FATHERS AND POST-NATAL DEPRESSION

Messages from Research

The evidence that impaired maternal mental health, including depression, in the post partum period, has adverse effects on the infant socially emotionally behaviourally and cognitively is extensive (e.g. Kurstjens & Wolke, 2001; Cummings & Davies, 1994; Hossain et al, 1994). Amelioration of the mother’s psychological distress after the first year does not necessarily improve the outcome for the child (Murray et al, 2003).

Mothers’ depression is associated with own personality, perinatal, infant-related and partner factors. These last include a poor relationship with the father, his being unavailable at the time of the baby’s birth and his provision of what is perceived by the mother to be insufficient emotional or practical support. This can include low participation in infant care. Other risk factors include his holding rigid sex-role expectations, or being critical, coercive or violent (for review, see Fisher et al, 2006).

The father’s functioning as a support person is key, since depressed new mothers receive more support from their partner than from any other individual, including medical staff (Holopainen, 2002). Can intervening with these men prove fruitful? Few interventions have been rigorously evaluated, and sample sizes are small. However, indications are positive.

• A randomized controlled trial in Canada found that where depressed women’s partners participated in 4 out of 7 psycho-educational visits, the women displayed a significant decrease in depressive symptoms and other psychiatric conditions. Interestingly, when only the women (and not their partners) received the intervention the general health of the depressed women’s partners deteriorated. This effect was not found where the men were included in the intervention (Misri et al, 2000).

• A shorter length of hospital stay among women with pre/postpartal psychiatric disorders is strongly and positively correlated with supportiveness by their (male) partners. However, only 30% of these men are categorized by the researchers as supportive (Grube, 2004).

• A brief, inexpensive US intervention (one prenatal session, in separate gender groups focusing on psychosocial issues related to becoming first-time parents) was associated with reduced distress in some mothers at six weeks postpartum. The key factor seemed to be their perception of an increased level of awareness in the men as to how they were experiencing the early postpartum weeks (Matthey et al, 2004).

Fathers’ own depression

Fathers’ own depression is also an issue for concern, not least because of its potential to exacerbate maternal depression. Although pregnancy is a period of greater stress for fathers than the post-birth period (Huang & Warner, 2005; Condon et al, 2004), fathers’ rates of depression are higher after the birth than before it (Huang & Warner, 2005).

As is the case with maternal depression, estimates of paternal depression range widely depending on the characteristics of the sample and the measure of depression used.

• Depression .rates of 7–30% have been identified in new fathers (for review, see Huang & Warner, 2005).

• In Denmark new fathers’ depression rates are double the national average for men in the same age group (Madsen et al, 2006).

• First time fathers are particularly prone to depression (Cowan et al, 1991) with mild to moderate depression most likely (Soliday et al, 1999).

• In Denmark, the risk of postpartum mental disorders necessitating hospital admission or outpatient contacts is increased for several months after childbirth for mothers, but among fathers no increase in severe mental disorders is found (Munk-Olsen et al, 2006).

What factors are linked with paternal depression at this time?

• The experience of a general lack of support, with the quality of the couple relationship, including disagreement about the pregnancy and perceived lack of supportiveness from the mother particularly central (Huang & Warner, 2005; Dudley et al, 2001; Matthey et al, 2000).

• Infant-related problems (Dudley et al, 2001).

• The father’s neuroticism and substance abuse/dependence (Huang & Warner, 2005).

• The mother’s personality difficulties, unresolved past events in her life and her current mental health status (Huang & Warner, 2005), most particularly her depression.

Low income new fathers, including young fathers, are particularly vulnerable to depression, seemingly due to interacting factors. In a low income African American sample, 56% of new fathers were found to have ‘depressive symptoms indicating cause for clinical concern’. Correlates included resource challenges, transportation and permanent housing difficulties; problems with alcohol and drugs; health problems/disability; and a criminal conviction history (Anderson et al, 2005).

In this study, and in opposition to findings elsewhere, higher levels of social support were associated with greater depressive symptomatology, leading researchers to speculate that for low-income men the perceived costs of reciprocity may have deterred them from utilizing available support; or that peer groups may have influenced their alcohol or drug use, or placed demands on their resources (Anderson et al, 2005).

The more tenuous the relationship with the mother, the more likely it is that the father will be depressed. Interacting factors and selection effects would seem to explain this in part, but the circumstances of the pregnancy are also likely to be relevant. Rates of paternal depression in one recent US study were 6.6% (married fathers), 8.7% (cohabiting), 11.9% (romantically involved but not living together); and, among the fathers who were described as ‘not involved’ with the mother 19.9% were depressed (Huang & Warner, 2005).

