Treating Paternal Postpartum Depression: Interdisciplinary Views, Interventions & Effectiveness Thesis Example
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One of the greatest obstacles that the field of paternal postpartum depression must overcome is a basic lack of recognition of the condition. Many practitioners and society as a whole, see the issue of postpartum depression as a purely feminine issue. This means that the nearly 11% of all men who suffer from symptoms of postpartum depression have serious emotional and mental health needs that are not being addressed. Two disciplines that desperately need to recognize paternal postpartum depression as a condition, and increase support for new fathers are the health community, especially with regard to medical health, and economists.
One macro theory that is being applied to postpartum depression is the behavioral-social learning theory, in the form of cognitive behavior therapy (CBT). The theory is that if we can understand the thoughts and feelings that effect human behavior, we can eliminate greater human struggles. Therefore, in the case of postpartum depression, if we can understand why such a large number of people in certain communities develop PPD, we can actively prevent the condition by breaking the cycle (Gray & Anderson, 2010). This focuses on how to globally reduce the number of people facing a struggle with PPD.
Inversely, some research suggests that we are better served to research PPD on the personal level. This calls for applying micro theories, like social constructionism. Social constructionism, believes that a great deal of human life is demined through social interaction. This means that PPD is best treated through interpersonal therapy, or by helping people who suffer from PPD manage their own environments. Instead of focusing on the cultural, or global thoughts and feelings that lead to PPD, this focuses on the personal beliefs that lead to perinatal depression. Treatment, in this case, lasts for 12 to 16 weeks, and the main goal is not to eliminate all postpartum depression, but to help a single patient minimize their symptomology.
In order to find the best way of treating paternal postpartum depression, it is important to understand which of these basic mindsets is currently showing the most promise. It could be argued that there is evidence to support both the macro and micro position, and that the best long terms strategy for amelioration of the condition in America is by leveraging what can be learned from each position, and combining them to create an all-inclusive treatment program for those suffering from paternal postpartum depression.
Numerous researchers have found that postpartum depression poses a real risk for new fathers (Kim & Swain 2010; Field, 2002). Kim and Swain found that the prevalence for PPD in fathers could be as high as 25%, and had a high co-morbidity with maternal PPD, and early signs of depression. Their study strongly urged the medical community to develop an accurate diagnostic tool and consistent and effective treatment programs for fathers who were suffering from PPD, because of its known negative impacts on the family (Kim & Swain, 2007). Similarly, Field called for universal screening of paternal figures during the postnatal period, because of the profound effect that postpartum depression has on parenting practices, father-child interaction and safety during the postnatal period (2002). These findings highlight that paternal postpartum depression has not been a focus for the medical community, but there is a cry for help, and a need for evidence supported best practice, with regard to screening and treatment.
Multiple studies have specifically highlighted the risk relationship between maternal and paternal post-partum depression. Paulson and Bazemore found through meta-analysis that roughly 10.4% of the paternal figures studied suffered from paternal postpartum depression, with a notable increase in emersion between month three and six (2010). Further a moderate positive correlation was found between maternal and paternal depression cases. Similarly, a population study in Brazil, conducted by Pinheiro et al determined that based on a sample of 386 couples, studied from the sixth to twelfth week of the post-partum period, 26% of mothers and 11.9% of fathers were found to suffer from some incidence of postpartum depression, with a marked rate of co-morbity, leading researchers to the conclusion that all male partners should be screened for depressive mood disorders during the postnatal period, especially when their partner is also showing signs of depression (2005). Finally, study by Janice Goodman found that paternal depression ranged as high as 25.5% in some community samples, and spiked to 50% in cases where the man’s partner was experiencing postpartum depression as well. These studies pointed to concern over the child’s wellbeing and development as the major concern, or risk factor related to allowing these cases of paternal postpartum depression to go untreated.
These negative effects on children are likely related to the father’s decreased ability to parent effectively while suffering from PPD. A study by Paulson et al determined that depression was directly related to undesirable parenting behaviors. Fathers suffering from depression were, according to Paulson and his peers, less likely to engage in enrichment activities with children including reading, singing songs, and telling stories (Paulson et al 2006). Similarly, Davis and his colleagues found that children whose father’s suffered from depression were more than 30% more likely to spank their child, under the age of 1 year, than those who did not suffer from PPD (2011).
The effects of these damaged parenting behaviors, on children, have become a major interest of paternal PPD studies, and what those studies have discovered are extremely concerning. A population-based study by Ramchandani et al determined that children of fathers who suffered from PPD, when assessed at 3 ½ years, were significantly more likely to suffer from emotional issues, conduct related disorders and hyperactivity than their peers (2005). Similarly, a second study by Ramchandani and his colleagues found that PPD had a direct correlation with psychiatric diagnosis of children at 7 years, and antisocial behavior at 12 years (2008). This may be because, as was demonstrated by a Longitudinal study by Hanington, et al, which indicated that paternal postpartum depression could have a long term negative impact on a child’s impact, with especially significant impact on male children’s overall temperament and ability to demonstrate attachment (2010).
