The findings indicated differences in perceived levels of discord between mothers and fathers regarding the issues: Recreational activities
, Aims and life goals
, Time together
, Household tasks
, Leisure time interests and activities
, and Decisions regarding career/personal development
. For all of the items, except Household tasks
, the fathers estimated that the couple disagreed more than the mothers did. An explanation may be that mothers actually expect to do more chores than fathers (40
). Another explanation might be that the father thinks that the spouse is more annoyed about the household than she really is. This demands knowledge about issues where parents disagree and about how to encourage the couples to communicate about those issues. An interesting finding was that the parents did not perceive that they disagreed about the issue Handling finances
, while previous research has concluded that disagreements about finances are a major source of marital conflicts (41
The results of the present study provide further evidence that postpartum depressive symptoms among both mothers and fathers are common. In our study, 16.5% of the mothers and 8.7% of the fathers self-reported depressive symptoms, which was in accordance with previous studies (4–6
). Our results indicated that nearly a quarter (23%) of the children had at least one parent with postpartum depressive symptoms. According to Pinheiro et al. at least one parent experienced depressive symptoms in 29% of the couples studied (18
). For a young child, to live with one or both parents suffering from depressive symptoms can have a negative effect on the parent–infant interaction and the child's behavioural and vocabulary development (12–14
In the present study, there was a correlation between marital discord and perceived depressive symptoms. This was consistent with previous research which found that higher levels of depressive symptoms were correlated with lower levels of marital satisfaction (25
). In another study, men whose partners suffered from postpartum psychiatric disorders reported greater marital dissatisfaction, and women who perceived satisfying marital relations were less likely to exhibit mental health problems during and after pregnancy (42
). The correlation between lower perceived discord and depressive symptoms was stronger for the fathers than for the mothers. One explanation for this might be that women often have larger social networks than men (43
). The connection between a high perceived level of discord and depressive symptoms may partly be due to the fact that if the mother or father feels unhappy it is easy to blame the partner (44
There was a correlation between higher levels of discord among mothers and fathers for the items: Socializing with family and friends, Important decisions, and Household tasks and perceived and depressive symptoms. If a person feels down it might be easy to think that her/his spouse does not understand the issues they have. For mothers, there was a correlation between higher levels of discord for the items: Friends and Philosophy and depressive symptoms. One explanation for this could be that a mother with depressive symptoms requires support from the father and wants him to prioritize herself and their child, as opposed to their friends.
A correlation existed between higher levels of discord among fathers for the items: Recreational activities
, Time together
, Leisure time interests and activities
, and Decisions regarding career/personal
and depressive symptoms. One could assume that some fathers feel that their spouses do not have enough time to spend with them. Another reason may be that the father misses time for himself after the childbirth. Some recent fathers do not have a clear idea of what it means to be a father and might need support to assume their new role (45
). If we had investigated marital discord after several weeks/months, the parents might have given different responses.
Limitations and strengths
The present study has a number of limitations that must be acknowledged. Firstly, DCS and EPDS were not measured on the same occasion so we do not know if the depressive symptoms were present at the time the marital consensus was assessed and vice versa. Another limitation was that marital discord was assessed 1 week after childbirth, i.e. a period in life that includes an overwhelming experience for most couples. However, the reason for this decision was that we intended to create a baseline variable for comparison with the 3-month assessments. Another option would have been to measure marital discord during pregnancy, although this is a period in life when many couples experience other types of problems (46
EPDS has only occasionally been validated on men (36
), and, to our knowledge, there has been no validation on men in Sweden, which is a shortcoming. The present study's EPDS cut-off of >9 increases the rate of false-positive postpartum depressions compared to a cut-off of >12. The latter gives few false-positives, but the sensitivity is far from adequate (47
) and will miss a considerable number of cases (39
). A cut-off of >9 is, however, recommended for routine examinations when the scale is used by primary care workers (27
). Choosing the cut-off of >9, which has been used in other Swedish studies (48–50
), also gives study groups large enough to compare the mothers' and fathers' DCS and EPDS scores.
Another limitation of the present study was that the printing error in the baseline questionnaire, with about one out of four questionnaires missing the DAS questions, resulted in 96 couples not being possible to analyse, and they were thus removed from the data set. However, the missing questionnaires were scattered across the field meaning that couples with complete questionnaires could be found in all communities.
The major strength of the present study was that both parents of the child were included which facilitated a description and comparison of their DCS and EPDS scores with each other. However, we could not control whether the couples influenced each other when filling in the questionnaires, even though our intention was, and the instructions emphasized, that the parents should fill in the questionnaires separately.
Suggestions for clinical implications
A recommendation that can be based on our results is that professionals in antenatal care, child health centres, as well as family caregivers should be conscious that mothers and fathers may have different views on relationship consensus, and that perceived discord can be related to postpartum depressive symptoms. The results from the present study might help professionals to make parents aware that they sometimes believe that their spouses are disagreeing with them, while, in reality, they are not. The professionals should also be aware of the high level of depressive symptoms in women and men who have recently become parents in order to minimize the harmful effects for the individual, the relationship, and the child. Further research is needed to examine perceived relationship discord and the development of depressive symptoms over a longer term.