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A Call to Action: Screening Fathers for Perinatal Depression Tova B

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A Call to Action: Screening Fathers for Perinatal Depression Tova B A Call to Action: Screening Fathers for Perinatal Depression Tova B. Walsh, PhD,a R. Neal Davis, MD,b Craig Garfield, MDc,d In early 2019, the American Academy of Pediatrics (AAP) released a policy statement1 recognizing that “maternal depression affects the whole family” and urging pediatric providers to “incorporate recognition and management of perinatal depression into pediatric practice.” Soon after, the US Preventive Services Task Force issued new recommendations on interventions to prevent perinatal depression.2 The convergence of these 2 statements from nationally recognized bodies of experts in evidence-based medicine underscores the urgency of a heightened focus on screening and making referrals for perinatal aSchool of Social Work, University of Wisconsin–Madison, Madison, b depression in pediatric practice. Wisconsin; Intermountain Healthcare, Salt Lake City, Utah; cDepartment of Pediatrics, Feinberg School of Medicine, Northwestern d The new recommendations do not go far enough and risk being out of University, Chicago, Illinois; and Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois touch with contemporary American families. The US Preventive Services Task Force evidence review and recommendations are focused exclusively Dr Walsh conceptualized the perspective piece and drafted the on interventions to prevent maternal depression. The AAP statement initial manuscript; Drs Davis and Garfield conceptualized the perspective piece; and all authors reviewed and revised the acknowledged paternal postpartum depression (PPD) as an established manuscript, approved the final manuscript as submitted, and clinical problem yet called for pediatricians to screen solely mothers at the agree to be accountable for all aspects of the work. “ 1-, 2-, 4-, and 6-month well-child visits and consider screening the DOI: https://doi.org/10.1542/peds.2019-1193 partner as well” at the 6-month visit. We believe it is inadequate to treat Accepted for publication May 29, 2019 the recognition and management of paternal depression as extra or optional. To promote optimal outcomes for children, pediatric providers Address correspondence to Tova B. Walsh, PhD, School of Social Work, University of Wisconsin, 1350 University Ave, must assess the mental health and adjustment to parenting of all new Madison, WI 53706. E-mail: [email protected] parents, regardless of gender or marital status, and make appropriate PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098- referrals for needed care. 4275). Copyright © 2020 by the American Academy of Pediatrics PATERNAL PPD FINANCIAL DISCLOSURE: The authors have indicated they have fi Fathers’ time spent with children has nearly tripled since 19653; even no nancial relationships relevant to this article to disclose. among unmarried couples, fathers typically want to be and are involved FUNDING: No external funding. with their children.4 Evidence has accrued over the last 2 decades POTENTIAL CONFLICT OF INTEREST: The authors have demonstrating the many ways that fathers contribute to their children’s indicated they have no potential conflicts of interest to health, including the association of paternal PPD with adverse child disclose. outcomes.5 One major issue is that a clear set of diagnostic criteria that is specific to paternal PPD does not exist. Nevertheless, paternal depression To cite: Walsh TB, Davis RN, Garfield C. A Call to Action: occurring within the first postpartum year is generally considered to be Screening Fathers for Perinatal Depression. Pediatrics. 2020;145(1):e20191193 PPD. Across studies, prevalence ranges from 2% to 25%.1 Fathers who are Downloaded from www.aappublications.org/news by guest on September 27, 2021 PEDIATRICS Volume 145, number 1, January 2020:e20191193 PEDIATRICS PERSPECTIVES younger, of lower socioeconomic comparable cost-benefit analysis is adjusted for fathers. These status, or have a history of depression needed to understand the economic adjustments may not be sensitive to are at greater risk.6 burden of paternal PPD and the value the distinct presentation of of effective treatment. depression in new fathers. For Paternal PPD impacts parenting and example, somaticizing symptoms and family functioning and has short- and externalizing behaviors are not long-term implications for children’s RECOGNITION AND MANAGEMENT OF measured in the most frequently used health. It is associated with reduced PATERNAL PPD IN PEDIATRICS scales for assessing maternal PPD. parenting engagement, warmth, and Paternal PPD has been associated fl sensitivity; increased couple con ict; with many poor outcomes in children 4 Efforts are underway to develop and child psychopathology. By