Research paperPaternal depression during pregnancy and postpartum: An international Delphi study
Introduction
Fathers are at increased risk for depression during a mother's gestation and the postpartum period (Bielawska-Batorowicz and Kossakowska-Petrycka, 2006, Kim and Swain, 2007, Matthey et al., 2000, Paulson and Bazemore, 2010, Ramchandani et al., 2005, Tuszynska-Bogucka and Nawra, 2014, Wee et al., 2011), and we are beginning to understand the biological, psychological, and sociological aspects that are unique to this mental health issue (Escribà-Agüir and Artazcoz, 2011, Huang and Warner, 2005, Kim and Swain, 2007, Letourneau et al., 2012a, Letourneau et al., 2012b, Storey et al., 2000, Yargawa and Leonardi-Bee, 2015). Becoming a father is associated with a variety of stressors and an episode or re-occurrence of depression during this time can result in significant negative effects for not only fathers, but for mothers and children as well (Carro et al., 1993, Jacob and Johnson, 1997, Paulson et al., 2006, Ramchandani et al., 2011). Much attention has been devoted to the mental health of peripartum1 mothers (Patel et al., 2012, Werner et al., 2015). While fathers have traditionally received less public and clinical attention, in the United States alone it is estimated that 10% of men will experience postpartum depression (Paulson and Bazemore, 2010). This is in comparison to the 5% of all U.S. men that will experience depression during a given year (Kessler et al., 2003). Similarly, a study in Denmark found a doubling of rates when looking at depression in men during the postpartum period (Madsen and Juhl, 2007). However, other international studies have found postpartum depression among fathers to range anywhere from 5.3% to 31.7% (Areias et al., 1996, Bergstrom, 2013, Dudley et al., 2001, Escribà-Agüir and Artazcoz, 2011). One particular study that excluded fathers who had a previous mood disorder found that 9.5% of fathers experience a mood disorder during the postpartum period, with 20.97% of depressed fathers at-risk for suicide (Quevedo et al., 2011). While estimates of the prevalence of paternal depression during the peripartum period have been suggested, there continues to be a lack of agreement on the defining factors of this mental health issue.
The need to identify a father's mental health as being important within the family system has been suggested by medical and behavioral health scholars (Habib, 2012, Letourneau et al., 2012b). Researchers and clinicians have struggled to define the issue and conclude that the lack of public and professional awareness could be addressed through studies aimed at consensus (Habib, 2012, Letourneau et al., 2012b, Melrose, 2010). Moreover, postpartum fathers have expressed a lack of understanding and responsiveness to their own mental health needs by healthcare providers (Letourneau et al., 2012b). This lack of understanding and awareness may lead to inadequate assessment, detection, and thus treatment. Without consensus providers may feel ill equipped to assess for depression in fathers, potentially not taking into account the unique experience that comes with fatherhood. While maternal depression has been identified as a risk factor for a father's depression (Paulson and Bazemore, 2010), the full scope of risk and protective factors for depression in this population have been gravely overlooked. The purpose of this study is to address these issues by utilizing a Delphi methodology (Fish and Busby, 1996, Keeney et al., 2011) in which expert consensus is obtained on the defining factors of depression in fathers during the gestational period and postpartum. This effort would result in a compilation of defining factors, which could then be made accessible to key stakeholders who were identified by the experts. The goals of the study were to seek diagnostic clarity and consensus on the biopsychosocial components of this mental illness, as well as the clinical, operational, and financial implications. While the study itself covered additional areas of interest such as treatment, social support factors, and future actions needed, this paper will describe the results of the following specific factors: terminology, diagnostics, symptomatology, risk/protective factors, assessment, costs if untreated, and key stakeholders.
Section snippets
Delphi method
The mixed methods approach of a Delphi study aims to reach consensus among experts on a particular topic through multiple rounds of questionnaires and opportunities for expert feedback (Fish and Busby, 1996, Keeney et al., 2011). The founders of the Delphi approach based their methodology on the assumption that having more than one opinion on a subject was better than just a single opinion, and that through a collective process it is possible to reach consensus (Linstone and Turoff, 1975).
Panelist characteristics
Panelists demonstrated considerable expertise through working directly with peripartum fathers (n=8), being involved as a principal investigator (PI) or Co-PI in a related grant or study (n=6), publishing relevant peer-reviewed articles (n=7), showcasing non-peer reviewed multimedia sources (n=11), and facilitating educational trainings to professionals and the general public (n=14). The panelist group held various medical and behavioral professional backgrounds and included psychiatrists,
Discussion
When considering a father's depression during this critical time in the family life cycle, several important factors to consider resulted from this study. According to open-ended responses from Round One, experts expressed that fathers do not respond well when labeled. For example, one expert said in response to the terminology question, “Depression, or whatever the father needs/wants it to be called. A lot of men run from a label and therefore avoid treatment if they expect to be labeled. My
Acknowledgments
The corresponding author would like to thank the Department of Counseling and Family Sciences at Loma Linda University for their educational support during this study. We would also like to acknowledge Bryson T. Greaves, Ph.D.(c) for his help in the qualitative analysis of this study.
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2020, Journal of Affective Disorders ReportsCitation Excerpt :However, their suggestions overlap considerably with existing literature about men's mental health and the way that difficulties may be expressed. Finally, some have argued that the definition of expert is subjective, and the small samples often used in Delphi studies may not be representative of all experts on this topic (Freitas et al., 2016). However, it has also been argued that samples over 15 tend not to add value in consensus studies and so this study aimed to recruit people from a range of sectors to improve representativeness among a small sample.
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