A Systematic Review T ∗ Alice Wickershama,C,D, , Daniel Leightleya, Marc Archera, Nicola T

Journal of Adolescence 79 (2020) 232–246

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Journal of Adolescence

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Review article The association between paternal psychopathology and adolescent depression and anxiety: A systematic review T ∗ Alice Wickershama,c,d, , Daniel Leightleya, Marc Archera, Nicola T. Fearb a King’s Centre for Military Health Research, King’s College London, United Kingdom b King’s Centre for Military Health Research and Academic Department of Military Mental Health, King’s College London, United Kingdom c Department of Psychological Medicine, King’s College London, United Kingdom d South London and Maudsley NHS Foundation Trust, United Kingdom

ARTICLE INFO ABSTRACT

Keywords: Introduction: Paternal psychopathology is associated with various adolescent outcomes. With Depression emotional disorders presenting a significant public health concern in the adolescent age group, Anxiety the aim of this systematic review was to synthesize evidence on the relationship between paternal Adolescent mental health and adolescent anxiety or depression. Paternal Methods: PubMed, Web of Science, Embase, Ovid MEDLINE, Global Health, and PsycINFO were Mental health searched for articles which primarily aimed to investigate the relationship between paternal mental health (exposure) and adolescent anxiety or depression (outcome). Articles were assessed for risk of bias, and findings are presented in a narrative synthesis. The protocol is registered on PROSPERO (CRD42018094076). Results: Findings from the fourteen included studies indicated that paternal depression is associated with adolescent depression and anxiety. Findings relating to other paternal mental health disorders were inconclusive. Results largely suggested that adolescent depression and anxiety is equally associated with paternal and maternal mental health. The included studies were mostly cross-sectional, and the quality of included studies was mixed. Attempts to focus on the 11–17 year age range were hampered by the variability of age ranges included in studies. Conclusions: Further longitudinal research is needed to clarify the association between paternal mental health disorders other than depression, and adolescent anxiety or depression. Mechanisms in this relationship should also be further explored, and could be informed by existing models on younger children.

1. Introduction

A recent review estimated that 15%–23% of children worldwide live with a parent with a mental health or substance use disorder (Leijdesdorff, van Doesum, Popma, Klaassen, & van Amelsvoort, 2017). Research on the impact that parental psychopathology has on children and adolescents tends to focus on mothers rather than fathers (Cabrera, Volling, & Barr, 2018). However, the role of fathers in their children's lives cannot be reasonably overlooked, as they increasingly engage in childcare and head up single parent households (Livingston, 2013; Parker & Wang, 2013). Accordingly, the inclusion of fathers in research is growing, such that the impact of paternal depression on child and adolescent outcomes has been extensively studied and reviewed (Gentile & Fusco, 2017;

∗ Corresponding author. Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, London, SE5 8AF, United Kingdom. E-mail address: [email protected] (A. Wickersham). https://doi.org/10.1016/j.adolescence.2020.01.007 Received 28 November 2018; Received in revised form 13 December 2019; Accepted 12 January 2020 Available online 25 January 2020 0140-1971/ © 2020 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved. A. Wickersham, et al. Journal of Adolescence 79 (2020) 232–246

Kane & Garber, 2004; Sweeney & MacBeth, 2016), and potential mechanisms in the relationship between paternal and child psychopathology have been considered (Ramchandani & Psychogiou, 2009; Sweeney & MacBeth, 2016). But while research is growing in this field, less consideration has been given to the impact of paternal mental health disorders other than depression. Given that disorders such as anxiety and substance abuse are known to be just as prevalent as depression in the general population, their potential impact warrants equal attention (McManus, Bebbington, Jenkins, & Brugha, 2016). A review which draws together evidence on paternal psychopathologies including but not limited to depression would provide insight to the comparative state of the literature regarding a range of disorders. Moreover, previous reviews of the literature have tended to examine findings from adolescence alongside childhood and even infanthood (Gentile & Fusco, 2017; Kane & Garber, 2004; Ramchandani & Psychogiou, 2009; Sweeney & MacBeth, 2016), despite indication that the effect of parental psychopathology changes throughout childhood and adolescence (Connell & Goodman, 2002). Previous reviews have also investigated both internalising and externalising outcomes in offspring, despite the predictors, course and outcomes of these disorders being heterogeneous and warranting independent and comprehensive study (Liu, 2004; Liu, Chen, & Lewis, 2011). Adolescents are particularly affected by anxiety and depressive disorders (Sadler et al., 2018), which during this developmental period are associated with suicide and a wide range of psychosocial and physical health issues, some of which extend into adulthood (Essau, Lewinsohn, Olaya, & Seeley, 2014; Keenan-Miller, Hammen, & Brennan, 2007; McLeod, Horwood, & Fergusson, 2016; Windfuhr et al., 2008; Woodward & Fergusson, 2001). Therefore these disorders were selected as the focus for this review. Consequently, our primary aim was to synthesize the evidence on the relationship between paternal mental health (exposure) and adolescent anxiety and depression (outcome). Focusing on this association will provide insight on a comparatively neglected relationship between fathers and adolescents, and on the circumstances surrounding anxiety and depression, which represent a major public health concern in this age group. Our secondary aims were to summarise findings on any potential mediators and moderators of this relationship investigated by included studies, and the relative importance of maternal mental health where investigated by included studies.

2. Methods

2.1. Inclusion and exclusion criteria

The protocol for this systematic review was registered on PROSPERO and can be accessed at www.crd.york.ac.uk/PROSPERO/ display_record.asp?ID=CRD42018094076. We followed PRISMA reporting guidelines, and a checklist can be found in Supplementary File 1. In light of the changing role of fathers between the 20th and 21st centuries, we sought to capture studies published since the year 2000 to ensure that the studies were as reflective of contemporary father-adolescent relationships as possible (Livingston, 2013; Parker & Wang, 2013). In addition, to ensure that we did not conflate results for child, adolescent and adult offspring, we focusedon the 11–17 year age range. With ongoing debate around the ‘true’ age of adolescence (Sawyer, Azzopardi, Wickremarathne, & Patton, 2018), this period was felt to capture adolescent years with the most certainty: 11 is the lowest age captured by globally relevant adolescent heath surveys (Sawyer et al., 2018), and 18 is adopted by the United Nations to mark adulthood (UN General Assembly, 1989). Therefore, we included studies which (i) as part of the primary aim, investigated the direct relationship between paternal mental health as the exposure, and adolescent anxiety or depression as the outcome; (ii) included adolescents in the 11–17 year age range at the time of outcome measurement; (iii) were published in English; (iv) were published since the year 2000. We excluded studies which did not meet inclusion criteria, or (i) were systematic reviews, grey literature, or conference abstracts; (ii) only investigated paternal mental health as a confounder, mediator or moderator; (iii) did not use primary data, or if using secondary data, did not use a methodology which had been previously published; (iv) did not use a validated measurement instrument or diagnostic procedure to measure the relevant exposure and outcome; (v) included adolescents outside the 11–17 year age range but did not either stratify analyses to focus exclusively on the 11–17 year age range, or report a mean age inside the 11–17 year age range.

2.2. Outcome

The outcome of interest was anxiety or depression in adolescents. This included internalising problems and emotional symptoms.

2.3. Exposure

The exposure of interest was any paternal mental health problem, including drug and alcohol misuse.

2.4. Search strategy

The search was conducted between May and June 2019. PubMed, Web of Science Core Collection, and Ovid (Embase, Ovid MEDLINE, Global Health, and PsycINFO) were searched using key words on 21 May 2019. Key words were constructed around the following five concepts which needed to be captured by the included studies:

233 A. Wickersham, et al. Journal of Adolescence 79 (2020) 232–246

Table 1 Search strategy for Ovid MEDLINE.

