Symptoms of Major Depression in a Sample of Fathers of Infants

Journal of Family Issues Volume 28 Number 1 January 2007 61-99 © 2007 Sage Publications 10.1177/0192513X06293609 Symptoms of Major http://jfi.sagepub.com hosted at Depression in a Sample of http://online.sagepub.com Fathers of Infants Sociodemographic Correlates and Links to Father Involvement Jacinta Bronte-Tinkew Kristin A. Moore Gregory Matthews Jennifer Carrano Child Trends, Washington, D.C.

Depression has been extensively studied for mothers but not for fathers. This study examines the sociodemographic correlates of symptoms of depression and how depression is associated with father involvement using the Composite International Diagnostic Interview–Short Form (CIDI-SF) for major depression. The study uses a sample of 2,139 resident fathers in the Fragile Families and Child Wellbeing 12-Month Father Survey. Results indicate that symptoms of major depression differ by race, marital status, and employment status but not by age and educational status. Major depression also differs significantly based on drug and alcohol use and criminal justice experience. Results of ordinary least squares regression models indicate that major depression is negatively associated with father–child activities (engagement), positively associated with paternal aggravation/stress in parenting, and negatively associated with both the quality of the mother-father relationship and coparental relationship supportiveness. Findings are important for identifying fathers for whom interventions would be valuable.

Keywords: fathers; CIDI-SF; major depression; parenting; sociodemographic correlates

lthough depression has been studied extensively among mothers, the inci- Adence and implications of depression have received much less attention

Authors’ Note: Research for this project was made possible by the generous support of the National Institute of Child Health and Human Development (NICHD) through Grant R03-HD042108-01A1.

61 62 Journal of Family Issues with regard to fathers (Dudley, Roy, Kelk, & Bernard, 2001). The occurrence of major depression is an important topic, but empirical work on this issue specifically as it relates to fathers has been slow to progress. Not only is the first episode of depression often devastating for individuals and those around them, but it is also a major burden for the health system and for society. Although men are less likely to suffer depression than are women, an estimated 6 million men in the United States, including, one assumes, many fathers, suffer from a depressive disorder, and they are less likely to be diagnosed than are women (National Institute of Mental Health [NIMH], 2002). There are a number of ways to conceptualize depression, from a depressive mood to a depressive syndrome to a major depressive disorder (Petersen, Compass, & Brooks-Gunn, 1993). A large and growing body of research suggests that major depression is a psychiatric disorder that can generate considerable impairment in an individual’s functioning, comparable to—or sometimes worse than—that caused by a chronic medical condition (Cross- National Collaborative Group, 1992). Major depression is evident when an individual experiences a period of 2 weeks or longer with either depressed mood or loss of interest in nearly all formerly enjoyable activities, with con- comitant psychomotor agitation, disruption of appetite, disruption of sleeping habits, and feelings of worthlessness or suicidality (American Psychiatric Association, 1994). Although a disposition toward depression may be inherited, other psychosocial factors such as stress and low self-esteem have been found to contribute to depression (NIMH, 2002). In addition, a male’s vulnerability to depression may be caused by factors such as parental loss before the age of 17, a poor marriage, unemployment (A. Roy, 1981), manual or working-class occupations, poor adjustment to a female partner’s pregnancy, an individual history of depression (Areias, Kumar, Barros, & Figueiredo, 1996), and an unsupportive relationship with the child’s mother (Ballard & Davies, 1996; Hoard & Anderson, 2004). Following an episode of major depression, the probability of subsequent episodes is significantly increased (NIMH, 2002). Despite a growing body of literature on the changing role of fathers, the benefits to children of paternal involvement, and the importance of men’s health for their functioning within families (Dudley et al., 2001), little prior research has focused on the consequences of major depression for fathers’ involvement in families. A large body of research indicates that parental depression has negative consequences for child well-being, although these studies have primarily focused on mothers. Maternal depression has been linked to less positive mother-child relationships, parenting behaviors, and child outcomes. Furthermore, research has found a reciprocal link between Bronte-Tinkew et al. / Major Depression in Fathers of Infants 63 parent and child mental health. Infants of depressed mothers are, for example, less attentive, less active, and fussier than are infants of nondepressed mothers (Field, Healy, Goldstein, & Guthertz, 1990). In general, poor parental mental health has been shown to be strongly associated with an increased risk for the development of emotional and behavioral problems and depressive symptoms in children (B. Brown et al., 2004). At the same time, a vast body of literature supports the idea that fathers play a significant role in determining child well-being (Flouri & Buchanan, 2002; Sidle-Fulingi & Brooks-Gunn, 2004). Given the strong influence fathers have on child well-being, it is often hypothesized that the effects of paternal depression on child outcomes will be similar to patterns observed in studies of maternal depression, with some preliminary studies finding such an association (Phares, 1997). Therefore, an understanding of male depression and its correlates would be valuable in reducing the financial and emotional costs associated with depression (Cichetti & Toth, 1998; Mizell, 1999) and enhancing the involvement of fathers in families and con- sequently children’s development. In addition, an understanding of the sociodemographic correlates of depression is important because it would enable programs and policies to target services toward those populations most at risk for developing depressive symptoms. Research shows that the prevalence of depression varies according to sociodemographic characteristics, with higher rates reported among individuals of lower socioeconomic status, single parents, those with lower levels of education, the unemployed, and those with lower levels of income (Mojtabai & Olfson, 2004). Although a fair body of extant research focuses on the intervention and treatment of individuals already suffering from depression, little work has been done to prevent the initial onset of depressive symptoms (NIMH, 2003). Understanding the correlates of male depression would allow prevention efforts to take place where they are most needed. Furthermore, given the strong influence fathers have on child outcomes, using knowledge about the correlates of paternal depression to deliver preventive services can benefit both fathers and children, which can lessen the financial and emotional costs families experience as a result of depression (Cichetti & Toth, 1998; Mizell, 1990). The role of men’s mental health and the implications for children and families are timely research and policy issues, and understanding fathers’ experiences is central to this dialogue. A primary issue motivating the present analyses is to determine how the presence of symptoms of major depression is related to men’s involvement in families among a sample of resident fathers. Considerable evidence links maternal depression with impaired parenting (Shonkoff & Phillips, 2000). 64 Journal of Family Issues

At present, however, little research exists that documents the sociodemographic correlates of paternal depression and its consequences for father involvement. In light of these gaps and shortcomings in existing research, this study uses a sample of resident fathers in the Fragile Families and Child Wellbeing Study to pose two research questions: (a) What are the sociodemographic correlates of 12-month major depressive symptoms among fathers of infants? and (b) Are symptoms of major depression associated with father involvement in families? We use data from the Fragile Families and Child Wellbeing Study. The Fragile Families is a new national study designed to track the conditions and capabilities of unmarried parents and their children over time subsequent to a nonmarital birth (McLanahan et al., 2001). The Fragile Families provides a unique opportunity to understand an understudied group of new fathers. This article focuses exclusively on a sample of resident fathers because the patterns and predictors of paternal involvement, coparenting, and the mother-child relationship are quite different for residential and nonresidential fathers. Considering the growing awareness of the importance of fathers in children’s lives, it is important to understand fathers’ depression because paternal depression may have implications for fathers’ roles in families.

Literature Review

Paternal Depression Researchers estimate that at least 6 million men in the United States suffer from a depressive disorder every year (NIMH, 2002). Results from the National Comorbidity Survey, using a national community sample, found that prevalence estimates were 2.8% for men compared to 5.9% for women (Blazer, Kessler, McGonagle, & Swartz, 1994). Research and clinical evidence also suggests that although both women and men can develop the stan- dard symptoms of depression, they often experience depression differently and may have different ways of coping with the symptoms. Extant research suggests that men’s psychological disorders and distress are different from those of women. Men have poorer social supports, and they ask for professional help less often (Wilhelm, Parker, & Dewhurst, 1998). Compared to women, depressed men tend to act out their distress exter- nally, through alcohol or drug use or excessive work hours. Signs of male Bronte-Tinkew et al. / Major Depression in Fathers of Infants 65 depression include irritability, anger, difficulty sleeping, dramatic weight gain or loss, sadness, difficulty making decisions, and a complete loss of interest in the outside world (Smyth, 2003). Even if men accept that they are depressed, they tend to be less willing to seek help than are women (NIMH, 2002). As opposed to acknowledging their feelings, asking for help, or seeking appropriate treatment, men may turn to alcohol or drugs when they are depressed or may become frustrated, discouraged, angry, irritable, or violently abusive. Some men deal with depression by throwing themselves compulsively into their work, whereas others may respond by engaging in reckless behavior (Cochran & Rabinowitz, 2000; NIMH, 2002, 2003). Suicide is also associated with depression (NIMH, 2003). Four times as many men as women die by suicide in the United States, even though women make more suicide attempts during their lives (NIMH, 2003). The higher suicide rate among men may reflect the fact that they are less likely to seek treatment for depression. Depression in men has also been shown to increase the likelihood of marital separation or divorce and is a crucial factor in determining partner’s depressive symptoms for 2 to 3 years following childbirth (Carro, Grant, Gotlib, & Compas, 1993).

