Study highlights need to address PPD in both parents

Postpartum depression (PPD) is a well-known risk for moms after childbirth, particularly when they have a preterm infant in the neonatal intensive care unit (NICU)—however, findings from a prospective longitudinal cohort study suggest that depression is also a major concern among fathers.

Craig F. Garfield, MD, MAPP, founder and director of Family & Child Health Innovations Program at Ann & Robert H. Lurie Children’s Hospital of Chicago and professor of pediatrics at Feinberg School of Medicine at Northwestern University, Chicago, and colleagues conducted their study to assess the trajectory of depression symptoms among both mothers and fathers from NICU admission to 30 days post-NICU discharge. They hypothesized that depression symptom scores would decrease for both parents as the infant stabilized in the NICU before increasing from discharge to 30 days at home as they assumed the responsibilities of parenthood.

Instead, Garfield and colleagues found that 33% of mothers and 17% of fathers suffered from PPD while their baby was in the NICU—and, notably, while depression symptoms declined significantly for mothers after the baby came home, they did not do the same for fathers, they reported in Pediatrics.

“Our findings point to the need for increased attention to the mental health of new fathers, during their baby’s NICU stay and after discharge,” Garfield said in a press release on the study. “This is crucial, not only for the well-being of new parents but also for the optimal development of their child.”

In an invited commentary accompanying the study, Michael W. Yogman, MD, MSc, of the department of pediatrics at Harvard Medical School in Cambridge, Massachusetts, wrote that this study “contributes to a growing literature on the importance of paternal postpartum depression better referred to as paternal perinatal affective disorder (PPAD), which encompasses both pre- and postnatal anxiety and depression. While maternal postpartum depression (PPD) is increasingly recognized, PPAD is underscreened, underdiagnosed, and undertreated despite a prevalence of 8-20% in some surveys.”

What’s more, he added that PPAD can have an adverse impact on mothers, children, and the familial relationship in the form of adverse childhood experiences, co-morbid maternal PPD, unemployment, and low socioeconomic status.

Yogman recommended four ways for pediatricians to engage fathers more actively in care and combat these outcomes:

  1. “Identify parents, fathers as well as mothers, in the NICU who have risk factors and provide supportive interventions and close follow-up after discharge.
  2. “Screen fathers at the 4-month well visit for PPAD as mothers are already screened for PPD; monitoring and screening fathers for depression can be continued through the 12-month well visit.
  3. “Advocate to include fathers in current proposals for paid postpartum family leave.
  4. “Advocate for the development of a workforce with expertise in parental mental health that acknowledges the presence and need for treatment of men with PPAD.”

For their longitudinal cohort study, Garfield and colleagues collected data from April 2019-Feb. 2020 “in a quasi-experimental control-intervention smartphone application trial designed to support parents of NICU infants,” they explained. All fathers and mothers of premature infants (<37 weeks gestational age) admitted to the NICU at Prentice Women’s Hospital in Chicago were eligible to participate if they were legal adults, spoke English, and expected to stay a minimum of one week at the NICU.

Approximately one week post-admission, parents were given a standardized parental depression symptom questionnaire, and symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS) (initial assessment); the same measure was administered three more times, upon NICU discharge, two weeks post-discharge, and 30 days post-discharge. EPDS score change across time and probability of a positive screen (EPDS ≥10) were assessed via mixed effect regression models.

Garfield and colleagues found that, “Of 431 parents enrolled (mothers, n=230 [53%]), 33% of mothers (n=57) and 17% of fathers (n=21) had a positive EPDS screening. Scores change was 1.9 points different between mothers and fathers (CI: 1.3, 2.6; P<0.0001) with mothers decreasing 2.9 points (CI: 2.1, 3.7; P<0.0001) and fathers decreasing 1.0 points (CI: 0.1, 2.0; P=0.04).”

“The odds of reporting depressive symptoms… was 10.96 times higher (CI: 2.99, 38.20; P=0.0003) at the initial assessment compared to 30 days post discharge for mothers; however, fathers’ odds did not change significantly during this time period (0.99 times [CI: 0.26,3.79, P=0.9854)]),” they added.

The study authors noted that the increased depression scores for mothers early following NICU admissions is consistent with previous research, and while the trajectory of depression symptoms over time in this group was lower than average reports, they noted that other research shows that “the pattern of maternal PPD is not homogenous.”

Meanwhile, they noted that previous analyses found that fathers of children in the NICU met the diagnostic criteria of a number of stress disorders at rates higher than mothers up to four months after their infants’ births, “further highlighting the importance of closely examining post-NICU psychological pathologies among fathers.”

“With the growing understanding of the importance of parental mental health on family and infant wellbeing, universal screening of parents along with training of NICU bedside staff to help communicate and potentially identify parents who are struggling is needed,” they wrote. “Resources made available to those parents at any point during the NICU or home timeframe can take the form of trained social work or mental health professionals embedded in the NICU to begin making referrals more available for outpatient support once the infant is discharged.”

Study limitations cited by the authors included the use of depression screening questionnaires without diagnostic interviews; the inability to predict how unpartnered parents might be impacted; the direct effect of infant condition on outcomes may be unaccounted for; models were not adjusted for known depression risk factors among parents, including past mental health diagnosis, substance abuse, or other trauma; and that the follow-up period lasted only 30 days.

  1. Researchers found that 33% of mothers and 17% of fathers suffered symptoms of postpartum depression while their baby was in the NICU—and while depression symptoms declined significantly for mothers after the baby came home, fathers’ depression symptoms persisted through 30 days post-discharge.

  2. These findings point to the need for increased attention to the mental health of new fathers, during their baby’s NICU stay and after discharge

John McKenna, Associate Editor, BreakingMED™

The study waa funded by Friends of Prentice.

The study authors and editorialist had no relevant relationships to disclose.

Cat ID: 138

Topic ID: 85,138,728,791,730,191,41,138,192,55,921