While perinatal depression is typically considered to be a woman’s illness, multiple studies have suggested that, while men do not experience any of the dramatic physiological or hormonal changes that go along with pregnancy and childbirth, new fathers may also suffer from depression related to pregnancy and the postpartum period. In a systematic review of the literature, Mazza and colleagues take a look at depression in expecting and new fathers, asking whether paternal perinatal depression is a valid diagnosis.
In this review, they evaluated 204 studies which measured depressive symptoms in expectant and new fathers with a total of 849,913 parents. Longitudinal studies represented more than half of the included studies; more than three-quarters of the studies used the Edinburgh Postnatal Depression Scale (EPDS) to measure depressive symptoms.
The prevalence of depression in fathers ranged from 0% to 33.79%, with a weighted mean prevalence of 4.97%. In the studies which included mothers and fathers, it was noted that depression was about twice as common in mothers than in fathers, and there was only a small degree of intracouple correspondence between mothers’ and fathers’ depression.
In an earlier meta-analysis, Cameron and colleagues reviewed a total of 74 studies including 41,480 participants. In this analysis, the authors also found a wide range of prevalence estimates across individual studies. Pooling the results, they estimated the prevalence of perinatal depression in new fathers to be somewhat higher, about 8.4%. The highest rates of paternal depression were observed at 3 to 6 months after delivery. Risk for paternal depression was not affected by parity, education level, paternal age, or history of depression. However, postpartum depression in the father was more likely to occur when the mother was also depressed.
Do Maternal and Paternal Depression Occur Together?
Based on these analyses, it appears that men are vulnerable to depression during pregnancy and the postpartum period, although it is clear that perinatal depression affects more women than men. The two meta-analyses differ to some degree with regard to the relationship between maternal and paternal depression in the context of the relationship. (It should be noted that these studies looked only at cis-gendered heterosexual couples.) While the most recent review from Maazza suggests only a small concordance between depression in couples, the meta-analysis from Cameron and colleagues noted that paternal depression appeared to be more common when the mother was depressed.
In a study published in the Archives of Women’s Mental Health, Paulson and colleagues attempted to clarify the association between maternal and paternal postpartum depression. This was a relatively small study where cohabitating couples with their first pregnancy were recruited from obstetric visits and community agencies and were enrolled during pregnancy, between 28 weeks of gestation and delivery. Subjects were assessed during the third trimester of pregnancy (baseline) and at 1, 3, and 6 months postpartum. For both mothers and fathers, symptom severity ratings were relatively stable across time, such that 75% of the mothers and 86% of the fathers who were depressed during pregnancy continued to be depressed throughout the postpartum period (up to 6 months after delivery). Prenatal depression in fathers predicted worsening depressive symptoms in mothers across the first six months postpartum; however, depression in the mother had no impact on the severity of symptoms in the father.
Although we think of hormonal shifts as the driving force for postpartum depression, at least in women, many studies suggest that perceived stress may play an important role in predicting risk for depression and may be a shared risk factor for mothers and fathers when it comes to postpartum depression. In a group of 54 fathers and 71 mothers, Seah and colleagues observed a significant correlation in levels of parenting stress within couples, although fathers reported lower levels of postpartum depression than mothers.
In another study, depressive symptoms in mothers and fathers were assessed using the Edinburgh Postnatal Depression Scale (EPDS). Prevalence of maternal and paternal postpartum depressive symptoms was 15.9% (EPDS>12) and 5.4% (EPDS>10), respectively. There was a moderate positive correlation between mothers’ and fathers’ EPDS scores (r=.30, p<.001). Parental stress was the strongest predictor for maternal and paternal postpartum depressive symptoms. Pregnancy- and birth-related distress and partners’ EPDS scores during pregnancy were also associated with higher levels of depressive symptoms in both parents after delivery. Relationship satisfaction was only inversely related with fathers’ EPDS scores, while mothers’ EPDS scores were additionally associated with stressful life events and history of childhood trauma.
Clinical Relevance and Some Food for Thought
While some of these studies are preliminary in nature, they raise some interesting questions. In our clinic, we encourage women with postpartum depression to bring in their partners. This approach is helpful in getting a better sense of how the mother is doing at home and with the baby and can help to educate her partner about postpartum mood disorders and to determine what other supports are needed.
But we may be missing something here. If there is a modest correlation between maternal and paternal depression, should we also be assessing women’s partners to determine if they have postpartum depression? Since co-occurrence of depressive symptoms in mothers and fathers is relatively common, developing and evaluating postpartum depression interventions for couples may be beneficial. Interventions to reduce parenting stress may also help to prevent perinatal depression in both parents.
Ruta Nonacs, MD PhD
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Cameron EE, Sedov ID, Tomfohr-Madsen LM. Prevalence of paternal depression in pregnancy and the postpartum: An updated meta-analysis. J Affect Disord. 2016 Dec; 206:189-203.
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