Research report
Paternal and maternal depressed mood during the transition to parenthood

https://doi.org/10.1016/S0165-0327(99)00159-7Get rights and content

Abstract

Background: The course of postnatal depression was examined in first-time mothers and fathers with emphasis on the role of personality and parental relationships as risk factors. Method: 157 couples were assessed at four points: antenatally and at 6, 12 and 52 weeks postnatally. Various measures of mood and personality were administered at each of these assessment points. Results: Examination of the factors associated with depressed mood suggested that a woman’s relationship with her own mother was important in the early postpartum stage, and also her level of interpersonal sensitivity and neuroticism. For the father, his relationship with either his mother or father and his level of neuroticism were associated with his mood level early on. By the end of the first year couple morbidity increased, with rates of distress being at their highest for both parents, and factors associated with depressed mood being linked to partner relationship variables, at least for mothers. At most time points, antenatal mood and partner relationship were significant predictor variables for the postnatal mood of both mothers and fathers. Limitations: The sample had a relatively high level of education and this should be taken into account when considering the generalisation of findings to less educated populations. At the time of conducting this study, the Edinburgh Postnatal Depression Scale (EPDS) had only been validated for use in the first few months postpartum, and thus we used another scale to measure the mother’s mood at the other assessment points (the Beck Depression Inventory). Current research would suggest that the EPDS is valid both antenatally and at other times in the first year postpartum. Conclusion: Whilst there was some consistency for mothers and fathers in the variables that predict their postpartum adjustment, these being antenatal mood and partner relationship, there is also evidence that adjustment to parenthood was related to different variables at different times. Early adjustment was related to the couple’s relationship with their own parents, as well as their own personality. Later adjustment was related to the couple’s functioning and relationship.

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)

  • P. Boyce et al.

    Parents, partners or personality? Risk factors for post-natal depression

    J. Affect. Disord.

    (1991)
  • J.A. Ungerer et al.

    Defence style and adjustment in interpersonal relationships

    J. Res. Personality

    (1997)
  • G. Andrews et al.

    The determination of defence style by questionnaire

    Arch. Gen. Psychiatry

    (1989)
  • M.E.G. Areias 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)
  • M.E.G. Areias et al.

    Correlates of postnatal depression in mothers and fathers

    Br. J. Psychiatry

    (1996)
  • A.K. Atkinson et al.

    Postpartum depression in primiparous parents

    J. Abnormal Psychol.

    (1984)
  • C.G. Ballard et al.

    Prevalence of postnatal psychiatric morbidity in mothers and fathers

    Br. J. Psychiatry

    (1994)
  • A.T. Beck et al.

    An inventory for measuring depression

    Arch. Gen. Psychiatry

    (1961)
  • P. Boyce et al.

    Development of a scale to measure interpersonal sensitivity.

    Aust N.Z. J. Psychiatry

    (1989)
  • C. Brems

    Women and depression: a comprehensive analysis

  • P.J. Cooper et al.

    Course and recurrence of postnatal depression: Evidence for the specificity of the diagnostic concepts.

    Br. J. Psychiatry

    (1995)
  • J. Cox et al.

    Detection of postnatal depression: development of the 10 item Edinburgh Postnatal Depression Scale.

    Br. J. Psychiatry

    (1987)
  • C. Dean et al.

    Comparison of research diagnostic systems in an Edinburgh community sample.

    Br. J. Psychiatry

    (1983)
  • J. Endicott et al.

    A diagnostic interview: The schedule for affective disorders and schizophrenia

    Arch. Gen. Psychiatry

    (1978)
  • H.J. Eysenck et al.

    Manual of the Eysenck Personality Inventory

    (1964)
  • D.P. Goldberg

    Manual of the General Health Questionnaire

    (1978)
  • Cited by (380)

    View all citing articles on Scopus
    View full text