Research reportPaternal and maternal depressed mood during the transition to parenthood
Introduction
Increased anxiety and depressed mood are to be expected during important life transitions, and such phenomena over the period of pregnancy and early parenting have been extensively studied in women. In contrast, relatively little research has focused on men’s adjustment to this major life transition, despite increased awareness of the importance of the family system as a whole for understanding the coping and adjustment of individual family members. The research to be reported here investigated the occurrence of postnatal depression in a sample of first-time mothers and fathers, with particular emphasis on exploring the incidence of couple morbidity and patterns of change in depressive symptomatology over time. Personality and relationship variables known to be correlated with depression were also investigated in order to compare factors associated with an increased risk of occurrence of the disorder.
Methods of assessing postnatal depression have included using structured diagnostic interviews (e.g., Schedule of Affective Disorders and Schizophrenia (SADS; Endicott and Spitzer, 1978) and self-report measures (e.g., Beck Depression Inventory (BDI; Beck et al., 1961), Edinburgh Postnatal Depression Scale (EPDS; Cox et al., 1987), General Health Questionnaire (GHQ: Goldberg, 1978)). Where diagnostic interviews are used to determine caseness, as opposed to using scores above a pre-determined cut-off on a self-report instrument, the rates of depression tend to be lower. While these two methods of calculating caseness or clinical depression are not directly comparable, the consistency of results suggests that both methods can be used to gain a realistic picture of mood disorders in new parents.
The prevalence of postnatal depression in mothers has been consistently reported as between 8 and 27.5%, with rates varying across studies depending upon factors such as the time of assessment postnatally, the definition of depression, the measures used to assess depression and the prior length of time to which the questions relate (i.e., 1 week or 1 month). Examples of the different rates and diagnostic methods include studies by Paykel et al. (1980) (a clinical interview for depression, 20%); Harris et al. (1989) (10 item EPDS and two other self-report scales, 14.9%); Ballard et al. (1994) (13 item EPDS, 27.5%); and O’Hara and Swain (1996) (meta analysis, 13%).
The rate of depression in fathers has been investigated less frequently. Estimates vary from 4.8 to 13% in the early postpartum period (Atkinson and Rickel, 1984: BDI, 13%; Ballard et al., 1994: 13 item EPDS, 9.0%; Areias et al., 1996a: EPDS and SADS, 4.8%) with the general consensus being that, as with depression at other times in life, the prevalence of the disorder is higher in women both antenatally and in the first few months postnatally. However, there is some evidence that the rate of depression in fathers may increase over the first year postpartum (Areias et al., 1996b).
The few studies that have looked at couple morbidity have shown a trend for higher rates of concordance in couples when fathers are depressed compared with when mothers are depressed. Around 6–8 weeks postpartum 22–50% of depressed fathers had depressed partners, while only 16–26% of depressed mothers had a depressed partner (Raskin et al., 1990, Ballard et al., 1994). When mothers are severely depressed, however, the rate of partner depression increases significantly, with two studies reporting rates between 40 and 50% (Harvey and McGrath, 1988: Psychiatric Assessment Schedule (Dean et al., 1983); Lovestone and Kumar, 1993: SADS).
Cooper and Murray (1995) have discussed the importance of distinguishing between ‘de novo’ and ‘recurrent’ depression postnatally. Research on the course of depression from the antenatal to the postnatal period consistently indicate that most mothers who are not depressed antenatally remain not depressed during the postpartum period (Kumar and Robson, 1984, Watson et al., 1984, Gotlib et al., 1989). In contrast, these same studies are much less consistent in their findings regarding the percentage of women who are depressed antenatally remaining depressed during the postpartum period. Reported percentages for this vary from 18 to 75%.
The data for the course of depression in fathers are harder to analyse in percentage terms because there is only one study providing such data, and the number of depressed fathers in that study was small. Ballard et al. (1994) found that 38% of fathers who were depressed at 6 weeks postnatally remained depressed by 6 months postnatally, while 93% of fathers who were not depressed at the first assessment remained not depressed.
