Zhu, & Su, 2011; Matthey, Barnett, Ungerer, & Waters, 2000; Paulson & Bazemore, 2010; Skari et al., 2002; Van Den Berg et al., 2009).

Our review also highlighted that men and women differ in their knowledge and beliefs about the symptoms and causes of PND, which has implications for antenatal education and postnatal care involving education for the family. PND is often perceived by women as having a biological rather than psychosocial cause, thus having implications for recognition of these symptoms for men. More specifically, the condition is unique to women who are pregnant and give birth, potentially excluding men in consideration of PND. Also, the recognition of anxiety in women and their partner (via screening) in the postnatal period was relatively low, although higher among those with mental health training. As revealed in this review, screening for PND in fathers is often underestimated, holding implications for screening, assessment, and treatment for postnatal mood conditions (Edmondson et al., 2010; Fisher, Kopelman, & O’Hara, 2012; Goodman, 2008; Lai, Tang, Lee, Yip, & Chung, 2010; Matthey, 2008; Matthey, Barnett, Howie, & Kavanagh, 2003; Tran, Tran, & Fisher, 2012) ultimately having implications for families.

Impact of Paternal Postnatal Depression

Relationships between mothers and fathers following the birth of their child can be fraught and depression is more likely to develop in both mothers and fathers in the first year of birth (Davé, Petersen, Sherr, & Nazareth, 2010). Having an unplanned pregnancy is associated with higher levels of paternal depression with lower mother–father relationship happiness, increased risk of disharmony within the relationship, and higher coparental conflict (Bronte-Tinkew, Scott, Horowitz, & Lilja, 2009; Muscat, Thorpe, & Obst, 2012; Nishimura & Ohashi, 2010; Ramchandani et al., 2011). If fathers experience PND, it can affect not only the interactions they have with their children but also interfere with the interactions with the child by their partner (Bradley & Slade, 2011). Work by Goodman (2008) demonstrated that maternal PND is associated with increased paternal depression resulting in higher paternal parenting stress and the risk of couple morbidity, with implications for bonding with the infant and maintaining relationships (Edhborg, 2008; Edhborg, Matthiesen, Lundh, & Widstrom, 2005). For fathers, the individual impact of PND depression includes working and short-term memory loss (Pio De Almeida et al., 2012) and on the ability to perform tasks at their place of employment (Melrose, 2010). PND in fathers can negatively affect the child as well as other relationships within the family unit. The children of depressive fathers are at risk for emotional and behavioral problems (Schumacher et al., 2008). Paternal depression is believed to have a specific effect on their children’s early behavioral and emotional development (LeFrançois, 2012; Letourneau et al., 2012; Ramchandani et al., 2011; Ramchandani, Stein, Evans, & O’Connor, 2005). Negative father and child relationships can lead to detrimental cognitive, behavioral, social, and emotional development of children (Fletcher, Feeman, Garfield, & Vimpani, 2011; Goodman, 2008; Paulson et al., 2006; Paulson, Keefe, & Leiferman, 2009; Sethna, Murray, & Ramchandani, 2012; Wanless, Rosenkoetter, & McClelland, 2008), psychiatric conditions developing in later childhood (Ramchandani, O’Connor, et al., 2008; Ramchandani, Stein, et al., 2008), and some research suggest this impact is more significant in male children (Hanington, Ramchandani, & Stein, 2010; Ramchandani et al., 2005; Ramchandani, O’Connor, et al., 2008). Davé et al. (2005) reveal that fathers experiencing a lower mood was associated with a negative infant temperament measured by the Infant Characteristics Questionnaire. Davis, Davis, Freed, and Clark (2011) reported that fathers experiencing depression were less likely to spend time reading to their 1-year-old child and more likely to report using spanking, which is supported in findings by Paulson et al. (2006), who state that depressive symptoms in both mothers and fathers is negatively associated with positive activity, such as reading and singing songs, with their child. Relationships are also affected between father and child, for example, depressed fathers are more likely than nondepressed to smack/spank their child (Davis et al., 2011).