Critique of Ramchandani’s work
(Ramchandani et al., 2010)
Rmachandani et al. (2010) attempted to describe the effect that paternal postpartum depression has on the long-term behavior, or behavioral issues, of their children. The participants included 3 ½ to 7 year old children whose fathers had been known to suffer from depression during the postnatal period. The method used to monitor these children’s development was a longitudinal population cohort study using the Avon Logitudinal Study of Parents and Children to specifically measure that association between paternal depression in the postnatal period, and behavioral, emotional, and psychiatric problem observed in children older than 3 and younger than seven. A total of 7,601 (n=7601) fathers, and their children were studied to determine the final correlation between paternal PPD and child behavioral concerns. This study found that children whose fathers were depressed during both the prenatal and postnatal period had the highest risk of becoming psychologically troubled by age three and a half, with an odds ratio of 3.55; (95% confidence interval 2.07, 6.08), and in increased level of psychiatric diagnosis by age 7, with an odds ratio of 2.54 (95% confidence internal of 1.19, 5.41). The study concluded that the study’s findings suggested that there was a moderately increased risk of psychological or behavioral difficulties for children whose fathers suffered from PPD. When fathers were chronically depressed created an increased level of psychological or psychiatric diagnosis was experienced in children by or before the age of 7.
One of the study’s greatest strengths, is its longitudinal design. The study accesses a wealth of data from a very large, and unselected population, which has been followed up over the course of 7 years multiple times. The measurement practices and assessment were well-validated and provided what could reasonably be considered a fundamentally unbiased measure of the cause and effect relationship in question. Further, by having a different body of researchers measure the correlations between child difficulties and its relation to maternal postpartum depression, and the correlation between child difficulties and its relation to paternal postpartum depression, the study design protected the final findings from cross-referencing bias, or skewing of data. The study, however, also suffered from some significant limitations. These limitations included the relatively small populations of each depression group, which might be seen as a control group. More specifically, the study, as a whole had a very large population (n=7601) but the separated groups, based on their depressive symptoms, were (n=89, n=166 and n=175) significantly smaller respectively.
Another limitation of the study was the tool used to measure paternal postpartum depression. The EPDS was the primary instrument used to diagnose the paternal postpartum depression among participants, and this study is designed to be used as a measure of maternal postpartum depression and not depression in fathers. This is because a diagnostic tool that is specific to Paternal Postpartum Depression has not yet been developed. Finally, the measurements used to judge depression could allow some overlap between the groups, with regard to those suffering from depression during the pre and post-natal period, which could have changed the overall outcome of each group’s findings.
Critique of Ramchandani’s work
(Edmonson et al., 2010)
Edmonson et al (2010) examined whether or not the postpartum depression too, the Edinburgh Postnatal Depression Scale (EPDS) is effective at measuring the level of postpartum depression experienced in fathers. This study recognized that a number of tools have been developed for detecting, and determining the severity of depression during the post-natal period, but few if any have been studied with regard to their usefulness in men. As a result, Edmonson and his peers studied a group of 192 men (n=192) to determine whether or not the EPDS, and its standard cut-off points for the detection of depression, could effectively be used in screening fathers for PPD.
In terms of methodology, the researchers sent a sample of fathers the EPDS at 7-weeks post-delivery of their child. Then clinical interviews were conducted with the same body of participants (n=192) in order to determine of the cut-offs determined by the EPDS reflected the same presence, or absence, or depression in the participants as the clinical interview. The interview employed the DSM-IV format for structural clinical interviews.
The study found that fathers with depression did, in fact, consistently score higher on the EPDS than non-depressed fathers. A score of greater than 10 was found to be the optimal cut-off point for registering the presence of postpartum depression in men. This cut of point had a sensitivity of 89.6% and a specificity of 78.2%. This contrasts with the maternal cut-off of just 9. Edmonson and his peers concluded that the EPDS is reasonably and respectively sensitive for use as a tool for determining paternal postpartum depression, with a cut of score that is set at 10.
One of the primary limitations of the study include the way fathers were recruited for the study. Participants were recruited from maternity services, and interviewed during the prenatal period. This may have generated a population of study participants who resist generalization with relation to the general public. Had the response rate been higher, this limitation might have been minimized. It was also found that older men (mean age=35 years) were more likely to complete the study than younger men, while younger men (mean age=27 years) were more likely to become fathers. This discrepancy, which nears a decade, could have further skewed the sample population. Another limitation was that the EPDS and the structured clinical interview were not given simultaneously, rather an average of 4.8 weeks lapsed between the completion of the EPDS and the scheduled clinical interview’s accomplishment. The researchers noted that it is possible that the clinical symptoms of depression, and their manifestation in the patients, and so in the measurement tools, could have occurred during that lapse, skewing the correlation between the two test’s findings.
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