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Paternal Depression: an Examination of Its Links with Father, Child and Family Functioning in the Postnatal Period

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Paternal Depression: an Examination of Its Links with Father, Child and Family Functioning in the Postnatal Period View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Apollo DEPRESSION AND ANXIETY 28 : 471–477 (2011) Research Article PATERNAL DEPRESSION: AN EXAMINATION OF ITS LINKS WITH FATHER, CHILD AND FAMILY FUNCTIONING IN THE POSTNATAL PERIOD à Paul G. Ramchandani, Lamprini Psychogiou, Haido Vlachos, Jane Iles, Vaheshta Sethna, Elena Netsi, and Annemarie Lodder Background: Maternal depression is common and is known to affect both maternal and child health. One of the mechanisms by which maternal depression exerts its effects on child health is through an increased rate of parental disharmony. Fathers also experience depression, but the impact of this on family functioning has been less studied. The aim of this study was to investigate the association between paternal depressive disorder and family and child functioning, in the first 3 months of a child’s life. Methods: A controlled study comparing individual and familial outcomes in fathers with (n 5 54) and without diagnosed depressive disorder (n 5 99). Parental couple functioning and child temperament were assessed by both paternal and maternal report. Results: Depression in fathers is associated with an increased risk of disharmony in partner relationships, reported by both fathers and their partners, controlling for maternal depression. Few differences in infant’s reported temperament were found in the early postnatal period. Conclusions: These findings emphasize the importance of considering the potential for men, as well as women, to experience depression in the postnatal period. Paternal symptoms hold the potential to impact upon fathers, their partners, and their children. Depression and Anxiety 28:471–477, 2011. r 2011 Wiley-Liss, Inc. Key words: depressive disorder; perinatal psychiatry; childhood experience INTRODUCTION potential importance of the early months of a child’s life for its subsequent development, and the importance Depression affecting parents is a common and of the impact of the couple relationship and maternal important condition. An estimated 13% of women mental health as possible pathways by which risk is experience depression following childbirth,[1] and this transmitted.[8] Studies of families with older children can have an enduring effect on both the mother’s health have demonstrated relatively consistent associations and their child’s development.[2,3] There is now a substantial body of research showing consistent asso- ciations between maternal postnatal depression and an Department of Psychiatry, University of Oxford, Oxford, increased risk of cognitive, emotional, and behavioral United Kingdom problems in offspring. More recent work has demonstrated that depression The authors disclose the following financial relationships within also affects 5–10% of fathers[4] and that it is associated the past 3 years: Contract grant sponsor: Wellcome Trust Clinical Research Fellowships; Contract grant number: 078434. with an increased risk of behavioral and cognitive à difficulties in children.[5–7] This effect is found to be Correspondence to: Paul G. Ramchandani, Department of independent of the impact of maternal depression and Psychiatry, University of Oxford, Warneford Hospital, Oxford may be particularly potent when the depression occurs OX3 7JX, UK. E-mail: [email protected] very early in the child’s life, in what may be a sensitive Received for publication 5 January 2011; Revised 16 February period of development. To date there has been only 2011; Accepted 16 February 2011 very limited research examining the impact of paternal DOI 10.1002/da.20814 depression on family life and child development in the Published online 19 April 2011 in Wiley Online Library (wiley postnatal period. This omission is important given the onlinelibrary.com). r 2011 Wiley-Liss, Inc. 472 Ramchandani et al. between parental depression and the couple relation- Depressive symptoms were measured with the 10 item EPDS.[13] ship, with interactional processes occurring, whereby This scale is sensitive to changes in severity of depression and has couple conflict is predicted by, but also predicts, been shown to have good sensitivity (91%) and specificity (95%) in parental depression.