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Association of adverse childhood experiences with postpartum depression and anxiety in fathers: A prospective study

Year: 2021

Type: article

Abstract: Paternal postpartum depression (the estimated prevalence in Japan is 8.8%) and anxiety (the prevalence rate ranged from 2.4% to 51.0%1) are common problems. To prevent these issues, risk factors need to be identified. Besides known risk factors,1 adverse childhood experience (ACE-) might be a significant risk factor. ACEs include all forms of physical, psychological, and sexual abuse, neglect, and household dysfunction such as parental death before the age of 18 years. Although paternal ACEs are associated with depression and anxiety during pregnancy,2 little is known about whether the associations continue into the postpartum period. This study examines the association between paternal ACEs and paternal depression and anxiety at 1 week and 3 months post-delivery. Furthermore, we examine whether the impact of paternal ACEs on depression and anxiety varies with time. In this study, 548 fathers were recruited from two obstetrics hospitals in Tokyo, Japan. Participants gave written informed consent and completed and returned anonymous questionnaires measuring ACEs (eight questions), depression (Edinburgh Postnatal Depression Scale), and anxiety (State–Trait Anxiety Inventory) at 1 week and 3 months post-delivery. All confounders such as basic demographics were assessed at 1 week post-delivery. Four hundred and eighteen participants at 1 week (response rate = 76.1%) and 398 participants at 3 months post-delivery (follow-up rate = 93.3%) completed the questionnaire. There were no significant differences in exposure, outcome, and confounding variables at 1 week post-delivery between the participants who returned the questionnaire both at 1 week and 3 months post-delivery and those who did not return at 3 months post-delivery. Multiple linear regression analyses were performed (analytical sample: n = 417) with multiple imputations for missing data (at most, n = 37, 8.9%) (Appendix S1). Among all participants, 15.4% had one ACE, and 4.3% had two or more ACEs. As for depression, in the crude model, fathers with two or more ACEs showed a higher score of EPDS at 1 week after delivery compared to those without ACE. The coefficient remained significant in Model 2 which adjusted confounders. However, there was no significant association between paternal ACEs and depressive symptoms, 3 months after delivery, in the crude model, which was not changed in further adjustment (Model 1–3) (Table 1). As for anxiety, fathers with two or more ACEs showed a higher score of STAI at 1 week after delivery compared to those without ACE, which showed significant association in Model 2. Similarly, fathers with two or more ACEs also showed a higher score of STAI at 3 months after delivery. The significant association was shown in Model 2. After adjusting paternal anxiety at 1 week after delivery, the coefficient of paternal two or more ACEs for STAI at 3 months became non-significant, suggesting that the impact of ACEs on anxiety at 1 week after delivery remained up to 3 months after delivery (Table 1). The association between paternal ACEs and postpartum depression and anxiety can be explained by three pathways. First, fathers with ACEs are more likely to show insecure attachment style in adulthood,3 which causes poor relationships with not only their partner, but also their child. Second, those with paternal ACEs are associated with poor social connection and social support. A meta-analysis has found that dissatisfaction with partner relationship and lack of social support are risk factors for postpartum depression in fathers.4 Third, ACEs may change the biology related to stress responses such as the hypothalamic–pituitary–adrenal (HPA),5 which deteriorates causing higher levels of mental health problems. When fathers need to face a new stress due to the transition to parenthood, the HPA axis may be activated. Further, the impact of paternal ACEs on mental health might vary over time due to adaptation,6 as we found that the association between paternal ACEs and depression at 3 months after delivery did not remain. A previous study showed that negative life events were associated with only maternal postnatal depression at 3 or 12 months after delivery, but not paternal.7 This is probably because fathers tend not to take paternity leave, that is, they start working, thus the distress due to child-rearing might be buffered through interaction with colleagues,8 being able to have personal time, or forgetting about child rearing stress by focusing on working. In this study, approximately 10% of the participants took paternity leave. Although poor job quality has negative influences on paternal mental health and child rearing,9 there might be a positive side to paternal work. Further studies should focus on possible pathways of the association between paternal ACEs and mental health problems, which may help develop an intervention to prevent postpartum depression and anxiety in fathers with ACEs. The authors are grateful to Manami Ochi, Michiko Sekiguchi, Yuri Hiramoto, and Hiromi Nakano who recruited the participants and managed the survey. This study was supported by Grants-in-Aid for Scientific Research from the Japan Society for the Promotion of Science (JSPS KAKENHI Grant Number 15K12735 and 18K13318), the Mitsubishi Foundation, Grants for Social Welfare Activities, and Research Development Grant for Child Health and Development from the National Center for Child Health and Development (25-13). The authors declare no conflicts of interest. This study was conducted according to the guidelines of the Declaration of Helsinki and approved by the institutional review board by the National Center for Child Health and Development and Tokyo Medical and Dental University. Appendix S1 Details of the methods in this study Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Source: Psychiatry and Clinical Neurosciences

DOI: 10.1111/pcn.13312

Authors: Satomi Doi, Aya Isumi, Takeo Fujiwara

Institutions: Tokyo Medical and Dental University, Japan Society for the Promotion of Science

Language: English

Topic: Maternal Mental Health During Pregnancy and Postpartum

Subfield: Public Health, Environmental and Occupational Health

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: bronze

Funders: National Center for Child Health and Development, Mitsubishi Foundation, Japan Society for the Promotion of Science