# Search terms

1 (adol* OR teen* OR offspring OR youth OR juvenile OR pubescent).mp 2 limit 1 to yr = “2000-Current” 3 (father OR paternal OR dad).mp 4 limit 3 to yr = “2000-Current” 5 (mental* OR psychiatr*).mp 6 limit 5 to yr = “2000-Current” 7 (anxiet* OR depress* OR mood).mp 8 limit 7 to yr = “2000-Current” 9 (risk* OR vulnerab* OR predict* OR caus* OR associat*).mp 10 limit 9 to yr = “2000-Current” 11 2 AND 4 AND 6 AND 8 AND 10

Note: * denotes truncation;.mp denotes multi-purpose field searching, and includes title, abstract, and subject heading word among other fields.

1. Age group (e.g. adolescent, teenager) 2. Fatherhood (e.g. father, paternal) 3. Exposure (e.g. mental health disorder) 4. Outcome (e.g. depression, anxiety) 5. Association (e.g. risk, predictor)

The full search strategy for Ovid MEDLINE can be found in Table 1. Duplicates were removed in Endnote. Titles, abstracts and full texts were screened according to the study inclusion and exclusion criteria. Reference lists of included studies and related literature reviews were hand searched. Relevant titles found during the hand search were then screened according to eligibility criteria. The search and screening was conducted by AW, and independently cross- checked by DL. If the authors were uncertain of an article's eligibility, the article was discussed and screened together, and a consensus was reached. A PRISMA flow diagram is presented in Fig. 1.

2.5. Data extraction and analysis

A data extraction form was developed, piloted and completed by AW. Data was extracted on study design, participant characteristics, exposure and outcome measurement, covariates and relevant findings. Data extraction was independently cross-checked by DL. Disagreements over data extraction were discussed and a consensus reached. Authors were contacted to supply missing information. Results are presented in a narrative synthesis. We did not find multiple studies which looked at the same exposures and outcomes, and which used similar study designs or statistical analyses to do so. Therefore in accordance with guidance from the Cochrane Collaboration which advises against combining the results of studies which make heterogenous comparisons, we did not synthesize the results in a meta-analysis (Cochrane Collaboration, 2011). Risk of bias was assessed at the study level using the Newcastle-Ottawa Scale (NOS) for cohort studies (Wells et al., 2012) and a version of the scale adapted for cross-sectional studies (Herzog et al., 2013). Two items on sample size and statistical testing only appear in the cross-sectional version of the scale, but as an important aspect of study quality, we also applied these items to the cohort studies, as has been done previously (Epstein et al., 2018). AW and DL independently conducted risk of bias assessments. Dis- agreements were discussed and a consensus reached. Study quality and risk of bias were taken into consideration throughout the narrative synthesis to help ascertain the strength of the studies’ findings.

3. Results

3.1. Study characteristics

In total, 14 studies were identified for inclusion in this review, collectively providing data on 31 271 fathers and 41205ado- lescents. The characteristics and findings of included studies are outlined in Table 2. The majority of included studies utilised a cross- sectional design. Some made use of longitudinal cohorts, such as the National Longitudinal Survey of Children and Youth (Elgar, Mills, McGrath, Waschbusch, & Brownridge, 2007). The follow-up periods of interest for the longitudinal study designs were one to three years (Tyrell, Yates, Reynolds, Fabricius, & Braver, 2018) two years (Elgar et al., 2007), four and seven years (Lewis, Neary, Polek, Flouri, & Lewis, 2017). Reeb and Conger (2009) did not specify the length of follow-up period. Lewis et al. (2017) analysed data from two cohorts, Growing Up in Ireland and the Millennium Cohort Study, giving them the largest total adolescent sample of the included studies (n = 6070 and n = 7768). The other studies had adolescent samples ranging from n = 81 (Kane & Garber, 2009) to n = 7809 (Amrock & Weitzman, 2014). Participating offspring ranged from ages 4–19 years (although we focus on results reported from analyses encompassing the adolescent years). A variety of instruments were used to

234 A. Wickersham, et al. Journal of Adolescence 79 (2020) 232–246

Fig. 1. Flow diagram of study selection. measure adolescent anxiety and depression, usually identifying disorders through the endorsement of emotions or behaviours by the adolescents or their parents. Only two studies conducted diagnostic interviews to identify adolescent anxiety and depression (Agerup, Lydersen, Wallander, & Sund, 2015; Ohannessian et al., 2005). Studies most frequently investigated paternal affective and anxiety disorders in relation to adolescent anxiety and depression, with nine of the included studies reporting on associations with paternal depression, anxiety, or internalising problems. Four studies investigated the effect of paternal alcohol misuse on adolescents. Other investigated paternal mental health disorders wereex- ternalising problems, Post-Traumatic Stress Disorder (PTSD), nonspecific psychopathology, antisocial personality disorder, Attention Deficit Hyperactivity Disorder, and avoidant personality problems. The following sections summarise the findings for eachofthese exposures. Where possible, we focus on the results from final models and analyses reported by the included studies, typically after adjusting for covariates.

3.2. Overview of study quality

Risk of bias assessments for all included studies can be found in Table 3 (cohort studies) and Table 4 (cross-sectional studies). It was a requirement that all included studies state the association between paternal and adolescent mental health as part of their primary aim, therefore the objective of all studies was clear. However, some aspects of the included studies were poorly reported. In some cases, the study design was not explicitly defined, and the data extractors had to decide the most likely design(Agerup et al., 2015; Choi et al., 2013; Middeldorp et al., 2016; Rognmo, Torvik, Ask, Røysamb, & Tambs, 2012; Selimbasic, Sinanovic, Avdibegovic, Brkic, & Hamidovic, 2017). The final sample size of included fathers was not always stated(Boricevic Marsanic, Aukst Margetic, Jukic, Matko, & Grgic, 2014; Ohannessian et al., 2005; Reeb & Conger, 2009; Selimbasic et al., 2017), such that the number of cases used in analyses was sometimes unclear. Additionally, the sample sizes were varied. Kane and Garber (2009) and Selimbasic et al. (2017) adopted the lowest adolescent sample sizes (n = 81 and n = 120 respectively), but did not report power calculations or otherwise justify their numbers. Overall the studies were reasonably consistent in reporting important descriptive statistics such as adolescent gender and age. However, it was not always clear whether the participating parents were biological parents, stepparents, adoptive or foster parents.

235 .Wcesa,e al. et Wickersham, A.

Table 2 Characteristics and findings of included studies.