Selected Sociodemographic Correlates of Depression A large literature examines how depression varies by demographic characteristics such as age, income, educational level, employment status, race, and marital status (Blazer et al., 1994; WHO International Consortium in Psychiatric Epidemiology, 2000) and by other factors such as substance use and criminal history. Although several of these correlates have been found to be associated with depression in studies using general population samples, in others they have not (Blazer et al., 1994). Therefore, findings remain inconsistent and inconclusive, and conclusions regarding causality should not be drawn. Age. Some studies find differences in depression estimates by age; however, findings are inconsistent. Some studies suggest that the likelihood of depression is rare before adolescence (Birmaher, Ryan, & Williamson, 1996) and tends to decline in later middle age or early old age. For young adults, depression cen- ters around transitions from being single to being a spouse or a parent. Some fathers may be particularly at risk if their partner is caught up in the demands of caring for a baby. On the other hand, some studies provide evidence that the highest prevalence occurs among the youngest age groups (WHO International 66 Journal of Family Issues

Consortium in Psychiatric Epidemiology, 2000). One study found that men who fathered a child during adolescence had significantly higher rates of depression than did men who fathered as adults, controlling for socioeconomic status, race, fertility, and age (Heath, McKenry, & Leigh, 1995). In contrast, recent evidence from patient samples and community samples in the United States and Europe suggests that major depression is higher among older adults (Beekman, Geerlings, & Deeg, 2002). It is hypothesized that there will be significant differences in major depression by fathers’ age, but given the lack of a clear prediction from the previous literature, there are no specific predictions regarding whether it will be more common among younger as opposed to older fathers. Income. The available epidemiological information on depression in the general population indicates that the prevalence of depression varies by poverty, income, and socioeconomic disadvantage (Mojtabai & Olfson, 2004); however, findings are again consistent. Some studies find that socioeconomic risk is positively correlated with depression (A. C. Brown, Brody, & Stoneman, 2000), and therefore depression tends to be more fre- quent among persons of low socioeconomic status (Lehtinen & Joukamaa, 1994). This relationship may be explained in part by a phenomenon of selection, whereby those with mental health problems are more inclined to drift toward economic disadvantage and remain there (Robins & Reiger, 1991). However, in a recent cross-national comparison of mental disorders conducted by the World Health Organization (WHO) across seven coun- tries, the highest estimated prevalence of mental disorders (including depression) revealed a pattern that was not entirely consistent in linking low income to higher prevalence estimates (WHO International Consortium in Psychiatric Epidemiology, 2000). It is hypothesized that the prevalence of major depression will be highest among fathers in situations of socioeconomic disadvantage. Educational level. Some research suggests that the highest estimated prevalence of mental disorders (including depression) tends to be among respondents at the lowest level of educational attainment (WHO International Consortium in Psychiatric Epidemiology, 2000). Based on this research, it is hypothesized that the prevalence of major depression will be highest among fathers with the lowest levels of education. Employment status. Several epidemiological studies suggest that employment status is related to mental health disorders (WHO International Consor- tium in Psychiatric Epidemiology, 2000). In a recent study, unemployed respondents consistently reported the highest prevalence of depression, Bronte-Tinkew et al. / Major Depression in Fathers of Infants 67 whereas employed respondents had the lowest estimated prevalence. A recent study among low-income noncustodial fathers also found depression to be highly associated with unemployment, reflecting a possible response to a lack of labor force attachment (Hoard & Anderson, 2004). It is therefore hypothesized that the prevalence of major depression will be highest among unemployed fathers. Race. Research examining whether depression varies by race has been inconclusive. Some studies find no significant differences in the prevalence of depression by race (S. M. Cummings, Neff, & Husaini, 2003), whereas other studies do find differences. A recent study documented that Puerto Ricans tend to report more depression than Whites (Oquendo et al., 2001). The 1-year prevalence rates of major depression were 3.6% for Whites, 3.5% for Blacks, 2.8% for Mexican Americans, 2.5% for Cuban Americans, and 6.9% for Puerto Ricans. Compared to the rate for Whites, the rateof depression was significantly higher for Puerto Ricans. Other studies report little differences by race (Saez-Santiago & Bernal, 2002). It is hypothesized that the prevalence of major depression will be highest among fathers from minority groups. Marital status. Available research indicates that the prevalence of major depression may differ by marital status. A study conducted by the WHO reported that the lowest estimated prevalence of mental disorders (including depression) was reported among married respondents compared to unmarried respondents (WHO International Consortium in Psychiatric Epidemiology, 2000). Research with U.S.-based populations also suggests that depression is higher in persons who are separated, divorced, or wid- owed (Lehtinen & Joukamaa, 1994). Based on prior research, it is hypothesized that the prevalence of major depression will be highest among divorced and unmarried fathers. Substance use (alcohol). Some studies suggest that individuals with alcohol-use disorders are almost twice as likely as those without such a disorder to suffer from major depression (NIMH, 2003). Alcohol-use disorders and depression commonly coexist, presenting unique challenges for men who suffer from this comorbidity and their family. Alcohol use can mask depression, making it harder to recognize depression as a separate illness. Men with an alcohol-use disorder tend to drink more alcohol than intended, may unsuccessfully try to reduce the amount they consume, may change their involvement in social, work, or other activities, and may continue to use alcohol despite awareness that it is harmful. Based on prior research, it is hypothesized that the prevalence of major depression will be highest among fathers with a substance use disorder in the form of alcohol. 68 Journal of Family Issues

Substance use (drugs). Like alcohol use, drug use disorders (abuse or dependence) also commonly co-occur with depression in men (NIMH, 2002, 2003). Several studies have found that that both men and women who use drugs are significantly more likely to develop symptoms of major depression than those who do not use drugs (Grant, 1997; Lynskey et al., 2004; Regier et al., 1990; Robins, Locke, & Regier, 1988; Weissman & Meyers, 1980). The reasons for this association are not fully understood. Some research suggests that drug use is a symptom resulting from depression, whereas other research suggests that depression causes individuals to self-medicate with substances, leading to substance abuse disorders (NIMH, 2003). Still others believe that substance use is merely a coexist- ing condition that more commonly develops in depressed men (NIMH, 2003). There is also speculation that societal gender roles play a part in the increased occurrence of substance use disorders among men with depression (NIMH, 2003). Men may be reluctant to express feelings of sadness, as this may be seen as a threat to their masculinity (Mayo Clinic, 2004), and may instead turn to drug use to mask their emotions. Still, other evidence suggests that there are genetic differences in the ways in which men and women experience depression, with different chromosomes being affected in men than in women (Mayo Clinic, 2004). Some recent research also suggests that there is a gene that is associated with both depression and substance use, suggesting a biological basis for the co-occurrence of these disorders (Mayo Clinic, 2004). Regardless of the causes, the coexistence of depression and substance use in men increases the risk that depressed males will remain undiagnosed and untreated, as many physicians are unfamiliar with the association and common diagnostic tools are geared toward identifying depressive symptoms commonly seen in women (Mayo Clinic, 2004; NIMH, 2003). Criminal history. A history of criminal conviction has also been found to be associated with father’s depression. A criminal conviction may prevent fathers from obtaining jobs, especially because employment applica- tions frequently inquire about prior convictions. Criminal convictions may follow fathers for years, having a lasting effect on fathers’ ability to acquire employment that is satisfying and that provides employment that fosters skill development and upward mobility. The lifelong consequences of a conviction may leave fathers frustrated and powerless to meet their family obligations, leading to depression (Hoard & Anderson, 2004). Based on prior research, it is hypothesized that the prevalence of major depression will be higher among fathers with a criminal history. Bronte-Tinkew et al. / Major Depression in Fathers of Infants 69