the and families, warranting a timely a screening tool specifically for ’ fi end of the child s rst year, fathers response from pediatric providers. paternal PPD.11 In the meantime, we with depression are more likely than The following is a set of evidence- can learn from those who have fathers without depression to report informed recommendations to reduce already adopted screening for fathers spanking their children and are less barriers to identification and at well-child visits despite the likely to report reading to their treatment and to prevent adverse 7 barriers. Pediatric providers can children. Paternal PPD is associated outcomes of paternal PPD. screen fathers using the Edinburgh with poorer child emotional and Postnatal Depression Scale, a well- behavioral outcomes in childhood and Depression Education validated and widely used screening adolescence.5 Fathers are less likely than mothers measure for mothers that has been Research on paternal PPD is limited, to seek help for depression.1 Lack of validated for fathers with minor 12 and additional research is needed, in awareness of paternal PPD presents adjustments in cutoff scores, or the particular to deepen understanding of a remediable barrier to fathers 2-item Patient Health Questionnaire, depression among fathers of diverse seeking treatment. Knowledge about a quick and valid screener for all backgrounds and family PPD has been shown to facilitate help adults. In addition, pediatric circumstances. Existing research seeking by mothers, and education providers can use observations across demonstrates notable variation regarding paternal PPD may lead to multiple encounters during the between the onset and presentation increased help seeking by fathers.10 infant’s first year of life to recognize of paternal PPD and maternal PPD. Through anticipatory guidance, behavior change, identify the Paternal PPD tends to develop more pediatric providers can help all new possibility of depression, and make gradually, with longitudinal studies parents recognize the possibility of appropriate referrals. suggesting that the rate of paternal depression in themselves and their depression decreases in the period partners, recognize the tangible Referral for Treatment shortly after childbirth then increases effects of depression on parenting, over the first postpartum year5; and know when to seek (or Both early identification and additional findings report as much as encourage a partner to seek) help. intervention are critical. Reducing a 68% increase in depressive paternal depression symptoms will symptoms in the 5 years after Screening With Appropriate increase the capacity for emotionally entrance into fatherhood compared Assessment Tools sensitive and responsive parenting, with nonfathers.8 Although some Opportunities to screen fathers in make it less likely that a father and symptoms are common across pediatrics exist; the vast majority of his infant will experience attachment maternal and paternal PPD (eg, new fathers attend at least some well- problems, and support new parents’ depressed mood or loss of interest in child visits, including a large majority relationships. Although there is still activities), mothers are more likely to of fathers with depression.7 However, much to learn about how best to report sadness, and fathers are more a universally accepted and well- engage fathers and treat paternal likely to present with increased validated diagnostic tool for PPD, existing evidence suggests the irritability and alcohol and substance screening for paternal PPD is lacking. benefits of pharmacologic or use.5 Maternal and paternal PPD are This absence is representative of the psychological therapies.13 If paternal highly correlated; combined, the larger problem of insufficient depression is resulting in impaired effect on children is compounded.1 research on paternal PPD. Because parenting, fathers can also be Research demonstrates the there is currently no specific paternal referred for support to build substantial societal costs of untreated PPD screening tool, paternal PPD has parenting skills.14 Pediatric maternal perinatal mental health typically been assessed by using providers may need to locate new issues and points toward the cost- screening instruments and cutoff referral resources to respond to effectiveness of early interventions9; scores developed for mothers and these needs. Downloaded from www.aappublications.org/news by guest on September 27, 2021 2 WALSH et al A Comprehensive Approach positioned to conduct PPD screening 1-year-old children. Pediatrics. 2011; 127(4):612–618 The Council on Patient Safety in and make needed referrals. Serving Women’s Health Care has developed the whole family with effective 8. Garfield CF, Duncan G, Rutsohn J, et al. A an evidence-based maternal mental interventions is the best way to longitudinal study
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