Lead Author, Year, Study design Father sample size Adolescent sample size, Relevant paternal Relevant adolescent Covariates considered Relevant findings Location of study gender and age (range exposure(s), measurement outcome(s), measurement and/or mean and SD) instrument(s) used instrument(s) used

Agerup Cross-sectional n = 186 Total n = 345; Internalising problems and Major depressive disorder/ Adolescent age and sex; After fully adjusting for all 2015 Females n = 250; externalising problems dysthymia versus depression parental perceived economic other variables, there were no Norway Males n = 95; Adult Self-Report not otherwise specified satisfaction, marital status of significant associations between 13.8–16.6 years; versus no depression biological parents, long-term adolescent depression and M = 15.0 (0.6) Mood and Feelings physical illness or disability paternal internalising Questionnaire; and internalising/ (OR = 1.02, p = 0.66) or Kiddie-Schedule for externalising problems externalising problems Affective Disorders and (OR = 1.01, p = 0.83). Schizophrenia-Present and Lifetime version; Children's Global Assessment Scale Amrock Cross-sectional n = 7809 Total n = 7809; Mental health status/ Emotional symptoms Children's ethnicity, region, After fully adjusting for all 2014 Females n = 3654; nonspecific psychological Extended-form Strengths birth weight, and health other variables, children aged 4 United States of Males n = 4155; distress and Difficulties insurance status; having to 11 were more likely to have America 4–17 years Kessler-6 Questionnaire delayed the child's medical abnormal emotional symptoms care for any reason within the if they had a psychologically

236 past year; family poverty distressed father (OR = 6.3, status; number of children in 95% CI: 2.2 to 17.7, the family; presence of p < 0.001). chronic disease in family; No such relationship was found parent's age, employment for adolescents aged 12 to 17 status, education status, body (p > 0.05). mass index, drinking, and smoking behaviours; child's relationship to respondent parent Boričević Maršanić Cross-sectional Not applicable – Total n = 244; Chronic PTSD Internalising syndrome Participants matched for age, Compared to those whose 2014 no fathers were Females 53.2% c; Diagnostic assessment (broken down into sex, educational level, family fathers did not have PTSD, Croatia directly recruited 12–18 years; including a structured withdrawn/depressed, income, parental employment adolescents whose fathers had for this study c M = 15.0 (3.49) diagnostic procedure and somatic complaints, status, ethnicity and PTSD showed higher rates of

analysis of military service anxious/depressed) residential area problems on the internalising Journal ofAdolescence79(2020)232–246 data Youth Self-Report scale as a whole (OR 1.92, 95% CI: 1.11 to 3.33, p = 0.02). Broken down, they showed higher rates of somatic complaints (OR 2.74, 95% CI: 1.48 to 5.08, p = 0.001), anxious/depressed problems (OR 1.71, 95% CI: 1.00 to 2.89, p = 0.046), but not withdrawn/ depressed problems (p > 0.05). (continued on next page) .Wcesa,e al. et Wickersham, A. Table 2 (continued)

Choi Cross-sectional Not applicable – Total n = 950; Drinking problems Depression Age, religion, participation in After adjusting for covariates, 2013 no fathers were Males n = 390; Father-Short Michigan Beck's Depression club activities, smoking, living paternal drinking problems Korea directly recruited Females n = 560; Alcoholism Screening Test Inventory with parents were associated with elevated for this study Males age M = 16.5 Anxiety odds of anxiety (OR 2.21, 95% (1.0); Beck's Anxiety Inventory CI: 1.05 to 4.63) but not Females age M = 16.5 depression (p > 0.05) in male (1.0) students. Conversely in female students, paternal drinking problems were associated with elevated odds of depression (OR 1.84, 95% CI: 1.24 to 2.74), but not anxiety (p > 0.05). Elgar Longitudinal cohort n = 330 Total n = 6048 a; Depressive symptoms Internalising problems None Paternal depressive symptoms 2007 Males n = 3125; 12-item version of Centre Items developed for the were correlated with Canada Females n = 2923; for Epidemiological Montreal Longitudinal subsequent internalising At Time 2: Studies - Depression Scale Survey and Ontario Child problems in boys (r = 0.42, 10–15 years; Health Study p < 0.01) and in girls Males age M = 12.59 (r = 0.33, p < 0.01). Paternal (1.69); depressive symptoms were Females age M = 12.58 correlated with concurrent 237 (1.71) internalising problems in girls (r = 0.32, p < 0.01) but not in boys (r = 0.13, p > 0.05). Kane Cross-sectional n = 81 Total n = 81; Depressive symptoms Internalising symptoms Mother's history of depression Paternal depressive symptoms 2009 Males n = 40; Beck's Depression Child Behaviour Checklist; and mother's current were highly correlated with United States of Females n = 41; Inventory Youth Self Report depressive symptoms internalising symptoms on the America M = 11.8 (0.63) Child Behaviour Checklist (r = 0.33, p < 0.01), but not on the Youth Self Report (r = 0.12, p > 0.05). Regression results were not fully reported. Lewis Two prospective Growing up in Growing up in Ireland: Growing up in Ireland Depressive symptoms Maternal depressive After all adjustments, paternal 2017 cohorts - Growing up Ireland n = 6070 Total n = 6070; Depressive symptoms Short Mood and Feelings symptoms, family income, depression and adolescent Journal ofAdolescence79(2020)232–246 Republic of in Ireland and Millennium Females n = 2909; Centre for Epidemiological Questionnaire paternal and maternal depressive symptoms were Ireland and Millennium Cohort Cohort Study Males n = 2945 b; Studies Depression Scale education, paternal, maternal positively associated in both the United Kingdom Study n = 7768 M = 9 (0.13) at baseline; Millennium Cohort Study and child age at time of Growing up in Ireland cohort M = 13 (0.13) at follow- Psychological distress exposure, child sex, ethnicity, (0.24, 95% CI: 0.03 to 0.45, up. Kessler-6 whether the father was a p = 0.023) and the Millennium Millennium Cohort biological parent, paternal Cohort Study (0.18, 95% CI: Study: Total n = 7768; and maternal alcohol use at 0.01 to 0.36, p = 0.041). Females n = 3945; time of exposure, child Results were similar in multiply Males n = 3823; emotional symptoms at time imputed and complete case 7 years at baseline; of exposure, interparental samples. 14 years at follow-up conflict (continued on next page) .Wcesa,e al. et Wickersham, A.

Table 2 (continued)

Middeldorp Cross-sectional n = 530 Total n = 757; Depression, anxiety, Depression and anxiety Parent age, offspring age, In the final multivariable 2016 Females n = 296; avoidant personality, Child Behaviour Checklist parental education model, only paternal anxiety Netherlands Males n = 375 b; attention deficit/ significantly predicted child 6–18 years; hyperactivity and antisocial depression (β = 0.18, Females age M = 11.7 personality problems SE = 0.06, p = 0.01) and child (3.4); Adult Self Report anxiety (β = 0.25, SE = 0.07, Males age M = 10.5 (3.2) p = 0.001). Ohannessian Cross-sectional n = 426 c Total n = 426; Lifetime diagnoses of alcohol Major depression and Family type (control versus Paternal depression was 2005 Females 52%; dependence, depression anxiety proband), race, whether a associated with adolescent United States of Males 48% d; Semi-Structured Semi-Structured family had more than one depression (β = 0.79, America 13–17 years; Assessment for the Assessment for the participating adolescent (case SE = 0.39, p < 0.05, M = 15.10 (1.42) Genetics of Alcoholism Genetics of Alcoholism for independence versus odds = 2.20, 95% CI: 1.04 to Adolescents dependence), adolescent 4.68) but not anxiety. Paternal gender, paternal antisocial alcohol dependence was not personality disorder. Maternal associated with adolescent mental health and interaction depression or anxiety. terms between adolescent gender and parental mental

238 health were also included in modelling Ranøyen Cross-sectional n = 3239 Total n = 5732; Anxiety and depression Anxiety and depression Adolescent age. Maternal Paternal alcohol abuse was not 2015 Females n = 2883; symptoms symptoms mental health was also associated with any of the Norway Males n = 2849; Cohort Norway Mental Symptom Check List-5 included in path models mental health indicators 13–18 years; Health Index Social anxiety symptoms measured in either sons or M = 15.8 (1.6) Alcohol abuse Social Phobia and Anxiety daughters. In Structural Cut down Annoyed Guilty Inventory for Children Equation Modelling, paternal Eye-opener scale anxiety/depression was associated with daughter anxiety/depression (β = −0.158, p < 0.001) and social anxiety (β = −0.097, p < 0.001), and with son

anxiety/depression Journal ofAdolescence79(2020)232–246 (β = −0.109, p = 0.001) but not social anxiety (β = −0.053, p = 0.056). Reeb Prospective n = 428 c Total n = 451; Depressed mood Depressed mood Previous adolescent Paternal depressive symptoms 2009 longitudinal cohort Females n = 236; Symptom Checklist-90- Symptom Checklist-90- depressive symptoms, were associated with increases United States of Males n = 215; Revised Depression Revised Depression maternal depressive in subsequent adolescent America M = 13.2 at Year 1 Subscale Subscale symptoms, family income, depressed mood symptoms parental age, parental (β = 0.180, p < 0.01). education, gender (continued on next page) .Wcesa,e al. et Wickersham, A. Table 2 (continued)