Fathers who feel supported by their partners in finding their own ways of caring for their infants are likely to develop a strong connection to their babies, and are also unlikely to develop depression (Cowan & Cowan, 1988). Participation in a fathers’ group has been found to assist men’s coping with their partner’s postnatal depression (Davey et al, 2006). However, group interventions may suit only particular types of fathers (Ghate et al, 2000).

Early Years Services often succeed in engaging fathers (particularly young fathers) via sports. Generally this tactic is regarded as a ‘hook’ activity to draw the men into involvement with other services (Fathers Direct, 2002-06). In fact, involving fathers in sports activities should perhaps be considered an end in itself, not least because of the potential of regular aerobic exercise for improving mood.

The impact of fathers’ depression on infants and children

A recent, substantial, UK/US study, which controlled for mothers’ depression, found high levels of emotional and behavioural problems in children (particularly boys) aged 3.5 years associated with earlier depression in their fathers (Ramchandani et al, 2005). The mechanisms by which this occurs are not fully understood. Both direct and indirect effects are likely. For example:

• Fathers’ depression puts at risk the quality of the relationship between the parents (Phares, 1997); and better couple relationship quality has been linked to lower infant fussiness scores (Dave et al, 2005).

• High psychological well being in fathers is positively associated with their sensitivity as parents (Broom, 1994).

• Fathers’ depression (like mothers’) limits their ability to parent effectively (Huang & Warner, 2005).

• A 3-year study of first-time fathers in Australia found stress negatively affecting fathers’ attachments to their infants (Buist et al, 2003).

• In the US, a study of Head Start families found that fathers with higher levels of depression had less involvement with their children (Roggman et al, 2002).

• When both parents are depressed and the depressed father spends medium/high amounts of time caring for his infant, his depression has been found to exacerbate the negative effects of mothers’ depression (Mezulis et al, 2004).

• A pilot study to assess the relationship between paternal mood and infant temperament found higher paternal depression scores, more traditional attitudes towards fathering and increased recent life events related to higher infant fussiness scores (Dave et al, 2005).

However, McElwain & Volling (1999) found depressed fathers less intrusive than non-depressed fathers when observed playing with their 12-month-olds; and Field et al (1999) reported that depressed fathers did not interact with their infants more negatively than non-depressed fathers did.

Ameliorating the impact of mothers’ depression on infants: ‘father-as-buffer’

When, and how, may fathers’ behaviour ‘buffer’ negative effects of mothers’ depression?

• Fathers have unusually high amounts of interaction with insecure-avoidant infant girls – the group with whom mothers interact least of all (Fagot & Kavenagh, 1993).

• A small (n: 25 families) observational study found that in most families where mothers suffered from persistent depressive mood, their infants had established joyful relationships with their fathers, and infant-father attachments were secure. (Edhborg et al, 2003). Similar findings are reported by Hossain et al (1994).

• Infants of chronically depressed mothers have been found to learn in response to fathers’ (but not mothers’ or other women’s) infant-directed speech (Kaplan et al, 2004).

• Where mothers are depressed post-natally fathers’ self-reported parenting styles interact with the amount of time they spend caring for their infants to moderate the longitudinal effects of the mothers’ depression on children’s internalising behaviours in childhood (Mezulis et al, 2004).

• Fathers’ support can shield the infants of chronically depressed mothers from negative outcomes (Field, 1998), promoting greater maternal responsiveness to their infants (Jackson, 1999) and minimizing power-assertive maternal child-reading attitudes (Brunelli et al, 1995).

• Women who, as children, experienced parental rejection and/or had a mother who experienced depressive symptoms are at elevated risk of developing depression in the post-natal period. However, if their relationship with their own father is remembered as positive and ‘accepting’: then they are much less likely to develop depressive symptoms postnatally (Crockenberg & Leerkes, 2003)

When mothers are especially vulnerable, it would seem wise for child and family professionals to pay particular attention to supporting positive and substantial father-child interaction. However, a proactive and tactful approach may be needed: where new mothers’ feelings of autonomy are low (Grossman et al, 1988) or they are depressed or lack confidence as mothers (Lupton & Barclay, 1997) they tend actively to exclude fathers, and the fathers may hang back, fearing their interference could exacerbate the situation (Lupton & Barclay, 1997; Lewis, 1986).

The finding that even after a mother’s recovery from post natal depression, adverse patterns of interaction with her child can continue (Cox et al, 1987) indicates the importance of including fathers in the intervention in both the short and longer term.

REFERENCES

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