Paternal Depression and Links to Father Involvement Little is known about how men’s depression influences their involvement within families. A recurring theme in the literature, however, is that impending and new fatherhood confronts all men with a set of adjustments and challenges. For those who suffer from mental disorders (including depression), these factors may negatively influence their involvement in families. The sequelae to major depression may be numerous and include: poorer social relationships, interference with long-term cognitive functioning (NIMH, 2002), functional differences in interactions with family members regarding positivity (M. J. Cox & Paley, 1997), and interactions in the parent-child relationship (Jacob & Johnson, 2001). Child characteristics influencing father involvement. Various researchers have explored the child and mother characteristics that are likely to affect fathers’ involvement with their family, notably child gender, age, and mother’s depression. Fathers may be more involved with boys than with girls for three reasons. First, fathers may feel they can identify more with a same-sex child and may have greater incentive toward—and perceived rewards from—active involvement with boys. Second, fathers may also believe that they have more appropriate knowledge and skills that allow them to be more involved with their sons compared to their daughters (Marsiglio, 1991). Third, there may be greater external pressure and expectations that fathers spend more time with boys and serve as role models for them (Lamb, 1987). The degree of influence that father involvement has on child outcomes has also been found to differ according to the gender of the child, with fathers having a stronger influence on outcomes for male children than for female children (Bronte-Tinkew & Moore, in press; Bronte-Tinkew, Moore, & Carrano, in press; Radin & Epstein, 1975; Sidle-Fuligni & Brooks-Gunn, 2004). However, differences in involvement by child gender are not always consistent and may vary by the age of the child and the type of involvement (Cooksey & Craig, 1998). Father involvement may also vary by the age of the child. Fathers tend to be more involved with older children than newborns (Lamb, 1987). However, other research has found that fathers are more involved with younger children than with older children (Pleck, 1997). More recent work has differentiated among different types of father involvement, finding that fathers become less involved in personal care, play, and companionship activities as children age 70 Journal of Family Issues

but become more involved in achievement-related and social activities as children age (Yeung, Sandberg, Davis-Kean, & Hofferth, 2001). Mother characteristics influencing father involvement. In recent years, a substantial body of literature has also highlighted the importance of mother’s depression as a factor that has implications for father involvement with children (reviewed in J. Cox & Holden, 1994; Kumar & Hipwell, 1994; Murray & Cooper, 1997). Previous research has shown that maternal depression negatively affects parent-infant interactions and interactions with a partner. Depressed mothers show more withdrawn and less positive behaviors than do nondepressed mothers (J. F. Cohn, Matias, Tronick, Connell, & Lyons-Ruth, 1986; Field, 1984). Several studies have found that depressed mothers elicit more negative parenting behaviors, such as increased aggres- sion, criticism, irritability, hostility, indifference, inconsistency, and rejec- tion toward children (J. F. Cohn, Campbell, Matias, & Hopkins, 1990; E. M. Cummings & Davies, 1994). In addition, these mothers exhibit flat affect, less stimulation, and less contingent responsivity during interactions with their infants (J. F. Cohn et al., 1990; Field et al., 1990). Independent of their style of interaction (withdrawn or intrusive), depressed mothers show behavior that is less positive than the behavior of nondepressed mothers (J. F. Cohn et al., 1986; J. F. Cohn & Tronick, 1983; Downey & Coyne, 1990). This style of interaction has been found to be associated with a male partner’s vulnerability to depression (Field, 1992). Men whose partners are depressed may experience similar disorders, with high rates of depression being noted among fathers whose spouses are depressed. Fathers with depressed spouses have also been found to be more withdrawn than those with nondepressed spouses (Field, Hossain, & Malphurs, 1999). Depression and father–child activities (father engagement). The literature linking paternal depression to father’s functioning suggests that paternal depression may affect a father’s ability to engage his child in activities (Ballard & Davies, 1996). When fathers have negative emotion or moods (both of which are symptoms of depression), engagement with children becomes more conflictual (Larson & Pleck, 1999), and levels of positive engagement decrease (Pleck, 1997). Fathers experiencing psychological distress are also more likely to be unresponsive to their children or even become hostile (Almeida, Wethington, & McDonald, 2001). In general, depressed parents tend to be less warm and provide less structure for interaction (D. A. Cohn, Cowan, Cowan, & Pearson, 1993). Paternal depression may be accompanied by less caring and nurturant behavior toward children (Hops et al., 1987; Short & Johnson, 1997). Depressed fathers Bronte-Tinkew et al. / Major Depression in Fathers of Infants 71

have been found to label their infants as weaker, less demanding, less cud- dly, fussier, less smart, and less attentive (Hart, Field, Stern, & Jones, 1997) and may hold negative stereotypes of infants. Accordingly, based on prior research, it is hypothesize that fathers exhibiting symptoms of major depression will be less engaged with children and involved in fewer father– child activities. Depression and father’s aggravation/stress in parenting. Studies on mental health and aggravation/stress in parenting are scant, and the majority of those that do exist focus on maternal stress/aggravation in parenting to the exclusion of fathers. What is known about parenting among depressed mothers suggests that parenting skills such as emotional availability, reciprocal behavior, involvement, and positive attitudes and interactions tend to be less common for depressed mothers compared to nondepressed mothers (Mowbray, Oyserman, Bybee, & MacFarlane, 2002). Studies have found that depressed mothers provide less encouragement, affection, and respon- siveness in their parenting (Goodman & Brumley, 1990; Scherer, Melloh, Buyck, Anderson, & Foster, 1996). Although no specific links have been found between paternal depression and parental aggravation/stress in parenting, some research suggests that psychological distress disrupts effective parenting behaviors (perhaps through parental stress), resulting in strained parent-child dyads and less positive parenting behaviors (Crouter, Bumpus, Head, & McHale, 2001; Gyamfi, Brooks-Gunn, & Jackson, 2001). Aggravation/stress in parenting has been found to be associated with fathers’ perceptions of their levels of competence as a parent (McBride, 1989), and in prior research (mostly done on mothers), maternal emotional distress has been linked to hostile and less responsive parenting practices (Short & Johnson, 1997). Thus, based on prior research, it is hypothesized that paternal depression will be positively associated with paternal aggravation/stress in parenting. Depression and the quality of the father–mother relationship. Paternal depression has been found to be associated with functional differences in marital interactions, a pattern that appears to have negative repercussions for the marital dyad (Jacob & Johnson, 2001). For example, couples with a depressed husband show less positivity following positive remarks—that is, when either partner makes a positive remark, the odds are lower that the other partner will make a positive remark in response (S. L. Johnson & Jacob, 2000). Some studies also suggest that marital relationships may be worse when only one parent is depressed compared to two parents (Field et al., 1999). If both parents are depressed, they may recognize the risk to 72 Journal of Family Issues their infant and work harder to interact with the infant. Among depressed married couples, evidence suggests that impaired mental states have a detrimental impact on the quality of marriage (Hulson, 1992; Mannion, Mueser, & Solomon, 1994; Whisman & Bruce, 1999). Divorce rates tend to be substantially higher among couples in which at least one member suffers from depression (Hulson, 1992), and depressed couples tend to rate their mar- riages substantially worse in all areas of functioning than do nondepressed couples. Depression often causes lifestyle changes such as restricted social and leisure activities, economic hardship, feelings of isolation, and a lack of support. These changes may account for a decrease in marital quality (Hulson, 1992; Mannion, Mueser, & Solomon, 1994; Merikangas, Prusoff, Kupfer, & Frank, 1985). Based on prior research, it is anticipated that paternal depression will be negatively associated with the quality of the father- mother relationship. Depression and coparenting. Despite a lack of research that directly examines the associations between depression and coparenting, one can draw inferences regarding how depression affects coparenting based on studies of depression and its associations with parent–child and mother– father dyads. The spouses of depressed individuals have been shown to react to depression in a variety of ways that can either further damage parenting ability in the family or that can protect children from some of the negative parenting received from the depressed parent. Some studies have found that fathers are more likely to develop depression themselves when their spouse is depressed, which can further deplete parenting ability in a family (Burke, 2003). Families in which both parents are depressed have been shown to be less effective at positive childrearing, as the deleterious effects of mental illness on children are additive in nature, often resulting in insecure attachment styles between children and their parents (Burke, 2003; Foley et al., 2001; Herring & Kaslow, 2002). On the other hand, fathers may react by exhibiting more positive parenting behaviors in the face of maternal depression, thus enabling them to act as a buffer protect- ing children from the consequences of poor parenting by the depressed parent (Belsky, 1984; Goodman & Gotlib, 1999; Tannenbaum & Forehand, 1994). Mothers with depressed husbands have also been shown to increase positive parenting behaviors in an effort to protect their children from the negative effects of paternal depression (Zaslow, Pedersen, Cain, Suwalsky, & Kramer, 1993). Overall, though, it is anticipated that paternal depression will be negatively associated with the quality of coparenting (coparental relationship supportiveness). Bronte-Tinkew et al. / Major Depression in Fathers of Infants 73