[9] A number of theoretical models predicting depressive disorder in mothers,[16] and only marginally [14,17] have been proposed for these processes, but empirical lower in fathers. research, particularly involving paternal depression, as Fathers’ antisocial traits were measured with the Antisocial Personality Problems scale from the Adult Self-Report DSM- well as maternal, is relatively lacking. Depressed men oriented scales. The scale consists of 20 items, with a response scale are more likely to express, and elicit, negative emotions from 0 5 Not true to 2 5 Very true or often true. In this study, 5.8% in interactions with their partners, and also more likely of fathers scored above the cut off considered to indicate borderline to disengage from couple interactions at times of or clinically significant antisocial personality problems. Internal stress.[10,11] Men are also noted to report some different consistency in this study was .73. symptoms when suffering with depression, with higher The Alcohol Use Disorders Identification Test (AUDIT)[18] levels of irritability and anger expressed.[12] These measured fathers’ alcohol usage. The AUDIT consists of 10 items factors may lead to differences in the impact of referring to alcohol consumption, drinking behavior and problems depression in fathers on their children’s development, caused by alcohol. Scores range from 0 to 40, with high scores compared to maternal depression, particularly in the indicating more problematic alcohol use. Previous research has shown high levels of sensitivity (88%) and specificity (81%) for early stages of child development. dependence in men with depression or anxiety.[19] In this study we sought to investigate the associations Parents’ couple relationships were measured with the Dyadic between paternal depression and parental couple Adjustment Scale (DAS).[20] This 32-item questionnaire consists of functioning and child temperament in the first months four subscales: consensus, affectional expression, satisfaction, and of a child’s life. cohesion. A total DAS score is obtained by summing all items of the questionnaire. Scores range from 0 to 151 with higher scores indicating a better couple relationship. High levels of internal MATERIALS AND METHODS consistency were found for both men (.89) and women (.87). Perceived criticism in the couple relationship was assessed with SAMPLE AND PROCEDURE two self-report items: (1) ‘‘How critical do you think you are of your The participants were recruited from the John Radcliffe General partner?’’ and (2) ‘‘How critical do you think your partner is of Hospital in Oxford, Oxfordshire and the General Hospital in Milton you?’’.[21] Responses were scored on a 10-point scale ranging from Keynes, Buckinghamshire, UK. Families were approached on the 0 5 Never critical to 10 5 Very critical indeed. Parents were also maternity wards and were invited to participate in the study, which asked to rate how confident they were that their relationship would included all family members but particularly focussed on fathers and succeed, using a 0–10 scale. their infants. The fathers who gave their consent received the Infant temperament was assessed using parents’ reports on sub- Edinburgh Postnatal Depression Scale (EPDS)[13] at 7 weeks. Of scales of the Infant Behavior Questionnaire—Revised (IBQ;[22] those completing the initial screening questionnaire 12.7% scored 10 activity level, smiling and laughter, soothability, and distress to or higher. All the fathers screening positive (10 or more on the limitations). Parents reported how often their baby showed a EPDS) and a random one-in-four sample of those screening negative particular behavior in the last week on a 7-point scale ranging from were asked to take part in the study. Further detail on the initial 1 5 Never to 7 5 Always. screening has been published.[14] To be eligible for inclusion in the study participants were required to be age 18 or over at the time of the child’s birth and to speak sufficient English to comprehend and complete the assessments. Infants’ were required to have been born at STATISTICAL ANALYSIS no less than 37 weeks, to have a birth weight of at least 2,500 g and to The analysis was conducted in the following stages: have no severe illness or abnormalities. Families were seen at home when the infant was 3 months old. All 1. Demographic and other clinical characteristics of depressed and fathers (and mothers) were interviewed using the Structural Clinical nondepressed fathers were compared, including rates of depres- Interview for DSM-IV (SCID[15]) to establish whether they met the sion in partners. criteria for major depressive disorder. Using the cut-off score of 10 or 2. Differences in measures of couple relationship between the two more, the EPDS was found to identify those with a current episode of groups were examined using t-tests. Hierarchical linear regres- depression with a high level of accuracy (sensitivity 89.5%; specificity sions were then used to investigate whether any differences found 78.2%).[14] The sample for this study consisted of a group of fathers remained after adjusting for the infant’s gender, father’s age and with depression (n 5 54) and a group of fathers without depression education, father’s antisocial traits and maternal depression, with
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