DOCSLIB.ORG

Paternal Depression in the Peripartum Period: an International Delphi Study Cassidy J

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Paternal Depression in the Peripartum Period: an International Delphi Study Cassidy J Loma Linda University TheScholarsRepository@LLU: Digital Archive of Research, Scholarship & Creative Works Loma Linda University Electronic Theses, Dissertations & Projects 12-2015 Paternal Depression in the Peripartum Period: An International Delphi Study Cassidy J. Freitas Follow this and additional works at: http://scholarsrepository.llu.edu/etd Part of the Counseling Commons, and the Marriage and Family Therapy and Counseling Commons Recommended Citation Freitas, Cassidy J., "Paternal Depression in the Peripartum Period: An International Delphi Study" (2015). Loma Linda University Electronic Theses, Dissertations & Projects. 342. http://scholarsrepository.llu.edu/etd/342 This Dissertation is brought to you for free and open access by TheScholarsRepository@LLU: Digital Archive of Research, Scholarship & Creative Works. It has been accepted for inclusion in Loma Linda University Electronic Theses, Dissertations & Projects by an authorized administrator of TheScholarsRepository@LLU: Digital Archive of Research, Scholarship & Creative Works. For more information, please contact [email protected]. LOMA LINDA UNIVERSITY School of Behavioral Health in conjunction with the Faculty of Graduate Studies ____________________ Paternal Depression in the Peripartum Period: An International Delphi Study by Cassidy J. Freitas ____________________ A Dissertation submitted in partial satisfaction of the requirements for the degree Doctor of Philosophy in Marital and Family Therapy ____________________ December 2015 © 2015 Cassidy June Espana Freitas All Rights Reserved Each person whose signature appears below certifies that this dissertation in his/her opinion is adequate, in scope and quality, as a dissertation for the degree Doctor of Philosophy. , Chairperson Jackie Williams-Reade, Assistant Professor of Counseling and Family Sciences Brian Distelberg, Associate Professor of Counseling and Family Sciences Curtis Fox, Professor of Counseling and Family Sciences Zephon Lister, Assistant Professor of Collaborative Care, University of California, San Diego iii ACKNOWLEDGMENTS I am deeply grateful to my dissertation committee for not only challenging me to conduct a study I believe in, but for fully supporting me throughout the process. Dr. Lister, I have always appreciated your constructive and critical eye and mentorship. Dr. Fox, thank you for encouraging me to publish Paper One in this dissertation, your support in the publication process, and in this study. Dr. Distelberg, your guidance in this dissertation, particularly in methodology, was invaluable. Dr. Williams-Reade, all students should be so lucky to have such a wonderful dissertation chair. You have pushed me with supportive guidance to produce a study I am proud of, thank you. Avo and Avoa, thank you for loving me and loving your role as grandparent. I have found so much comfort in knowing that my children were with family who loved them when I couldn’t be there myself. Mom and Dad, your unwavering support and guidance in my role as student and mother has allowed me to feel like I could take on anything. Mom, you have been an incredible example for how to balance motherhood and work life. I hope my kids always know they are the most important part of my life, just as I know I am to you. Dad, I’ve always known you are my biggest fan, and would drop everything whenever I called upon you for help (and I’ve needed a lot of help the last couple years!) I’m sorry you aren’t allowed to watch me in therapy sessions and when I’m teaching, I know you wish you could cheer me on in the sidelines like you always have. Dave, you have supported me in everything I do. When I deferred my acceptance to this program, you pushed me to begin a journey that you knew I was ready to take on. You are my best friend, my partner in life, and I feel confident taking on the iv biggest of tasks knowing that I always have you in my corner. For many reasons, I am here today because of you. This dissertation is dedicated to all of the peripartum families impacted by depression. I would like to thank every expert who believed in this study and took the time to be involved. Thank you for trusting me in this process, and for sharing your knowledge and expertise. v CONTENT Approval Page .................................................................................................................... iii Acknowledgements ............................................................................................................ iv List of Tables ..................................................................................................................... ix Abbreviations .......................................................................................................................x Abstract .............................................................................................................................. xi Chapter 1. Introduction ..............................................................................................................1 Background ........................................................................................................2 Prevalence, Trajectory, and Symptomology ................................................3 Biological Factors ..................................................................................5 PPPD and the Family System ................................................................6 Objectives ..........................................................................................................7 