Both Mothers and Fathers at Risk for Depression in First Year After Child's Birth

From Medscape Medical News

Deborah Brauser

September 9, 2010 — Although both mothers and fathers are at risk of experiencing incidences of depression by their child's 12th birthday, the highest risk is within their first year post partum, according to researchers from the United Kingdom.

"The main takeaway message for clinicians is that both parents are at risk of developing depression soon after the birth of the baby," Irwin Nazareth, PhD, MBBS, director of the Medical Research Council (MRC) General Practice Research Framework and professor of primary care at University College London, United Kingdom, told Medscape Medical News.

He noted that the UK National Institute for Clinical Excellence has recommended regular screenings for mothers for depression through the antenatal and postnatal period. However, "this should be extended to fathers so that the family is considered as a whole unit. Special attention must also be paid to young parents who have had a past history of depression and those who are socioeconomically deprived."

The study was published online September 6 in the Archives of Pediatrics and Adolescent Medicine.

Paucity of Paternal Depression Research

Although past research has shown that parental depression is associated with adverse outcomes for their children in behavior, development, and cognition, most have focused only on maternal depression, write the study authors.

"The effect of a new baby on the father has received little attention," said Dr. Nazareth. "This study was hence done to ascertain the extent of the problem and to identify those groups of fathers who were at particular risk of depression. Moreover, we believe that simultaneously studying the effect of the birth of the baby both on fathers and mothers provides us a much fuller picture of the wider effects of birth on the family unit."

He also noted that his investigative group at the MRC "has always had a special interest in mental health problems in primary care" and that this particular study resulted from 8 years of research work undertaken by lead study author Shreya Dave, PhD, MSc, BSc.

For this study, the investigators evaluated data from between 1993 and 2007 from The Health Improvement Network database, which includes information on almost 5 million primary care patients from the United Kingdom. They then identified a cohort of 86,957 mother-father-child units.

Patient records and read code entries were also assessed for unipolar depression, antidepressant prescriptions, and sociodemographic information, including follow-up data up to the child's 12th birthday.

Both Parents Experience Depression

The investigators found that 19,286 of the mothers and 8012 of the fathers had an episode of depression during the period between their child's birth up to the age of 12 years.

Of these moms, 77% experienced 1 episode of depression, 18% had 2 episodes, and 5% had 3 or more episodes. Of the depressed fathers, 83% had 1 episode, 14% had 2, and 3% had 3 or more.

The overall incidences of depression during this same period for mothers were 7.53 per 100 person-years vs 2.69 per 100 person-years for fathers.

However, the depression rates were highest for both parents during the first year after the child's birth at 13.93 per 100 person-years for mothers and 3.56 for fathers.

"What was striking in this study was the extent of the depression in fathers vs mothers and how the first year of the birth of the baby was in particular a risk period for both parents," said Dr. Nazareth.

The researchers write that in addition to such things as poor parental sleep and change in responsibilities, the high rates of depression found during the first year post partum may be partly due "to a resumption of antidepressant use following a break during pregnancy and breastfeeding."

Finally, both mothers and fathers who were between the age of 15 and 24 years at the birth of their child were significantly more likely to be depressed than parents older than 25 years, as were those who had a history of depression and were in the highest quintile for deprivation.

Dr. Nazareth noted that this link was particularly interesting. "This informs general practitioners on the need to consider closer monitoring of these at risk groups from early pregnancy and soon after."

In addition, the study authors write that future research should examine other factors potentially associated with parental depression, such as the couple's relationship quality and stressful events, as well as the effects of this depression on the child's health and development.

Awareness, Screenings Needed

"This was an interesting study that addresses an important issue that hasn't been clearly resolved in research and, in fact, has been the subject of some debate over the past 10 years," James Paulson, PhD, associate professor and clinical psychologist in the Department of Pediatrics at Eastern Virginia Medical School at Children's Hospital of the King's Daughters in Norfolk, told Medscape Medical News, when contacted for comment.

"That issue is depression in mothers during the first year post partum, which clearly has negative connotations for the family," he added. "This study works strongly in favor of the argument that depression is something that's happening in postpartum — not only in mothers but also in fathers — more than at any other time point during parenthood."

Dr. Paulson, who was not involved with this study, recently conducted a meta-analysis looking specifically at prenatal and postpartum depression in fathers.

"I thought it was great that these investigators included paternal depression in their methodology, which I think we'll find in more and more studies. This article really underscores the point that depression is happening more often in fathers."

He noted that, due to continuing stigma, men often do not admit to having depression and often do not seek help. "I also think they're less likely to recognize depression as depression when they experience it. So I think increasing awareness will really help ring that bell for more people."

Although Dr. Paulson had no concerns with this study, he said that he would have liked to have seen more about what was going on within the family and not just an exclusive focus on the individual parents.

"Turning the focus more toward the family is very important for moving this field forward, and it gives us a lot more traction in terms of what we can do for catching depression, for intervening, and for minimizing its effect on the family and the child," he explained.

"For clinicians, I think the number 1 takeaway is that when working with expecting new parents — and I think we need to start thinking about this during the pregnancy — realize that this a situation where depression is a much higher risk than it is at any other time point," concluded Dr. Paulson. "Take whatever steps are needed to screen for depression in both mothers and fathers because clearly this is a risk that occurs in both parents."

This study was funded in part through a grant from the MRC. The study authors and Dr. Paulson have disclosed no relevant financial relationships.

Arch Pediatr Adolesc Med. Published online September 6, 2010.