Screening for PND in Fathers

The Edinburgh Postnatal Depression Scale (EPDS) was devised as a screening measure for postpartum depression in women; it can also be applied during pregnancy. Best practice guidelines indicate the EPDS should be used by health professionals as a component of the assessment of women for symptoms of depression in the antenatal period and women in the postnatal period. The EPDS assesses symptoms of anhedonia and reactivity, self-blame, anxiety, panic, coping, sleeplessness (due to unhappiness), sorrow, tearfulness, and thoughts of self-harm. The EPDS is a 10-item scale that includes questions such as “I have been able to laugh and see the funny side of things” and “I have blamed myself unnecessarily when things went wrong.” Respondents indicate on a 4-point scale the response that best describes the way they have been feeling over the past seven days. Items are scored from 0 to 3 with a resulting range of 0 to 30. The EPDS has been validated and used extensively in screening for depression in new mothers; some studies have reported its use with fathers. Matthey, Barnett, Kavanagh, and Howie (2001) recruited couples at two time points—antenatally and at 6 weeks postnatally—and EPDS scores in 208 fathers and 230 mothers were validated using the Diagnostic Interview Schedule. In the fathers, using distress (depression or anxiety disorders) as the criterion, a cutoff of 5/6 was optimum, whereas for mothers the optimum cutoff screening was at 7/8. The lower cutoff values for fathers was mostly due to differential response to the “crying” item. In a study exploring the sensitivity of the EPDS for fathers (n = 607) 6 weeks after the birth of their child, the EPDS identified 5% of fathers to have depressive symptoms (using a cutoff of >10) as compared with 3.4% with a male depression scale (Gotland Male Depression Scale; Madsen & Juhl, 2007; see Table 1 for details related to Scale cutoff points for men for the EPDS and other depression screening scales). Thus, the EPDS is a suitable screening tool for fathers in the postpartum period, albeit cutoffs are different to those applicable in women. It is important to note the EPDS does not diagnose depression (Dennis, 2005) but can alert the clinician to the need for a full diagnostic interview.

Table 1.

Scale Cutoff Points for Men for the EPDS and other Depression Screening Scales.

Year	Reference and country	n, men (women)	Methods	Postnatal timeframe	Standardized tools used	Scale cutoff, men (women)
1994	Ballard and Davies; United Kingdom	200	Comparative	6 weeks postbirth	EPDS	≥13
1994	Ballard and Davies; United Kingdom	200	Comparative	6 months	EPDS	≥13
2001	Dudley, Roy, Kelk, and Bernard; Australia	92 (92)	Cross-sectional with interview	Birth to 12 months	EPDS	>12 (>12)
2001	Matthey, Barnett, Kavanagh, and Howie; Australia	157 (157)	Longitudinal	Antenatal	EPDS	>12
				6 weeks	BDI	>9
				12 weeks	GHQ	>7
				12 months
2002	Skari et al.; Norway	122 (127)	Prospective, longitudinal cohort study	0-4 days postbirth	GHQ-28	≥6 (≥6)
				0-4 days postbirth	STAI-X1	≥40 (≥40)
				6 weeks
				6 months
2004	Pinheiro et al.; Brazil	386 (386)	Cross-sectional	6-12 weeks postbirth	BDI	>10
2005	Edhborg, Matthiesen, Lundh, and Widstrom; Sweden	106 (106)	Cross-sectional	1 week postbirth	PBQ	≥12 1st factor
				2 months	EPDS	≥17 2nd factor
						≥10 3rd factor
						≥9/10 (≥9/10)
2008	Edhborg; Sweden	113 (155)	Cross-sectional	Birth	EPDS	≥9/10 (≥9/10)
				1 week
				2 months
2009	Gao, Chan, and Mao; China	130 (130)	Cross-sectional	6-8 weeks postbirth	EPDS	≥13 (≥13)
2010	Nishimura and Ohashi; Japan	133 (178)	Cross-sectional	4 weeks postbirth	EPDS	≥7/8 (≥8/9)
2010	Nishimura and Ohashi; Japan	133 (178)	Cross-sectional	4 weeks postbirth	CES-D	≥16
2011	Escriba-Aguir and Artazcoz; Spain	409 (420)	Longitudinal	3rd trimester	EPDS	≥11 (12/13)
				3 months postbirth
				12 months
2011	Mao, Zhu, and Su; China	376 (376)	Cross-sectional	Birth	EPDS	≥13 (≥13)
2011	Mao, Zhu, and Su; China	376 (376)	Cross-sectional	6-8 weeks postbirth		≥13 (≥13)
2012	Pio De Almeida et al.; Brazil	173 (222)	Cross-sectional	Postbirth (exact time not specified)	EPDS	≥13 (≥13)

