A significant number of men experience prenatal and postpartum depression, and the rate is marginally higher in the United States than in other countries, according to a meta-analysis of 43 studies published in the May 19 issue of JAMA.

The overall rate of paternal depression was 10.4%, with a U.S. rate of 14.1% vs. 8.2% in other countries.

In addition, the study reported maternal depression at a rate of 23.8%, with a moderate positive correlation between maternal and paternal depression.

The findings suggest that “more efforts should be made to improve screening and referral, particularly in light of the mounting evidence that early paternal depression may have substantial emotional, behavioral, and developmental effects on children,” noted lead author James F. Paulson, Ph.D., and his colleague Sharnail D. Bazemore of the department of pediatrics at Eastern Virginia Medical School in Norfolk (JAMA 2010;303:1961-9).

The correlation between paternal and maternal depression “also suggests a screening rubric – depression in one patient should prompt clinical attention to the other,” the investigators wrote.

The meta-analysis included studies from 16 countries and involved 28,004 new and expectant fathers aged 18 years or older.

Most studies (n = 40) assessed depression with a self-report rating scale, while 3 used a semistructured or structured interview. In addition to reporting paternal depression, 35 of the studies also reported rates of maternal depression, with 14 of them reporting the correlation between paternal and maternal symptoms.

The primary outcome was the point prevalence rate of paternal depression, and the secondary outcome included rates of depression of female partners. Regarding different time periods in relation to the birth, the 3- to 6-month postpartum period showed the highest rate of paternal (25.6%) and maternal (41.6%) depression, “although the small number of studies measuring paternal depression during this period suggests cautious interpretation,” they noted.

The studies in the meta-analysis showed a wide variation in rates of depression for both fathers and mothers; however, “since recent national data on base rates of depression in men place the 12-month prevalence at 4.8%, this suggests that paternal prenatal and postpartum depression represents a significant public health concern,” they wrote.

The authors suggested various potential causes of differences they observed between studies in the meta-analysis, including diverse measures of depression, locations, and sample characteristics. Another possible source “is the liberal inclusion of cases that can be classified as minor depression,” they added.

The correlation between paternal and maternal depression suggests that “prevention and intervention efforts for depression might be focused on the couple and family rather than the individual. Future research in this area should focus on parents together to examine the onset and joint course of depression in new parents,” Dr. Paulson and Ms. Bazemore said.

The meta-analysis also examined and found no evidence for publication bias.

Dr. Paulson and Ms. Bazemore said they had no conflicts of interest to disclose.

Copyright (c) 2009 Elsevier Global Medical News. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

5月19日，《美国医学会杂志》(JAMA)发表了一篇纳入了43项研究的meta分析报告，结果显示，有相当数量的男性在其妻子生产后也会出现产后抑郁，而且在美国，父亲产后抑郁的患病率略高于其他国家。

 

父亲抑郁的总患病率为10.4%，美国为14.1%，而其他国家为8.2%。

 

此外，一项研究报告称，母亲产后抑郁的患病率高达23.8%，并且母亲抑郁与父亲抑郁之间存在一定程度的正相关性。

 

作为第一作者，美国诺福克东弗吉尼亚医学院的James F. Paulson博士及其同事Sharnail D. Bazemore指出，这些发现表明“还应作出进一步努力以完善相关的筛查和转诊，尤其是考虑到越来越多的证据显示早期父亲抑郁可能对婴儿的情感、行为和发育产生重大的影响。”

 

研究者写道，父亲抑郁与母亲抑郁之间的相关性“也强调了筛查的重要性——一旦发现其中一方存在抑郁，也应引起对另一方的临床重视。”

 

这项meta分析纳入了来自16个国家的研究，共涉及28,004例年龄在18岁或18岁以上的新爸爸或准爸爸。

 

大部分研究(n = 40)采用抑郁自评量表进行评价，而其余3项研究则采用了半结构式或结构式访谈。除了报告父亲抑郁的评价结果外，有35项研究还报告了母亲抑郁的患病率，其中14项报告了父亲与母亲症状之间的相关性。

 

研究者指出，主要结局指标是父亲抑郁的时点患病率，次要结局指标包括女性伴侣抑郁的患病率。从婴儿出生后的不同时段来看，产后3~6个月这一时段内父亲抑郁(25.6%)和母亲抑郁(41.6%)的患病率最高，“尽管评价了这一时段内父亲抑郁情况的少数研究提醒应谨慎看待研究结果。”

 

研究者写道，这项meta分析所纳入的研究无论是在父亲还是母亲抑郁的患病率上都存在很大的差异；不过，“鉴于近期公布的有关男性抑郁基础概率的全国性数据显示，12个月内的患病率为4.8%，这表明父亲产前和产后抑郁已经成为了一个重要的公共卫生问题。”

 

对于meta分析所纳入的研究在患病率上的差异，作者提出了多种可能导致这种差异的原因，包括抑郁的评价指标、地理位置以及样本的特点均有所不同。研究者补充道，还有一种可能是“有的研究把本来可以归为轻度抑郁的病例也计算在内了。”

 

Paulson博士和Bazemore女士说，父亲抑郁与母亲抑郁之间的相关性表明，“针对抑郁的预防和干预措施可能应该重点关注夫妻双方和整个家庭，而不仅仅是针对个人。这个领域的未来研究应该同时评价夫妻双方以了解新爸爸新妈妈们抑郁的发病过程以及之间的相关性。”

 

这项meta分析还评价了发表偏倚，结果提示无证据证明存在发表偏倚。

 

Paulson博士和Bazemore女士声明无相关利益冲突。