A significant number of men experience prenatal and postpartum depression, and the rate is marginally higher in the United States than in other countries, according to a meta-analysis of 43 studies.
The overall rate of paternal depression was 10.4%, with a U.S. rate of 14.1% vs. 8.2% in other countries.
In addition, the study reported maternal depression at a rate of 23.8%, with a moderate positive correlation between maternal and paternal depression.
The findings suggest that “more efforts should be made to improve screening and referral, particularly in light of the mounting evidence that early paternal depression may have substantial emotional, behavioral, and developmental effects on children,” noted lead author James F. Paulson, Ph.D., and his colleague Sharnail D. Bazemore of the department of pediatrics at Eastern Virginia Medical School in Norfolk (JAMA 2010;303:1961–9).
The correlation between paternal and maternal depression “also suggests a screening rubric – depression in one patient should prompt clinical attention to the other,” the investigators wrote.
The meta-analysis included studies from 16 countries and involved 28,004 new and expectant fathers aged 18 years or older.
Most studies (n = 40) assessed depression with a self-report rating scale, while 3 used a semistructured or structured interview. In addition to reporting paternal depression, 35 of the studies also reported rates of maternal depression, with 14 of them reporting the correlation between paternal and maternal symptoms.
The primary outcome was the point prevalence rate of paternal depression, and the secondary outcome included rates of depression of female partners. Regarding different time periods in relation to the birth, the 3- to 6-month postpartum period showed the highest rate of paternal (25.6%) and maternal (41.6%) depression, “although the small number of studies measuring paternal depression during this period suggests cautious interpretation,” they noted.
The studies in the meta-analysis showed a wide variation in rates of depression for both fathers and mothers; however, “since recent national data on base rates of depression in men place the 12-month prevalence at 4.8%, this suggests that paternal prenatal and postpartum depression represents a significant public health concern,” they wrote.
The authors suggested various potential causes of differences they observed between studies in the meta-analysis, including diverse measures of depression, locations, and sample characteristics. Another possible source “is the liberal inclusion of cases that can be classified as minor depression,” they added. The correlation between paternal and maternal depression suggests that “prevention and intervention efforts for depression might be focused on the couple and family rather than the individual. Future research in this area should focus on parents together to examine the onset and joint course of depression in new parents,” Dr. Paulson and Ms. Bazemore said.