by Joye C. Anestis
Wow, things are certainly different around here since the last time I sat down to write a post, over 4 months ago. I ask for your patience as I put my writing hat back on and scramble to post things during naptimes...this should be interesting!
In honor of the wonderful reason behind my absence on PBB, I thought I would write about an interesting article on paternal prenatal and postpartum depression I came across recently in JAMA (the Journal of the American Medical Association).
Now I know from recent firsthand experience, that bringing a new baby home is tough...for everyone - mom, dad, and in our case, cats and dogs too! Thanks to recent high-profile stories about postpartum depression in moms, health care professionals are on the lookout for warning signs. It is discussed in appointments with healthcare providers, both prenatal and postpartum (be it OBs, midwives, doulas, etc.). It is discussed in childbirth classes. The focus, however, is entirely on moms (for information on postpartum depression in moms, check out these previous articles) - for good reason, of course, maternal postpartum depression can be scary and has many negative consequences. But, what about dads? No one really asks them how they're feeling at prenatal appointments or childbirth classes. Are dads at risk for depression as well? James Paulson and Sharnail Bazemore set out to see what the existing literature had to say about that (you can check out the original article in JAMA).
After applying exclusion criteria, Paulson & Bazemore identified 43 studies (total of 28,004 participants) which reported data on paternal depression. They then utilized meta-analytic techniques to answer the following questions:
What are the rates of paternal depression between the first trimester and 1 year postpartum?
The overall estimate of paternal depression across studies was 10.4%. This is a high rate in general...but even more concerning considering that recent national estimates of depression in men is 4.8% (Kessler et al., 2003). There is evidence to suggest that early parental depression can have negative effects on child development (Paulson et al., 2009; Ramchandani et al., 2008), so it behooves us to screen and provide resources for both mom and dad. With all the focus on moms, dads may slip under the radar.
Does depression risk change at different points between the first trimester and 1 year postpartum?
Moderator analyses found significant variability between different time periods. The 3-6 month postpartum period had the highest rate (25.6%) and the first 3 months post-birth had the lowest rate (7.7%). The authors do caution our interpretation of these findings, however, since such a small number of studies contained the 3-6 month postpartum time period. I would have loved for the authors to hypothesize about potential reasons for this spike in depression rates at this point in time (since I'm living the 3-6 month postpartum period now, I can guess that complete lack of sleep hygiene playing a large role!).
Is there an association between paternal and maternal depression?
The overall correlation between paternal and maternal depression was significantly larger than 0 (r = 0.308). This moderate correlation is not surprising - it makes sense (at least to me) that, if one parent is depressed, the other might be as well. We should remember, however, that this correlation says nothing about causation. Data do not yet exist to tell us if a maternal depression causes paternal depression or vice versa.
What is the prevalence of maternal prenatal and postpartum depression in studies focusing on paternal depression?
Prevalence of maternal depression was higher than the rate in dads (maternal depression rate of 23.8%). Depression estimates were higher for moms during the 3-6 month postpartum period (41.6%). I am always astounded by how high estimates of maternal depression are. So many women struggling during this important time in life. I also find this spike interesting because, at this point in time, doctor's appointments for mom have ended and there are generally less people checking in on her. In light of this data, perhaps that should be modified.
How are published rates of paternal depression affected by methodological factors?
Methodological factors influenced paternal depression rates across the studies included. Depression rates in U.S. fathers (average of 14.1%) were higher than the rates reported in international studies (average of 8.2%). The method of depression measurement affected the depression rates, with interview-based definitions resulting in lower overall prevalence estimates (4.9% vs. 11.0% for rating scales). Similarly, maternal depression estimates were lower when interviews were used (9.8%) versus rating scales (25.5%). There was a non-significant trend for U.S. moms (29.6%) to have higher depression rates than international moms (19.7%).
Of course, I can't write about any meta-analysis without acknowledging the problems inherent in this type of study. We've talked at length about the downfalls of meta-analysis (here, for example). Admirably, Paulson & Bazemore took strides to bolster their findings. First, they examined the studies for evidence of publication bias. The three tests they reported (funnel plots, the Egger intercept, and the Orwin fail-safe procedure) revealed no evidence of publication bias. The authors also conducted sensitivity analyses to ensure that no one study was unduly influencing the findings. They sequentially removed each study and reanalyzed the remaining data set. No study effected the overall estimate more than 0.5%. In other words, they tried really hard to make their findings be as solid as possible, while at the same time acknowledging that meta-analysis is imperfect.
Even if we are cautious about how we interpret these findings, it is apparent that the prenatal and postpartum period is a time of depression risk for new and expecting dads. One thing the authors did not mention is the treatment options available for prenatal and postpartum depression in dads. I'm not aware of any data indicating specialized treatments for dads in this time period...and I wonder if the standard ESTs for depression would be effective. I assume they would. Although I question the application of standard depression treatments for postpartum moms due the hormonal factors which could be involved, I don't have the same concern for dads. Of course, this is purely my opinion... if any of you know of any data on treatments for prenatal/postpartum depression in dads, let me know!
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