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Prenatal depressive symptoms, anxiety, anger and daily hassles were investigated in 156 depressed and non-depressed pregnant women and their depressed and non-depressed partners (fathers-to-be). Depressed versus non-depressed fathers had higher depression, anxiety and daily hassles scores. Although the pregnant women in general had lower anxiety, anger and daily hassles scores than the men, the scores on the measures for depressed fathers and depressed mothers did not differ. Paternal depression appeared to have less effect than maternal depression on their partners’ scores. However, the similarity between the scores of depressed mothers and depressed fathers highlights the importance of screening for depression in fathers-to-be as well as mothers-to-be as well as during pregnancy.
Prenatal maternal depression is noted to negatively affect fetal activity (increased) and fetal growth (decreased) and neonatal outcome (greater incidence of prematurity and low birthweight) in different cultures (Field, Diego, Dieter, et al 2004; Lundy, et al 1999; Zuckerman, Bauchner, Parker, & Cabral, 1990). Many fathers are also depressed. In an Australian study, for example, 20% of mothers and 12% of fathers were significantly distressed at mid-pregnancy (Morse, Buist, & Durkin, 2000). In a Norwegian study, psychological distress was reported by 37% of the mothers and 13% of the fathers a few days after childbirth, and severe distress symptoms were reported by 9% and 2% of the mothers and fathers, respectively (Skari, et al 2002). In an American study (Goodman, 2004), the incidence of paternal depression ranged from 1% to 26% in community samples, and from 24% to 50% among partners of women experiencing depression. In at least one study, prenatal paternal and maternal depressed mood were significant predictor variables for the postnatal moods of both mothers and fathers (Matthey, Barnett, Ungerer, Waters, 2000). The negative effects of paternal depression on early interactions between fathers and infants and on child development have been documented if prenatal paternal depression is predictive of postnatal paternal depression, it would be important to identify depressed fathers prenatally for early intervention to help prevent postnatal paternal depression and its negative effects. Paternal depression during the postnatal period has been associated with adverse emotional and behavioral problems in preschool children after controlling postnatal for maternal depression (Ramchandari, Stein, Evans, O’Connor, 2005). In addition, depression in the father-to-be might be expected to negatively affect the mother’s mood state during pregnancy and thereby have indirect negative effects on fetal development and neonatal outcome.
The present study investigated prenatal depression and other mood states in both depressed and non-depressed pregnant women and their depressed and non-depressed partners (fathers-to-be). Comparisons were made between the prenatal mood states of 1) depressed versus non-depressed fathers; 2) depressed fathers versus mothers; 3) all fathers versus mothers; 4) mothers coupled with depressed fathers versus non-depressed fathers; and 5) fathers coupled with depressed versus non depressed mothers.
Pregnant women (N= 156) and their husbands/ significant others were recruited at a prenatal clinic during the second trimester (M= 20 weeks). The women were distributed 55% Hispanic white, 22% non-Hispanic white and 23% Black and were lower to middle SES (M= 4.1 on the Hollingshead Index), and averaged 28.4 years of age. They were classified as depressed or non-depressed based on the Center for Epidemiology Studies-Depression (CES-D) scale (N= of the women 36% depressed). Their husbands/ significant others were similarly classified as depressed or non-depressed on the CES-D (N= 32% of the men depressed). The fathers averaged 33.5 years of age. 52 % of the depressed and 5.8 % of the non-depressed fathers were married and 31% of the depressed and 36% of the non-depressed fathers were residing with their partners.
Following the completion of the CES-D at the prenatal ultrasound clinic, the mothers and fathers completed other mood state questionnaires. These included the State Anxiety Inventory and the State Anger Inventory as well as the Daily Hassles Scale.
This 20-item scale was included to assess symptoms of depression. The subject is asked to report on his/her feelings during the preceding week. The scale has adequate test/retest reliability (.60 over several weeks), internal consistency (.80–.90) and concurrent validity (Wells, Klerman & Deykin, 1987), and takes about 5 minutes to complete. A score of 16 on the CES-D is considered the cut point for depression, for research purposes (Range=0–60) (Radloff, 1991).
This scale was used to assess the co-morbidity of anxiety and depression which is a common phenomenon on. The State/ Trait Anxiety Inventory is comprised of 20 items and is summarized by a score ranging from 20 to 90 and assesses how the subject usually feels in terms of severity (“not at all” to “very much so”). Characteristic items include “I feel nervous” and “I feel calm.” Research has demonstrated that the STAI has adequate concurrent validity and internal consistency (r=.83) and takes about 5 minutes to complete. The cutoff score for high anxiety is 48.
State/ Trait Anger Inventory (STAXI) (Spielberger, 1995) is a 10-item inventory that assesses general feelings of anger based on a 4-point Likert scale ranging from 1 (almost never) to 4 (almost always). Typical questions include “I am quick tempered” and “I fly off the handle”. Psychometric properties have been established for the STAXI on diverse ethnic groups. Reliability coefficients have been reported between 0.97 (state) and 0.89 (trait) and takes about 5 minutes to complete. Anger was assesed because anger has been also noted to be co-morbid with depression and to have negative effects on fetal development and neonatal outcome ( Field, Diego, Hernandez-Reif, et al 2003) and this scaletakes about 5 minutes to complete.