Rognmo Cross-sectional n = 4012 Total n = 4012; Alcohol abuse Mental distress (comprising Adolescent age, gender, the Paternal alcohol abuse was 2012 Females n = 2015; Cut down Annoyed Guilty depression and anxiety other parent's alcohol abuse, marginally associated with Norway Males n = 1997; Eye-opener scale symptoms) parental income and greater mental distress in 12–19 years; Short version of the education, having siblings, offspring (b = 0.13, 95% M = 16.0 Hopkins Symptom extraversion, psychoticism CI: 0.00 to 0.25, p = 0.05). Checklist-25 Selimbasic Cross-sectional Not reported Total n = 120; PTSD symptoms Internalising Symptoms None Paternal total PTSD was 2017 Females n = 59; Harvard Trauma Child Behaviour Checklist positively correlated with scores Bosnia and Males n = 61; Questionnaire for parents of children on total CBCL internalising Herzegovina M = 12.69 (1.46) aged 6 to 18 (r = 0.355, p < 0.01). Depression Paternal total PTSD was also Depression self-rating positively correlated with the scale CBCL anxiety/depression subscale (r = 0.389, p < 0.01), but negatively correlated with the CBCL withdrawal/depression subscale (r = −0.267, p < 0.01). No statistically significant findings emerged for adolescent 239 depression level (p > 0.05). Tyrell Longitudinal study n = 392 Total n = 392; Depressive symptoms Internalising symptoms Maternal depressive Paternal depression was not 2018 Females 52%; Hopkins Symptom Child Depression symptoms were also in the significantly associated with United States of Wave 1 M = 12.89 Checklist Inventory and Revised cross-lagged panel model adolescent internalising America (0.48); Children's Manifest symptoms at Waves 2 or 3 Wave 2 M = 13.89 Anxiety Scale (p > 0.05). (0.76); Wave 3 M = 15.53 (0.65)

Abbreviations: M = Mean, OR=Odds Ratio, CI=Confidence Interval, PTSD=Posttraumatic Stress Disorder, SE=Standard Error. a This is the figure for all participating children. It is unknown precisely how many participating children had fathers who also participated, although the author estimatesn=~477. b Missing data. c Information supplied by the author, not available from publication.

d Not reported in the publication, but calculated using information available in the publication. Journal ofAdolescence79(2020)232–246 .Wcesa,e al. et Wickersham, A.

Table 3 Risk of bias assessment for cohort studies.

Lead Exposed cohort Non-exposed Paternal mental Adjustment Sample size Study controls Adolescent Follow-up Attrition low Statistical test Total star rating author, truly or somewhat cohort drawn health ascertained made for justified and for any depression or long enough (< 20%) or clearly (maximum = 10) year representative of from same via diagnostic baseline or prior satisfactory covariates anxiety ascertained for outcomes described and described and the target community as procedure or adolescent (other than via diagnostic to occur (≥1 accounted for appropriateb populationa exposed cohort named depression or prior procedure or year) in analysis measurement anxiety in adolescent named instrument relevant analysis depression or measurement anxiety) instrument 240 Elgar * * * – * * * * – * 8/10 2007 Lewis * * * * – * * * * * 9/10 2017 Reeb – * * * – * * – * * 7/10 2009 Tyrell – * * – – * * * – – 5/10 2018

* = criteria for study quality met; - = criteria for study quality not met. a Determined by whole-population, random or purposive sampling, or evidence of sample representativeness. b Determined by reporting of an appropriate effect estimate (such as beta or odds ratio), confidence intervals or the standard error, andapvalue. Journal ofAdolescence79(2020)232–246 .Wcesa,e al. et Wickersham, A.

Table 4 Risk of bias assessment for cross-sectional studies.

Lead author, year Sample truly or Comparability between Paternal mental health Sample size Study controls Adolescent depression or Statistical test Total star rating somewhat respondents and non- ascertained via diagnostic justified and for any anxiety ascertained via clearly described (maximum = 7) representative of the respondents established and procedure or named satisfactory covariates diagnostic procedure or and appropriateb target populationa response rate satisfactory measurement instrument named measurement instrument

Agerup * – * – * * * 5/7 2015 Amrock – – * – * * * 4/7 2014 Boričević – – * – * * * 4/7 Maršanić 2014 241 Choi – – * – * * – 3/7 2013 Kane – – * – – * – 2/7 2009 Middeldorp – – * – * * * 4/7 2016 Ohannessian – – * – * * * 4/7 2005 Ranøyen * – * – * * – 4/7 2015 Rognmo * – * – * * * 5/7 2012 Selimbasic 2017 – – * – – * – 2/7

* = criteria for study quality met; - = criteria for study quality not met. Journal ofAdolescence79(2020)232–246 a Determined by whole-population, random or purposive sampling, or evidence of sample representativeness. b Determined by reporting of an appropriate effect estimate (such as beta or odds ratio), confidence intervals or the standard error, andapvalue. A. Wickersham, et al. Journal of Adolescence 79 (2020) 232–246

Where this was specified, there was heterogeneity between the studies: for instance, Ohannessian et al. (2005) only sampled biological fathers, Tyrell et al. (2018) further included stepfathers, and Elgar et al. (2007) also included stepparents, adoptive parents and foster parents. Additionally, many of the studies acknowledged some selection bias that caused the representativeness of their samples to be in doubt, and there was often limited capacity to generalise their findings to other populations. However, a major strength of the included studies is that almost all of them gave some consideration to covariates and confounders. It was required that all studies use a validated instrument or diagnostic procedure to measure the relevant exposures and outcomes, so the psychometric properties of instruments in included studies are largely reasonable. However, there were some issues, such as Choi et al. (2013) using adolescents as informants to measure paternal drinking problems. There was also variation in whether studies assessed parents and adolescents for a diagnosis, or whether they measured symptoms, the clinical importance of which may be in question. Additionally, the procedures for data collection were sometimes poorly reported. In particular, blinding of assessors was only explicitly discussed in one study (Agerup et al., 2015), although this is likely because many studies used self-report measures rather than assessors.

3.3. Paternal depression and anxiety

Eight studies investigated the association between paternal depression and adolescent outcomes. Most studies found evidence for associations between paternal depression and either adolescent depression, anxiety, or internalising problems (Elgar et al., 2007; Kane & Garber, 2009; Lewis et al., 2017; Ohannessian et al., 2005; Ranoyen, Klockner, Wallander, & Jozefiak, 2015; Reeb & Conger, 2009). Three of these were longitudinal studies which received high study quality ratings. In particular, Lewis et al. (2017) employed two large prospective cohorts, providing evidence for a possible causal relationship between paternal and adolescent depression. Meanwhile, only two cross-sectional studies (neither of which had high study quality ratings) investigated paternal anxiety as an exposure, but both found it to be associated with adolescent depression and anxiety (Middeldorp et al., 2016; Ranoyen et al., 2015). The majority of studies therefore found associations between paternal and adolescent depression and anxiety. However, some findings were contradictory. Tyrell et al. (2018) did not find paternal depressive symptoms to predict internalising problems in adolescent waves of their cross-lagged model of longitudinal data, although this was rated as the lowest quality longitudinal study. Middeldorp et al. (2016) also did not find any evidence for a cross-sectional association between paternal depression and adolescent anxiety or depression, although they acknowledge a response bias in their sample, with a possible underestimation of psychopathology prevalence rates in fathers. Ohannessian et al. (2005) found paternal depression to be cross-sectionally associated with adolescent depression but not anxiety, and Kane and Garber (2009) found paternal depressive symptoms to be cross-sectionally associated with mother-reported (Achenbach, 1991a), but not self-reported adolescent internalising symptoms (Achenbach, 1991b). Finally, Agerup et al. (2015) did not find paternal internalising problems to be cross-sectionally associated with adolescent depression, although their fairly modest sample size may have limited their power to detect an effect.

