Opportunities to Detect and Manage Perinatal Depression in Men
Am Fam Physician. 2016 May 15;93(10):824-825.
Related article: Identification and Management of Peripartum Depression.
In this issue of American Family Physician, Langan and Goodbred review the identification and management of perinatal depression in women.1 Although new fathers are at lower risk of depression than are new mothers,2 the prevalence of depression in new fathers is higher than that in the general population.3 Depression occurs in 10% of men from their partner's first trimester to one year postpartum; three to six months after birth is a particularly sensitive period of increased symptoms.2 Fathers who live with their children do not have a history of increased depressive symptoms prior to having a child but are at increased risk of depressive symptoms from birth through the first five years of life.4
Perinatal depression in fathers can be attributed to psychosocial risk factors, including a history of depression that increases vulnerability to recurrent symptoms, stress of raising children, role changes, interparental conflict, and financial concerns.5 Maternal depression is moderately correlated with paternal depression during the perinatal period,1 likely because depression in one partner can impact the other's mood. In turn, after accounting for the effects of maternal depression, paternal postnatal depression has a longitudinal impact on parenting practices (e.g., less reading, more corporal punishment),6 the child internalizing behaviors (e.g., anxiety) and externalizing behaviors (e.g., misbehavior, school performance),7 and the family environment (e.g., interparental conflict).8,9
While the maternal-child health care system routinely screens for perinatal depression in mothers, fathers are increasingly also involved in all aspects of their child's care, including attending well-child visits.10 Opportunities for identifying fathers with depression can occur at the mother's prenatal visits and postnatal check-up, or during newborn and infant clinical encounters. The Edinburgh Postnatal Depression Scale (EPDS; available at https://www.aafp.org/afp/2010/1015/p926.html#afp20101015p926-f1) is commonly used to screen for depression in new mothers and has been validated for assessing postnatal depression in fathers using a cutoff of 10 points.11 Even if the father does not attend such visits, the EPDS has been adapted and validated as a proxy screening for paternal depression through the report of the mother.12 A positive screening result based on the mother's proxy report (score of 5 or more) would indicate a follow-up screening test with the father directly. Early detection can offset the risk of chronic depression.
Traditional screening measures have been found to underreport depressive symptoms in men, and men are inclined to mask their symptoms through avoidant or numbing behaviors (e.g., aggression, alcohol or drug use).5 Measures of “masculine depression,” such as the Masculine Depression Scale13 and Male Depression Risk Scale,14 can supplement traditional depression measures.
Once perinatal depression is diagnosed in a father, interventions include pharmacotherapy, psychotherapy, or a combination. Treatment recommendations should be tailored based on depression severity and factors that would affect compliance (e.g., time constraints for attending therapy, medication adverse effects).
Effective psychotherapy approaches include cognitive behavior therapy, mindfulness-based therapies (e.g., acceptance and commitment therapy), and interpersonal psychotherapy.15,16 Selective serotonin reuptake inhibitors are first-line pharmacotherapy options. These medications can have adverse effects, however, including sexual dysfunction, which is even more likely in men than in women (62% vs. 57%, respectively).17 The adverse effects of selective serotonin reuptake inhibitors can be barriers for some men, so a discussion of the benefits, adverse effects, and alternatives may maximize compliance.
Depression screening tests do not differentiate between unipolar and bipolar depression. Bipolar disorder includes the hypomanic or manic symptoms of euphoria, increased energy, or persistent irritability. Physicians should ask about a history of these symptoms before prescribing an unopposed antidepressant. The Mood Disorder Questionnaire (available at http://www.dbsalliance.org/pdfs/MDQ.pdf) is a brief screening instrument for lifetime hypomanic episodes18 that has been validated during the postnatal period.19
Just as the past few decades have brought advances in the identification and treatment of maternal perinatal depression, the coming decades are likely to bring gains in these areas for paternal depression. Ample opportunities exist across the health care spectrum to identify and treat paternal depression to improve health outcomes of parents and children.
