Review articlePrevalence of paternal depression in pregnancy and the postpartum: An updated meta-analysis
Introduction
Depression is a serious mental health concern for fathers during the transition to parenthood, with prevalence rates estimated to range from 1% to 46% depending on the mental health of the man's partner, sample size from which incidence was drawn, and measure used to assess prenatal and postpartum depression (Dudley et al., 2001, Goodman, 2004, Skari et al., 2002). Paternal depression is negatively associated with intimate relationship satisfaction (Don and Mickelson, 2012, Wee et al., 2011), parenting practices (Paulson et al., 2006, Wilson and Durbin, 2010), and emotional and behavioural outcomes in children including later psychopathology (Ramchandani et al., 2008, Ramchandani et al., 2005). Paternal depression is also highly correlated with maternal depression (Paulson and Bazemore, 2010, Wee et al., 2011) with an increase in depression in one partner potentially leading to an increased risk in the other (Wee et al., 2011). This relationship poses a further risk to the child for future psychopathology as exposure to two parents with depression is exponentially worse than exposure to only one (Foley et al., 2001, Goodman et al., 1993). Due to the significant consequences of paternal prenatal and postpartum depression, research attention in the area has recently increased substantially.
Prevalence estimates of paternal depression during the transition to parenthood range widely due to the heterogeneity of assessment time points, methods used, and populations assessed (Paulson and Bazemore, 2010). To date, only one review has quantitatively evaluated the prevalence of paternal prenatal and postpartum depression in the available literature (Paulson and Bazemore, 2010). Paulson and Bazemore (2010) reported a meta-estimate of paternal depression of approximately 10% based on 43 studies published from 1980 to 2009. The meta-analysis also indicated that there was a relatively higher rate of depression in the 3- to 6-month postpartum period (Paulson and Bazemore, 2010). Due to small sample sizes in the first trimester and 9–12 months postpartum, Paulson and Bazemore (2010) created discrete categories of 0–6 months gestation (i.e., first and second trimester) and 6–12 months postpartum, which may not accurately represent the rate of risk during these periods. Narrowing the time periods to more specific ranges could assist health care providers in applying screening procedures during the critical months during the transition to parenthood. Similarly, when comparing rates of depression in different study locations, the review's sample sizes limited the extent of these analyses leading to a dichotomous comparison of the United States and International countries (Paulson and Bazemore, 2010). Identifying continents with higher risks of depression may inform priority areas for implementation of screening and intervention procedures for paternal prenatal and postpartum depression. Lastly, risk factors for paternal depression during the transition to parenthood have been reported to include paternal age, education, psychiatric history, and maternal depression (Ballard and Davis, 1996; Schumacher et al., 2008, Wee et al., 2011). However, to date there has been no meta-analysis that has investigated the moderation of paternal demographics and maternal depression on rates of paternal prenatal and postpartum depression.
Since the previous review was conducted in 2009, the number of published studies on this subject has nearly doubled rendering an updated and inclusive meta-estimate necessary. An increasing number of available studies means that there is room for further synthesis and clarification of moderators of prevalence rates. Meta-analysis is an ideal method to quantitatively answer questions about prevalence rates and associated moderators in the literature. Thus, the current study provides a meta-estimate of prevalence rates of paternal prenatal and postpartum depression with attention paid to conditional effects of assessment method, time of measurement, study location, publication year, age, education, parity, history of depression, and maternal depression.
Section snippets
Method
A meta-analysis of peer-reviewed articles of prenatal and postpartum correlates and predictors of paternal depressive symptoms in male human participants was conducted. Published literature analyzing depression prevalence in fathers was reviewed with specific attention paid to the methodology and time points of assessment, measures used to assess depression, location of study, paternal sociodemographic information, maternal depression, and inclusion and exclusion criteria outlined. This
Results
Electronic database searches resulted in 709 potentially relevant studies of which 502 did not meet inclusion criteria (e.g., articles on unrelated topics, reviews or summaries, depression not assessed in fathers, sample fathers experience infant death or illness, participants under the age of 18). Of the 207 studies reviewed in full-text, 94 were excluded because the proportion of fathers with depression was not reported, 34 reported on a sample already included in the meta-analysis, and five
Discussion
The prevalence estimate for paternal depression experienced during pregnancy and up to one-year postpartum was approximately 8%. Although prevalence estimates appeared relatively higher in the 3- to 6-month postpartum period and lower in the second trimester, rates were not conditional on the timing of assessment. These findings are inconsistent with previous reports that found prevalence estimates to be moderated by timing of assessment (Paulson and Bazemore, 2010). Rates of depression varied
Declaration of interest
The authors declare no conflict of interest.
Acknowledgements
This work was supported by the generous donors of the Alberta Children’s Hospital Foundation (LT), the Alberta Children's Hospital Research Institute (EC), and the Social Science and Humanities Research Council of Canada (EC; IS).
References (112)
- et al.
Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation
Clin. Psychol. Rev.
(1988) - et al.
Psychosocial factors associated with paternal postnatal depression
J. Affect. Disord.
(2013) - et al.
Healthcare costs of paternal depression in the postnatal period
J. Affect. Disord.
(2011) - et al.
Prenatal paternal depression
Infant Behav. Dev.
(2006) - et al.
Common perinatal mental disorders and alcohol dependence in men in northern Viet Nam
J. Affect. Disord.
(2012) - et al.