Note. BDI = Beck Depression Inventory; CES-D = Center for Epidemiologic Studies Depression Scale; EPDS = Edinburgh Postnatal Depression Scale; GHQ = General Health Questionnaire; GHQ-28 = General Health Questionnaire–28; SAI = State Anxiety Inventory; PBQ = Postpartum Bonding Questionnaire.

Interventions for Fathers With PND

Areias, Kumar, Barros, and Figueiredo (1996) and Morse, Buist, and Durkin (2000) have emphasized the importance of prevention and treatment for fathers with PND. Prevention was the focus of a randomized controlled trial of the impact of education and support (i.e., antenatal education led by a male facilitator and a 6-week postpartum education and support materials) for fathers with a breast-feeding partner (Tohotoa et al., 2012). The results revealed that both the intervention and control group experienced anxiety prior to birth but fathers in the intervention group reported less anxiety measured using the Hospital Anxiety and Depression Scale than those in the control group at first night of the hospital-based antenatal program and at 6 weeks postpartum. Additionally, fathers reporting higher levels of perceived social support throughout the pregnancy experience significantly lower levels of depression and distress 6 weeks postdelivery (Castle, Slade, Barranco-Wadlow, & Rogers, 2008). Interventions such as cognitive behavior therapy, group therapy, comprehensive antenatal psychosocial assessment, and the traditional psychodynamic therapy can be effective for men experiencing PND (Fletcher, Vimpani, Russell, & Sibbritt, 2008; Spector, 2006). Furthermore, support gain through sharing experiences among other fathers in the transition toward fatherhood can have benefit (Chin, Hall, & Daiches, 2011).

Longitudinal studies identify a high incidence of distress in couples during mid to late pregnancy (Morse et al., 2000), some of which is related to changes in intimacy and sexual behaviors as a couple. Health care professionals are well placed to discuss some of these potential sexual/intimacy changes and expectations to facilitate a more positive transition to parenthood for father and mothers (Condon, 2006). Education can be facilitated by health care professionals and be accessed through other forums. For example, father-inclusive guidelines added to website information regarding perinatal depression can assist fathers with connection to their newborn or for possible interaction with other fathers (Fletcher, 2011), and early indications indicate access to this education for fathers can positively influence their approach to parenting (Fletcher, Vimpani, Russell, & Keatinge, 2008). Pilot work performed by Letourneau, Duffett-Leger, Dennis, Stewart, and Tryphonopoulos (2011) reported that fathers whose partners had PND experienced barriers such as not knowing where to look for PND resources and the difficulty in reaching out to others, whether it be social supports or referrals to health care professionals.

