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 Table of Contents  
VIEWPOINT
Year : 2022  |  Volume : 6  |  Issue : 1  |  Page : 108-110

Fatherhood and depression: Sound the alarms!


1 Department of Psychiatry, 166 Military Hospital, Jammu, Jammu and Kashmir, India
2 Department of Anaesthesiology and Critical Care, Level III Hospital, Goma, Congo
3 Department of Paediatrics, 166 Military Hospital, Jammu, Jammu and Kashmir, India
4 Consultant Radiologist, Ojas Hospital, Panchkula, Haryana, India

Date of Submission25-Dec-2020
Date of Decision09-Jan-2021
Date of Acceptance13-Jan-2021
Date of Web Publication29-Apr-2022

Correspondence Address:
Dr. Harpreet Singh Dhillon
Departments of Psychiatry 166 Military Hospital, Jammu, Jammu and Kashmir
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aip.aip_145_20

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  Abstract 


Maternal mental health during and after pregnancy is a well researched entity. However, father's mental health during the same period and even while raising the children has not been given due consideration. Recent studies have tried to explore the paternal depression and its impact on the children, marriage and the whole family. In this short communication, we aim to bring to the fore the risk factors, impact and recommendations to address the issue of paternal depression.

Keywords: Paternal depression, parenting behaviour, psychosocial development, depression screening


How to cite this article:
Dhillon HS, Sasidharan S, Dhillon GK, Manalikuzhiyil B. Fatherhood and depression: Sound the alarms!. Ann Indian Psychiatry 2022;6:108-10

How to cite this URL:
Dhillon HS, Sasidharan S, Dhillon GK, Manalikuzhiyil B. Fatherhood and depression: Sound the alarms!. Ann Indian Psychiatry [serial online] 2022 [cited 2022 May 22];6:108-10. Available from: https://www.anip.co.in/text.asp?2022/6/1/108/344421




  Introduction Top


Maternal depression during antenatal and postnatal periods is a well-known risk factor for poor physical and psychological child outcomes.[1] However, more recently paternal mental health during the same period is gaining significance in view of high incidence of depression among fathers, ranging from 6% to 12%. This is considerably high in comparison with the prevalence of 3%–5% in the general adult male population.[2]

Second, similar to maternal depression, recent literature has documented negative association between paternal depression and poor outcomes in children. However, this concept of paternal depression is especially foreign to developing countries where even maternal mental health has not been given due attention due to poor resources. This short communication is an attempt to sensitize the reader about this new, often ignored, yet important topic.


  Risk Factors Top


There are certain risk factors, which can independently predict depression in fathers, especially in the postnatal period. This includes a history of severe depression in the past, prenatal depression/anxiety, partner prenatal depression, lower educational level, and having other children. Prenatal maternal depression is considered to be the most significant predictor for postnatal depression in men.[3]

There are changing sociocultural norms, which might act as precipitating factors for paternal depression. Traditionally, fathers have been portrayed as sturdy family breadwinners but largely uninvolved in child-rearing practices. However, in the last 2–3 decades, there have been significant ideological, technological, social, and economical changes, which have veered fathers to be more involved and assume a new role in child rearing. The role of women in society is also changing with majority of them working full time, shorter maternity leaves and quick return to the jobs, nuclear families, higher divorce rates, etc., forcing fathers to take on responsibilities for which they were not very well prepared.

The clinical presentation can be varied ranging from unwarranted anger outbursts, marked irritability, social isolation from loved ones, resorting to substance use etc. There can be physical symptoms such as tension headaches, myalgias, sleep disturbances and nonspecific gastrointestinal symptom. The symptoms of self-harm/impulses to harm the child are less frequent unlike in maternal depression.


  Impact Top


There is growing evidence regarding the impact of paternal depression on physical, emotional, and behavioral difficulties of children, thus impacting the overall psychosocial development.[3],[4]

Impact on parents

  1. Studies with paternal depression in early childhood have described undesirable aggressive or harsh disciplinary parenting behaviors[5]
  2. Significant depression in fathers tends to negatively affect parental warmth, healthy engagement behaviors such as reading, and other positive developmentally important parent–child interactions.[6],[7]


Impact on children

Child outcomes associated with paternal depression include:

  1. Significant expressive language delay in children[8]
  2. Depression in fathers in the postnatal period was found to be significantly associated with oppositional defiant/conduct disorders. In a comparison study between children of depressed fathers versus children of nondepressed fathers, the prevalence of psychiatric disorders was almost double (12% vs. 06%). Children with paternal depression also scored high on scores of hyperactivity, conduct disorder, and peer group problems.[9]


It is to be noted that conduct problems are strongly predictive of later serious societal concerns such as antisocial and criminal behavior.[10]

Impact on marriage and family

It is already well reported in various studies that transition of the couple to parenthood is associated with a marked depreciation in marital quality,[11],[12] which only get compounded with the co-occurrence of depression in either partner leading to crippling of the family functioning and the developing child.[13]