Data and Method

Data These analyses are based on data from the Fragile Families and Child Wellbeing Study 12-Month Father Surveys. The Fragile Families is a nation- ally representative longitudinal study of nonmarital and marital births in cities with populations over 200,000. Data collection began in 1998 and will continue until 2005. The study provides information on the characteristics and capabilities of new fathers, on the relationships between urban mothers and fathers, on the factors that push parents together or apart, and on how public policies such as welfare reform affect parents’ behaviors and living arrange- ments. The study includes a sample of close to 5,000 families from 20 cities across the United States,1 including 3,712 unmarried couples and 1,186 married couples (McLanahan et al., 2001). Sample weights make these data representative of nonmarital births in large U.S. cities with populations greater than 200,000. Parents are interviewed at the birth of the child, and further interviews are scheduled when the child is 1, 3, and 5 years old. Sampled children are drawn from births at 75 hospitals in 20 cities. Both fathers and mothers were interviewed in the hospital separately following the birth of their child. When the father was not present at birth, the mother reported on the father of the baby; thus, there is information on father characteristics, even when the mother has no current relationship with the father. In this study, data from the 12-Month Father Survey are used. A total of 3,367 fathers were interviewed in the 12-Month Father Survey (1-year follow-up): 2,105 (63%) in person and 1,262 (37%) by phone. Of those interviewed, 93% were interviewed both at baseline and the 1-year follow-up. Roughly 88% of eligible resident fathers responded to the 12-Month Father Interview (McLanahan et al., 2001). A total of 2,137 resident fathers in 20 cities responded to the Composite International Diagnostic Interview-Short Form (CIDI-SF). These fathers range in age from 17 to 81 years.

Dependent Variables Four aspects of fathers’ involvement in families as reported by fathers are examined. Father–child activities (father engagement). An index was created from items adapted from the Home Observation for Measurement of the Environment (HOME) Scale (Bradley & Caldwell, 1984). The items used 74 Journal of Family Issues

in the index resemble a modified version of the HOME scale—called the HOME-Short Form—that was created in the National Longitudinal Survey of Youth (Baker & Mott, 1992). The subscales capture both cognitive stimulation and emotional supportiveness. The father–child activity (engagement) index is composed of 8 items asked of resident fathers regarding whether the father participated in the following activities with the child in a week: plays games such as “peek-a-boo” or “gotcha,” sings songs or nurs- ery rhymes, reads stories, plays inside with toys such as blocks or Legos, takes the child to visit relatives, hugs or shows affection, puts child to bed, and tells stories. The responses are measured on a 7-point scale ranging from strongly disagree (0) to strongly agree (7). Scores could range from 0 to 56 (α = .84, M = 38.3 for resident fathers). Higher scores indicate that fathers participate with greater frequency in activities with their children. Father’s aggravation/stress in parenting. An index was created from items selected from the Aggravation/Stress in Parenting Scale (Abidin, 1995). This scale was originally used in the National Evaluation of Welfare-to-Work Strategies Child Outcome Study. Items from the scale have been used in the Survey of Income and Program Participation and National Survey of American Families and were adapted for use in the Fragile Families 12- Month Father Survey. This index is composed of 4 items asked of resident fathers regarding whether: “Being a parent is harder than I thought it would be”; “I feel trapped by my responsibilities as a parent”; “I find that taking care of my child(ren) is much more work than pleasure”; “I often feel tired, worn out or exhausted from raising a family.” The responses are measured on a 4-point scale ranging from strongly disagree (0) to strongly agree (3). Scores on the paternal aggravation/stress in parenting scale range from 0 to 12 (α = .60, M = 4.6 for resident fathers). Higher scores indicate that fathers experience higher levels of paternal aggravation/stress in parenting. Father–mother relationship quality. A 9-item index was created to measure the father–mother relationship, for example, the mother being fair and willing to compromise when the mother and the father have a disagreement; the mother insulting or criticizing the father or the father’s ideas; the mother encouraging or helping the father with important things; the mother express- ing affection or love for the father; the mother trying to keep the father from seeing or talking with father’s friends or family; the mother trying to prevent the father from going to work or school; the mother withholding money, making the father ask for money, or taking the father’s money; the mother lis- tening to the father when the father needs someone to talk to; and the mother understanding the father’s hurts and joys. An index of relationship quality Bronte-Tinkew et al. / Major Depression in Fathers of Infants 75

ranging from 0 to 18 (α = .71, M = 15.2 for resident fathers) was created. Higher scores indicate a higher quality father–mother relationship. Coparenting (coparental relationship supportiveness). Coparental relationship supportiveness was measured using a 5-item index related to the father’s perceptions of about how often: the mother acts like the mother you want for child when she is with child, the father can trust the mother to take good care of child, the mother respects schedules or rules the father makes for child, the mother supports the father in the way to raise child, and the father and mother talk about problems that come up raising child. The items were added to obtain an overall coparental relationship supportiveness score (range = 0 to 10, α = .68, M = 9.2 for residential fathers), with higher scores indicating a higher level of coparenting relationship supportiveness.

Independent Variables Major depression. Symptoms of major depression are assessed by the short form of the CIDI-SF (Kessler, Andrews, Mroczek, Utsun, & Wittchen, 1998),2 based on the criteria for major depression in Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R; American Psychiatric Association, 1994). The Composite International Diagnostic Interview–Short Form for Major Depression (CIDI-SFMD) is a comprehensive, standardized instrument used to assess the presence of mental disorders as defined by the DSM-IV (American Psychiatric Association, 1994). Widely used and well known for its strong psychometric properties, the CIDI evaluates seven DSM- IV mental disorders—major depression, generalized anxiety, specific phobia, social phobia, agoraphobia, panic attack, and obsessive-compulsive disorder— and alcohol and drug dependence (Walters, Kessler, Nelson, & Mroczek, 2002). The length of the original CIDI instrument prompted investigators to adopt items based on fewer single-item measures to create a short-form measure (CIDI-SF) that would reduce research costs in large-scale studies (Kessler & Mroczek, cited in WHO International Consortium in Psychiatric Epidemiology, 2000). The short form was created in part to reduce the time spent identifying symptoms of mental illness during long surveys and is intended for use in epidemiological and cross-cultural studies and for clinical and research purposes. Respondents of the short form who affirmed stem questions were asked about seven symptoms: losing interest, feeling tired, change in weight, trouble with sleep, trouble concentrating, feeling down, and thoughts about death. 76 Journal of Family Issues