Implications for Practice: Referral Options

For fathers the potential stigma related to paternal depression may represent a barrier to help-seeking behaviors and subsequent referral for paternal PND. Referral is a four-stepped process that involves assessment, education, brokering for services for patients, and linking of the patient into the referral endpoint (Blashki et al., 2003). General practitioners and psychiatrists have a key role in the referral pathway for the management of PND. Importantly, the assessment provides an opportunity for engagement of the patient and their partner. This includes establishing an effective therapeutic relationship, education, providing a rationale for treatment, and explaining expected timeframes (RANZCP, 2009). A recent systematic review supports that any psychosocial or psychological involvement, compared to usual postpartum care, is associated with a decrease in the rate of depression within the first year postpartum (Dennis & Hodnett, 2007). Referral options for parents postnatally include general practitioners, psychiatrists, psychologist and other allied health professionals with mental health expertise, as well as mental health nurses.

Implications for Policy, Practice, and Research

Routine screening and assessment of both men and women needs to occur during periods of interaction with health professionals across pregnancy and the postnatal period. The use of the EPDS for screening of depression in both mothers and fathers is appropriate in terms of sensitivity and specificity of the scale, in addition to the user friendly nature of the scale, which can be easily adapted to routine practice in the hospital or postnatal setting. Since the family unit is affected by depressed fathers as much as it can be affected by depressed mothers, screening both parents in practice is logical. For fathers, support from their partner, PND educational programs, PND and particularly paternal PND health promotion campaign potentially influencing community behaviors, policy for paid paternal leave, as well as consideration of mental health care may help fathers cope with stressful experiences during the postnatal period. Further examination of sexual relationship and communication between parents is potentially an area that can offer insight into paternal PND. An area for further exploration in light of a paucity of literature is the experience of fatherhood including adopted children, the number of children, and the role of culture on the experience of paternal PND.

Limitations

An integrative review offers a unique perspective of the current literature regarding paternal PND; however, there are limitations associated with using different research methods that can contribute to a lack of rigor and bias. When mixed data are synthesized together, there could be a chance of invalid assumptions. This review was limited to peer-reviewed articles. Inclusion of gray literature and book chapters might have brought others perspectives.

Conclusions

This integrative review revealed the recognition, assessment, and treatment of PND in fathers after the birth of their child rarely happens in practice, even thought there are potential benefits to the father, the mother, and the family in the early assessment of paternal depression. Additionally, very little has been reported on current practices that includes assessment and referral of fathers during the perinatal period. Some barriers may well be related to timing of screening/assessment and referral and whether this is an intervention to be undertaken by the hospital obstetric hospital staff or the obstetrician or for fathers to self-refer to their own general practitioner if they experience mood changes. Clinicians working in the obstetric field as well as community service providers need to be aware of PND not only in the mother but also in the father. Clinicians need to consider increasing their awareness of the referral options available in their institution and/or community for both mothers and fathers where further assessment is required. Education for midwifery staff is required, since highlighting the existence of PND in men may be a new consideration for staff. The recognition of the health of the family unit as a whole (including the father) rather than components parts (i.e., mother and baby) presents an opportunity to lead the way in excellence in clinical care for these health care consumers.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

References

Areias

Kumar

Barros

Figueiredo

(1996). Correlates of postnatal depression in mothers and fathers. British Journal of Psychiatry, 169, 36-41. doi:10.1192/bjp.169.1.36

Ballard

Davies

(1996). Postnatal depression in fathers. International Review of Psychiatry, 8(1), 65-71.

Beaumont

Lofts

(2013). Measuring national well-being: Health, 2013. Newport, England: Office for National Statistics.

Blashki

Hickie

Littlefield

Scott

Pirkis

Groom

. . .Davenport

(2003). Referral of patients with depression to specialist psychological care from general practice. Australian Family Physician, 32, 998-1002.

