In part due to the paucity of research on paternal prenatal and postpartum depression, experts are still sketchy on the risk factors for fathers. A personal history of depression puts both mothers and fathers at a higher risk, as does a sick baby, financial strain or relationship problems. Add to that list the changing expectations pushing dads to become more involved parents, says Courtenay, and many new fathers are left feeling overwhelmed and at greater risk for anxiety and depressive symptoms.
In a study Courtenay is currently undertaking, initial data from some 1,500 fathers have shown that other risk factors include an unexpected pregnancy or unhappiness with the baby's gender.
Downsides of depressed dads
Like mothers who are depressed, fathers who suffer from depression can have negative impacts on their children's development years down the road.
"When Dad is depressed, Dad tends to interact less with the child and bonds less with the child," Paulson notes. He coauthored a study that found fathers with depression were less likely to read to their children, and those children were more likely to have relatively poor language skills.
A study of more than 10,000 children in the U.K., published in 2005 in The Lancet, found that "depression in fathers during the postnatal period was associated with adverse emotional and behavioral outcomes in children aged 3.5 years." This correlation was seen even when the researchers controlled for maternal depression, the authors, led by Paul Ramchandani of the University of Oxford, concluded.
Another study, published in 2008 in The Journal of Child Psychology and Psychiatry, found that children whose fathers had been depressed during their early infancy were more likely to have behavioral problems by the time they were school age—a finding Paulson calls "very alarming." The longitudinal study, also led by Ramchandani, found that kids whose fathers had been depressed in both the prenatal stage and the first month of infancy "had the highest risk of subsequent psychopathology." And the effect was especially strong in boys who had had depressed fathers.
Depression in dads also seems to correlate with depression in mothers. Although the relationship is not one-to-one, having a partner with this sort of depression seems to increase an individual's likelihood of having it, too. This should prompt clinicians to assess the partners of parents with depression, Paulson says. Currently, however, he notes, "we don't know what direction that influence moves."
Addressing dads' depression
Although he has been studying paternal postpartum depression for several years, Paulson was surprised to find a big difference between rates in the U.S. and those from studies based elsewhere. U.S. fathers had nearly twice the rate of paternal prenatal and postpartum depression, leading Paulson and his coauthor, Sharnail Bazemore, also of Eastern Virginia Medical School, to suggest further research on the "varying social norms and postpartum work practices cross-nationally."
As in mothers, postpartum depression in fathers seems to spike between three and six months after the birth of a child. Paulson speculates that this might have to do with the typical three-month term for maternity leave in the U.S., after which many mothers return to work, shifting responsibilities within the family. It is also an age at which children start exhibiting more challenging behavior, he notes.
Paulson recommends investigating treatment that focuses on whole families, addressing depression "as a family problem, not an individual problem."
Courtenay proposes ways to help prevent paternal—and maternal—depression from becoming a problem in the first place. With a growing checklist of risk factors, he says, the best thing to do is address any of them "before the baby comes along." If there is a history of depression, be prepared for a relapse and have plans in place for seeking treatment quickly. If there is strife in the relationship between the parents, seek counseling or other help before or during pregnancy. Or if a father-to-be is starting to feel anxious about his new role and responsibilities, he should enroll in a parenting class. "Putting that stuff in order beforehand" can help keep disruptive parental depression at bay, Courtenay notes.