Risk factors for postpartum depressive symptoms among fathers: A systematic review and meta-analysis

Abstract

Introduction The transition to parenthood is a major life change that may affect the mental well-being of both mothers and fathers and place them at an increased risk for depression. The objective of our study was to systematically review the literature and identify factors associated with postpartum depressive symptoms in fathers. Material and methods Searches were conducted in PubMed, PsychInfo, Embase, and CINAHL to identify studies published until March 2020. Studies that reported factors associated with depression among fathers were included. The data from these studies were extracted independently by two authors with disagreements resolved by a third author and consensus. The odds ratio (OR) was used as a measure of association between the risk factor and the primary outcome: depression within the first 12 months following childbirth among fathers diagnosed using any method. Summary estimates were calculated using a random effects model. The associations between the risk factors and depressive symptoms were evaluated. Results The search identified 1040 reports. After screening titles and abstracts, 62 full-text articles were assessed for eligibility and 25 studies involving 13 972 fathers were included in the systematic review. Fathers with a prior mental health illness episode had higher odds of developing depressive symptoms than those with no mental health history (eight studies, n = 3515, pooled OR 6.77, 95% CI 5.07-9.04; I-2 = 0%). Other significant risk factors included relationship dissatisfaction (eight studies, n = 6924, pooled OR 1.53, 95% CI 1.29-1.81; I-2 = 93%), maternal depression (seven studies, n = 6661, pooled OR 1.66, 95% CI 1.27-2.17; I-2 = 88%), financial instability (five studies, n = 3052, pooled OR 2.24, 95% CI 1.44-3.48; I-2 = 74%), paternal unemployment (three studies, n = 1505, pooled OR 6.61, 95% CI 1.94-22.54; I-2 = 59%), low education level (two studies, n = 1697, pooled OR 3.56, 95% CI 1.06-11.97; I-2 = 88%), and perceived stress (two studies, n = 692, pooled OR 1.06, 95% CI 1.02-1.11; I-2 = 5%). Lack of support and low parenting self-efficacy were also associated with paternal postpartum depressive symptoms. Conclusions A history of paternal mental illness, maternal depression, and diverse psychosocial factors were associated with depressive symptoms among fathers postnatally. These findings can guide the development of family-level interventions for early identification and treatment and social media campaigns to promote help-seeking behaviors and engagement in preventive strategies.