Clinical Context

Mental health disorders are common during pregnancy and the postpartum period, and the effects of these disorders can be devastating for the patient and their family. The authors of the current study provide a review of risk factors for both maternal and paternal mood disorders during the perinatal period.

Strong psychosocial variables associated with maternal perinatal mood disorders include early life stressors, limited social support, and intimate partner violence. Somatic symptoms such as back pain and nausea/vomiting also contribute to depression during pregnancy. Regarding paternal depression and anxiety, risk factors include a low level of education attainment, unemployment, low social support, and marital distress. Finally, a history of mood disorders in either parent is a risk factor for perinatal depression and anxiety.

There is also an interaction between mood disorder diagnosed in 1 parent and the risk for mood disorder in the other parent. The current study focuses on mood disorders among parent dyads during the perinatal period.

Study Synopsis and Perspective

Healthcare providers have screened new and expectant mothers for perinatal depression for years. But what about fathers?

A new systematic review and meta-analysis suggests that it is time for healthcare providers to ask both parents about any mental health symptoms before and after their baby is born.

"We are screening most mothers for signs of perinatal depression," said Kara Smythe, MD, from the Department of Primary Care and Population Health and Institute of Epidemiology and Health Care at the University College London, who is the lead author of the study. "But we aren't always asking about the relationship between them and the person helping them care for this newborn. If we don't consider the experience of new fathers, we're doing a disservice to everyone."

Without screening both parents, healthcare providers can miss important clues as to why child and parents experience adverse health outcomes after birth.

The study, published June 24 in JAMA Network Open, found that for 3.18% of couples, both parents concurrently experienced depression before and after a birth. The mental illness was more common in the late postnatal period (3-12 months).

According to the Centers for Disease Control and Prevention, about 1 in 8 women experience symptoms of postpartum depression. Other sources indicate that the incidence may be much higher. Findings from a mobile app using the Edinburgh Postnatal Depression Scale presented at the American Psychiatric Association's annual meeting in 2019 indicated that more than half of the 164,237 women who used the free app reported symptoms of depression for up to a year after the birth of their baby.

Dr Smythe and colleagues reviewed previously published observational studies on the prevalence of perinatal depression or anxiety in couples from the Ovid and Web of Science between January 1, 1990, and June 8, 2021.

They ultimately included 23 studies with data from 29,286 couples. They broke the data into subgroups of persons with antenatal depression, early postnatal depression (0-12 weeks), late postnatal depression (3-13 months), and perinatal anxiety.

About 1.7% (P<.001) of couples experienced antenatal depression, and about 2.4% (P<.001) experienced early postnatal depression. About 3.2% (P<.001) experienced late postnatal depression. The data on perinatal anxiety were insufficient, they write.

The vast majority of couples included in the samples were White, heterosexual, and highly educated with a middle to high socioeconomic background. The pregnancies were reportedly wanted, if not planned. The majority of the studies (21) included in the analysis were from countries other than the United States.

According to the study, evidence suggests that paternal depression can lead to increased symptoms of depression in mothers during pregnancy and the following 6 months. Men reported perinatal depression at similar rates as women, and Dr Smythe said that it is becoming clear that men experience similar struggles as they transition into fatherhood.

J. J. Parker, MD, a pediatric and internal attending physician at Lurie Children's Hospital of Chicago and Northwestern Medicine, said that the findings solidify what he has observed from his own experience as a new father and resident.

"You're at higher risk of having depression if your partner has depression, but it's important to see that in the numbers," Dr Parker told Medscape Medical News. "I think from a clinician standpoint this demonstrates that 3% of infants are living in households where both parents are depressed, and that has major implications for the development and health of those children."

Dr Smythe and colleagues found that if even 1 parent is experiencing a mood disorder such as depression or anxiety, the newborn can experience impaired bonding, behavioral problems, and other harms later in life.

If both parents are experiencing perinatal depression, those negative outcomes could be amplified, although Dr Smythe said that more research is needed to solidify the link.

"I think one quick takeaway for pediatricians, clinicians, and any other healthcare providers taking care of mothers and infants is to ask about the nonbirthing parent," Dr Parker said. "All clinicians can do that right away, even if the mother does not have depression."

The study was independently supported. Dr Smythe and colleagues have disclosed no relevant financial relationships.

JAMA Netw Open. Published online June 24, 2022.^[1]

Clinical Implications

• Strong psychosocial variables associated with maternal perinatal mood disorders include early life stressors, limited social support, and intimate partner violence. Somatic symptoms such as back pain and nausea/vomiting also contribute to depression during pregnancy. Regarding paternal depression and anxiety, risk factors include a low level of education attainment, unemployment, low social support, and marital distress. Finally, a history of mood disorders in either parent is a risk factor for perinatal depression and anxiety.
• In the current study, rates of depression in both mother and father generally ran between 1% and 3%, with a gradual increase from the antenatal to the early postnatal and late postnatal periods. The prevalence of maternal/paternal anxiety was more variable.
• Implications for the healthcare team: Members of the healthcare team should screen both parents for identifiable risk factors of mood disorders during pregnancy and consider the social and emotional impact of parental mood disorders on the entire family.

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