A range of variables has consistently been found to be associated with postnatal depression in women. These include a previous history of depression, marital disharmony, being a single parent, significant life events in the 12 months preceding the birth, lack of social support, and neuroticism (Webster et al., 1994, Areias et al., 1996b). Of particular interest to us was a study by Boyce et al. (1991) which focused on relationship variables and personality characteristics as risk factors in postnatal depression. They assessed 149 non-depressed women antenatally using measures of the women’s childhood relationship with their own parents (Parental Bonding Instrument (PBI), Parker et al., 1979) and their current relationship with their partner (Intimate Bond Measure (IBM), Wilhelm and Parker, 1988). The women’s level of interpersonal sensitivity was also measured using a self-report questionnaire, the Interpersonal Sensitivity Measure (IPSM) (Boyce and Parker, 1989), which is similar in content to Eysenck’s neuroticism scale. The results indicated that each measure contributed to the mothers’ risk of postnatal depression, with different risk factors being important at different times postnatally. At 1 month postpartum, the greatest risk factor was reporting a spouse as offering low Care or high Control on the IBM. At 3 months postpartum the greatest risk factors for mothers were these same spousal variables as well as scoring her own father as highly Controlling on the PBI. At 6 months postpartum, high Interpersonal Sensitivity was the greatest maternal risk factor for the development of depression. Our research attempted to replicate these findings in mothers and to extend the analysis to a group of fathers.
Section snippets
Design of the study
The data for this research were collected as part of a larger longitudinal study of psychosocial development in first-born children in the first 3 years of life (Ungerer et al., 1992). The sample was recruited early in the second trimester of the mother’s pregnancy, and assessments were conducted at that time (20–24 weeks gestation) and at 6 weeks, 4 months, and 12 months postpartum. The sample was recruited through approaches to the mothers who were screened prior to enrolment to ensure that
Prevalence
The prevalence of depression was measured by calculating the percentage of mothers and fathers who scored above the EPDS (mothers, 6 weeks postpartum), the BDI, or the GHQ (mothers and fathers, remaining timepoints) clinical cut-off points at each assessment period. Between 7.7% and 12.4% of mothers, and between 2.8% and 5.3% of fathers scored above the cut-off points on these measures across the four assessment periods (see Fig. 1). Chi-square analysis indicated no significant change in the
Discussion
These results identified both similarities and differences between mothers and fathers in the incidence and course of depression antenatally and in the first postpartum year. We found, as did Atkinson and Rickel (1984) and Ballard et al. (1994), that the incidence of self-reported depression in fathers was consistently lower than that in mothers. The fact that these differences achieved statistical significance only antenatally and at 12 months postpartum was likely due to the low incidence of
Conclusion
Overall, the results of this research indicate that fathers have lower rates of clinically significant distress or depression than mothers in the first postpartum year, although the patterns of stability and change in depression over time are similar for the two groups. These findings should be interpreted cautiously, however, since our data also provide evidence for underreporting of distress by fathers, and for considerable stability in fathers’ levels of acknowledged distress across the
Acknowledgements
This research was supported by grants from the Australian Research Council, the National Health and Medical Research Council, Macquarie University and the University of New South Wales. We are grateful for the assistance of Robyn Dolby, Sharyn Moses, Sally Beardmore, Judy Chan, Alison Malbourne, Leisa Landers, Pauline Presland, Rosemary Simmons, Susan McGovern, and Kay Roy for assistance in data collection and analyses.
References (33)
- et al.
Parents, partners or personality? Risk factors for post-natal depression
J. Affect. Disord.
(1991) - et al.
Defence style and adjustment in interpersonal relationships
J. Res. Personality
(1997) - et al.
The determination of defence style by questionnaire
Arch. Gen. Psychiatry
(1989) - et al.
Comparative incidence of depression in women and men during pregnancy and after childbirth. Validation of the Edinburgh Postnatal Depression Scale in Portuguese mothers
Br. J. Psychiatry
(1996) - et al.
Correlates of postnatal depression in mothers and fathers
Br. J. Psychiatry
(1996) - et al.
Postpartum depression in primiparous parents
J. Abnormal Psychol.
(1984) - et al.
Prevalence of postnatal psychiatric morbidity in mothers and fathers
Br. J. Psychiatry
(1994) - et al.
An inventory for measuring depression
Arch. Gen. Psychiatry
(1961) - et al.
Development of a scale to measure interpersonal sensitivity.
Aust N.Z. J. Psychiatry
(1989) Women and depression: a comprehensive analysis