Rates of paternal depression range from 5% to 10% with a growing body of literature describing the harm to fathers, children, and families. Changes in depression symptoms over the life course, and the role of social factors, are not well known. This study examines associations with changes in depression symptoms during the transition to fatherhood for young fathers and whether this association differed by key social factors.
We combined all 4 waves of the National Longitudinal Study of Adolescent Health to support a 23-year longitudinal analysis of 10 623 men and then created a “fatherhood-year” data set, regressing age-adjusted standardized depressive symptoms scores on fatherhood status (nonresidence/residence), fatherhood-years, and covariates to determine associations between Center for Epidemiologic Studies Depression Scale scores and fatherhood life course intervals.
Depressive symptom scores reported at the entry into fatherhood are higher for nonresident fathers than nonfathers, which in turn are higher than those of resident fathers. Resident fathers have a significant decrease in scores during late adolescence (β = –0.035, P = .023), but a significant increase in scores during early fatherhood (β = 0.023, P = .041). From entrance into fatherhood to the end of early fatherhood (+5 years), the depressive symptoms score for resident fathers increases on average by 68%.
In our longitudinal, population-based study, resident fathers show increasing depressive symptom scores during children's key attachment years of 0–5. Identifying at-risk fathers based on social factors and designing effective interventions may ultimately improve health outcomes for the entire family.
Comments
Depression in Young Fathers
A Longitudinal Study of Paternal Mental Health During Transition to Fatherhood as Young Adults(1) by Garfield et al is a significant contribution to the growing literature on paternal depression. This study outlines three trajectories of depressive symptoms in young men who fall into one of the three groups: nonfathers, residential fathers or nonresidential fathers. These trajectories highlight changes over time and associations with important social factors. However, this study does not address other important mental health issues relevant to this population including anxiety and substance use. Future studies using similar methodology are needed in order to better understand how anxiety symptoms and substance use behaviours change during the transition to fatherhood.
This study may also underestimate the severity and prevalence of depression in young fathers because the National Longitudinal Study of Adolescent Health included only 10 out of the 20 questions of the Centre for Epidemiologic Studies Depression Scale (CESD). The 10 questions included and analyzed in this study do not capture important symptoms of depression including sleep disturbance, psychomotor agitation or retardation, changes in appetite, increased guilt or thoughts about death; therefore, cases of depression may have gone undetected for men in all three groups. More recently, the CESD has been revised to the CESDR-20 (20 questions) and CEDSR-10 (10 questions). Both revised forms have been validated in adolescent and young adult populations.(2,3) Clinicians may want to include these scales (http://cesd-r.com) in addition to those suggested by Garfield when screening young men, expectant fathers, and new fathers for depression.
(1)Garfield CF, Duncan G, Rutsohn J, McDade TW, Adam EK, Coley RL, Chase-Lansdale PL. A Longitudinal Study of Paternal Mental Health During Transition to Fatherhood as Young Adults. Pediatrics. 2014
(2)Van Dam NT, Earleywine M. Validation of the Center for Epidemiologic Studies Depression Scale--Revised (CESD-R): Pragmatic depression assessment in the general population. Psychiatry Research. 2011. Mar;186:128-32
(3)Haroz EE, Ybarra M,L, Eaton WW. Psychometric evaluation of a self- report scale to measure adolescent depression: The CESDR-10 in two national adolescent samples in the United States. J Affect Disord. 2014 Apr;158:154-60
Andrew Howlett MD FRCPC Lecturer, University of Toronto Child and Adolescent Psychiatrist St. Joseph's Health Centre - Toronto, Canada
Conflict of Interest:
None declared