Following the procedures of Kessler et al. (1998), a numeric score ranging from 0 to 7 was converted to a probability of caseness between 0 and 1. Respondents reporting 3 or more symptoms with a probability score greater than 0.5 are considered to have major depression (Walters et al., 2002), and this is used as the cutoff score for major depression to identify those with major depressive symptoms versus those without. The responses were rated as a dichotomous variable. Fathers’ sociodemographic characteristics. A variety of self-reported measures of father’s sociodemographic characteristics from the baseline survey are included. Demographic covariates include categorical variables for fathers’ age (17-24, 25-29, 30-44, 45+ years of age), educational attainment (less than high school, high school/GED, and high school and higher), race (non-Hispanic White, non-Hispanic Black, Hispanic, and other), marital status (separated/divorced, married, never married, and cohabiting), poverty status (less than 100% of the poverty line, above the poverty line), and employment status (working in the week prior to the survey, not working in the week prior to the survey). More detailed information is not available about father’s employment history, and so this measure is used as a proxy for father’s labor force attachment. Substance use (drug use). A dummy variable was included to indicate whether the father had a history of drug use based on fathers’ responses to two questions: (a) whether the father had smoked pot or marijuana in the past month and (b) whether the father used cocaine, crack, speed, LSD, heroin, or other hard drugs in the past month. Respondents who replied yes to either of these questions were coded as 1 (drug use); respondents replying no to both of these questions were coded as 0 (no drug use). Respondents responding no to either one of these questions but missing the other question received a missing value. Substance use (alcohol use). A dummy variable was included to indicate whether the father uses alcohol, based on fathers’ responses to whether the father had had 5 or more drinks in any one day in the past month. Respondents who replied yes to this question were coded as 1 (alcohol use); respondents replying no to this question were coded as 0 (no alcohol use). Criminal history. A dummy variable indicating whether the father had ever spent time in jail, prison, or other correctional institution is included. Respondents who replied yes to this question were coded as 1 (criminal history); respondents replying no to this question were coded as 0 (no criminal history). Child characteristics. A dummy variable indicating the sex of the child is included. Female is the omitted category. Bronte-Tinkew et al. / Major Depression in Fathers of Infants 77

Mother characteristics. A measure of maternal depression using the CIDI-SF was included and was coded using the same criteria as was done for fathers. Also included are a measure of maternal age, measured as a continuous variable, and the number of children the father has with the mother, also measured as a continuous variable.

Analytical Strategy Analyses were conducted in two stages. First, the sociodemographic correlates of major depression were examined using contingency table analyses. All estimates were weighted using national sampling weights to adjust for selection probabilities and demographic characteristics. Therefore, data are representative of all nonmarital births in the 20 U.S. cities with populations greater than 200,000. Second, ordinary least squares (OLS) regression models controlling for social and demographic covariates were estimated to examine whether fathers’ reports of major depression were associated with measures of fathers’ involvement in families, specifically, father–child activities, fathers’ aggravation/stress in parenting, relationship quality, and coparental relationship supportiveness. OLS models were built using hierarchical regression. The use of hierarchical regression enables an understanding of the extent to which differences in the initial observed relationship between depression and the individual outcomes of interest are affected when additional covariates are added. Also included are independent variables that are correlated with the dependent variables but are not highly correlated among themselves. First, each event of interest is modeled using the major depression variable as the primary independent variable. At the second stage of the model building process, the effects of fathers’ sociodemographic characteristics are tested independently of other variables. Next, child characteristics and mother characteristics are added to the models to measure their effects on the four aspects of father involvement and the size and statistical significance of the depression coefficient.

Results

Descriptive Statistics Table 1 presents the demographic characteristics of the sample. All estimates are weighted. At the time of the 12-month interview, fathers ranged in age from 17 to 81 years, with the mean age of resident fathers being 29.9 78 Journal of Family Issues

Table 1 Descriptive Statistics of Variables Used in the Analysis, Fragile Families 12-Month Father Survey

Resident Fathers

Variable M or Frequency SD Range

Major depression (Composite International Diagnostic Interview-Short Form) Father’s 12-month major depression 5.4 0.3 — Mother’s 12-month major depression 6.7 1.7 — Father’s age 17-24 45.3 0.49 — 25-29 39.3 0.48 — 30-44 12.4 0.32 — 45 or older 3.2 0.17 — Father’s education level Less than high school 38.6 0.48 — High school/GED 36.1 0.48 — More than high school 25.2 0.43 — Father’s employment status Unemployed 65.0 0.50 — Employed 35.1 0.47 — Father’s race Non-Hispanic White 10.6 0.44 — Non-Hispanic Black 67.7 0.49 — Hispanic 17.2 0.44 — Other 4.6 0.20 — Father’s marital status Separated/divorced 3.9 0.07 — Married 3.4 0.49 — Never married 79.2 0.22 — Cohabiting 13.6 0.49 — Father’s poverty level Below poverty line (100%) 18.7 0.45 — Above poverty line 81.3 0.55 — Child gender Male 51.3 0.49 — Female 49.7 0.50 — Father’s substance use in previous month Alcohol use 9.4 0.20 — Drug use 10.4 0.24 — Criminal history Father spent time in jail/prison 12.8 1.20 — Number of children with the mother 1.4 0.79 — Mother’s age 24.8 5.65 — Bronte-Tinkew et al. / Major Depression in Fathers of Infants 79

Table 1 (continued)

Resident Fathers

Variable M or Frequency SD Range

Dependent variables Father–child activities (engagement) 38.3 14.10 0-56 Paternal aggravation/stress in parenting 4.6 2.67 0-12 Father–mother relationship (quality) 15.2 2.70 0-18 Coparenting (relationship supportiveness) 9.2 1.35 0-1-0 N 2,137 years. The largest group of respondents was non-Hispanic Black (67.7%), followed by Hispanic (17.2%) and non-Hispanic White (10.6%), and 4.6% belonged to the other race category. The majority of these fathers received less than a high school-level education (38.6%), followed by a high school- level education (36.1%) and high school and higher-level education (25.2%). The majority of these fathers are employed (65%), whereas 35% are unemployed. Less than 19% live below the poverty line. Roughly 10.4% of these fathers reported drug use in the month prior to the survey, 9.4% reported alcohol use in the past month, and 12.8% had ever spent time in a jail or prison. Roughly 5.4% of resident fathers reported 12-month symptoms of major depression.

Sociodemographic Correlates of 12-Month Major Depression The selected sociodemographic correlates of symptoms of major depression are presented in Table 2. The prevalence of symptoms of major depression according to fathers’ sociodemographic characteristics is for the most part in accordance with prior research (Blazer et al., 1994). Although there are no statistically significant differences in prevalence estimates by age, the highest prevalence of 12-month symptoms of major depression according to age is for fathers age 30 to 44, with 9% of fathers in this age group reporting 12-month major depression. There are significant differences in the prevalence of major depression by race. The highest estimated prevalence of major depression is among Hispanic fathers, who reported 7.7% prevalence. Prevalence estimates differ significantly by marital status. Separated or divorced fathers reported a higher prevalence of depression compared to cohabiting fathers with the lowest prevalence (6.5% vs. 0.6%). Although prevalence estimates do not differ significantly 80 Journal of Family Issues

Table 2 Symptoms of Major Depression by Sociodemographic Characteristics of Resident Fathers in the Fragile Families and Child Wellbeing Study, 12-Month Father Survey

Resident Fathers

Percentage Contingency Unweighted With Major 95% Confidence Table Analysis Characteristic n Depression Interval Results (F)a

Total 2,137 5.4 4.3-10.4 — Age (years) 17-24 572 7.3 5.0-6.7 25-29 1,023 7.0 5.1-8.8 30-44 469 9.0 6.5-11.5 45 or older 73 7.6 0.8-14.5 1.60 Race/ethnicity Non-Hispanic White 560 6.8 4.7-8.9 Non-Hispanic Black 872 7.0 4.2-9.8 Hispanic 566 7.7 5.4-10.0 Other 91 1.6 1.0-2.1 3.16* Marital status Separated/divorced 12 6.5 3.4-9.6 Married 1,021 2.7 1.7-3.2 Never married 115 1.6 0.7-2.4 Cohabiting 989 0.6 0.3-0.8 6.15*** Education Less than high school 609 8.3 5.6-10.9 High school/GED 985 6.1 3.6-8.6 More than high school 840 8.2 6.3-10.2 0.68 Current employment status Unemployed 354 14.3 10.4-18.1 Employed 1,776 8.3 5.6-9.1 12.62*** Poverty level Below poverty 294 7.6 5.9-9.2 line (100%) Above poverty line 1,274 5.0 1.3-8.7 1.52 Criminal history Spent time in jail 274 14.3 10.4-16.1 Did not spend time 1,863 5.3 4.3-10.4 7.20*** in jail Substance use Used alcohol 201 15.1 9.1-16.2 Did not use alcohol 1,936 5.5 5.2-9.6 3.20*** Used marijuana or pot 222 17.1 13.6-20.1 Did not use marijuana 1,915 6.0 5.1-8.2 4.1*** or pot a. Design-based F test. *p < .05. **p < .01. ***p < .001. Bronte-Tinkew et al. / Major Depression in Fathers of Infants 81

by educational levels, they do differ by employment status. Unemployed resident fathers reported the highest prevalence (14.3%) compared to employed fathers (8.3%). Similarly, fathers below the poverty line reported the highest estimated prevalence of 12-month major depression (7.5%), whereas fathers above the poverty line reported a lower prevalence (5.1%), although findings are not significantly different by poverty status. Resident fathers with a history of drug use reported a significantly higher prevalence of 12-month depression (14.0%) compared to resident fathers with no history of drug use (6.5%). Similarly, resident fathers with a history of alcohol use in the past month reported a significantly higher prevalence of 12- month depression (15.1%) compared to resident fathers with no history of alcohol use (5.5%). Resident fathers with a criminal history reported a significantly higher prevalence of 12-month depression (17.1%) compared to resident fathers with no criminal history (6.0%).

