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Paternal Depression, Anxiety, and Stress in the Perinatal Period

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Paternal Depression, Anxiety, and Stress in the Perinatal Period i Fatherhood and Psychological Distress: Paternal Depression, Anxiety, and Stress in the Perinatal Period by Adrian Schulz BSc, BBus, Grad Dip Psych Submitted in partial fulfillment of the requirements for the degree of Doctor of Psychology (Health) Deakin University, January 2016 Principal Supervisor: Professor Helen Skouteris Associate Supervisor: Dr Ben Richardson iv Acknowledgements Firstly, thank you to Professor Helen Skouteris for your supervision, advice and guidance in writing this thesis. I am grateful for your help and encouragement, and for your tireless and always prompt feedback that turned a few messy first drafts that were lacking in direction and “story”, into a document that I am proud of. Thank you also to Dr Ben Richardson for your statistical expertise and helping me understand data that failed every assumption we had learned about in our Research Methods studies. I would also like to acknowledge all the fathers who participated in these studies and took the time to complete the questionnaires. For many of them it may have been the busiest and most stressful time of their lives, so I am indebted to them for their commitment and honesty. To my clinical placement supervisors Susan and Glenda, Sue B., Jane and Jo, and Sue Y., and everyone at Peninsula Health, Cabrini, and Yarra Ranges Health. Thank you for your advice and providing an important outsider perspective, and being forgiving on the many mornings I came to placement having not had enough sleep the night before because I was up writing this thesis. Thank you to Sean for cooking me countless meals, to my late great-uncle Tom Cattle whose beneficence provided me with the financial support to undertake this degree, to Donovan for all the great coffee, and to all my DPsych classmates who have shared many fantastic, interesting and inspiring experiences, and many tiring, frustrating and emotionally draining experiences with me over the last three years. To Mum, Dad, Martyn, Caroline and Richard, thank you for listening when I just want to complain about things, helping with me with participant recruitment, giving me encouragement to keep going, and most of all, for your love and support. And finally, to Kate, who first encouraged me to study psychology, but has then had to endure me being a student year, after year, after year. Your unwavering love and support has given me the motivation, inspiration and self-belief to do something that years ago I never would have thought possible. When the stress and frustration of being a DPsych student got too much, all you had to do was smile at me and I knew “everything was gonna be OK.” v Table of Contents Access to Thesis – A…………………………………………………………………………..ii Candidate Declaration ............................................................................................................... iii Acknowledgements ................................................................................................................... iv Table of Contents……………………………………………………………………………..iii Lists of Figures and Tables ..................................................................................................... viii List of Appendices ..................................................................................................................... x Abstract ..................................................................................................................................... xi CHAPTER ONE Introduction and Overview of Thesis ........................................................................................ 1 CHAPTER TWO Literature Review ...................................................................................................................... 9 2.1 - Parental Perinatal Depression ........................................................................................ 9 2.2 - Prevalence of paternal depression in the perinatal period. .......................................... 11 2.3 - Assessment of paternal depression in the perinatal period .......................................... 13 2.4 - Predictors and correlates of Paternal Perinatal Depression ......................................... 19 2.5 - Consequences of Paternal Postnatal Psychopathology ................................................ 24 2.6 - Summary ...................................................................................................................... 29 CHAPTER THREE Comparison of Depressive Symptoms between Fathers and Childless Men: A Systematic Review ..................................................................................................................................... 32 3.1 - Introduction .................................................................................................................. 32 3.2 - Method ......................................................................................................................... 35 vi 3.3 - Results .......................................................................................................................... 37 3.4 - Discussion .................................................................................................................... 47 3.5 - Conclusion ................................................................................................................... 51 CHAPTER FOUR Theoretical Explanations for the Development of Depression in the Postnatal Period for Men and Women .............................................................................................................................. 54 4.1 - Medical Model ............................................................................................................. 55 4.2 - Sociocultural Factors ................................................................................................... 57 4.3 - Attachment Theory ...................................................................................................... 58 4.4 - Ecological factors......................................................................................................... 61 4.5 - Conclusion ................................................................................................................... 63 CHAPTER FIVE Study One: Perinatal Relationship Adjustment, Social Support and Paternal Depression, Anxiety, and Stress .................................................................................................................. 67 5.1 - Introduction .................................................................................................................. 67 5.2 - Method ......................................................................................................................... 70 5.3 - Results .......................................................................................................................... 77 5.4 - Discussion .................................................................................................................... 88 5.5 - Conclusion ................................................................................................................... 95 CHAPTER SIX Boys Don’t Cry: Depression and Gender ................................................................................ 98 CHAPTER SEVEN Study Two: Male Depressive Syndrome in the Postnatal Period .......................................... 107 vii 7.1 - Introduction ................................................................................................................ 107 7.2 - Method ....................................................................................................................... 112 7.3 - Results ........................................................................................................................ 117 7.4 – Discussion ................................................................................................................. 126 7.5 - Conclusion ................................................................................................................. 133 CHAPTER EIGHT General Discussion ................................................................................................................ 135 References .............................................................................................................................. 144 viii Lists of Figures and Tables Figures Page Figure 3.1 Search terms used in database search 36 Figure 3.2 Study screening and selection process 37 Tables Table 3.1 Cross-sectional studies comparing levels of depression symptoms in 40 fathers and childless men Table 3.2 Longitudinal studies comparing levels of depression symptoms in 41 fathers and childless men Table 3.3 Comparative rates of Depressive Symptoms in Fathers (reference group 46 childless men) Table 5.1 Cronbach’s Alpha Reliability Co-efficients for the DASS-42 Subscales 74 Table 5.2 Cronbach’s Alpha Reliability Co-efficients for Relationship 75 Adjustment, Sexual Satisfaction, and Social Support Measures Table 5.3 Demographic characteristics of expectant fathers at 18 weeks 78 pregnancy Table 5.4 Mean Depression, Anxiety and Stress scores (DASS-42) at each time 79 point, and percentage of participants reporting mild to severe (M-S) symptom levels Table 5.5 Mean levels of Sexual Satisfaction, Relationship Adjustment and Social 81 Support over the perinatal period Table 5.6 Percentages of Missing Data and Role of each Variable in Imputation 83 Process Table 5.7 Negative
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