3.4. Paternal alcohol misuse

Choi et al. (2013) found a cross-sectional association between paternal alcohol misuse and adolescent depression and anxiety. However, it should be noted that Choi et al. (2013) did not consider the potentially confounding effects of socioeconomic status, and only measured paternal drinking using the adolescent as an informant, so the validity of their findings are in doubt. The remaining studies did not find alcohol abuse or dependence to be associated with adolescent depression oranxiety(Ohannessian et al., 2005; Ranoyen et al., 2015), or else only found a borderline significant association (Rognmo et al., 2012), and no longitudinal studies investigated this association.

3.5. Other paternal mental health disorders

Six studies investigated other paternal mental health disorders. Paternal externalising problems (Agerup et al., 2015), antisocial personality disorder and Attention Deficit Hyperactivity Disorder (Middeldorp et al., 2016) were not found to be cross-sectionally associated with adolescent depression or anxiety. However, findings regarding other paternal affective or anxiety disorders werevery mixed. Paternal nonspecific psychopathology or distress predicted adolescent depression in a large, high quality longitudinal study (Lewis et al., 2017), but not adolescent emotional symptoms in a large cross-sectional study (Amrock & Weitzman, 2014). Paternal PTSD was cross-sectionally associated with adolescent internalising symptoms in Boričević Maršanić et al. (2014) but gave conflicting results in Selimbasic et al. (2017). Finally, paternal avoidant personality problems were not cross-sectionally associated with adolescent depression and anxiety in Middeldorp et al. (2016).

3.6. The role of maternal mental health

The role of maternal mental health was considered in the majority of studies. Reeb and Conger (2009) took account of the effects of maternal mental health as a covariate in longitudinal analyses, while others considered maternal mental health as another exposure associated with of adolescent mental health. Their findings largely suggested that adolescent anxiety or depression was associated with both maternal and paternal mental health, often reporting similar statistically significant or non-significant associations for each parent in both cross-sectional and longitudinal studies (Amrock & Weitzman, 2014; Lewis et al., 2017; Middeldorp et al., 2016; Ranoyen et al., 2015; Tyrell et al., 2018). However, there were some exceptions. For instance, maternal but not paternal

242 A. Wickersham, et al. Journal of Adolescence 79 (2020) 232–246 depression was cross-sectionally associated with adolescent anxiety in Ohannessian et al. (2005). Two other cross-sectional studies suggested that adolescent wellbeing might be more associated with maternal than paternal mental health (Agerup et al., 2015; Rognmo et al., 2012).

3.7. Other findings

Several studies considered the role of adolescent gender, although the way they did so was varied, with some adjusting analyses for gender as a covariate and others stratifying analyses by gender. Among those which aimed to explore the effect of adolescent gender, one longitudinal study found a greater impact of paternal mental health in girls than in boys (Reeb & Conger, 2009). Others found that the effect of adolescent gender varied according to whether the outcome under study was depression oranxiety(Choi et al., 2013) and according to whether associations were concurrent or longitudinal (Elgar et al., 2007). Still more found no significant evidence for an effect of adolescent gender(Middeldorp et al., 2016; Ohannessian et al., 2005; Ranoyen et al., 2015; Rognmo et al., 2012; Selimbasic et al., 2017). A range of other mediators and moderators in the relationship between paternal and adolescent mental health were also explored. However, these findings are tentative and should be interpreted with caution. For instance, there was longitudinal evidence fromone study that parental rejection and low parental monitoring may be mediators on the pathway between parental depression more generally and adolescent internalising disorders (Elgar et al., 2007). Another longitudinal study suggested that father-daughter closeness may modify the effect of paternal depression on female adolescent depression (Reeb & Conger, 2009). Findings from other studies were more inconclusive. Rognmo et al. (2012) proposed a range of mediators and moderators between paternal alcohol abuse and adolescent mental health, but found no significant interactions, and did not present adequate mediation analyses to properly determine their role in the association. It is similarly unclear how the modifying effects of ethnicity, family structure and adolescent gender impacted Tyrell et al. (2018) findings during the study waves limited to adolescence.

4. Discussion

The primary aim of this review was to synthesize the evidence on the relationship between paternal mental health and adolescent anxiety and depression. Overall, there is evidence to suggest that some mental health disorders in fathers are associated with anxiety and depression in adolescents. Consistent with previous research, paternal depression was the most strongly evidenced variable associated with adolescent anxiety and depression, while evidence for an association with other paternal disorders was more limited.

4.1. Research implications

Paternal depression has received a large amount of attention in recent years, and as was the case at the time of Ramchandani and Psychogiou’s (2009) review, depression remains the most comprehensively studied psychiatric disorder in this field. But the effect of other paternal affective and anxiety disorders has been comparatively neglected. Other studies which investigated theeffectsof paternal anxiety including children outside the 11–17 year age range have produced mixed results (Al-Turkait & Ohaeri, 2008; Clark, Cornelius, Wood, & Vanyukov, 2004; Esbjorn et al., 2013). Depression and anxiety are highly comorbid (Kessler et al., 2015), and as such studies about depression may also speak to the association between paternal and adolescent anxiety to some extent. However, the research landscape would now benefit from a robust, large scale longitudinal study on the effect of paternal anxiety onadolescent outcomes. It would also benefit from further investigation of the effects of paternal comorbidities and of other paternal anxiety disorders, such as Obsessive Compulsive Disorder and PTSD. Most studies did not find that alcohol misuse and other behavioural disorders in fathers were associated with anxiety orde- pression in adolescents. Findings in other age groups are more mixed (Agerup, Lydersen, Wallander, & Sund, 2014; Ayer, Kohl, Malsberger, & Burgette, 2016; Fals-Stewart, Kelley, Fincham, Golden, & Logsdon, 2004; Kelley & Fals-Stewart, 2004; Moss, Baron, Hardie, & Vanyukov, 2001; Moss, Lynch, Hardie, & Baron, 2002), but in this regard our findings are consistent with the suggestion that specific mental health disorders in parents are more likely to be associated that same mental health disorder inchildren(Clark et al., 2004). Although continued clarification of whether externalising disorders in fathers are associated with internalising disorders in adolescents might be beneficial, future research could focus on paternal anxiety and depression as risk factors for anxietyand depression in adolescents. Connell and Goodman (2002) and Ramchandani and Psychogiou (2009) suggested that mothers might have a greater impact on emotional and internalising outcomes. Findings in other age groups regarding the primacy of maternal versus paternal mental health are mixed (Agerup et al., 2014; Al-Turkait & Ohaeri, 2008; Clark et al., 2004; Jacobs, Talati, Wickramaratne, & Warner, 2015). However, in our review the association between paternal mental health and adolescent anxiety and depression was not negligible, and most included studies did not find maternal mental health to be more influential than paternal mental health. Thereforethe importance of fathers in adolescent emotional wellbeing must not be underestimated, and future research should continue to consider the effect of fathers to an equal extent as mothers. There is speculation in the literature that sons might be more exposed to the effects of paternal mental health disorders compared to daughters. However, the small number of our included studies which investigated this did not find strong evidence for adolescent gender moderating the association between paternal and adolescent mental health. This finding might be interpreted in various ways. For instance, the increased vulnerability experienced by boys who are thought to spend more time with fathers (Raley & Bianchi, 2006) might be offset by the increased vulnerability experienced by girls who are thought to be more empathetic totheemotionsof