Bradley

Slade

(2011). A review of mental health problems in fathers following the birth of a child. Journal of Reproductive and Infant Psychology, 29(1), 19-42. doi:10.1080/02646838.2010.513047

Bronte-Tinkew

Scott

M. E.

Horowitz

Lilja

(2009). Pregnancy intentions during the transition to parenthood and links to coparenting for first-time fathers of infants. Parenting: Science & Practice, 9(1-2), 1-35. doi:10.1080/15295190802656729

Buist

Morse

C. A.

Durkin

(2003). Men’s adjustment to fatherhood: Implications for obstetric health care. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 32, 172-180. doi:10.1177/0884217503252127

Castle

Slade

Barranco-Wadlow

Rogers

(2008). Attitudes to emotional expression, social support and postnatal adjustment in new parents. Journal of Reproductive and Infant Psychology, 26, 180-194. doi:10.1080/02646830701691319

Chin

Hall

Daiches

(2011). Fathers’ experiences of their transition to fatherhood: A metasynthesis. Journal of Reproductive and Infant Psychology, 29(1), 4-18. doi:10.1080/02646838.2010.513044

10.

Condon

(2006). What about dad? Psychosocial and mental health issues for new fathers. Australian Family Physician, 35, 690-692.

11.

Davé

Nazareth

Sherr

Senior

(2005). The association of paternal mood and infant temperament: A pilot study. British Journal of Developmental Psychology, 23, 609-621. doi:10.1348/026151004x22962

12.

Davé

Petersen

Sherr

Nazareth

(2010). Incidence of maternal and paternal depression in primary care: A cohort study using a primary care database. Archives of Pediatrics & Adolescent Medicine, 164, 1038-1044. doi:10.1001/archpediatrics.2010.184

13.

Davey

S. J.

Dziurawiec

O’Brien-Malone

(2006). Men’s voices: Postnatal depression from the perspective of male partners. Qualitative Health Research, 16, 206-220.

14.

Davis

R. N.

Davis

M. M.

Freed

G. L.

Clark

S. J.

(2011). Fathers’ depression related to positive and negative parenting behaviors with 1-year-old children. Pediatrics, 127, 612-618. doi:10.1542/peds.2010-1779

15.

Dennis

(2005). Psychosocial and psychological interventions for prevention of postnatal depression: systematic review. British Medical Journal, 331(7507), 15.

16.

Dennis

Hodnett

(2007). Psychosocial and psychological interventions for treating postpartum depression. Cochrane Database of Systematic Reviews, (4), CD006116.

17.

Dudley

Roy

Kelk

Bernard

(2001). Psychological correlates of depression in fathers and mothers in the first postnatal year. Journal of Reproductive & Infant Psychology, 19, 187-202. doi:10.1080/02646830120073206

18.

Edhborg

(2008). Comparisons of different instruments to measure blues and to predict depressive symptoms 2 months postpartum: A study of new mothers and fathers. Scandinavian Journal of Caring Sciences, 22, 186-195. doi:10.1111/j.1471-6712.2007.00512.x

19.

Edhborg

Matthiesen

A. S.

Lundh

Widstrom

A. M.

(2005). Some early indicators for depressive symptoms and bonding 2 months postpartum: A study of new mothers and fathers. Archives of Women’s Mental Health, 8, 221-231. doi:10.1007/s00737-005-0097-5

20.

Edmondson

O. J. H.

Psychogiou

Vlachos

Netsi

Ramchandani

P. G.

(2010). Depression in fathers in the postnatal period: Assessment of the Edinburgh Postnatal Depression Scale as a screening measure. Journal of Affective Disorders, 125, 365-368. doi:10.1016/j.jad.2010.01.069

21.

Escriba-Aguir

Artazcoz

(2011). Gender differences in postpartum depression: A longitudinal cohort study. Journal of Epidemiology and Community Health, 65, 320-326. doi:10.1136/jech.2008.085894

22.

Figueiredo

Conde

(2011). Anxiety and depression in women and men from early pregnancy to 3-months postpartum. Archives of Women’s Mental Health, 14, 247-255.

23.

Fisher

Kopelman

O’Hara

(2012). Partner report of paternal depression using the Edinburgh Postnatal Depression Scale–Partner. Archives of Women’s Mental Health, 15, 283-288. doi:10.1007/s00737-012-0282-2

24.

Fletcher

(2011). Field testing of father-inclusive guidelines for web-based information and support aimed at families with perinatal depression. Health Promotion Journal of Australia: Official Journal of Australian Association of Health Promotion Professionals, 22, 231-233.