REFERENCESshow all references
1. Langan RC, Goodbred AJ. Identification and management of peripartum depression. Am Fam Physician. 2016;93(10):852–858....
2. Paulson JF, Bazemore SD. Prenatal and postpartum depression in fathers and its association with maternal depression: a meta-analysis. JAMA. 2010;303(19):1961–1969.
3. Hasin DS, Goodwin RD, Stinson FS, Grant BF. Epidemiology of major depressive disorder: results from the national epidemiologic survey on alcoholism and related conditions. Arch Gen Psychiatry. 2005;62(10):1097–1106.
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.
5. Fisher SD. Paternal mental health: Why is it relevant? [published ahead of print February 16, 2016]. Am J Lifestyle Med. http://ajl.sagepub.com/content/early/2016/02/16/1559827616629895.abstract. Accessed March 16, 2016.
6. Davis RN, Davis MM, Freed GL, Clark SJ. Fathers' depression related to positive and negative parenting behaviors with 1-year-old children. Pediatrics. 2011;127(4):612–618.
7. Shen H, Magnusson C, Rai D, et al. Associations of parental depression with child school performance at age 16 years in Sweden. JAMA Psychiatry. 2016;73(3):239–246.
8. Ramchandani P, Stein A, Evans J, O'Connor TG; ALSPAC study team. Paternal depression in the postnatal period and child development: a prospective population study. Lancet. 2005;365(9478):2201–2205.
9. Fisher SD, Brock RL, O'Hara MW, Kopelman R, Stuart S. Longitudinal contribution of maternal and paternal depression to toddler behaviors: interparental conflict and later depression as mediators. Couple Family Psychol. 2015;4(2):61–73.
10. Garfield CF, Isacco A. Fathers and the well-child visit. Pediatrics. 2006;117(4):e637–e645.
11. Edmondson OJ, Psychogiou L, Vlachos H, Netsi E, Ramchandani PG. Depression in fathers in the postnatal period: assessment of the Edinburgh Postnatal Depression Scale as a screening measure. J Affect Disord. 2010;125(1–3):365–368.
12. Fisher SD, Kopelman R, O'Hara MW. Partner report of paternal depression using the Edinburgh Postnatal Depression Scale-Partner. Arch Womens Ment Health. 2012;15(4):283–288.
13. Magovcevic M, Addis ME. The masculine depression scale: development and psychometric evaluation. Psychol Men Masc. 2008;9(3):117–132.
14. Rice SM, Fallon BJ, Aucote HM, Möller-Leimkühler AM. Development and preliminary validation of the male depression risk scale. J Affect Disord. 2013;151(3):950–958.
15. Forman EM, Herbert JD, Moitra E, Yeomans PD, Geller PA. A randomized controlled effectiveness trial of acceptance and commitment therapy and cognitive therapy for anxiety and depression. Behav Modif. 2007;31(6):772–799.
16. O'Hara MW, Stuart S, Gorman LL, Wenzel A. Efficacy of interpersonal psychotherapy for postpartum depression. Arch General Psychiatry. 2000;57(11):1039–1045.
17. Montejo AL, Llorca G, Izquierdo JA, Rico-Villademoros F. Incidence of sexual dysfunction associated with antidepressant agents. J Clin Psychiatry. 2001;62(suppl 3):10–21.
18. Hirschfeld RM, Williams JB, Spitzer RL, et al. Development and validation of a screening instrument for bipolar spectrum disorder: the Mood Disorder Questionnaire. Am J Psychiatry. 2000;157(11):1873–1875.
19. Sharma V, Xie B. Screening for postpartum bipolar disorder: validation of the Mood Disorder Questionnaire. J Affect Disord. 2011;131(1–3):408–411.
Copyright © 2016 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact email@example.com for copyright questions and/or permission requests.
Want to use this article elsewhere? Get Permissions
More in AFP
MOST RECENT ISSUE
Jul 15, 2018
Access the latest issue of American Family Physician