243 A. Wickersham, et al. Journal of Adolescence 79 (2020) 232–246 others (Christov-Moore et al., 2014). Other factors such as parenting practices and the father-adolescent relationship may play a role. Parenting practices are included in Ramchandani and Psychogiou’s (2009) proposed model on the pathway between paternal and child psychopathology. While this model might also apply to adolescents, it has been noted that the nature of relationships between fathers and their offspring changes as the child ages (Flouri & Buchanan, 2003). Therefore, a similar but distinct model might be developed for adolescents, with greater emphasis on factors which might be especially pertinent in the adolescent age group, such as father-adolescent conflict (Sheeber, Davis, Leve, Hops, & Tildesley, 2007) and peer support (Vaughan, Foshee, & Ennett, 2010). Additionally, the potentially mediating or moderating effects of family dynamics and structure may be worthy of further investigation in this particular context(Bramlett & Blumberg, 2007), such as the role of non-resident fathers (Flouri, 2006) and other family-level factors thought to mediate the association between father and adolescent mental health, such as marital conflict (Sweeney & MacBeth, 2016). Future studies should continue to explore mechanisms in the association between paternal and adolescent mental health, towards developing a pathway model which is informed by what is already known for younger children, but which also considers other factors relevant to the adolescent development period. Finally, it is important to note that the focus of this review was the association between paternal mental health as an exposure and adolescent mental health as an outcome, and we only included studies which treated these variables as such. However, many of the studies included in this review were cross-sectional, such that we are unable to infer a direction of effect with any certainty. Indeed, there is growing evidence to suggest that the relationships between child and parent mental health may be reciprocal (Ahmadzadeh et al., 2019). Exploring bidirectional effects was beyond the scope of this review, but should be a topic for further investigation.

4.2. Clinical implications

Given the small number of high quality, longitudinal studies identified in this review, caution is warranted in adopting these findings into clinical practice. Nonetheless, the potential association between paternal and adolescent mental health couldhave tentative implications for how fathers and adolescents are supported. First, it remains important that primary care settings be equipped to identify mental health disorders in fathers, and that support is equally accessible for both mothers and fathers, particularly in light of known gender disparities in help-seeking behaviour (Oliver, Pearson, Coe, & Gunnell, 2005). Second, the mental well-being of the father (and indeed the family more generally) should continue to be considered when assessing and treating adolescents for mental health disorders. Kane and Garber (2004) have previously suggested that family-based interventions might benefit from including and supporting fathers as part of efforts made to treat adolescent mental health disorders. Whetherornotthis is successful may depend on other factors mediating or moderating the relationship between paternal and adolescent mental health – future efforts to explore these mechanisms will therefore contribute to the discussion around how best to intervene whenpaternaland adolescent mental health disorders co-occur.

4.3. Limitations

Our search terms and strategy were in keeping with the primary aim of our review, and we followed PRISMA reporting guidelines (Moher, Liberati, Tetzlaff, & Altman, 2009). However, our review has several limitations. First, due to time constraints, key re- searchers in the field were not contacted to suggest relevant titles. Second, attempts to focus on the adolescent age range of 11–17 years were hampered by the variability of age ranges adopted in studies, with many excluded because they recruited children of various ages but did not report separate results for adolescents and younger children. This speaks to the challenge of identifying the precise definition of adolescence (Sawyer et al., 2018). Adolescence does represent a developmental period encompassing major biological and social transitions, and efforts to distinguish it from childhood in research and analyses must be made. Future studies should avoid conflating childhood and adolescence, and some attempt to stratify by age should be made in statistical analyses, such that conclusions on the differential associations in childhood and adolescence can be drawn. Third, as discussed in our results section, the quality of included studies was mixed. Study quality was rated using existing versions of the NOS, and some items were less suited to this review – for instance, studies were only included if they used validated measurement instruments or diagnostic procedures for assessing mental health, so all studies necessarily met quality criteria for methods of exposure and outcome ascertainment. Nonetheless, inconsistent reporting of important methodological features such as study design, power calculations, data collection procedures, and the possible role of bias were particularly concerning. Authors in this field would benefit from following reporting guidelines for observational studies(von Elm et al., 2007). Finally, we only included studies which investigated the direct association between paternal and adolescent mental health as part of the primary aim. While this ensured that potentially spurious secondary findings were not included, relevant findings mayhave been missed. Additionally, we could not draw meaningful conclusions regarding mechanisms in the relationship between paternal and adolescent mental health, because our primary interest was in the direct association.

5. Conclusions

The findings of this review reiterate the importance of paternal depression in adolescent mental health. However, the findingsalso highlight the need for continued consideration of the relationship between other paternal mental health disorders, particularly anxiety disorders, and adolescent anxiety and depression. Additional priorities for research include further exploration of

244 A. Wickersham, et al. Journal of Adolescence 79 (2020) 232–246 mechanisms, and study designs which can imply a causal direction and which do not conflate child and adolescent age groups. Importantly, despite previous implications that fathers primarily influence adolescent externalising and behavioural problems, evidence that they were any less implicated in their adolescent's emotional wellbeing than mothers was sparse in this review. The importance of the father in adolescent emotional wellbeing should not be underestimated.

Contributions

AW conducted the search, extracted the data, conducted risk of bias assessments, and wrote all versions of the manuscript. DL cross-checked the search and data extraction, conducted risk of bias assessments, and contributed to all versions of the manuscript. MA contributed to synthesis. NTF participated in design of the work and commented on drafts of the manuscript. All authors have approved the manuscript.

Funding and declaration of potential conflicts of interest

This work was funded by the US Department of Defense [grant number W81XWH-14-1-0079]. DL and AW were funded from the grant. The funders had no influence over the work plan, data analysis or data interpretation. AW receives salary support from the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London. NTF is part funded by the United Kingdom’s Ministry of Defence, sits on the Independent Group Advising on the Release of Data at NHS Digital, and is also a trustee of two military related charities. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, the Department of Health and Social Care or the UK Ministry of Defence. DL and MA declare no other conflicts of interest.

Appendix A. Supplementary data

Supplementary data to this article can be found online at https://doi.org/10.1016/j.adolescence.2020.01.007.