Cross-cultural and social diversity of prevalence of postpartum depression and depressive symptoms
J. Affect. Disord.
(2006) Transition to fatherhood. An exploratory study
J. Obstet. Gynecol. Neonatal Nurs.
(1983)- et al.
Detecting postnatal depression in Chinese men: a comparison of three instruments
Psychiatry Res.
(2010) - et al.
Paternal depression in the postnatal period assessed with traditional and male depression scales
J. Mens Health Gend.
(2007) - et al.
How well does the Edinburgh Postnatal Depression Scale identify depression and anxiety in fathers? A validation study in a population based Swedish sample
J. Affect. Disord.
(2013)
Paternal and maternal depressed mood during the transition to parenthood
J. Affect. Disord.
Validation of the Edinburgh Postnatal Depression Scale for men, and comparison of item endorsement with their partners
J. Affect. Disord.
Predictors of maternal and paternal depressive symptoms at postpartum
J. Psychosom. Res.
Working and short-term memories are impaired in postpartum depression
J. Affect. Disord.
Paternal depression in the postnatal period and child development: a prospective population study
Lancet
Depression in men in the postnatal period and later child psychopathology: a population cohort study
J. Am. Acad. Child Adolesc. Psychiatry
Postnatal depression in Mexican American fathers: demographic, cultural, and familial predictors
J. Affect. Disord.
Bringing birth-related paternal depression to the fore
Women birth
Comparative levels of psychological distress, stress symptoms, depression and anxiety after childbirth – a prospective population-based study of mothers and fathers
Br. J. Obstet. Gynaecol.
Continental Divides: Remapping the Cultures of North America
Diagnostic and Statistical Manual of Mental Disorders: DSM-5
Comparative incidence of depression in women and men, during pregnancy and after childbirth. Validation of the Edinburgh Postnatal Depression Scale in Portuguese mothers
Br. J. Psychiatry
Postpartum depression in primiparous parents
J. Abnorm. Psychol.
Postnatal depression in fathers
Int. Rev. Psychiatry
Prevalence of postnatal psychotic morbidity in mothers and fathers
Br. J. Psychol.
Fathers' involvement in child care and perceptions of parenting skill over the transition to parenthood
J. Fam. Issues
Operating characteristics of a rank correlation test for publication bias
Biometrics
Paternal depressive symptoms during pregnancy are related to excessive infant crying
Pediatrics
Depressive symptoms in new first-time fathers: associations with age, sociodemographic characteristics, and antenatal psychological well-being
Birth
Depressive mood in men after the birth of their offspring in relation to a partner's depression, social support, fathers' personality and prenatal expectations
J. Reprod. Infant Psychol.
Gender ideology, depression, and marital quality in working-class, dual-earner couples across the transition to parenthood
Diss. Abstr. Int.: Sect. B: Sci. Eng.
Low rates of PTSD in men attending childbirth: A preliminary study
Br. J. Clin. Psychol.
Symptoms of major depression in a sample of fathers of infants: sociodemographic correlates and links to father involvement
J. Fam. Issues
Postpartum depression and child development: an investigation of mothers and fathers as sources of risk and resilience
Dev. Psychopathol.
Infants in a neonatal intensive care unit: parental response
Arch. Dis. Child Fetal Neonatal Ed.
Prevalence of paternal perinatal depressive mood and its relationship with maternal depression symptomatology: an Italian study
Int. J. Adv. Nurs. Stud.
The first-time fathers study: a prospective study of the mental health and wellbeing of men during the transition to parenthood
Aust. N.Z. J. Psychiatry
The Handbook of Research Synthesis and Meta-Analysis
The use of Edinburgh Postnatal Depression Scale to identify postnatal depression symptoms at well child visit
Ital. J. Pediatr.
The association of paternal mood and infant temperament: a pilot study
Br. J. Dev. Psychol.
Incidence of maternal and paternal depression in primary care
Arch. Pediatr. Adolesc. Med.
Clinically identified maternal depression before, during, and after pregnancies ending in live births
Am. J. Psychiatry
Paternal postpartum depression: the role of maternal postpartum depression, spousal support, and relationship satisfaction
Couple Fam. Psychol.
Psychological correlates of depression in fathers and mothers in the first postnatal year
J. Reprod. Infant Psychol.
Comparisons of different instruments to measure blues and to predict depressive symptoms 2 mnths postpartum: a study of new mothers and fathers
Scand. J. Caring Sci.
Bias in meta-analysis detected by a simple, graphical test
Br. Med. J.
Mother-infant and father-infant attachment among alcoholic families
Dev. Psychopathol.
Gender differences in postpartum depression: a longitudinal cohort study
J. Epidemiol. Commun. H.
Influence of parental mental health on early termination of breast-feeding: a case-control study
J. Am. Board Fam. Pract.
Cited by (344)
Mothers' and fathers' depressive symptoms across four years postpartum: An examination of between- and bidirectional within-person relations
2024, Journal of Affective DisordersDuration and timing of depression and risk of family dissolution: A register-based cohort study of newly-formed Danish families
2024, Journal of Affective DisordersLinks between perceived social support, sense of parental efficacy and postpartum paternal depression
2024, Annales Medico-PsychologiquesPre-pandemic adversity and maternal mental health during the COVID-19 pandemic: the mediating role of pandemic stress and family relationships
2024, Journal of Affective Disorders