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Focusing on Depression in Expectant and New Fathers
By James F. Paulson, PhD |
May 20, 2011
Dr Paulson is assistant professor in the division of community health and research of the department of pediatrics at Eastern Virginia Medical School in Norfolk. He reports no conflicts of interest concerning the subject matter of this article.
Belsky and Rovine30 found that perceived marital love and intimacy declined linearly across the 3 years following the transition to parenthood (with a sharper quadratic decline for new mothers), while marital ambivalence and conflict similarly increased. Although this average trend represented declining marital quality, there was difficulty in modeling the considerable variability among trends: some couples remained the same while others experienced increased marital quality over this period.30
Second, work by Kendler and colleagues31,32 has led to 2 expansive models for depression, each specific to men and women. Among other causes (including genetic risk, substance misuse, personality, and early history), these sex-based models place a strong emphasis on stressful life events and marital difficulties. The models provide a more general conceptual framework in which early parental depression can be positioned.
The third, Belsky’s determinants of parenting,33 provides a model that places parental relationship and depression in a broader family systems context that affects parenting behavior and that, in future research, will be used to include child outcomes as an end point.
These models, individually and together, emphasize partner relations as a dynamic that is sensitive to new parenthood and predictive of depression. This, combined with the growing evidence on relational ties in early parental depression, led to the working model that is presented in the Figure. In this model, central emphasis is placed on the parental relationship (defined broadly to include relationship intimacy and support, effective communication, tangible support, shared interests/time together, shared values, and mutually satisfactory negotiation of household, childcare, and work/financial duties). The parental relationship is viewed as a hypothetical mediator of the impact of one parent’s depression on the other’s.
In the postpartum period, the model suggests that the parental relationship is negatively affected by depression in either parent. The parental relationship before conception is also important in this model and is viewed as a moderator of the stresses surrounding new parenthood. Each partner is also susceptible to his or her own risks for depression, such as personal history of depression and stressful life events.31,32 Early parental engagement with the offspring, the quantity of basic caregiving, other enriching interactions, and parent-child bonding are predicted by both the individual parent’s depression and the relationship with the other parent.
Future directions
The current literature on depression in early fatherhood has not found a clear center. This may be because many studies that address paternal depression are incidental to larger studies. More work is needed that specifically focuses on paternal depression, with close attention to representative samples sensitive to the considerable cultural variability in paternal involvement prenatally and postnatally. Researchers who study depression in new fathers need to reach a consensus on definitional issues that include timing, the father’s position in the family, and a consistent set of terminology.
Future research should specifically include:
• Rigorous case definition methods (eg, structured interview) to address not only the general incidence of depression in fathers following childbirth but the severity of depressive symptoms, subclinical elevations in depressive mood, and the specific timing of both prenatal and postnatal depression
• The incidence of maternal depression and the range of parental relationship domains that may be associated with (or protective of) a depressive contagion between the parents
• The temporal order of depression or depressive symptom elevation within a couple (eg, does maternal depression more often precede paternal depression?)
• Strategies to increase the timely identification of depression in both parents that operate through increasing public awareness and/or enhancing provider awareness and screening efforts
Even when considering the preliminary status of much of this research, a compelling case can be found for encouraging providers to conduct more aggressive screening for postnatal depression in both parents, as well as educating expectant and new parents about depression.
References
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Evidence-Based References
Goodman JH. Paternal postpartum depression, its relationship to maternal postpartum depression, and implications for family health. J Adv Nurs. 2004;45: 26-35.
McQueen K, Montgomery P, Lappan-Gracon S, et al. Evidence-based recommendations for depressive symptoms in postpartum women. J Obstet Gynecol Neonatal Nurs. 2008;37:127-136.
