Postnatal depression and fathers

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Presentation given to Primary Care Conference 2009, Birmingham, UK, 21 May 2009

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  • Postnatal depression and fathers

    1. 1. Fathers & postnatal depression Duncan Fisher Birmingham, 21 May 2009
    2. 2. Better Birth & Beyond @ Faculty of Health & Social Care www.dad.info a www.duncanfisher.com a
    3. 3. <ul><li>Why should (overstretched) maternity services extend to support fathers with depression? </li></ul>
    4. 5. 8 studies published since 2008
    5. 6. Prevalence <ul><li>10% (US, Paulson et al 2006) </li></ul><ul><li>8% (European study, Davé et al 2008 ) </li></ul><ul><ul><li>Severe: 3% </li></ul></ul><ul><li>2x average rate for men in age group (Danish study, Madsen 2006) </li></ul><ul><li>First-time fathers more prone (Cowan et al 1991) </li></ul>
    6. 7. Correlates <ul><li>History of severe depression (Ramchandani et al 2008) </li></ul><ul><li>Depression and anxiety antenatally (Ramchandani et al 2008a, Matthey et al 2000, Perren et al 2005) </li></ul><ul><li>Infant-related problems (Perren et al 2005, Dudley et al 2001) </li></ul>
    7. 8. Correlates <ul><li>Depression in mother (Areias et al 1996, Gao et al 2009 - Chinese study, Goodman 2004, Morse et al 2000) </li></ul><ul><li>Relationship with mother (Matthey et al 2000, Huang & Warner 2005, Dudley et al 2001, Matthey et al 2004) </li></ul>
    8. 9. Correlates of maternal PND <ul><li>Relationship with father - lack of support (including single parenthood), low participation in care of children, being critical/coercive/violent (Review: Fisher et al 2006) </li></ul><ul><li>Support of fathers correlates with shorter length of hospital stay for women with psychiatric disorders (Grube 2004) </li></ul>
    9. 10. Interdependence <ul><li>Depression in one parent correlates with depression in the other </li></ul><ul><li>Relationship between parents affects mental health of both </li></ul>
    10. 11. Impacts on children <ul><li>Depressed fathers interact less with their children (Broom 1994, Roggman et al 2002, Buist et al 2003, Huang & Warner 2005, Paulson et al 2006) </li></ul><ul><li>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) </li></ul><ul><li>Major depression in fathers correlates with 8-36x greater likelihood of child behaviour and peer problems (Davé et al 2008) </li></ul>
    11. 12. Interdependence again <ul><li>Impact on children of depressed mothers substantially worse if father also depressed (Kahn et al 2004) </li></ul><ul><li>Fathers in better mental health appear to buffer influence of mother’s poor health </li></ul><ul><li>Infants of chronically depressed mothers learn in response to fathers’, but not mothers’ infant-directed speech (Kaplan et al 2004) </li></ul>
    12. 13. Interdependence <ul><li>Also emerges in research on breastfeeding, smoking, birth experience </li></ul><ul><li>Fathers = key influence on mother and baby </li></ul>
    13. 14. Mother (carer, now carer + worker) ££ Father (worker) Child The model from tradition
    14. 15. Mother Father (carer + worker) (carer + worker) Child The model based on evidence
    15. 16. <ul><li>Why should (overstretched) maternity services extend to support fathers with depression? </li></ul><ul><li>Because it is necessary to achieve core goals: </li></ul><ul><li>maternal and infant health </li></ul>
    16. 17. Does engaging with fathers work? <ul><li>One antenatal session for first-time parents together on mental health issues - less distress in mothers at 6 weeks (Matthey et al 2004) </li></ul><ul><li>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) </li></ul><ul><li>Corroborated by trials involving fathers in breastfeeding promotion & smoking cessation </li></ul>
    17. 18. Markers for good practice <ul><li>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”. </li></ul><ul><li>NICE Guideline, 2007 </li></ul>
    18. 19. Markers for good practice <ul><li>Direct eye contact and vocalisation prepare baby for language and social interaction </li></ul><ul><li>Babies and fathers can ‘bond’- multiple attachment </li></ul><ul><li>Paternal bonding important where mother depressed </li></ul><ul><li>Mothers lacking confidence can exclude fathers and fathers can hang back (Lupton & Barclay 1997, Lewis 1986) </li></ul><ul><li>Requires proactive and tactful approach </li></ul><ul><li>at www.dad.info </li></ul>
    19. 20. <ul><li>[email_address] </li></ul>

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