Why screen new fathers for postpartum depression?

Craig F Garfield, MD

Erika R Cheng, PhD

Table 1

Table 2

Dads get sad, too. Postpartum depression (PPD) in mothers has long been recognized and receives considerable attention, but the same is not true for fathers-until recently.

Accumulating research and study on the influence of fathers on the early development of their children is shining a needed light on the challenges men encounter as they become parents and face the many similar situations that new mothers face. One challenge is PPD and the cascading difficulties that this can have on new parents as well as their children.

Data show that between 2% and 25% of fathers experience PPD, a prevalence that increases up to 50% if the mother also is depressed.¹ The effect of parental PPD on children is and can be profound, and includes the potential for child abuse/neglect, adverse effects on early brain development, family dysfunction, as well as increased medical care costs and inappropriate medical care.²

The American Academy of Pediatrics (AAP) recently published a clinical report on the evolving understanding of the important role fathers play in early childhood development, highlighting the influence of paternal mental health on the well-being of their children and urging pediatricians to take a more active role in supporting new fathers as they transition into parenting.¹

“Dads are an important member of the team when we think about supporting families today, and one we often fail to include in pediatrics,” says Craig F. Garfield, MD, professor of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, a coauthor of the report published in 2016. “This is unfortunate because father involvement and father well-being can benefit children and mothers.”

“If we want to optimize child outcomes, we should be sure fathers and mothers are both supported and able to be the best parent they can be,” Garfield says.

One main way pediatricians can support fathers is by recognizing the real and increasing rates of paternal PPD. Although screening mothers for PPD is now recommended by the AAP,² no such screening is yet recommended for fathers.

Screening fathers for PPD

Recently published data from Cheng and colleagues adds to the growing body of evidence on the prevalence of PPD in fathers and the importance of paternal PPD screening.³

In the study, investigators used a computer-based decision support system for pediatric health surveillance, and management-called the Child Health Improvement Through Computer Automation (CHICA) system–to estimate the prevalence of paternal and maternal PPD found during pediatric well-child care visits. Between August 1, 2016, and December 31, 2017, 9572 parents responded to a prescreening form that included assessment of PPD.

Of the parent responses from 9572 clinical visits, 2946 (30.8%) were attended by fathers and 806 (8.4%) responded to the prescreening questionnaire. Among the fathers who responded to the questionnaire, 4.4% screened positive for depression. This was comparable to the 5.0% of mothers who screened positive.

“Our study found that depression in new fathers is almost as common as it is in mothers,” says lead author of the study Erika R. Cheng, PhD, assistant professor of Pediatrics, Indiana University School of Medicine, Department of Pediatrics, Division of Children’s Health Services Research, Indianapolis.

“The fact that so many new dads are experiencing this is significant because depression can have serious consequences if left untreated,” Cheng says, adding that depressed fathers are less engaged with their children, and this can lead to cognitive and behavioral problems.

Among previous studies that also highlight the prevalence of PPD in fathers, data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) provides additional information on specific variables of PPD in men. Using data from a nationally representative sample of 10,623 adolescent boys in the United States who were followed for nearly 20 years into young adulthood, the study found that the prevalence of PPD rates in this cohort differed based on where the father lived (in the same home as the child or not).

Garfield, who was the lead author of the study, says the study showed that fathers who lived with their child had lower depressive scores before the child’s birth but that the depressive symptoms increased on average by 68% over the first 5 years of the child’s life. Conversely, fathers who did not live with their child had higher depressive symptoms prior to the child’s birth and lower depressive symptoms during the child’s first early years.

An important issue highlighted by this study is that fathers can and do play a diverse role in their children’s lives, living either with them or apart as described by the above study, and often are not the biological father but an adoptive father, stepfather, grandfather, or foster father.¹ Given this diversity, the AAP defines a father broadly as “the male or males identified as most involved in caregiving and committed to the well-being of the child, regardless of living situation, marital status, or biological relation.”¹

Including fathers in ongoing care of children

“Pediatricians are in a unique position to screen parents for depression, and well visits provide an opportunity to address family health by screening fathers who otherwise might not get assessed or treated,” says Cheng.

The AAP clinical report provides a list of ways to help pediatricians include fathers in the child well visit (Table 1). Included in the list is screening fathers for perinatal depression (Table 2). The AAP recommends that pediatricians have a plan in place (such as a referral to a parent’s primary care physician) if a father or mother screens positive for depression or exhibits depressive symptoms.

Garfield urges pediatricians to use this list and the clinical report as a guide. “Making sure to talk with both parents, regardless of marital status, about the transition to parenthood is important,” he says. “Checking in on how they are both dealing with the new roles and responsibilities and seeing if there is a way the pediatrician can help both parents is key.”

References:

1. Yogman M, Garfield CF; Committee on Psychosocial Aspects of Child and Family Health. Fathers’ roles in the care and development of their children: the role of pediatricians. Pediatrics. 2016;138(1):e20161128. Available at: http://pediatrics.aappublications.org/content/138/1/e20161128.long. Accessed August 2, 2018.

2. Earls MF; Committee on Psychosocial Aspects of Child and Family Health; American Academy of Pediatrics. Incorporating recognition and management of perinatal and postpartum depression into pediatric practice. Pediatrics. 2010;126(5):1032-1039. Available at: http://pediatrics.aappublications.org/content/126/5/1032.long. Accessed August 2, 2018.

3. Cheng ER, Downs SM, Carroll AE. Prevalence of depression among fathers at the pediatric well-child care visit. JAMA Pediatr. July 23, 2018. Epub ahead of print.

4. Garfield CF, Duncan G, Rutsohn J, et al. A longitudinal study of paternal mental health during transition to fatherhood as young adults. Pediatrics. 2014;133(5):836-843. Available at: http://pediatrics.aappublications.org/content/133/5/836.long. Accessed August 2, 2018.