Fathers & postnatal depression Duncan Fisher Birmingham, 21 May 2009

Better Birth & Beyond @ Faculty of Health & Social Care www.dad.info a www.duncanfisher.com a

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

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)

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)

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)

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)

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

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)

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)

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

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) Child 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

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

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

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

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

[email_address]

[email_address]