The effect of paternal depression on depressive symptoms in adolescent offspring
Authors: Lisa Underwood, Karen Waldie
Journal: The Lancet Psychiatry (2017)

Almost one in ten men will experience depression at some time in their life. Although there is evidence that partnered (and particularly married) men are at lower risk of depression than are the general male population,1Hopcroft RL Dana Burr B The sex difference in depression across 29 countries.Social Forces. 2007; 85: 1483-1507Crossref Scopus (99) Google Scholar rates of depression among fathers are difficult to estimate on the basis of existing evidence.2Underwood L Waldie KE Peterson E et al.Paternal depression symptoms during pregnancy and after childbirth among participants in the Growing Up in New Zealand Study.JAMA Psychiatry. 2017; 74: 1-10Crossref PubMed Google Scholar Fathers might not be exposed to the same risk factors for depression as mothers, but they do experience a range of biopsychosocial stressors that might affect their mental health and also have indirect effects on their partners, their children, or both.3Ramchandani PG Stein A The impact of parental psychiatric disorder on children. Avoiding stigma, improving care.BMJ. 2003; 327: 242-243Crossref PubMed Scopus (51) Google Scholar Regardless of prevalence or risk, there is now an increasing awareness of the role that paternal depression can have in child development and later psychosocial outcomes.4Stein A Pearson RM Goodman SH et al.Effects of perinatal mental disorders on the fetus and child.Lancet. 2014; 384: 1800-1819Summary Full Text Full Text PDF PubMed Scopus (1145) Google Scholar, 5Ramchandani P Stein A Evans J O'Connor TG Paternal depression in the postnatal period and child development: a prospective population study.Lancet. 2005; 365: 2201-2205Summary Full Text Full Text PDF PubMed Scopus (613) Google Scholar, 6Ramchandani PG O'Connor TG Evans J Heron J Murray L Stein A The effects of pre- and postnatal depression in fathers: a natural experiment comparing the effects of exposure to depression on offspring.J Child Psychol Psychiatry. 2008; 49: 1069-1078Crossref PubMed Scopus (143) Google Scholar That being said, high quality evidence to support the development of effective policy and intervention remains scarce. The effect of perinatal paternal depression on early childhood was shown by research with longitudinal data from the Avon Longitudinal Study of Parents and Children (ALSPAC) in the UK. Children (n=6449) whose fathers were depressed during the antenatal or postnatal periods had higher risk of emotional and behavioural problems than did those whose fathers did not have depression, when they were assessed at age 3·5 and 7 years.6Ramchandani PG O'Connor TG Evans J Heron J Murray L Stein A The effects of pre- and postnatal depression in fathers: a natural experiment comparing the effects of exposure to depression on offspring.J Child Psychol Psychiatry. 2008; 49: 1069-1078Crossref PubMed Scopus (143) Google Scholar Similarly, in different samples of Australian 5–6-year-olds (n=4253) and 8–9-year-olds (n=4196), childhood social and emotional wellbeing was negatively associated with paternal psychological distress (as well as mental health problems among mothers and grandparents).7Hancock KJ Mitrou F Shipley M Lawrence D Zubrick SR A three generation study of the mental health relationships between grandparents, parents and children.BMC Psychiatry. 2013; 13: 1-11Crossref PubMed Scopus (40) Google Scholar A Finnish study of 1247 pre-adolescents found an association between paternal postnatal distress and internalising behaviour problems among their children at age 12 years.8Pihlakoski L Sourander A Aromaa M et al.Do antenatal and postnatal parental psychological distress, and recognized need of help predict preadolescent's psychiatric symptoms? The Finnish Family Competence Cohort study.Child Psychiatry Hum Dev. 2013; 44: 305-319Crossref PubMed Scopus (8) Google Scholar In this issue of The Lancet Psychiatry, Gemma Lewis and colleagues9Lewis G Neary M Polek E Flouri E Lewis G The association between paternal and adolescent depressive symptoms: evidence from two population-based cohorts.Lancet Psychiatry. 2017; (published online Nov 15.)http://dx.doi.org/10.1016/S2215-0366(17)30408-XSummary Full Text Full Text PDF PubMed Scopus (33) Google Scholar provide evidence that associations between paternal mental health and child outcomes persist and affect adolescents, as well as younger children.8Pihlakoski L Sourander A Aromaa M et al.Do antenatal and postnatal parental psychological distress, and recognized need of help predict preadolescent's psychiatric symptoms? The Finnish Family Competence Cohort study.Child Psychiatry Hum Dev. 2013; 44: 305-319Crossref PubMed Scopus (8) Google Scholar Adolescents from the Millennium Cohort Study (MCS; n=7768) and Growing Up in Ireland (GUI; n=6070) were assessed at age 13–14 years. After adjusting for child emotional symptoms, paternal depression symptoms were significantly associated with symptoms of depression in