Rationale ............................................................................................................8 2. Conceptual Framework ..........................................................................................10 Family Systems Theory ...................................................................................10 Major Figures of Family Systems Theory and PPPD ................................11 Major Concepts of Family Systems Theory and PPPD .............................15 A Biopsychosocial Model ................................................................................19 Biological Factors ......................................................................................20 Psychological Factors ................................................................................22 Social Factors .............................................................................................22 Conclusion .......................................................................................................24 3. Review of the Literature ........................................................................................25 Paternal Peripartum Depression .......................................................................25 Prevalence, Trajectory, and Symptomology ..............................................26 vi Biological Factors ......................................................................................28 Psychological Factors and Measures .........................................................29 PPPD and the Family System ....................................................................31 Operational and Clinical Considerations ...................................................32 Financial Considerations: The Potential Cost of PPPD .............................35 Limitations of the Literature ............................................................................36 4. Methodology ..........................................................................................................38 Delphi Method .................................................................................................39 Historical Foundation.................................................................................39 Philosophical Assumptions ........................................................................40 Recruitment ................................................................................................41 Analytic Strategy .......................................................................................45 Reliability and Validity ..............................................................................48 Limitations .................................................................................................49 Conclusion .......................................................................................................50 References ........................................................................................................51 5. Publishable Paper One ...........................................................................................66 Abstract ............................................................................................................67 Introduction ......................................................................................................68 Paternal Peripartum Depression .......................................................................70 Prevalence of PPPD ...................................................................................70 Trajectory and Symptomology ..................................................................70 Biological Factors ......................................................................................71 Assessment Tools for PPPD ......................................................................72 PPPD and the Family System ....................................................................73
Load more

Recommended publications
  • The Impact of Maternal Depression in Pregnancy on Early Child Development
    DOI: 10.1111/j.1471-0528.2008.01752.x General obstetrics www.blackwellpublishing.com/bjog The impact of maternal depression in pregnancy on early child development T Deave,a J Heron,b J Evans,c A Emondd a Centre for Child and Adolescent Health, University of the West of England, Bristol, UK b Department of Social Medicine, ALSPAC, University of Bristol, Bristol, UK c Academic Unit of Psychiatry and d Centre for Child and Adolescent Health, University of Bristol, Bristol, UK Correspondence: Dr T Deave, Centre for Child and Adolescent Health, University of the West of England, Bristol, Hampton House, Cotham Hill, Bristol BS6 6JS, UK. Email [email protected] Accepted 20 March 2008. Objective Postpartum depression in mothers is associated with Main outcome measure Child development at 18 months using developmental problems in their children. Many women who are a modified Denver Developmental Screening Test (modified depressed following childbirth are also depressed during DDST). pregnancy. The aim of this study was to examine the associations Results Applying the standard 12/13 cutoff, 1565 (14%) women between maternal depressive symptoms during pregnancy and were depressed antenatally but not at either time-points child development at 18 months of age. postnatally. Employing the modified DDST, 893 (9%) children Design A prospective cohort study, Avon Longitudinal Study of were developmentally delayed at 18 months of age. Persistent Parents and Children. depression (EPDS ‡ 10 at both time-points) is associated with developmental delay (adjusted OR 1.34, 95% CI 1.11–1.62). Setting The former county of Avon, southwest England.
