Paternal depression has an equally deleterious impact on children’s mental health as maternal depression, new research shows.
Investigators led by Gemma Lewis, PhD, research associate in psychiatric epidemiology, University College London, United Kingdom, used data from two major prospective cohort studies to investigate depressive symptoms in adolescents whose fathers suffered from depression.
Adolescents in the Growing Up in Ireland (GUI) study, which included 6070 families, and in the Millennium Cohort Study (MCS), which involving 7768 families, were assessed at ages 13 and 14 years, respectively. Their parents had been assessed for depression when the children were 9 and 7 years old, respectively.
Paternal depression was significantly associated with depressive symptoms in adolescents. The association was of a similar magnitude to the association between maternal depression and adolescent depressive symptoms.
“We hope our findings will be widely disseminated and encourage fathers who think they may be experiencing depression to seek help,” Dr Lewis told Medscape Medical News.
“Men are less likely to seek treatment than women, so it is important to treat depression in both parents, and fathers should be involved in family-based interventions to prevent teenage depression,” she said.
The study was published online November 15 in Lancet Psychiatry.
Fathers Neglected
Adolescent depression is an “important time for the prevention of adult depression,” the authors write.
Although maternal depression has been recognized as one of the most important risk factors for adolescent depression, there have been few studies of the potential impact of paternal depression, Dr Lewis said.
“The existing studies of fathers have various limitations, such as small sample sizes or retrospective design, that we address in this study, which is the largest and most methodologically robust to investigate paternal and child depression so far,” she added.
To gather a substantial and representative sample, the researchers drew on data from two ongoing studies: the GUI and the MCS.
The present study consisted of a secondary analysis of children (n = 8568) in the GUI study. In wave 1, the mean age of the children was 9 years (SD, 0.13). In wave 2, the mean age of the children was 13 years (SD, 0.13, n = 7525).
One adult was asked to identify himself or herself as the primary caregiver; resident partners were regarded as secondary caregivers.
The MCS is an ongoing representative study of 18,552 families and 18,818 children. The children were between the ages of 9 and 11 months.
The study included six waves of data collection. The data that were collected when the participants were aged 7 years (MCS4) and aged 14 years (MCS6) were used for the current study to replicate the time points used in the GUI cohort.
At MCS4, 13410 mothers provided data. Interviews were also conducted with 9429 partners, most of whom were fathers.
Only two-parent families were included in the cohorts in order that the researchers could analyze the relationship between paternal and maternal depressive symptoms.
Biological and nonbiological parents were included in both studies.
At follow-up endpoints, adolescents completed the Short Mood and Feelings Questionnaire (SMFQ), a 13-item self-report measure of depression symptom severity in the past 2 weeks.
In the GUI, depression in parents was measured by the short 8-item version of the Center for Epidemiological Studies Depression Scale (CES-D) at waves 1 and 2. In the MCS, parents completed the Kessler 6-item distress scale (K6) at waves 2 to 6.
The researchers adjusted for family income, parental education, age, ethnicity, substance abuse, the child’s emotional symptoms, and interparental conflict, which might be common causes of depression in children.
“Surprising” Findings
In the GUI cohort, data for depressive symptoms were available for 7789 mothers and 6400 fathers. Data for both were available for 6070 participants.
The mean CES-D score for fathers in the GUI cohort (n = 6400) was 1.4 (SD, 3.1) and for mothers (n = 7789), 1.9 (4.4). Paternal and maternal CES-D scores were correlated (r = 0.15, 95% confidence interval [CI], 0.11 – 0.19).
The mean SMFQ score for the 5424 adolescents form whom data were available was 3.7 (SD, 5.3). When all confounders were included, data for a complete-case sample were available for 4397 families.
In the MCS cohort, the mean K6 score for fathers (n = 8169) was 2.9 (SD, 3.8). For mothers (n = 12270), it was 2.6 (SD, 4.3). In this study too, paternal and maternal K6 scores were correlated (r = 0.18; 95% CI, 0.15 – 0.21).
The mean offspring SMFQ score for the 6087 adolescents for whom data were available was 5.4 (SD, 8.3). When all confounders were included, data for a complete case sample were available for 4864 families.
Parental depressive symptom scores were higher for families that were not included in complete-case samples.
In the GUI cohort, the mean difference for mothers and fathers was 0.71 (95% CI, 0.57 – 0.86; P < .0001) and 0.12 (95% CI, .00 – 0.24; P = 0.049), respectively. In the MCS, the mean difference for mothers and fathers was 1.10 (95% CI, 0.97 – 1.24; P < .0001) and 0.34 (95% CI, 0.19 – 0.49; P < .0001), respectively.
For each 3-point increase in paternal depressive symptoms (1 SD) in the GUI sample, adolescent depressive symptoms increased by 0.35 of an SMFQ point; in the MCS, they increased by 0.28 of a point.
These associations between paternal and adolescent depressive symptoms remained after adjustment for maternal depressive symptoms and all other confounders. Similar results were obtained from the complete-case sample.
The researchers found no differences in regression coefficients for maternal and paternal depressive symptoms (Wald test P = .435 and 0.470 for the GUI and the MCS cohorts, respectively).
The association remained whether or not the father was biologically related to the adolescent.
“I think many people will be surprised by our findings that depression in fathers is as important to the child’s risk of depression as depression in mothers,” Dr Lewis said.
Involve the Whole Family
Commenting on the study for Medscape Medical News, Lisa Underwood, PhD, research fellow in population health, University of Auckland, New Zealand, described the GUI and the MCS as “really high-quality studies with large samples that kept in contact with their samples over time.”
The current study, which drew on both cohorts, “gives us great insight into a really large population of diverse fathers and their children,” said Dr Underwood, who is the coauthor of an accompanying editorial. Dr Underwood was not involved in the study.
“A key message is that nobody functions in isolation. All children develop within family systems. If one or more parents has mental health problems, it will have an impact on the children.”
This is especially the case during adolescence, which Dr Underwood described as a “pivotal, critical time in development when mental health is at risk.”
She encouraged clinicians who see a “young person experiencing mental health problems” to “use the opportunity to find out how the parents are doing and involve the whole family in intervention.”
Dr Lewis noted that maternal depression comes to the attention of clinicians more frequently because it is the mother who typically accompanies children to their pediatrician appointments or goes to the gynecologist for her own needs.
“The question is how fathers might be brought in to receive more help,” she said.
She suggested that clinicians “chat with mothers and children about the wider family environment, because if the mother is experiencing depression, there is increased risk that the father will be too.”
The GUI receives funding from the Department of Children and Youth Affairs. It also receives a contribution from the Atlantic Philanthropies. The MCS is core-funded by the Economic and Social Research Council and a consortium of government departments. The authors have disclosed no relevant financial relationships.
Lancet Psychiatry. Published online November 15, 2017. Full text, Editorial
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