References

Achenbach, T. (1991a). Manual for the child behaviour checklist/4-18 and 1991 profile. Burlington: Department of Psychiatry, University of Vermont. Achenbach, T. (1991b). Manual for the youth self-report and 1991 profileBurlington: Department of Psychiatry, University of Vermont. Agerup, T., Lydersen, S., Wallander, J., & Sund, A. M. (2014). Longitudinal course of diagnosed depression from ages 15 to 20 in a community sample: Patterns and parental risk factors. Child Psychiatry and Human Development, 45(6), 753–764. https://doi.org/10.1007/s10578-014-0444-8. Agerup, T., Lydersen, S., Wallander, J., & Sund, A. M. (2015). Maternal and paternal psychosocial risk factors for clinical depression in a Norwegian community sample of adolescents. Nordic Journal of Psychiatry, 69(1), 35–41. https://doi.org/10.3109/08039488.2014.919021. Ahmadzadeh, Y. I., Eley, T. C., Leve, L. D., Shaw, D. S., Natsuaki, M. N., Reiss, D., et al. (2019). Anxiety in the family: A genetically informed analysis of transactional associations between mother, father and child anxiety symptoms. Journal of Child Psychology and Psychiatry, 60(12), 1269–1277. https://doi.org/10.1111/jcpp. 13068. Al-Turkait, F. A., & Ohaeri, J. U. (2008). Psychopathological status, behavior problems, and family adjustment of Kuwaiti children whose fathers were involved in the first gulf war. Child and Adolescent Psychiatry and Mental Health, 2(1), 12. https://doi.org/10.1186/1753-2000-2-12. Amrock, S. M., & Weitzman, M. (2014). Parental psychological distress and children's mental health: Results of a national survey. Academic Pediatrics, 14(4), 375–381. https://doi.org/10.1016/j.acap.2014.02.005. Ayer, L., Kohl, P., Malsberger, R., & Burgette, L. (2016). The impact of fathers on maltreated youths' mental health. Children and Youth Services Review, 63, 16–20. https://doi.org/10.1016/j.childyouth.2016.02.006. Boricevic Marsanic, V., Aukst Margetic, B., Jukic, V., Matko, V., & Grgic, V. (2014). Self-reported emotional and behavioral symptoms, parent-adolescent bonding and family functioning in clinically referred adolescent offspring of Croatian PTSD war veterans. European Child & Adolescent Psychiatry, 23(5), 295–306. https://doi. org/10.1007/s00787-013-0462-2. Bramlett, M. D., & Blumberg, S. J. (2007). Family structure and children's physical and mental health. Health Affairs, 26(2), 549–558. Cabrera, N. J., Volling, B. L., & Barr, R. (2018). Fathers are parents, too! Widening the lens on parenting for children's development. Child Development Perspectives, 12(3), 152–157. Choi, D. H., Kim, J. S., Jung, J. G., Ryou, Y. I., Kim, Y. S., & Uh, W. C. (2013). The role of paternal drinking problems in the psychological characteristics of high school students. Korean journal Family Medicine, 34(6), 377–384. https://doi.org/10.4082/kjfm.2013.34.6.377. Christov-Moore, L., Simpson, E. A., Coudé, G., Grigaityte, K., Iacoboni, M., & Ferrari, P. F. (2014). Empathy: Gender effects in brain and behavior. Neuroscience & Biobehavioral Reviews, 46, 604–627. Clark, D. B., Cornelius, J., Wood, D. S., & Vanyukov, M. (2004). Psychopathology risk transmission in children of parents with substance use disorders. American Journal of Psychiatry, 161(4), 685–691. https://doi.org/10.1176/appi.ajp.161.4.685. Cochrane Collaboration (2011). In J. P. T. Higgins, & S. Green (Eds.). Cochrane handbook for systematic reviews of interventions version 5.1. 0. Connell, A. M., & Goodman, S. H. (2002). The association between psychopathology in fathers versus mothers and children's internalizing and externalizing behavior problems: A meta-analysis. Psychological Bulletin, 128(5), 746–773. Elgar, F. J., Mills, R. S. L., McGrath, P. J., Waschbusch, D. A., & Brownridge, D. A. (2007). Maternal and paternal depressive symptoms and child maladjustment: The mediating role of parental behavior. Journal of Abnormal Child Psychology, 35(6), 943–955. https://doi.org/10.1007/s10802-007-9145-0. von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gotzsche, P. C., & Vandenbroucke, J. P. (2007). Strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies. BMJ, 335(7624), 806–808. https://doi.org/10.1136/bmj.39335.541782.AD. Epstein, S., Roberts, E., Sedgwick, R., Finning, K., Ford, T., Dutta, R., et al. (2018). Poor school attendance and exclusion: A systematic review protocol on educational risk factors for self-harm and suicidal behaviours. BMJ Open, 8(12), e023953. https://doi.org/10.1136/bmjopen-2018-023953. Esbjorn, B. H., Pedersen, S. H., Daniel, S. I., Hald, H. H., Holm, J. M., & Steele, H. (2013). Anxiety levels in clinically referred children and their parents: Examining the unique influence of self-reported attachment styles and interview-based reflective functioning in mothers andfathers. British Journal of Clinical Psychology, 52(4), 394–407. https://doi.org/10.1111/bjc.12024. Essau, C. A., Lewinsohn, P. M., Olaya, B., & Seeley, J. R. (2014). Anxiety disorders in adolescents and psychosocial outcomes at age 30. Journal of Affective Disorders, 163, 125–132. https://doi.org/10.1016/j.jad.2013.12.033. Fals-Stewart, W., Kelley, M. L., Fincham, F. D., Golden, J., & Logsdon, T. (2004). Emotional and behavioral problems of children living with drug-abusing fathers: Comparisons with children living with alcohol-abusing and non-substance-abusing fathers. Journal of Family Psychology, 18(2), 319–330. https://doi.org/10.1037/