    [Show full text]
  • Maternal and Paternal Depression Symptoms During NICU Stay and Transition Home
    Prepublication Release Maternal and Paternal Depression Symptoms During NICU Stay and Transition Home Craig F. Garfield, MD, MAPP, Young S. Lee, PhD, Liam Warner-Shifflett, Rebecca Christie, MA, Kathryn Jackson, MA, Emily Miller, MD DOI: 10.1542/peds.2020-042747 Journal: Pediatrics Article Type: Regular Article Citation: Garfield CF, Lee YS, Warner-Shifflett L, Christie R, Jackson K, Miller E. Maternal and paternal depression symptoms during NICU stay and transition home. Pediatrics. 2021; doi: 10.1542/peds.2020-042747 This is a prepublication version of an article that has undergone peer review and been accepted for publication but is not the final version of record. This paper may be cited using the DOI and date of access. This paper may contain information that has errors in facts, figures, and statements, and will be corrected in the final published version. The journal is providing an early version of this article to expedite access to this information. The American Academy of Pediatrics, the editors, and authors are not responsible for inaccurate information and data described in this version. Downloaded from©202 www.aappublications.org/news1 American Academy by of guest Pediatrics on September 24, 2021 Prepublication Release Maternal and Paternal Depression Symptoms During NICU Stay and Transition Home Craig F. Garfield, MD, MAPPa,b, Young S. Lee, PhDb, Liam Warner-Shifflettb, Rebecca Christie, MAb, Kathryn Jackson, MAb, Emily Miller, MDb Affiliations aAnn and Robert H. Lurie Children’s Hospital of Chicago, bNorthwestern University Feinberg School of Medicine Address Correspondence Craig Garfield, Professor of Pediatrics, Feinberg School of Medicine, 633 St. Clair, Suite 19- 059, Chicago, IL 60611, [[email protected]], 312-503-5465 Conflict of Interest Disclosures The authors have no conflicts of interest relevant to this article to disclose.
    [Show full text]
  • 171122 Assessing and Managing Paternal Mental Health Issues
    Copyright EMAP Publishing 2017 This article is not for distribution Nursing Practice Keywords Antenatal clinics/Childbirth/ Depression/Fathers/Relationships Discussion This article has been Mental Health double-blind peer reviewed In this article... ● Why it is important to raise awareness of paternal mental health issues ● Symptoms of postnatal depression in men ● Assessment tools for use in new fathers Assessing and managing paternal mental health issues Key points Authors Jane Hanley is honorary lecturer in perinatal mental health at Swansea The mental health of University and course director at PMH Training; Mark Williams is an international fathers is not as well campaigner and trainer in perinatal and paternal mental health. researched as that of mothers Abstract How do men cope with pregnancy, childbirth and fatherhood? How do these events affect their mental wellbeing, their relationships with their partners and It is increasingly their attitudes towards their newborn child? Paternal mental health has long been recognised that neglected, but we now know that it is crucial to monitor it and recognise, assess and fathers can have treat any mental health issues experienced by men in the perinatal period. This article postnatal depression offers an overview of this under-researched topic and provides guidance for health or post-traumatic professionals in contact with future and young fathers. stress disorder Citation Hanley J, Williams M (2017) Assessing and managing paternal mental health Paternal depression issues. Nursing Times [online]; 114: 12, 26-29. is under-diagnosed because it does not necessarily manifest hile maternal mental A few studies have explored the atti- through classic health is well researched, tudes of potential fathers and found that symptoms the mental health of men most men had used contraception and had Wbefore, during and after the not contemplated the thought of their Allowing men birth of their child is not (Ramirez and partner becoming pregnant (Kågesten et to explore their Badger, 2014).
    [Show full text]
  • Perinatal Mental Health Toolkit for Ontario Public Health Units
    Perinatal Mental Health Toolkit for Ontario Public Health Units Module 2.1: The Importance of Perinatal Mental Health Module 2.2: The Role of Public Health November 2018 Perinatal Mental Health Toolkit for Ontario Public Health Units i Modules 2.1 (The Importance of Perinatal Mental Health) and 2.2 (The Role of Public Health) are part of the Perinatal Mental Health Toolkit for Ontario Public Health Units. To view the full document and additional resources please visit Healthy Human Development Table Toolkit webpage. Acknowledgements The Healthy Human Development Table (HHDT) members would like to thank the Public Health Unit staff and partner organizations for providing the practice examples included in this toolkit. The HHDT would also like to thank Public Health Ontario for providing secretariat support for the development of this toolkit. The views expressed in this toolkit are those of the HHDT and do not necessarily reflect those of Public Health Ontario. How to cite this document: Healthy Human Development Table. Perinatal mental health toolkit for Ontario public health units. Toronto, ON: Queen's Printer for Ontario; 2018. Disclaimer The views expressed in this Toolkit are the views of the project team, and do not necessarily reflect those of Public Health Ontario. The Toolkit is not a product of the Ministry of Health and Long-Term Care (MOHLTC). The MOHLTC is not responsible for the Toolkit or its contents. The MOHLTC does not provide any representations, warranties or guarantees with respect to the Toolkit, its quality or its accuracy. MOHLTC has not critically assessed the content of the Toolkit, nor has it evaluated any potential alignment between the content of the Toolkit and any policies or directives issued by the Government of Ontario.