adolescents, as noted by an increase in Short Mood and Feelings Questionnaire score (GUI 0·24 points, 95% CI 0·03–0·45, p=0·023; MCS 0·18, 0·01–0·36, p=0·041). This study explores the clinical significance of the findings, reporting an increase of 0·03–0·04 of an SD in adolescent depression scores for each 1 SD increase in paternal depressive symptoms. This association was of a similar magnitude to that between maternal depressive symptoms and adolescent depression scores. It is notable that much of the research on the influence of parental mental health on child wellbeing has used data from population-based longitudinal studies from around the world10Underwood L Waldie K D'Souza S Peterson ER Morton S A review of longitudinal studies on antenatal and postnatal depression.Arch Womens Ment Health. 2016; 19: 711-720Crossref PubMed Scopus (173) Google Scholar (eg, ALSPAC, the Finnish Family Competence Study, GUI, Growing Up in New Zealand, the Longitudinal Study of Australian Children, and MCS). The design and execution of these studies provides high-quality, well-powered data that allow for a wide range of multi-generational moderators, mediators, and confounding variables from across the lifespan to be taken into account (especially when loss to follow-up is low).7Hancock KJ Mitrou F Shipley M Lawrence D Zubrick SR A three generation study of the mental health relationships between grandparents, parents and children.BMC Psychiatry. 2013; 13: 1-11Crossref PubMed Scopus (40) Google Scholar As Lewis and colleagues9Lewis G Neary M Polek E Flouri E Lewis G The association between paternal and adolescent depressive symptoms: evidence from two population-based cohorts.Lancet Psychiatry. 2017; (published online Nov 15.)http://dx.doi.org/10.1016/S2215-0366(17)30408-XSummary Full Text Full Text PDF PubMed Scopus (33) Google Scholar acknowledge, the precise onset of depression symptoms in the adolescent participants and their fathers is not clear. This finding reflects a gap in the broader evidence base, resulting from methodological differences between studies that have measured paternal and child symptoms at different life stages and ages. Research that combines high quality data from these studies, and meta-analyses, which are able to investigate the complex longitudinal links between parental mental health, the parent–child relationship, and child mental health, are much needed.11Giallo R Cooklin A Wade C D'Esposito F Nicholson JM Fathers' postnatal mental health and child well-being at age five.J Fam Issues. 2013; 35: 1543-1562Crossref Scopus (46) Google Scholar, 12Nath S Russell G Kuyken W Psychogiou L Ford T Does father-child conflict mediate the association between fathers' postnatal depressive symptoms and children's adjustment problems at 7 years old?.Psychol Med. 2016; 46: 1719-1733Crossref PubMed Scopus (19) Google Scholar Underwood and colleagues2Underwood L Waldie KE Peterson E et al.Paternal depression symptoms during pregnancy and after childbirth among participants in the Growing Up in New Zealand Study.JAMA Psychiatry. 2017; 74: 1-10Crossref PubMed Google Scholar found that, 9 months after childbirth, fathers who were no longer in a relationship with their child's mother were at increased risk of having postnatal depression symptoms. As such, it is important that studies do not exclude fathers who do not always live with their children. Mothers have traditionally been seen as the vital nurturing influence on developing children, whereas fathers have been more commonly ascribed roles of the power figure, disciplinarian, or breadwinner for the family as a whole. Only relatively recently has the influence and input of fathers in children's early development been seen as essential for adaptive psychosocial and cognitive outcomes. There is increasing evidence that fathers' mental health affects their children's development, both directly and indirectly, from infancy. As such, it is crucial that depression symptoms are recognised and treated early in fathers as well as mothers. Understanding who is most at risk of developing depression symptoms could help health professionals design better methods to help the whole family. Particularly, relationship quality and the family environment appear to be key factors in parental depression, and therefore interventions for parents or their children should be family focused. Understanding the role of social support for fathers (another key area for intervention) and its potential to improve paternal mental health and, therefore, outcomes for children, is essential. We declare no competing interests The association between paternal and adolescent depressive symptoms: evidence from two population-based cohortsOur results show an association between depressive symptoms in fathers and depressive symptoms in their adolescent offspring. These findings support the involvement of fathers as well as mothers in early interventions to reduce the prevalence of adolescent depression, and highlight the importance of treating depression in both parents. Full-Text PDF Open Access