This scale was developed to assess the degree of hassle being experienced by expectant mothers. The 16 items on a 4-point Likert scale include questions on people such as family members, landlord and friends creating hassles and finding resources as creating hassles. This scale was included because daily hassles have been a source of stress in other samples of prenatally depressed women.
Multivariate analyses of variance (MANOVAs) were conducted on the group of self-report measures (CES-D, STAI, STAXI and Daily Hassles) for each of the group comparisons made between depressed and non-depressed mothers and fathers. These were followed by ANOVAs on the individual self-report measures.
As can be seen in table 1, depressed versus non-depressed fathers had higher scores on the depression (CES-D), anxiety (STAI) and daily hassles scales. The groups did not differ on the anger (STAXI) scores.
As can be seen in table 2, the depressed mothers’ depression (CES-D) and anxiety (STAI) scores were slightly higher than those of the depressed fathers, and the depressed fathers’ anger (STAXI) and daily hassle scores were slightly higher than those of the depressed mothers. However, none of these differences were statistically significant.
As can be seen in table 3, fathers in general (depressed and non-depressed) had higher anxiety, anger and daily hassles scores. As can be seen in table 4, the mothers who were coupled with depressed fathers had slightly higher depression (CES-D) and anxiety (STAI) scores than mothers who were coupled with non-depressed fathers. However, these differences were not statistically significant.
As can be seen in table 5, the fathers who were coupled with depressed mothers versus non-depressed mothers had higher depression (CES-D) and anxiety (STAI) scores. No group differences were noted for the anger (STAXI) and daily hassles scores.
These results suggest that depressed fathers as compared to non-depressed fathers experience depression and anxiety symptoms during pregnancy, not unlike the depression and anxiety symptoms reported for depressed mothers versus non-depressed mothers during pregnancy (Field et al., 2004). The comparison of depressed mothers and fathers in the current sample further suggest that the level of depression and anxiety symptoms are not significantly different for depressed mothers and depressed fathers during pregnancy. That the entire sample of women tended to have in general, higher depression scores was not surprising, inasmuch as pregnant women are typically thought to have exacerbated symptoms related to hormonal changes. The slightly higher depression scores may have related to increased cortisol levels during pregnancy as Field et al (2004) have previously reported.
This was a surprising finding inasmuch as depressed fathers versus depressed mothers have typically shown more positive interactions behaviors with their infants (Field, Hossain & Malphurs, et al, 1999; Hossain, Field, Gonzalez, Malphurs, DelValle & Pickens, 1994).
The hormonal effects on the women may have been greater than the environmental effects, as suggested by the mothers’ scores being less affected by depressed fathers than the fathers’ scores were affected by depressed mothers. Comparing tables 4 and and5,5, the mothers coupled with depressed (table 4) fathers had only marginally higher scores on depression and anxiety than the mothers (table 5) coupled with non-depressed fathers. In contrast, the fathers who were living with depressed mothers had significantly higher depression and anxiety scores than the fathers living with non-depressed mothers.
These data suggest that maternal depression had greater effects on the fathers’ scores than paternal depression on the mothers’ scores. These data suggest, then, that depressed fathers have higher depression and anxiety scores than non-depressed fathers during pregnancy, not unlike depressed mothers having higher depression and anxiety scores over than non-depressed mothers (Field et al, 2004) Fathers’ depression scores, for the entire sample, however, tended to be lower than mothers’ scores, possibly because of the greater hormonal (e.g. cortisol) effects on the pregnant women (Field et al., 2004).
The clinical implications of this study are that prenatally depressed fathers also need to be identified and provided intervention to prevent the negative effects they may have on the mother’s prenatal mood state and, in turn, the indirect effects on fetal development. Paternal depression has been noted to have negative effects on infant development. Fathers might, for example, provide massage therapy for the mothers during pregnancy inasmuch as massage is noted to lower depression and stress in both the person giving ( ), and the person receiving (Field, Hernandez-Reif, & Diego, (2006).
Future research is needed to assess larger samples, in other cultures and with diagnostic interviews. Further, other interventions for prenatal depression need to be investigated for both fathers and mothers-to-be.
We would like to thank the mothers and infants who participated in this study. This research was supported by a merit award (MH # 46586) and Senior Research Scientist Awards from NIH (MH#00331 and AT# 001585) and a March of Dimes grant (# 12-FY03-48) to Tiffany Field and funding by Johnson and Johnson Pediatric Institute to the Touch Research Institutes. Correspondence and requests for reprints should be sent to Tiffany Field, Ph.D., Touch Research Institutes, University of Miami School of Medicine, PO Box 016820, Miami, FL 33101. Business phone number (305) 243–6781.