25.

Fletcher

Feeman

Garfield

Vimpani

(2011). The effects of early paternal depression on children’s development. Medical Journal of Australia, 195, 685-689.

26.

Fletcher

Vimpani

Russell

Keatinge

(2008). The evaluation of tailored and web-based information for new fathers. Child: Care, Health and Development, 34, 439-446.

27.

Fletcher

Vimpani

Russell

Sibbritt

(2008). Psychosocial assessment of expectant fathers. Archives of Women’s Mental Health, 11, 27-32.

28.

Gao

Chan

S. W.

Mao

(2009). Depression, perceived stress, and social support among first-time Chinese mothers and fathers in the postpartum period. Research in Nursing & Health, 32(1), 50-58. doi:10.1002/nur.20306

29.

Goodman

J. H.

(2004). Paternal postpartum depression, its relationship to maternal postpartum depression, and implications for family health. Journal of Advanced Nursing, 45, 26-35. doi:10.1046/j.1365-2648.2003.02857.x

30.

Goodman

J. H.

(2008). Influences of maternal postpartum depression on fathers and on father–infant interaction. Infant Mental Health Journal, 29, 624-643. doi:10.1002/imhj.20199

31.

Hanington

Heron

Stein

Ramchandani

(2012). Parental depression and child outcomes: Is marital conflict the missing link? Child: Care, Health & Development, 38, 520-529. doi:10.1111/j.1365-2214.2011.01270.x

32.

Hanington

Ramchandani

Stein

(2010). Parental depression and child temperament: Assessing child to parent effects in a longitudinal population study. Infant Behavior and Development, 33(1), 88-95.

33.

Kessler

R. C.

Berglund

Demler

Jin

Koretz

Merikangas

K. R.

. . .Wang

P. S.

(2003). The epidemiology of major depressive disorder. Results from the National Comorbidity Survey Replication (NCS-R). Journal of the American Medical Association, 289, 3095-3105.

34.

Kim

Swain

J. E.

(2007). Sad dads: Paternal postpartum depression. Psychiatry (Edgmont), 4(2), 35-47.

35.

Lai

B. P. Y.

Tang

A. K. L.

Lee

D. T. S.

Yip

A. S. K.

Chung

T. K. H.

(2010). Detecting postnatal depression in Chinese men: A comparison of three instruments. Psychiatry Research, 180(2/3), 80-85. doi:10.1016/j.psychres.2009.07.015

36.

Lane

Keville

Morris

Kinsella

Turner

Barry

(1997). Postnatal depression and elation among mothers and their partners: Prevalence and predictors. British Journal of Psychiatry, 171, 550-555.

37.

LeFrançois

B. A.

(2012). Distressed fathers and their children: A review of the literature. International Journal of Social Psychiatry, 58, 123-130.

38.

Letourneau

Dennis

C.-L.

Benzies

Duffett-Leger

Stewart

Tryphonopoulos

P. D.

. . .Watson

(2012). Postpartum depression is a family affair: Addressing the impact on mothers, fathers, and children. Issues in Mental Health Nursing, 33, 445-457. doi:10.3109/01612840.2012.673054

39.

Letourneau

Duffett-Leger

Dennis

C. L.

Stewart

Tryphonopoulos

P. D.

(2011). Identifying the support needs of fathers affected by post-partum depression: A pilot study. Journal of Psychiatric and Mental Health Nursing, 18(1), 41-47.

40.

Madsen

S. A.

Juhl

(2007). Paternal depression in the postnatal period assessed with traditional and male depression scales. Journal of Men’s Health and Gender, 4(1), 26-31.

41.

Mao

Zhu

L. X.

X. Y.

(2011). A comparison of postnatal depression and related factors between Chinese new mothers and fathers. Journal of Clinical Nursing, 20, 645-652.

42.

