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Am Fam Physician. 2006;73(1):158

Maternal postnatal depression is well recognized as a predictor of behavioral and other problems in children. Much less is known about the incidence of paternal depression during the postpartum period and the potential consequences of this condition for children. Ramchandani and colleagues used data from a large cohort study of early childhood in western England to assess the incidence of paternal depression in the postpartum period and to identify any adverse outcomes in children whose fathers were depressed.

All women in the region who were due to deliver between April 1991 and December 1992 were eligible for the study. About 85 to 90 percent of eligible participants were recruited and received questionnaires regularly during and after pregnancy. The data collected included information on environmental and psychosocial risk factors as well as medical and developmental information about the family. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess mothers and fathers eight weeks after delivery. Fathers were asked to complete this assessment again at 21 months. The emotional and behavioral development of children was assessed at 42 months using standardized, validated questionnaires that reported results in the domains of emotional problems, conduct problems, hyperactivity, and prosocial behavior.

Data on postpartum depression were obtained from 11,833 (89 percent) of the 13,351 participating mothers and from 8,431 (65 percent) of the 12,884 fathers. Information about behavior at 42 months was obtained for 10,024 (75 percent) of the children in the study. Severe postpartum depressive symptoms in mothers, but not fathers, were associated with nonparticipation at 42 months. Using the accepted EPDS cut-off score of 12 to indicate depression, 1,203 (10 percent) of mothers and 303 (4 percent) of fathers suffered from postpartum depression. Scores were significantly correlated for mothers and fathers. Depression in fathers was strongly associated with high scores for emotional, conduct, and hyperactivity problems at 42 months in children but was not significantly associated with pro-social behavior. The associations with total problems, conduct, and hyperactivity problems remained after statistical adjustment for social class, educational achievement, and maternal depression. The association between paternal depression and conduct problems was significantly higher in sons than in daughters. Maternal depression was associated with problems in all areas assessed and in both sons and daughters.

The authors conclude that depression in fathers during the postnatal period is associated with behavioral problems, especially in sons at 3.5 years of age. This association is independent of maternal status and other factors, including paternal depression occurring later than the postpartum period. They speculate that early paternal depression could directly influence behavior later in childhood. They call for greater attention to the role of fathers in early childhood, especially their influence on boys.

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