    [Show full text]
  • 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.
    [Show full text]
  • Perinatal Mood & Anxiety Disorders
    INSIGHTS Perinatal Mood & Anxiety Disorders How to Reduce Your Risk SCARY THOUGHTS AND OTHER SYMPTOMS Nobody Has Told You About PMAD IT’S MORE THAN JUST POSTPARTUM DEPRESSION THE MOST COMMON COMPLICATION OF PREGNANCY When Dad Is Depressed INSIGHTS magazine is a publication of Pine Rest Christian Mental Health Services CONTENTS and is reviewed by Pine Rest clinical and medical staff. INSIGHTS is produced by the Pine Rest Marketing and Is Postpartum Depression Real? ................................................3 Communications Department. What Are Perinatal Mood and Anxiety Disorders? ................................. 3 To learn more about perinatal mood and anxiety disorders, visit pinerest.org/pmad. More than “Baby Blues” ...........................................................4 About Pine Rest The fourth largest behavioral health provider in the U.S., Pine Rest is Baby Blues vs. PMAD ............................................................... 4 a comprehensive mental health center for Types of PMAD: Beyond Postpartum Depression .................................. 5 treatment, higher education and research. Services for PMAD Pine Rest provides treatment for perinatal Reducing PMAD Risk .................................................................7 mood and anxiety disorders and paternal Risk Factors.............................................................................................. 7 depression at all levels of care. Outpatient Treatment & Professional Support ............................................8 Counseling,
    [Show full text]
  • 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 Ã 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.
    [Show full text]
  • A Group Parenting Intervention for Depressed Fathers (LTP + Dads): a Feasibility Study from Pakistan
    children Article A Group Parenting Intervention for Depressed Fathers (LTP + Dads): A Feasibility Study from Pakistan Muhammad I. Husain 1,*, Imran B. Chaudhry 2, Ameer B. Khoso 3, Ming W. Wan 4, Tayyeba Kiran 3, Tinevimbo Shiri 5, Nasim Chaudhry 3, Nasir Mehmood 6 , Syed F. Jafri 7, Farooq Naeem 1 and Nusrat Husain 4 1 Department of Psychiatry, University of Toronto, Toronto, ON M5S, Canada; [email protected] 2 Department of Psychiatry, Ziauddin Hospital, Karachi 75600, Pakistan; [email protected] 3 Pakistan Institute of Living and Learning, Karachi 75600, Pakistan; [email protected] (A.B.K.); [email protected] (T.K.); [email protected] (N.C.) 4 Division of Psychology and Mental Health, University of Manchester; Manchester M13 9PL, UK; [email protected] (M.W.W.); [email protected] (N.H.) 5 Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; [email protected] 6 Karwan e Hayat, Karachi 75620, Pakistan; [email protected] 7 Department of Community Health Sciences, Karachi Medical and Dental College, Karachi 74700, Pakistan; [email protected] * Correspondence: [email protected] Abstract: Background: Globally, paternal depression is a neglected and under-researched area. Aims: To feasibility test Learning Through Play Plus Dads (LTP+ Dads), a group parenting psychoed- ucation program adapted for depressed Pakistani fathers of children under 3 years of age. Methods: Fathers with depression were recruited in Karachi, Pakistan, for a pre-post feasibility
    [Show full text]
  • Effects of Perinatal Mental Disorders on the Fetus and Child
    Series Perinatal mental health 3 Eff ects of perinatal mental disorders on the fetus and child Alan Stein*, Rebecca M Pearson*, Sherryl H Goodman, Elizabeth Rapa, Atif Rahman, Meaghan McCallum, Louise M Howard, Carmine M Pariante Lancet 2014; 384: 1800–19 Perinatal mental disorders are associated with increased risk of psychological and developmental disturbances in This is the third in the Series of children. However, these disturbances are not inevitable. In this Series paper, we summarise evidence for three papers about perinatal associations between parental disorders and off spring outcomes from fetal development to adolescence in mental health high-income, middle-income, and low-income countries. We assess evidence for mechanisms underlying *Joint fi rst authorship transmission of disturbance, the role of mediating variables (underlying links between parent psychopathology and Section of Child and Adolescent off spring outcomes) and possible moderators (which change the strength of any association), and focus on factors Psychiatry, Department of Psychiatry, University of that are potentially modifi able, including parenting quality, social (including partner) and material support, and Oxford, Oxford, UK duration of the parental disorder. We review research of interventions, which are mostly about maternal depression, (Prof A Stein FRCPsych, and emphasise the need to both treat the parent’s disorder and help with associated caregiving diffi culties. We R M Pearson PhD, E Rapa DPhil); conclude with policy implications and underline the need for early identifi cation of those parents at high risk and MRC/Wits Rural Public Health and Health Transitions for more early interventions and prevention research, especially in socioeconomically disadvantaged populations Research Unit (Agincourt), and low-income countries.
