Elsevier

Journal of Affective Disorders

Volume 202, 15 September 2016, Pages 128-136
Journal of Affective Disorders

Research paper
Paternal depression during pregnancy and postpartum: An international Delphi study

https://doi.org/10.1016/j.jad.2016.05.056Get rights and content

Highlights

  • Fathers are at-risk for depression during and after a partner's pregnancy.

  • Unique symptomatology is found in depressed fathers.

  • Fathers are at risk particularly when they have poor social support.

  • Normal experienced physiological changes may put a father at risk for depression.

  • Current assessment tools may be inadequate in detecting paternal depression.

Abstract

Background

Fathers are at risk for depression during a mother's gestation and postpartum. Assessment, detection, and treatment are hampered by the lack of consensus on this issue. The purpose of this study was to reach expert consensus through the Delphi method on the defining factors of depression in peripartum fathers.

Methods

Purposive sampling resulted in the surveying of 14 international expert panelists. The study used a modified Delphi approach in which experts participated in two rounds of open-ended and scale questionnaires, followed by two rounds of opportunities to adjust their responses and/or comment on evolving data until consensus was achieved.

Results

Experts responded to 10 questions on terminology, diagnostics, symptomology, risk/protective factors, biological factors, assessment tools/protocol, cost implications, and key stakeholders. Of these 10 questions presented for discussion, the analysis resulted in 197 coded themes. Consensus was met for 119 of the 197 coded responses (60.41%).

Limitations

Diversity of opinion within this Delphi Study was excluded for the sake of consensus. Regression to the mean may have occurred after continuous surveying and when evolving results were shared with panelists. Critics of Delphi methodologies have pointed to the issue of small expert samples typically used and the subjectivity of “expert.”

Conclusion

Consensus identified diagnostic criteria and symptomology that differentiates the paternal experience of peripartum depression. Experts indicated the importance of a father's social context, biological risk factors, limitations of current assessment tools, key stakeholders, and potential financial costs. Stakeholders on this issue would benefit from translating consensus into assessment and treatment.

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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