Mathers

Boerma

Ma Fat

(2008). The global burden of disease: 2004 update. Retrieved from http://www.who.int/healthinfo/global_burden_disease/2004_report_update/en/index.html

43.

Matthey

(2008). Using the Edinburgh Postnatal Depression Scale to screen for anxiety disorders. Depression and Anxiety, 25, 926-931.

44.

Matthey

Barnett

Howie

Kavanagh

D. J.

(2003). Diagnosing postpartum depression in mothers and fathers: Whatever happened to anxiety? Journal of Affective Disorders, 74, 139-147.

45.

Matthey

Barnett

Kavanagh

D. J.

Howie

(2001). Validation of the Edinburgh Postnatal Depression Scale for men, and comparison of item endorsement with their partners. Journal of Affective Disorders, 64, 175-184.

46.

Matthey

Barnett

Ungerer

Waters

(2000). Paternal and maternal depressed mood during the transition to parenthood. Journal of Affective Disorders, 60, 75-85.

47.

Melrose

(2010). Paternal postpartum depression: How can nurses begin to help? Contemporary Nurse: A Journal for the Australian Nursing Profession, 34, 199-210. doi:10.5172/conu.2010.34.2.199

48.

Morse

C. A.

Buist

Durkin

(2000). First-time parenthood: Influences on pre- and postnatal adjustment in fathers and mothers. Journal of Psychosomatic Obstetrics and Gynaecology, 21, 109-120.

49.

Muscat

Thorpe

Obst

(2012). Disconfirmed expectations of infant behaviours and postnatal depressive symptoms among parents. Journal of Reproductive and Infant Psychology, 30(1), 51-61.

50.

Nishimura

Ohashi

(2010). Risk factors of paternal depression in the early postnatal period in Japan. Nursing & Health Sciences, 12, 170-176. doi:10.1111/j.1442-2018.2010.00513.x

51.

Paulson

Bazemore

S. D.

(2010). Prenatal and postpartum depression in fathers and its association with maternal depression. Journal of the American Medical Association, 303, 1961-1969.

52.

Paulson

Dauber

Leiferman

J. A.

(2006). Individual and combined effects of postpartum depression in mothers and fathers on parenting behavior. Pediatrics, 118, 659-668.

53.

Paulson

Keefe

H. A.

Leiferman

J. A.

(2009). Early parental depression and child language development. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 50, 254-262.

54.

Pinheiro

R. T.

Magalhaes

P. V. S.

Horta

B. L.

Pinheiro

K. A. T.

Da Silva

R. A.

Pinto

R. H.

(2006). Is paternal postpartum depression associated with maternal postpartum depression? Population-based study in Brazil. Acta Psychiatrica Scandinavica, 113, 230-232.

55.

Pio De Almeida

L. S.

Jansen

Kohler

C. A.

Pinheiro

R. T.

Da Silva

R. A.

Bonini

J. S.

(2012). Working and short-term memories are impaired in postpartum depression. Journal of Affective Disorders, 136, 1238-1242.

56.

Ramchandani

O’Connor

T. G.

Evans

Heron

Murray

Stein

(2008). The effects of pre- and postnatal depression in fathers: A natural experiment comparing the effects of exposure to depression on offspring. Journal of Child Psychology and Psychiatry and Allied Disciplines, 49, 1069-1078.

57.

Ramchandani

Psychogiou

Vlachos

Iles

Sethna

Netsi

Lodder

(2011). Paternal depression: An examination of its links with father, child and family functioning in the postnatal period. Depression and Anxiety, 28, 471-477. doi:10.1002/da.20814

58.

Ramchandani

Stein

Evans

O’Connor

T. G.

(2005). Paternal depression in the postnatal period and child development: A prospective population study. Lancet, 365, 2201-2205.

59.

Ramchandani

Stein

O’Connor

T. G.

Heron

Murray

Evans

(2008). Depression in men in the postnatal period and later child psychopathology: A population cohort study. Journal of the American Academy of Child & Adolescent Psychiatry, 47, 390-398.