Links Between Major Depression and Father Involvement To estimate the associations between 12-month major depression and measures of father involvement, a series of OLS models is estimated. Table 3 presents the results of these analyses for the four outcomes: father– child activities, paternal aggravation/stress in parenting, the quality of the father–mother relationship, and coparenting (coparental relationship supportiveness). Symptoms of major depression and father–child activities. Table 3 (Model 1) presents the results of the analyses regarding the association between 12-month major depression and father–child activities. It was hypothesized that major depression would be negatively associated with father–child activities (engagement) for resident fathers. This hypothesis is supported, suggesting that the presence of depression is associated with a lower frequency of paternal engagement with young children. Table 3 (Model 1) shows that for resident fathers, additional factors that are negatively associated with father–child activities include being in the other race category, being never married, having more than one child, having a criminal history, and reporting both drug use and alcohol use in the past month. Covariates that are positively associated with father–child activities include being a father aged 17 to 24 (of marginal significance) and not being employed in the week prior to the survey (being unemployed). Taken together, these results suggest that paternal depression as measured by the CIDI-SF overlaps with relevant aspects of father’s functioning—specifically father–child interactions—net of critical correlated factors. SE (0.11) † β SE β SE Paternal Coparenting Father–Mother β Table 3 Table SE (0.93) .36 (0.25) –.42 (0.24) –.42*** (0.12) Model 1 Model 2 Model 3 Model 4 Activities in Parenting Supportiveness) Quality † Father–Child Aggravation/Stress (Relationship Relationship β Resident Fathers Resident Fathers Resident Fathers Resident Fathers 1.91 (1.61) –.34 (0.43) –.40 (0.42) –.03 (0.20) Quality Among Resident Fathers,Quality Survey 12-Month Father Fragile Families Activities,Aggravation, Paternal (Relationship Supportiveness), Coparenting and Relationship Ordinary Least Squares Regression Models of the Effects of Paternal Depression on Father–Child Depression Models of the Effects Paternal Regression Ordinary Least Squares † 17-24 1.18 35-4445 Non-Hispanic BlackHispanicOther marriedNever .89CohabitingSeparated/divorced .35 line) poverty (1 = below (0.83) –.94 –6.73*** (0.76) –6.20 –2.55* –.56 –.23 (1.90) .50 (0.75) .31 (1.19) (9.80) (0.86) (0.22) .65 –.46* (0.82) 1.23*** (0.20) .56 –.24 –.23 (0.20) (0.51) (0.32) .08 –.03 (2.60) (0.22) (0.23) –3.38*** –1.41*** .14 (0.20) (0.22) –.04 (0.54) (0.31) –.56* .32 (0.20) –.11 –.08 –1.10*** –.57*** (0.23) (0.11) (2.99) (0.25) .01 (0.15) (0.10) (0.21) .21 –.53 (0.10) –.09 (1.19) (0.10) Paternal depressionPaternal age Father’s –1.10* (1.12) .59* (0.30) –1.65*** (0.30) –.74** (0.14) Variable Father’s race Father’s Marital status Poverty

82 (0.26) .11 (0.13) (0.15) .07 (0.07) † † (0.19) .11 (0.19)(0.02) .06 –.02 (0.09) (0.02) .00 (0.00) † † (0.18) .05 (0.04) –.01 (0.02) .17 (0.14) .182 .200 .339 .274 † 2,137 2,137 2,137 2,137 .001. < p .01. *** < p .05. ** < p 1.0. * < (1 = spent time in jail)(1 = drug use)(1 = alcohol use) –.68*Number of children ageMother’s (1.12) –1.42* –1.71*** –.69* .40**Intercept (0.33) (1.54) (–1.01) –.05 (0.30) –.08 .24* .69* (0.07) –.89** (0.09) (–1.51) (0.41) .04 (0.29) –.12 –.48** –.52** 2.024*** –.04** (0.60) (0.40) (0.09) (0.14) –.41** –.32* –.05 1.853*** (0.60) (0.20) (0.04) 1.936* 1.149** (1 = unemployed) 3.16** (1.01)Maternal depression .64** .33 (0.27) .48 Less than high schoolHigh school/GED –.25 .77 (0.88) (0.72) .60** .35 (0.23) .00 (0.23) .06 (0.11) Child’s age (months)Child’s (1 = male) .12 (0.09) .88 –.02 (0.57) (0.02) .01 .02 (0.15) (0.02) .26 .00 (0.01) 2 p Criminal justice experience Substance use R N Employment status Employment Education level † Child gender

83 84 Journal of Family Issues

Symptoms of major depression and paternal aggravation/stress in parenting. Table 3 (Model 2) shows results for paternal aggravation/stress in parenting. Consistent with prior research done among mothers, the results here also indicate that depression is positively associated with aggravation/stress in the parenting role for resident fathers. The covariate that is negatively associated with paternal aggravation/stress in parenting is being a Hispanic father. Covariates that are positively associated with paternal aggravation/stress in parenting include belonging to the other race category, having less than a high school level education (compared to high school and above), not being employed in the week prior to the survey, having a criminal history, and reporting both alcohol use and drug use in the past month. In sum, these results suggest that major depression is positively associated with aggravation/stress in parenting. Symptoms of major depression and coparental relationship supportiveness. Table 3 (Model 3) shows that depression is negatively associated with coparenting relationship supportiveness. These findings suggest that being a depressed father is associated with less supportiveness in the coparental relationship. Other covariates that are significant and negatively associated with coparental support for resident fathers include being a younger father (age 17-24), being of the other racial category, being in poverty, being never married, having a criminal history, and reporting both alcohol and drug use. Symptoms of major depression and father–mother relationship quality. Table 3 (Model 4) shows that for resident fathers, there is a significant negative association between major depression and father–mother relationship quality. The additional covariates that are significant and negatively associated with relationship quality include belonging to the other race category, being never married, being aged 17 to 24, having a criminal history, and reporting both alcohol and drug use.

Discussion

The goals in these analyses were twofold: first, to examine selected sociodemographic correlates of major depression and, second, to examine how depression is associated with father involvement in families among a sample of resident men. Analyses were conducted using 12-month father data from the Fragile Families and Child Wellbeing Study. Findings from the analyses support most of the hypotheses. Bronte-Tinkew et al. / Major Depression in Fathers of Infants 85

