Do Fathers Get Depressed After Childbirth?

New studies shows that it is important to detect postnatal depression in fathers

Posted Jul 28, 2018

Erika Cheng, PhD and colleagues from Indiana University School of Medicine (department of Pediatrics) evaluated the amount of postnatal depression (depression after the birth of a child) in fathers, compared that percentage to postnatal depression in mothers, and published their results in JAMA on July 23rd, 2018.

Dr. Cheng contacted 5 community health care centers in Indianapolis, Indiana and examined data from parents of children 15 months or younger who came for their well-child care visit from August 1st, 2016 to December 31st, 2017.  The data were taken from a 20-item prescreening form on a tablet with the option of English and Spanish and a 3-item version of the Edinburgh Postnatal Depression Scale.  Thanks to computer automation, the pediatrician’s attention was called when abnormal results were detected.

Responses from 9,572 clinic visits were analyzed.  Fathers attended 30.8% of these visits and were the ones answering the questionnaire in a total of 806 visits.

Among fathers who answered the questionnaire, 4.4% screened positive for depression, which is comparable to the 5% of mothers who screened positive for depression in the same study.

Because Dr. Cheng’s numbers were lower than the 9.4% depression in women and 5.4% depression in men reported by the CDC in 2015-2016, I called her to ask her if she had an explanation for this difference and what was the main take-away from her results.

Dr. Cheng told me that she was aware that the numbers from her survey were lower than the general population and said that more research was warranted to find out why.  She also said that the take-away from her results was that men get nearly as depressed as women after the birth of a child and that pediatricians are on the front line to diagnose and treat depression in parents.

What could be the reasons for fathers’ depression?

As I asked Dr. Cheng this question, she mentioned that fathers of infants could be stressed out because of more sleep disturbances when their infants cry at night and more financial pressure.

Other reasons for fathers to be depressed could be less sex with the mother (since vaginal tissues were traumatized by child birth) and less attention in general given to them by the mother (because more attention is needed for the newborn).

In addition, fathers’ depression could be linked to mothers’ depression.  JF Paulson and colleagues showed in 2010 that there was a positive but moderate correlation between mothers’ and fathers’ depression.

Who can evaluate fathers for depression and why is it important to do so?

Because fathers seldom take the time to see their primary care physicians, pediatricians need to not only assess children for their well-child care visit but also evaluate and treat mothers and fathers for postnatal depression.

Unfortunately, Dr. Cheng mentions that studies show that 80% of pediatric residents report not receiving any training to manage depression in parents.

Yet, diagnosing and treating postnatal depression in both mothers and fathers is critical for children’s mental health.

Michael Yogman and colleagues reviewed several research articles on postpartum depression in Pediatrics (June 2016): They found out that mothers tend to start being depressed the first 3 months after delivery whereas fathers start depression up to one year after a child’s birth.  Yogman also mentions that expressions of depression are different in men and women: Men are more likely than women to avoid emotional expression, deny vulnerability, turn to alcohol, get angry, defensive, compulsive, antisocial, and not seek help.  Depressed fathers are more likely to spank their infants and less likely to read to them. Other research shows that depression in fathers is a risk factor for excessive infant crying,

A sample of 12,884 fathers (The Avon Longitudinal Study of Parent and Children) showed that depression in fathers was associated with an increase in child conduct problems at ages 3 and 5 years, even when maternal depression was controlled for.  

WT Boyce and colleagues showed in a 2006 article in the Journal of American Academy of Child and Adolescent Psychiatry that when fathers were more caring, playing and communicating with their children, those children had less mental health symptoms at 9 years of age.

Taken together the above studies show how important it is to diagnose and treat postnatal depression in fathers as soon as possible, and to encourage fathers to have age-appropriate physical activity and play with their children, in order to prevent childhood conduct problems and to restore emotional balance in the family. 

References

https://jamanetwork.com/journals/jamapediatrics/article-abstract/2687933

http://pediatrics.aappublications.org/content/early/2016/06/10/peds.2016-1128

https://jamanetwork.com/journals/jamapsychiatry/fullarticle/1748838

Garfield  CF, Duncan  G, Rutsohn  J, et al: A longitudinal study of paternal mental health during transition to fatherhood as young adults. Pediatrics. 2014;133(5):836–843pmid:24733877

https://www.cdc.gov/nchs/products/databriefs/db303.htm

https://www.ncbi.nlm.nih.gov/pubmed/20483973

http://pediatrics.aappublications.org/content/138/1/e20161128

Boyce WT, Essex MJ, Alkon A, Goldsmith HH, Kraemer HC, Kupfer DJ Early father involvement moderates biobehavioral susceptibility to mental health problems in middle childhood. J Am Acad Child Adolesc Psychiatry. 2006;45(12):1510–1520pmid:1713