60.

RANZCP. (2009). Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of schizophrenia and related disorders. Melbourne, Victoria, Australia: Author.

61.

Schumacher

Zubaran

White

(2008). Bringing birth-related paternal depression to the fore. Women and birth, 21(2), 65-70.

62.

Sethna

Murray

Ramchandani

P. G.

(2012). Depressed fathers’ speech to their 3-month-old infants: A study of cognitive and mentalizing features in paternal speech. Psychological Medicine, 42, 2361-2371. doi:10.1017/S0033291712000487

63.

Skari

Skreden

Malt

U. F.

Dalholt

Ostensen

A. B.

Egeland

Emblem

(2002). Comparative levels of psychological distress, stress symptoms, depression and anxiety after childbirth: A prospective population-based study of mothers and fathers. BJOG: An International Journal of Obstetrics and Gynaecology, 109, 1154-1163.

64.

Spector

A. Z.

(2006). Fatherhood and depression: A review of risks, effects, and clinical application. Issues in Mental Health Nursing, 27, 867-883.

65.

Taylor

Reeves

Ewings

Binns

Keast

Mears

(2000). A systematic review of the effectiveness of critical appraisal skills training for clinicians. Medical Education, 34, 120-125.

66.

Tohotoa

Maycock

Hauck

Y. L.

Dhaliwal

Howat

Burns

Binns

C. W.

(2012). Can father inclusive practice reduce paternal postnatal anxiety? A repeated measures cohort study using the hospital anxiety and depression scale. BMC Pregnancy and Childbirth, 12(75). doi:10.1186/1471-2393-12-75

67.

Tran

T. D.

Tran

Fisher

(2012). Validation of three psychometric instruments for screening for perinatal common mental disorders in men in the north of Vietnam. Journal of Affective Disorders, 136, 104-109. doi:10.1016/j.jad.2011.08.012

68.

Van Den Berg

M. P.

van der Ende

Crijnen

A. A. M.

Jaddoe

V. W. V.

Moll

H. A.

Mackenbach

J. P.

. . . Verhulst

F. C.

(2009). Paternal depressive symptoms during pregnancy are related to excessive infant crying. Pediatrics, 124, e96-e103. doi:10.1542/peds.2008-3100

69.

Veskrna

(2010). Peripartum depression: Does it occur in fathers and does it matter? Journal of Men’s Health, 7, 420-430.

70.

Wanless

S. B.

Rosenkoetter

S. E.

McClelland

M. M.

(2008). Paternal depression and infant cognitive development: Implications for research and intervention. Infants & Young Children: An Interdisciplinary Journal of Special Care Practices, 21, 134-141.

71.

Wee

K. Y.

Skouteris

Pier

Richardson

Milgrom

(2011). Correlates of ante- and postnatal depression in fathers: A systematic review. Journal of Affective Disorders, 130, 358-377.

72.

World Health Organization. (2007). Projected DALYs for 2005, 2015 and 2030 by WHO region under the baseline scenario. Retrieved from http://www.who.int/healthinfo/ statistics/bodprojections2030/en/index.html

73.

World Health Organization. (2011). Depression. Retrieved from http://www.who.int/topics/depression/en/

74.

Wilhelm

Mitchell

Slade

Brownhill

Andrews

(2003). Prevalence and correlates of DSM-IV major depression in an Australian national survey. Journal of Affective Disorders, 75, 155-162.

An Integrative Review of Paternal Depression

Abstract

Keywords

Introduction

Objectives

Method

Search Outcomes

Databases Searched

Inclusion Criteria

Exclusion Criteria

Quality Appraisal

Synthesis

Results

Prevalence and Risk Factors

Impact of Paternal Postnatal Depression

Screening for PND in Fathers

Interventions for Fathers With PND

Implications for Practice: Referral Options

Implications for Policy, Practice, and Research

Limitations

Conclusions

Footnotes

Declaration of Conflicting Interests

Funding

References