The Sociodemographic Correlates of Major Depression Regarding the sociodemographic correlates of major depression, it was hypothesized that the prevalence of major depression will differ according to fathers’ selected sociodemographic characteristics such as age, education, income level, race, marital status, employment status, substance use (drug and alcohol use), and criminal history, consistent with previous investiga- tions. With regard to marital status, for example, analyses find that there are significant differences in the prevalence of major depression, with the highest prevalence among fathers who are divorced or separated. This is in keep- ing with a vast literature documents that divorced persons have lower levels of psychological well-being than do their married counterparts (Mirowsky & Ross, 1993). Compared to divorced or single individuals, married persons are less likely to experience depression, substance abuse, suicide, psychotic disorders (Horwitz & Raskin, 1996; Horwitz & White, 1991), or any other psychological disorder (de Vaus, 2002). Furthermore, studies have found that men tend to experience more mental health benefits than do women as a result of marriage (D’Arcy & Siddique, 1985; Horwitz & Raskin, 1996; Horwitz & White, 1991). Married men have been shown to be less likely than both unmarried men and married women to experience depression, suggesting that marriage may have protective benefits for men, providing them with companionship and help (D’Arcy & Siddique, 1985; Horwitz & White, 1991). The experience of divorce and separation, on the other hand, can have negative implications for mental health. De Vaus (2002) reports that divorced and separated adults have the highest incidences of both mood and anxiety disorders. The findings about differences in the prevalence of symptoms depression by education and employment status are also consistent with prior research that shows that depression is higher among fathers who are unemployed. This study found that high school graduates are less likely to be depressed than fathers with more or less education. However, the causal dynamics of this relationship are not clear because this pattern could be because of the cumu- lative effects of environmental adversity or because of selection processes or some combination of social causation and selection (WHO International Consortium in Psychiatric Epidemiology, 2000). Recent research also suggests that being unable to achieve self-sufficiency, coupled with a reliance on parents or others for support, may erode the foundations of fathers’ psychological well-being (Cochran & Rabinowitz, 2000). Fathers who are unemployed may feel they have limited resources to contribute to their family and extended kin networks. If fathers are unable to reciprocate support and follow 86 Journal of Family Issues the traditions of their community, they may feel powerless or that they have let down their kin. It is possible that these feelings of hopelessness may further manifest in some form of depressive symptomatology (Hoard & Anderson, 2004). Findings also suggest differences in the symptoms of major depression by race, with depression highest among fathers who are ethnic minorities. The exception is the other group, where depressive symptoms are reported very infrequently. There are divergent views in the literature questioning the relationship between ethnicity/race and depression. Findings suggest that particular characteristics of ethnicity and race may influence psychological well-being among men (U.S. Department of Health and Human Services, 2001). Another possible explanation for the racial disparity in research findings is socioeconomic status. Several researchers have found that controlling for one’s socioeconomic status results in similar rates of depression among Caucasians and African Americans (Eaton & Kessler, 1981; Neff & Husaini, 1980; Yancey, Rigsby, & McCarthy, 1972). Such findings are interesting because African American males often face more psychosocial stressors (e.g., racism and discrimination) than do those of majority groups (Hamer, 1997; W. E. Johnson, 1998; Mizell, 1999; K. Roy, 1999). Furthermore, clinical issues affecting minority males’ depression rates may be related to limited access to care and lower rates of men seeking mental health services (Addis & Mahalik, 2003; D’Augelli & Vallance, 1981; Padesky & Hammen, 1981; Vessey & Howard, 1993). These differences by race may also be a result of cultural beliefs about the nature of mental illness that may influence the fathers’ view of the course of treatment of any condition or that may reflect differences in how fathers from different cultural backgrounds experience and manifest symptoms of mental illness, and the diagnoses of mental disorders may vary across cultures and, moreover, among subcultures. Race differences in depression may also reflect the fact that some fathers are more vulnerable to develop depression as a result of their subordinated and defeated status (as in the case of members of minority groups; Oquendo et al., 2001). Like some previous studies on the relationship between major depression and age, this study finds that there are no significant differences in prevalence estimates for younger versus older fathers. Some studies suggest that the likelihood of depression is rare before adolescence (Birmaher et al., 1996) and declines in later middle age or early old age. In contrast, recent evidence from patient samples and community samples in the United States and Europe suggest that major depression is common in older adults (Beekman et al., 2002). This study finds no differences in prevalence estimates by age. Like prior Bronte-Tinkew et al. / Major Depression in Fathers of Infants 87 research on the relationship between major depression and age, the reasons for this are not immediately obvious. This study also finds significant differences in symptoms of depression for fathers who reported drug use and alcohol use. Research indicates that individuals with alcoholism are almost twice as likely as those without alcoholism to suffer from major depression (NIMH, 2003). Alcohol-use disorders and depression commonly coexist, presenting unique challenges for men who suffer from this comorbidity and for their families. Some researchers currently debate whether substance use is a symptom of underlying depression in men or a co-occurring condition that more commonly develops in men. Several studies have examined this question (Brady, Grice, Dustan, & Randall, 1993; Nunes & Quitkin, 1997; Zilberman, Tavares, Blume, el-Guebaly, 2003) and have found that although either onset scenario is possible, there are important differences by gender. Specifically, men are more likely to develop depression as a result of a substance abuse problem, whereas for women, depression more often precedes substance use. For example, studies have found that when men who exhibit both depressive symptoms and substance use abstain from substance use, their depression is likely to disappear (American Psychiatric Association, 1994; Brady et al., 1993; Nunes & Quitkin, 1997; Zilberman et al., 2003). These studies suggest that for most men exhibiting this particular comorbidity, depression likely results (perhaps biologically or chemically) from their abuse of substances like drugs or alcohol. An alternate theory found in research is that substance use can mask depression, making it harder to recognize depression as a separate illness that needs treatment. Some researchers have sug- gested that individuals with mood disorders such as depression may use substances as a form of self-medication in an attempt to alleviate mood- related symptoms (Khantzian, 1985; Quitkin, Rifkin, Kaplan, & Klein, 1972). In these instances, substance abuse can be considered a symptom of underlying depression. Finally, given the fact that both depression and substance use are relatively common among the general population, there is likely to be a subset of individuals who experience both as separate disorders (Nunes & Quitkin, 1997). Analyses also find significant differences in symptoms of depression for fathers with a criminal history. Criminal convictions may follow fathers for years, having a lasting effect on fathers’ ability to acquire employment that is satisfying and that provides employment for skill development and upward mobility. The lifelong consequences of a conviction may leave fathers frustrated and powerless to meet their family obligations, leading to depression (Hoard & Anderson, 2004). 88 Journal of Family Issues

Symptoms of Major Depression and Father Involvement

The second objective of this study was to examine associations between paternal depression and specific aspects of father involvement in families. Specifically, it was hypothesized that major depression would be negatively associated with father–child activities (engagement), positively associated with paternal aggravation/stress in parenting, negatively associated with coparental relationship supportiveness, and negatively associated with father– mother relationship quality. The analyses support all of these hypotheses for resident fathers. Consistent with prior research, the results of this study suggest that the presence of major depression reduces the frequency of fathers’ engagement with young children above and beyond controlling for mothers’ depression and other socioeconomic characteristics. The literature linking paternal depression to fathers’ functioning suggests that paternal depression may affect a father’s ability to engage his child in activities (Ballard & Davies, 1996). As is the case with maternal depression, paternal depression negatively affects parent-infant interactions (J. F. Cohn et al., 1990). Depressed fathers show behavior that is less positive (J. F. Cohn et al., 1986; J. F. Cohn & Tronick, 1983; Downey & Coyne, 1990) and provide less stimulation (Field, 1992). Fathers are therefore less reciprocal, less involved, and less positive (Cohler, Gallant, Grunebaum, Weiss, & Gamer, 1980; Musick, Stott, Spencer, Goldman, & Cohler, 1984; Stott et al., 1984; Stott, Musick, Clark, & Cohler, 1983). Results of this study suggest that, as prior research on mothers has indicated, this is also the case for resident fathers in this sample. This study also tested the hypothesis that paternal depression would be positively associated with paternal aggravation/stress in parenting. Findings show that this hypothesis was also supported in the sample of resident fathers. Although little has been done on depression and paternal aggravation/stress in parenting for fathers, what is known about parenting among depressed mothers suggests that parenting skills such as emotional availability, reciprocal behavior, and positive parenting tend to be less common for depressed mothers, with implications for aggravation/stress in the parenting role (Mowbray et al., 2002). This finding also seems true for fathers. The current study also tested the hypothesis that depression will be negatively associated with father–mother relationship quality. It was found that for resident fathers there is a significant negative association between major depression and relationship quality controlling for various social and demographic covariates. These findings are consistent with prior research suggesting that Bronte-Tinkew et al. / Major Depression in Fathers of Infants 89 among married individuals who do suffer from mental illness, there exists evidence suggesting that their impaired mental states have a detrimental impact on the quality of marriage (Hulson, 1992; Mannion et al., 1994; Whisman & Bruce, 1999). It is possible that in the presence of depression, the family dynamic changes. The quality of the father–mother relationship may be worse when only one parent is depressed, and that strained relationship affects the quality of interaction. Some studies indicate that a father’s psychological state and that of the marital or de facto relationship make men more vulnerable to depression, and how a father perceives his relationship with the mother has been found to be associated with his vulnerability to depression. These findings are consonant with the empirical observation that men tend to rely emotionally on women in marriage but women tend to internalize their distress and to count on other women for emotional support (Bernard, 1991). Of course, with cross-sectional data, one cannot address causality, but it is worth men- tioning that these are resident fathers. Hence, their depressive symptoms do not reflect a failure to form or sustain a residential relationship with their children and the mother of their children, which rules out at least one likely cause of depression. The hypothesis that depression will be negatively associated with coparenting (coparental relationship supportiveness) was also tested, and the analyses support this hypothesis. Research has found that perceived support—one’s cognitive appraisal of connection to others (Barerra, 1986)—is related to depression. Fathers’ perceptions of support in the coparenting role may be positively associated with fathers’ involvement and investments in the socialization and care of their children. The more supportive the mother and father are to each other, the more positive the influence on parent-child interaction. In the presence of depression, such support may be eroded. Therefore, support in the parenting role not only appears to have a positive influence on a father’s well-being but also may have a positive effect on his interactions with his spouse and children. This study extends previous research by providing a preliminary analysis of selected sociodemographic correlates of major depression and assess- ing how depression is linked to father involvement. Most prior research has focused on mothers’ depression. The current purpose of these analyses has been to address shortcomings in extant research. Because few other studies have focused on men and even less so specifically on fathers, one can use these findings to come to certain limited but interesting conclusions concerning the influence of symptoms of major depression on fathers. The role of men’s mental health, and the consequences for children and families, is a timely research and policy issue, and understanding fathers’ experiences is paramount to this dialogue. 90 Journal of Family Issues