    [Show full text]
  • 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.
    [Show full text]
  • Protocol for the Northern Babies Longitudinal Study: Predicting Postpartum Depression and Improving Parent–Infant Interaction with the Newborn Behavioral Observation
    Open Access Protocol BMJ Open: first published as 10.1136/bmjopen-2017-016005 on 27 September 2017. Downloaded from Protocol for the Northern babies longitudinal study: predicting postpartum depression and improving parent–infant interaction with The Newborn Behavioral Observation Ragnhild Sørensen Høifødt,1,2 Dag Nordahl,1,3 Gerit Pfuhl,1,4 Inger Pauline Landsem,3,5 Jens C Thimm,1 Linn Kathrin K Ilstad,2 Catharina Elisabeth Arfwedson Wang1 To cite: Høifødt RS, Nordahl D, ABSTRACT Strengths and limitations of this study Pfuhl G, et al. Protocol for the Introduction Postpartum depression (PPD) is a prevalent Northern babies longitudinal disorder. Studying the factors related to PPD will help study: predicting postpartum ► This study will provide new knowledge about to identify families at risk and provide preventive depression and improving cognitive vulnerability and protective factors interventions. This can in turn improve the developmental parent–infant interaction associated with postpartum depression (PPD), with The Newborn Behavioral trajectories for the children. Several previous studies parent–infant interaction and child development. have investigated risk factors for PPD. However, few Observation. BMJ Open ► The study is the first to examine the effect 2017;7:e016005. doi:10.1136/ studies have focused on cognitive vulnerability factors. of Newborn Behavioral Observation, a brief bmjopen-2017-016005 The first aim of the present study is to explore a range relationship-enhancing parent–infant intervention, of protective and risk factors, including cognitive ► Prepublication history for delivered as a universal preventive intervention both this paper is available online. factors, for PPD, parent–infant interactions and child for PPD and for parent–infant interaction difficulties.
    [Show full text]
  • Exploring the Experiences of First Time Fatherhood and Paternal Postnatal Depression: a Grounded Theory Analysis Revealing the Importance of the Concept of 'Coping'
    Exploring the experiences of first time fatherhood and paternal postnatal depression: A grounded theory analysis revealing the importance of the concept of 'coping' KARINA BRIA RN, RM, BN, Master of Midwifery June 2013 Discipline of General Practice School of Population Health & Clinical Practice School of Psychology Discipline of Gender, Work and Social Inquiry The University of Adelaide Thesis submitted in fulfilment of the requirements for the Degree of Doctor of Philosophy I NOTE: Pagination of the digital copy does not correspond with the pagination of the print copy TABLE OF CONTENTS LIST OF TABLES ..................................................................................................... VII LIST OF FIGURES .................................................................................................. VIII LIST OF APPENDICES .............................................................................................. IX ABSTRACT ............................................................................................................... XII PUBLICATIONS ...................................................................................................... XIII DECLARATION ...................................................................................................... XIV ACKNOWLEDGEMENTS ....................................................................................... XV CHAPTER 1 – FIRST TIME FATHERS AND PATERNAL POSTNATAL DEPRESSION ..............................................................................................................
    [Show full text]