245 A. Wickersham, et al. Journal of Adolescence 79 (2020) 232–246

0893-3200.18.2.319. Flouri, E. (2006). Non-resident fathers' relationships with their secondary school age children: Determinants and children's mental health outcomes. Journal of Adolescence, 29(4), 525–538. https://doi.org/10.1016/j.adolescence.2005.08.004. Flouri, E., & Buchanan, A. (2003). What predicts fathers' involvement with their children? A prospective study of intact families. British Journal of Developmental Psychology, 21(1), 81–97. https://doi.org/10.1348/026151003321164636. Gentile, S., & Fusco, M. L. (2017). Untreated perinatal paternal depression: Effects on offspring. Psychiatry Research, 252, 325–332. https://doi.org/10.1016/j. psychres.2017.02.064. Herzog, R., Álvarez-Pasquin, M. J., Díaz, C., Del Barrio, J. L., Estrada, J. M., & Gil, Á. (2013). Are healthcare workers' intentions to vaccinate related to their knowledge, beliefs and attitudes? A systematic review. BMC Public Health, 13(1), 154. https://doi.org/10.1186/1471-2458-13-154. Jacobs, R. H., Talati, A., Wickramaratne, P., & Warner, V. (2015). The influence of paternal and maternal major depressive disorder on offspring psychiatric disorders. Journal of Child and Family Studies, 24(8), 2345–2351. https://doi.org/10.1007/s10826-014-0037-y. Kane, P., & Garber, J. (2004). The relations among depression in fathers, children's psychopathology, and father-child conflict: A meta-analysis. Clinical Psychology Review, 24(3), 339–360. https://doi.org/10.1016/j.cpr.2004.03.004. Kane, P., & Garber, J. (2009). Parental depression and child externalizing and internalizing symptoms: Unique effects of fathers' symptoms and perceived conflict asa mediator. Journal of Child and Family Studies, 18(4), 465–472. https://doi.org/10.1007/s10826-008-9250-x. Keenan-Miller, D., Hammen, C. L., & Brennan, P. A. (2007). Health outcomes related to early adolescent depression. Journal of Adolescent Health, 41(3), 256–262. https://doi.org/10.1016/j.jadohealth.2007.03.015. Kelley, M. L., & Fals-Stewart, W. (2004). Psychiatric disorders of children living with drug-abusing, alcohol-abusing, and non–substance-abusing fathers. Journal of the American Academy of Child & Adolescent Psychiatry, 43(5), 621–628. Kessler, R. C., Sampson, N. A., Berglund, P., Gruber, M. J., Al-Hamzawi, A., Andrade, L., et al. (2015). Anxious and non-anxious major depressive disorder in the World Health Organization World Mental Health Surveys. Epidemiology and Psychiatric Sciences, 24(3), 210–226. https://doi.org/10.1017/s2045796015000189. Leijdesdorff, S., van Doesum, K., Popma, A., Klaassen, R., & van Amelsvoort, T. (2017). Prevalence of psychopathology in children of parents with mentalillnessand/ or addiction: An up to date narrative review. Current Opinion in Psychiatry, 30(4), 312–317. https://doi.org/10.1097/yco.0000000000000341. Lewis, G., Neary, M., Polek, E., Flouri, E., & Lewis, G. (2017). The association between paternal and adolescent depressive symptoms: Evidence from two population- based cohorts. Lancet Psychiatry, 4(12), 920–926. https://doi.org/10.1016/s2215-0366(17)30408-x. Liu, J. (2004). Childhood externalizing behavior: Theory and implications. Journal of Child and Adolescent Psychiatric Nursing, 17(3), 93–103 official publication of the Association of Child and Adolescent Psychiatric Nurses, Inc. Liu, J., Chen, X., & Lewis, G. (2011). Childhood internalizing behaviour: Analysis and implications. Journal of Psychiatric and Mental Health Nursing, 18(10), 884–894. https://doi.org/10.1111/j.1365-2850.2011.01743.x. Livingston, G. (2013). The rise of single fathers: A ninefold increase since 1960. Retrieved from http://www.pewsocialtrends.org/2013/07/02/the-rise-of-single- fathers/. McLeod, G. F., Horwood, L. J., & Fergusson, D. M. (2016). Adolescent depression, adult mental health and psychosocial outcomes at 30 and 35 years. Psychological Medicine, 46(7), 1401–1412. https://doi.org/10.1017/s0033291715002950. McManus, S., Bebbington, P., Jenkins, R., & Brugha, T. (2016). Mental health and wellbeing in England: Adult psychiatric morbidity survey 2014: A survey carried out for NHS digital by NatCen social research and the Department of health Sciences. University of Leicester: NHS Digital. Middeldorp, C. M., Wesseldijk, L. W., Hudziak, J. J., Verhulst, F. C., Lindauer, R. J., & Dieleman, G. C. (2016). Parents of children with psychopathology: Psychiatric problems and the association with their child's problems. European Child & Adolescent Psychiatry, 25(8), 919–927. https://doi.org/10.1007/s00787-015-0813-2. Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Medicine, 6(7), e1000097. https://doi.org/10.1371/journal.pmed.1000097. Moss, H. B., Baron, D. A., Hardie, T. L., & Vanyukov, M. M. (2001). Preadolescent children of substance-dependent fathers with antisocial personality disorder: Psychiatric disorders and problem behaviors. American Journal on Addictions, 10(3), 269–278. Moss, H. B., Lynch, K. G., Hardie, T. L., & Baron, D. A. (2002). Family functioning and peer affiliation in children of fathers with antisocial personality disorder and substance dependence: Associations with problem behaviors. American Journal of Psychiatry, 159(4), 607–614. https://doi.org/10.1176/appi.ajp.159.4.607. Ohannessian, C. M., Hesselbrook, V. M., Kramer, J., Kuperman, S., Bucholz, K. K., Schuckit, M. A., et al. (2005). The relationship between parental psychopathology and adolescent psychopathology: An examination of gender patterns. Journal of Emotional and Behavioral Disorders, 13(2), 67–76. https://doi.org/10.1177/ 10634266050130020101. Oliver, M. I., Pearson, N., Coe, N., & Gunnell, D. (2005). Help-seeking behaviour in men and women with common mental health problems: Cross-sectional study. British Journal of Psychiatry, 186, 297–301. https://doi.org/10.1192/bjp.186.4.297. Parker, K., & Wang, W. (2013). Modern parenthood: Roles of moms and dads converge as they balance work and family. Retrieved from http://www.pewsocialtrends. org/2013/03/14/modern-parenthood-roles-of-moms-and-dads-converge-as-they-balance-work-and-family/. Raley, S., & Bianchi, S. (2006). Sons, daughters, and family processes: Does gender of children matter? Annual Review of Sociology, 32, 401–421. Ramchandani, P., & Psychogiou, L. (2009). Paternal psychiatric disorders and children's psychosocial development. Lancet, 374(9690), 646–653. https://doi.org/10. 1016/s0140-6736(09)60238-5. Ranoyen, I., Klockner, C., Wallander, J., & Jozefiak, T. (2015). Associations between internalizing problems in adolescent daughters versus sons and mentalhealth problems in mothers versus fathers (the HUNT study). Journal of Child and Family Studies, 24(7), 2008–2020. https://doi.org/10.1007/s10826-014-0001-x. Reeb, B., & Conger, K. J. (2009). The unique effect of paternal depressive symptoms on adolescent functioning: Associations with gender and father-adolescent relationship closeness. Journal of Family Psychology, 23(5), 758–761. https://doi.org/10.1037/a0016354. Rognmo, K., Torvik, F. A., Ask, H., Røysamb, E., & Tambs, K. (2012). Paternal and maternal alcohol abuse and offspring mental distress in the general population: The Nord-Trøndelag health study. BMC Public Health, 12(1), 448. Sadler, K., Vizard, T., Ford, T., Goodman, A., Goodman, R., & McManus, S.. Mental health of children and young people in England. (2018). Retrieved from https://digital. nhs.uk/data-and-information/publications/statistical/mental-health-of-children-and-young-people-in-england/2017/2017 2017. Sawyer, S. M., Azzopardi, P. S., Wickremarathne, D., & Patton, G. C. (2018). The age of adolescence. The Lancet Child & Adolescent Health, 2(3), 223–228. https://doi. org/10.1016/S2352-4642(18)30022-1. Selimbasic, Z., Sinanovic, O., Avdibegovic, E., Brkic, M., & Hamidovic, J. (2017). Behavioral problems and emotional difficulties at children and early adolescents of the veterans of war with post-traumatic stress disorder. Medical Archives, 71(1), 56. Sheeber, L. B., Davis, B., Leve, C., Hops, H., & Tildesley, E. (2007). Adolescents' relationships with their mothers and fathers: Associations with depressive disorder and subdiagnostic symptomatology. Journal of Abnormal Psychology, 116(1), 144–154. https://doi.org/10.1037/0021-843X.116.1.144. Sweeney, S., & MacBeth, A. (2016). The effects of paternal depression on child and adolescent outcomes: A systematic review. Journal of Affective Disorders, 205, 44–59. https://doi.org/10.1016/j.jad.2016.05.073. Tyrell, F. A., Yates, T. M., Reynolds, C. A., Fabricius, W. V., & Braver, S. L. (2018). The unique effects of maternal and paternal depressive symptoms on youth's symptomatology: Moderation by family ethnicity, family structure, and child gender. Development and Psychopathology, 1–14. UN General Assembly (1989). Convention on the rights of the child. Retrieved from https://www.unicef.org.uk/what-we-do/un-convention-child-rights/. Vaughan, C. A., Foshee, V. A., & Ennett, S. T. (2010). Protective effects of maternal and peer support on depressive symptoms during adolescence. Journal of Abnormal Child Psychology, 38(2), 261–272. https://doi.org/10.1007/s10802-009-9362-9. Wells, G., Shea, B., O’connell, D., Peterson, J., Welch, V., Losos, M., et al. (2012). The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa: Ottawa Hospital Research Institute. Windfuhr, K., While, D., Hunt, I., Turnbull, P., Lowe, R., Burns, J., et al. (2008). Suicide in juveniles and adolescents in the United Kingdom. Journal of Child Psychology and Psychiatry, 49(11), 1155–1165. https://doi.org/10.1111/j.1469-7610.2008.01938.x. Woodward, L. J., & Fergusson, D. M. (2001). Life course outcomes of young people with anxiety disorders in adolescence. Journal of the American Academy of Child & Adolescent Psychiatry, 40(9), 1086–1093. https://doi.org/10.1097/00004583-200109000-00018.

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