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Review | Clinician's Corner

Prenatal and Postpartum Depression in Fathers and Its Association With Maternal Depression:  A Meta-analysis

James F. Paulson, PhD; Sharnail D. Bazemore, MS
JAMA. 2010;303(19):1961-1969. doi:10.1001/jama.2010.605.
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Published online

Context It is well established that maternal prenatal and postpartum depression is prevalent and has negative personal, family, and child developmental outcomes. Paternal depression during this period may have similar characteristics, but data are based on an emerging and currently inconsistent literature.

Objective To describe point estimates and variability in rates of paternal prenatal and postpartum depression over time and its association with maternal depression.

Data Sources Studies that documented depression in fathers between the first trimester and the first postpartum year were identified through MEDLINE, PsycINFO, EMBASE, Google Scholar, dissertation abstracts, and reference lists for the period between January 1980 and October 2009.

Study Selection Studies that reported identified cases within the selected time frame were included, yielding a total of 43 studies involving 28 004 participants after duplicate reports and data were excluded.

Data Extraction Information on rates of paternal and maternal depression, as well as reported paternal-maternal depressive correlations, was extracted independently by 2 raters. Effect sizes were calculated using logits, which were back-transformed and reported as proportions. Random-effects models of event rates were used because of significant heterogeneity. Moderator analyses included timing, measurement method, and study location. Study quality ratings were calculated and used for sensitivity analysis. Publication bias was evaluated with funnel plots and the Egger method.

Data Synthesis Substantial heterogeneity was observed among rates of paternal depression, with a meta-estimate of 10.4% (95% confidence interval [CI], 8.5%-12.7%). Higher rates of depression were reported during the 3- to 6-month postpartum period (25.6%; 95% CI, 17.3%-36.1%). The correlation between paternal and maternal depression was positive and moderate in size (r = 0.308; 95% CI, 0.228-0.384). No evidence of significant publication bias was detected.

Conclusions Prenatal and postpartum depression was evident in about 10% of men in the reviewed studies and was relatively higher in the 3- to 6-month postpartum period. Paternal depression also showed a moderate positive correlation with maternal depression.

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Figure 1. Study Selection for Inclusion in Meta-analysis
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Figure 2. Prevalence of Paternal Birth-Related Depression From Gestation to 1 Year Postpartum
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Overall effects were calculated through random-effects model estimates, with separate calculations for overall effects within each period and across all periods. Effect sizes were calculated via a logit transformation of rates (number of reported cases divided by the sample size), which were back-transformed to proportions after estimates and standard errors were computed. Studies are stratified by period of assessment. For studies that assessed depression at multiple time points, only the earliest estimate is reported. Data marker size corresponds to study sample size.

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