Depression and parental stress among Swedish fathers in the postnatal period: Screening and working through help-seeking barriers

Introduction/Objectives: The meta-analytical prevalence of paternal postnatal depression (PPND) is 8.4% (Cameron et al., 2016). However, measures for PPND are scarce and the commonly used Edinburgh Postnatal Depression Scale (EPDS) has low sensitivity, as many men express depression with somatization and/or externalizing symptoms. Recent studies show higher prevalences, indicating that affected men conceal their symptoms and underscoring the lack of knowledge concerning adequate PPND screening. We addressed these issues in three studies. Methods/Results: By assessing fathers of infants 0–18 months old (study 1, N=447) with multiple measures (Beck Depression Inventory-II (BDI-II), Gotland Male Depression Scale (GMDS), EPDS), we found that a combination of depression items from EPDS and depressive-equivalent symptom items from GMDS yields a highly sensitive screening instrument for PPND. Structural equation modelling (study 2, N=395) revealed a strong mediating role of parental stress, but not relational variables, between fathers’ attachment anxiety/avoidance and depressive symptoms. Finally, fathers’ (study 3, N=172) widespread tendency to conceal depressive symptoms comprises convictions that negative feelings/symptoms are normal and best managed privately, desires to fulfill expectations of being happy and to be perceived as a ‘good father’, and fears of not being taken seriously by healthcare professionals. Conclusions: In all studies, 25%-35% of fathers reported symptom levels indicative of PPND, with unchanged prevalences for the 18-month period; 90% of affected fathers had no treatment/support professional contact, underscoring the usefulness of our highly sensitive screening instrument for PPND and the importance of exploring also alternative routes for screening to support the developing father role