Review
Correlates of ante- and postnatal depression in fathers: A systematic review

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Abstract

Background

Contemporary research findings suggest that depression during the ante- and postnatal periods is a significant problem not only for women but also for many men. This paper provides a conceptual and methodological review of the literature on cross-sectional and prospective correlates of depressive symptoms in men during both pregnancy and the postpartum period.

Methods

The search, via several electronic databases, was limited to English papers published between January 1996 and August 2009, and identified 30 relevant articles.

Results

The most common correlate of paternal depressive symptoms pre- and post birth was having a partner with elevated depressive symptoms or depression; poor relationship satisfaction was also frequently associated with elevated depressive symptoms or depression in men.

Limitations

There were significant methodological limitations of existing studies, including small sample sizes; the use of cross-sectional designs; varied measures of depression; focus on depression in the postpartum only; and in the few longitudinal gestational studies, the inclusion of only one assessment point. The limitations of the current systematic review include the inclusion of only papers written in English and potential publication bias, where studies with null findings are less likely to be published.

Conclusion

The scientific study of predictors of men's depressive symptoms pre and post birth remains in its infancy. Given the implications of clinical depression in men both during the gestational and postpartum periods, further systematic investigation of direct and indirect predictors of elevated depressive symptoms in men during this time is warranted.

Introduction

Antenatal and postnatal depression is a well-recognised health issue in women. Antenatal depression affects approximately 12 to 20% of expectant mothers (Leigh and Milgrom, 2008) and depression after birth affects about 10 to 15% of women (Tammentie et al., 2004). Antenatal depression affects a woman's ability for self-care and may also contribute to other problems such as inadequate nutrition, drug or alcohol abuse and poor antenatal clinic attendance (Leigh and Milgrom, 2008). Postnatal depression may commonly result in a predisposition to fret over the newborn's health and well-being (Henshaw and Cox, 1995), and the mother–infant relationship may be affected (Milgrom et al., 2004). Both antenatal depression and postnatal depression are typified by persistent sadness or a moderated ability to experience pleasure, irritability, feelings of low self-esteem and manifest anxiety (Milgrom and McCloud, 1996). Sufferers often are constantly fatigued, as well as having alterations in sleep patterns and appetite. According to the Diagnostic and Statistical Manual of Mental Disorders IV (APA, 2000), postnatal depression is no different from other types of depressive conditions in terms of symptomatology.

There is a prevalent belief that only women are affected by depression during pregnancy and the postpartum period and, as a consequence, most research to date has focused on mothers. However, there is evidence that men are also affected by depression in the antenatal and postnatal periods (e.g., Fletcher et al., 2006, Matthey et al., 2003). Men can experience their partner's pregnancy and the birth of a new baby as a stressful time filled with new challenges and adjustment to routines (Condon, 2006). These stressful changes can lead to depression for men in similar ways that it does for some women (Solantaus and Salo, 2005). Fletcher et al. (2006) found that the rate of diagnosed depression in new fathers at six weeks postpartum was around 2% to 5%. Other researchers have reported that this rate of diagnosis can be as high as 10% (e.g., Ballard and Davies, 1996, Lunn, 2008).

Both maternal and paternal depressions following childbirth can also have detrimental effects on a couple's relationship, the parent–child relationship, and on children's development (e.g., Cornish et al., 2008, Deater-Deckard et al., 1998, Kane and Garber, 2004, Ramchandani et al., 2005, Ramchandani et al., 2008a, Ramchandani et al., 2008b, Paulson et al., 2006). Likewise, depression during the antenatal period has negative effects on men as it does for women. Best estimates for the prevalence rate of depression during pregnancy vary widely for men (as well as for women) across published studies to date due to small sample sizes and different instruments, ranging from diagnostic interviews to screening tools. For example, Areias et al. (1996), using semi-structured interviews, reported that 4.8% of men (out of 42 men) in their study were depressed during their partner's pregnancy, while Boyce et al., 2007, Condon et al., 2004, using the General Health Questionnaire (GHQ, Goldberg, 1978), reported that 18.6% of the men in their study (out of 312) were considered cases for depression during pregnancy (≥ 5 on the GHQ). Buist et al. (2003), using a score of greater than 10 on the Edinburgh Postnatal Depression Scale to indicate depression(EPDS, Cox et al., 1987), showed that 12% of their sample of 294 men were distressed at 26 weeks pregnancy and 8.7% at 36 weeks pregnancy. In contrast, in a large cohort study, Ramchandani et al. (2008a) reported a lower prevalence of 2.3% men showing elevated depressive symptoms (≥ 12 on the EPDS) at 18 weeks pregnancy.

To date, the correlates of depressive symptoms in men post childbirth have been reviewed in two literature reviews (Ballard and Davies, 1996, Schumacher et al., 2008) and one integrated literature review (Goodman, 2004). All three reviews revealed that having a depressed partner, or a partner with a high level of depressive symptoms, was a strong correlate of elevated symptoms of depression in fathers in the postpartum. Having an unsupportive marital relationship, paternal unemployment (Ballard and Davies, 1996), immaturity, as well as unplanned pregnancy (Schumacher et al., 2008) were also factors that were found to be associated with elevated paternal depressive symptoms, or a diagnosis of clinical depression, post birth.

To our knowledge, there has been no systematic review that has focused on correlates of depressive symptoms in men during pregnancy and after the birth of the baby. Given the critical period of both pregnancy and the postpartum for the development of depression in men, and the fact that a better understanding of the development of depression in fathers both during the antenatal and postnatal periods is clearly warranted, we have undertaken a systematic conceptual and methodological review of the literature on correlates of depressive symptoms in expectant fathers pre- and post birth.

Section snippets

Search strategy

Prior to commencing the review, a search of databases (e.g. Academic Search Premier, Health Source: Nursing/Academic Edition) revealed no systematic review conducted on correlates of depressive symptoms in fathers pre- and post birth. Articles were sourced from five databases: Medline, PsychINFO, Academic Search Premier, Health Source: Nursing/Academic Edition, and CINAHL. The search was limited to English language papers published between January 1996 and August 2009, and used terms from

Results

Details of the included studies, their design, sample size, and main outcome findings are summarised in Table 1, Table 2. Given that researchers across the studies set different criteria for the classification of “depression” and/or used different measures to assess levels of depressive symptoms or different tools to diagnose clinical depression, we have added a column to Table 1, Table 2 that provides the criterion used in each study. Furthermore, for ease of presentation of the findings, the

Discussion

The current review identified correlates associated with paternal depression pre- and post birth. According to the reviewed studies, having a depressed partner, poor quality relationship between the father and the mother, and low social support are the most common correlates of depression in men both during their partners' pregnancy and in the postpartum period. Indeed, another theme that emerged in the studies reviewed suggest that there is a possible cumulative effect with an increase in

Role of funding source

Not applicable.

Conflict of interest

There is no conflict of interest.

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