Fathers & postnatal depression

Duncan Fisher

Birmingham, 21 May 2009

Better Birth & Beyond @ Faculty of Health & Social Care

www.dad.infoa

www.duncanfisher.coma

Why should (overstretched) maternity services extend to support fathers with

depression?

8 studies published since 2008

Prevalence

• 10% (US, Paulson et al 2006)

• 8% (European study, Davé et al 2008 )

– Severe: 3%

• 2x average rate for men in age group (Danish study, Madsen 2006)

• First-time fathers more prone (Cowan et al 1991)

Correlates

• History of severe depression (Ramchandani et al 2008)

• Depression and anxiety antenatally (Ramchandani et al 2008a, Matthey et al 2000,

Perren et al 2005)

• Infant-related problems (Perren et al 2005, Dudley et al 2001)

Correlates

• Depression in mother (Areias et al 1996, Gao et al 2009 - Chinese study, Goodman 2004, Morse et al 2000)

• Relationship with mother (Matthey et al 2000, Huang &

Warner 2005, Dudley et al 2001, Matthey et al 2004)

Correlates of maternal PND

• Relationship with father - lack of support (including single parenthood), low participation in care of children, being critical/coercive/violent (Review: Fisher et al 2006)

• Support of fathers correlates with shorter length of hospital stay for women with psychiatric disorders (Grube 2004)

Interdependence

• Depression in one parent correlates with depression in the other

• Relationship between parents affects mental health of both

Impacts on children

• Depressed fathers interact less with their children (Broom 1994, Roggman et al 2002, Buist et al 2003, Huang & Warner 2005, Paulson et al 2006)

• Significant correlation with psychiatric disorders in children of 3.5 and 7 years - mainly oppositional/defiant conduct (Ramchandani et al 2005, Ramchandani et al 2008a, Ramchandani et al 2008b)

• Major depression in fathers correlates with 8-36x greater likelihood of child behaviour and peer problems (Davé et al 2008)

Interdependence again

• Impact on children of depressed mothers substantially worse if father also depressed (Kahn et al 2004)

• Fathers in better mental health appear to buffer influence of mother’s poor health

• Infants of chronically depressed mothers learn in response to fathers’, but not mothers’ infant-directed speech (Kaplan et al 2004)

Interdependence

• Also emerges in research on breastfeeding, smoking, birth experience

• Fathers = key influence on mother and baby

Mother(carer, now carer + worker)

££ Father (worker)

Child

The model from tradition

Mother Father (carer + worker) (carer + worker)

ChildChild

The model based on evidence

Why should (overstretched) maternity services extend to support fathers with depression?

Because it is necessary to achieve core goals:

maternal and infant health

Does engaging with fathers work?

• One antenatal session for first-time parents together on mental health issues - less distress in mothers at 6 weeks (Matthey et al 2004)

• Randomised control trial in Canada: less maternal depression where fathers participated in 4 out of 7 visits. More paternal depression if fathers left out. (Misri et al 2000)

• Corroborated by trials involving fathers in breastfeeding promotion & smoking cessation

Markers for good practice

• Health professionals should “assess and, where appropriate address, the needs of the partners, family members and carers of a woman with a mental disorder during pregnancy and the postnatal period”.

NICE Guideline, 2007

Markers for good practice

• Direct eye contact and vocalisation prepare baby for language and social interaction

• Babies and fathers can ‘bond’- multiple attachment• Paternal bonding important where mother depressed• Mothers lacking confidence can exclude fathers and

fathers can hang back (Lupton & Barclay 1997, Lewis 1986)

• Requires proactive and tactful approach

at www.dad.info

duncan@duncanfisher.com