Although these findings are promising, there are, however, several limita- tions of this work that should be noted. First, one should not ignore the potentially selective nature of this sample of fathers. The Fragile Families study, which includes samples of children born within and outside of marriage in large cities, has lower response rates for uninvolved versus involved fathers. Nonresponse is because of two factors: (a) The father was not nominated, either because he had not been in touch with the child or because the mother did not want him to fill out a survey, or (b) once he was nominated, he did not fill out the survey. These samples may therefore potentially create important selectivity biases. The response rate for fathers was modest, and reasons for nonresponse were not collected. It is not known if nonresponding fathers were less psychologically well (being too stressed or depressed to complete the bat- tery of tests) or coping better psychologically (and therefore perhaps less moti- vated to participate in the research study). It is likely that some respondents in general population surveys consciously fail to disclose information about mental disorders because of embarrassment or concerns about discrimination. Although some fathers may have answered the questions thoroughly, one cannot ensure truthfulness. The stigma associated with poor mental health indica- tors must be noted, and caution must be used when interpreting data based on survey methodology. This type of bias could be stronger among males than females given gender role expectations that fathers be strong. Second, this study is limited by the fact that these data are cross-sectional, and longitudinal data are not yet available to examine consistency in prevalence estimates and changes over time in major depression in this sample of fathers. Third, ongoing psychometric analyses of the CIDI short-form measure by Kessler should evaluate how well it discriminates among groups differing in diagnosis and disease severity. This will help establish the limits of the short-form measure and understand the trade-offs involved in its use. Unlike some studies that validate the CIDI-SF using various research diagnostic criteria, this study took such findings concerning the diagnostic screening potential of the CIDI-SFMD as given. It used the CIDI-SF not as a diagnostic tool but as an index of the severity of depression (Weissman & Klerman, 1997). It is also conceivable that prevalence estimates based on these data are less accu- rate that those in the modified versions of the instrument or that the CIDI diagnoses are less consistent with clinical diagnoses. In addition, it does not necessarily follow that short-form measures such as the one used in this study will achieve equivalent precision in measuring major depression. Although some sacrifice in precision is likely with short measures, compared with lengthier ones, these short-form instruments may represent a gain in precision relative to single-item measures that are more coarse. Trade-offs between Bronte-Tinkew et al. / Major Depression in Fathers of Infants 91 short- and long-form measures in detecting changes in depression over time are currently being evaluated in the National Comorbidity Survey (Kessler & Mroczek, cited in WHO International Consortium in Psychiatric Epidemiol- ogy, 2000). Fourth, the associations observed here may be mediated by processes not measured here, such as active coping by the fathers, or by interactions not monitored in the study, such as the depressed fathers’ interactions with mental health services. In addition, the current measure of aggravation/stress in parenting exhibits moderate levels of reliability, suggesting that items may not hold together as well for the sample of fathers. At the same time, however, these data provide important details on the associations between fathers’ depression and levels of involvement and add an important dimension to studies of family functioning. The study under- lines the importance of paternal depression over and above the effect of maternal depression. It seems particularly important to replicate findings to assess the stability of these patterns to determine whether estimates gener- alize across different samples and measurement characteristics. The findings from this study provide data on a central issue in understanding paternal depression: that symptoms of major depression are a fairly preva- lent experience for new fathers and, furthermore, that major depression is linked to distinctive behavior patterns in families, involving both mother– father and father–infant interactions.

Implications for Future Research These findings suggest that depression is an important concern for fathers and for mothers and that physicians should consider screening men for depression. Unemployment may be a relatively malleable factor that predicts depression, but addressing drug and alcohol use also constitutes a potential prevention strategy. Given that depression seems to be linked with less positive family functioning, it might be anticipated that paternal depression is associated with diminished child development, and this represents a continued topic for future research. The field would also benefit from research on fathers in high-risk groups for depressive symptoms, such as those with substance use problems (drugs and alcohol) and a history of incarceration. Child well-being is most likely to be compromised when children have fathers in such situations. In addition, research using longitudinal data would allow for an examination of the association between symptoms of major depression and father involvement and how these associations are played out over time. Future research could also be conducted on paternal depression as a function 92 Journal of Family Issues of race/ethnicity, specifically about how cultural differences in perceptions of depression may influence fathers’ views of a course of treatment. In addition, there is a need to understand whether depression and other study measures are culturally appropriate and sensitive across all groups or whether there is a need to continue to refine our understanding of the nuances that likely exist within and between different cultural and socioeconomic status groups with regard to measures.

Implications for Policy and Practice The findings have several implications for practice and policy making. It is important to recognize that depression affects the entire family system, and therefore services should be extended to children and spouses as well. Couples, new parents, counselors, and educators should be alert to the need for treatment among fathers and mothers. Marriage therapists should consider the possibility that fathers and mothers may benefit from treatment for depression. In addition, given how pervasive the association is between symptoms of major depression and family functioning, it would be valuable to explore prevention strategies. Because children of depressed parents experience an increased risk of developing depression and other socioemotional problems, policies and services that treat depressed fathers should include components that monitor child well-being and deliver services to children who show signs of being affected by paternal depression. The fact that depression also affects family relationships in addition to the depressed individual suggests that policies and programs targeting the treatment of depressed individuals will benefit not only the afflicted person but also the entire family system, which may lead to improvements in child well-being in families affected by depression. Groups that work with families on the local level can help assist them in the utilization of effective prevention interventions. This study emphasizes the importance of considering the possibility of paternal depression among new fathers and new mothers. The coping capacity of men in relation to issues of family functioning has long been taken for granted. These analyses suggest that a revision of this assumption could have positive implications not only for men but also for their partner and children.

Notes

1. The 20 cities are Oakland, California; San Jose, California; Jacksonville, Florida; Chicago, Illinois; Indianapolis, Indiana; Boston, Massachusetts; Baltimore, Maryland; Detroit, Michigan; Newark, New Jersey; New York, New York; Toledo, Ohio; Philadelphia, Pennsylvania; Pittsburgh, Bronte-Tinkew et al. / Major Depression in Fathers of Infants 93

Pennsylvania; Nashville, Tennessee; Austin, Texas; Corpus Christi, Texas; San Antonio, Texas; Norfolk, Virginia; Richmond, Virginia; and Milwaukee, Wisconsin. 2. The Composite International Diagnostic Interview–Short Form (CIDI-SF) yields a probability of “caseness” ranging from 0.0 to 1.0. This score can be interpreted as the probability that a respondent with a particular response profile would meet the full diagnostic criteria if given the complete CIDI. The diagnostic stem requirement to determine major depression was derived in two stages: by either endorsing all questions about having 2 weeks of dysphoric moods or endorsing all questions about having 2 weeks of anhedonia. Each of these series requires the respondents to report 2 weeks of this symptom lasting at least most of the day, every day. Either denying the existence of the symptoms or denying persistence leads to a skip out, and the respondent receives a probability of caseness equal to 0. If the respondent endorsed the stem series, an additional seven symptom questions are asked: losing interest, feeling tired, change in weight, trouble with sleep, trouble concentrating, feeling down, and thoughts about death.

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