  Recommendations Top


  1. Awareness – It is important to raise awareness by mass media campaigns and make couples/society in general made aware about this entity. It can help reassure individuals that they are not particularly weak/vulnerable. On the contrary, a large number of fathers across the globe experience this. It is especially important in a developing country like India where gender is strongly linked with mental robustness and male gender is expected to be immune from such sensitivities, making it particularly difficult for sufferers to even seek help
  2. Screening – The available literature has indicated that depression in mothers is a significant predictor of paternal depression and hence routine screening during well-baby clinic visits is warranted.[14] Screening questionnaires, such as the Edinburgh Postnatal Depression Scale, can serve as a screening tool for both the parents[9]
  3. Support groups – Fathers often perceive that the health professionals are not taking their mental health seriously as the latter's entire focus is on the mother–child duo. This warrants a proper social support group for the fathers where they can clearly discuss their apprehensions
  4. Build self-reliance – Enhancing the self-efficacy of fathers by advising them to be as involved as possible in child care routine chores such as bathing them, soothe them to sleep, burp them, read them stories, and take them on errands. It will support father's mental health as well as take the load off the mother
  5. Help from pediatricians – There is a felt need for pediatricians to enhance the father's participation in their child's health care. It is recommended that pediatricians be trained in the use of depression screening tools and a referral system for psychiatric assessment for fathers be put in place
  6. Counseling regarding traumatic birth – In today's world, more than 90% of fathers are present at the birth of their child. If that birth becomes traumatic, the father witnessing these events can encounter a “rollercoaster of emotion.” There are studies reporting that fathers are offered little information and support in such cases.[15],[16]


Hence, in case of a potential possibility of a traumatic childbirth, fathers need to be counseled including option not to witness.


  Conclusion Top


One in ten dads gets postpartum depression, and up to 18% develop a clinically significant anxiety disorder such as generalized anxiety disorder, obsessive–compulsive disorder, and posttraumatic stress disorder at some point during the pregnancy or the 1st-year postpartum.

It should be made clear to fathers through the above recommendations and how the primary practical application of these findings relates to identification and management of postnatal depression not only for the fathers but also for the family as a whole. More importantly, fathers need to know that they are not alone and that by getting the right kind of support, things will get better.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Beardslee WR, Versage EM, Gladstone TR. Children of affectively ill parents: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry. 1998 Nov;37(11):1134-41. doi: 10.1097/00004583-199811000-00012. PMID: 9808924.  Back to cited text no. 1
    
2.
American Psychiatric Association. Diagnostic Criteria from DSM-IV-TR. Washington, DC:American Psychiatric Pub; 2000.  Back to cited text no. 2
    
3.
Gutierrez-Galve L, Stein A, Hanington L, Heron J, Ramchandani P. Paternal depression in the postnatal period and child development: Mediators and moderators. Pediatrics 2015;135:e339-47.  Back to cited text no. 3
    
4.
Phares V, Compas BE. The role of fathers in child and adolescent psychopathology: Make room for daddy. Psychol Bull 1992;111:387-412.  Back to cited text no. 4
    
5.
Bronte-Tinkew J, Moore KA, Matthews G, Carrano J. Symptoms of major depression in a sample of fathers of infants sociodemographic correlates and links to father involvement. Fam Issues 2007;28:61-99.  Back to cited text no. 5
    
6.
Mark Cummings E, Keller PS, Davies PT. Towards a family process model of maternal and paternal depressive symptoms: Exploring multiple relations with child and family functioning. Journal of Child Psychology and Psychiatry. 2005;46:479-89.  Back to cited text no. 6
    
7.
Paulson JF, Dauber S, Leiferman JA. Individual and combined effects of postpartum depression in mothers and fathers on parenting behavior. Pediatrics. 2006 Aug 1;118(2):659-68.  Back to cited text no. 7
    
8.
Paulson JF, Keefe HA, Leiferman JA. Early parental depression and child language development. J Child Psychol Psychiatry 2009;50:254-62.  Back to cited text no. 8
    
9.
Ramchandani P, Stein A, Evans J, O'Connor TG, ALSPAC Study Team. Paternal depression in the postnatal period and child development: a prospective population study. The Lancet. 2005 Jun 25;365(9478):2201-5.  Back to cited text no. 9
    
10.
Murray L, Hipwell A, Hooper R, Stein A, Cooper P. The cognitive development of 5-year-old children of postnatally depressed mothers. J Child Psychol Psychiatry 1996;37:927-35.  Back to cited text no. 10
    
11.
Condon JT, Boyce P, Corkindale CJ. The first-time fathers study: A prospective study of the mental health and wellbeing of men during the transition to parenthood. Aust N Z J Psychiatry 2004;38:56-64.  Back to cited text no. 11
    
12.
Schulz MS, Cowan CP, Cowan PA. Promoting healthy beginnings: a randomized controlled trial of a preventive intervention to preserve marital quality during the transition to parenthood. Journal of consulting and clinical psychology. 2006 Feb;74(1):20.  Back to cited text no. 12
    
13.
Goodman JH. Paternal postpartum depression, its relationship to maternal postpartum depression, and implications for family health. J Adv Nurs 2004;45:26-35.  Back to cited text no. 13
    
14.
Freeman MP, Wright R, Watchman M, Wahl RA, Sisk DJ, Fraleigh L, Weibrecht JM. Postpartum depression assessments at well-baby visits: screening feasibility, prevalence, and risk factors. Journal of Women's Health. 2005;14:929-35.  Back to cited text no. 14
    
15.
Etheridge J, Slade P. “Nothing's actually happened to me.”: The experiences of fathers who found childbirth traumatic. BMC Pregnancy Childbirth 2017;17:80.  Back to cited text no. 15
    
16.
Harvey ME, Pattison HM. Being there: a qualitative interview study with fathers present during the resuscitation of their baby at delivery. Archives of Disease in Childhood-Fetal and Neonatal Edition. 2012 Nov 1;97(6):F439-43.  Back to cited text no. 16
    




 

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Abstract
Introduction
Risk Factors
Impact
Recommendations
Conclusion
References

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