30 settembre 2010

La depressione post partum è presente anche nei padri

From MedscapeCME Clinical Briefs

Both Mothers and Fathers at Risk for Depression in First Year After Child's Birth CME

News Author: Deborah Brauser
CME Author: Charles P. Vega, MD

Target Audience

This article is intended for primary care clinicians, psychiatrists, obstetrician-gynecologists, and other specialists who care for parents and their children.


The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care.

Authors and Disclosures

As an organization accredited by the ACCME, Medscape, LLC requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.
Medscape, LLC encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.
Deborah Brauser
is a freelance writer for Medscape.
Disclosure: Deborah Brauser has disclosed no relevant financial relationships.
Brande Nicole Martin
CME Clinical Editor, Medscape, LLC
Disclosure: Brande Nicole Martin has disclosed no relevant financial relationships.
Charles P. Vega, MD
Associate Clinical Professor, Residency Program Director, Prime-LC, University of California-Irvine, Orange, California; Department of Family Medicine, University of California-Irvine, Orange, California
Disclosure: Charles P. Vega, MD, has disclosed no relevant financial relationships.
Sarah Fleischman
CME Program Manager, Medscape, LLC
Disclosure: Sarah Fleischman has disclosed no relevant financial relationships.

Learning Objectives

Upon completion of this activity, participants will be able to:
  1. Distinguish consequences of paternal depression in children.
  2. Describe the findings of the current study regarding their risk for depression in parents after the birth of their child.
September 16, 2010 — Although both mothers and fathers are at risk of experiencing incidences of depression by their child's 12th birthday, the highest risk is within their first year postpartum, according to researchers from the United Kingdom.
"The main takeaway message for clinicians is that both parents are at risk of developing depression soon after the birth of the baby," Irwin Nazareth, PhD, MBBS, director of the Medical Research Council (MRC) General Practice Research Framework and professor of primary care at University College London, United Kingdom, told Medscape Medical News.
He noted that the UK National Institute for Clinical Excellence has recommended regular screenings for mothers for depression through the antenatal and postnatal period.  However, "this should be extended to fathers so that the family is considered as a whole unit. Special attention must also be paid to young parents who have had a past history of depression and those who are socioeconomically deprived."     
The study was published online September 6 in the Archives of Pediatrics & Adolescent Medicine.
Paucity of Paternal Depression Research
Although past research has shown that parental depression is associated with adverse outcomes for their children in behavior, development, and cognition, most have focused only on maternal depression, write the study authors.
"The effect of a new baby on the father has received little attention," said Dr. Nazareth. "This study was hence done to ascertain the extent of the problem and to identify those groups of fathers who were at particular risk of depression. Moreover, we believe that simultaneously studying the effect of the birth of the baby both on fathers and mothers provides us a much fuller picture of the wider effects of birth on the family unit."
He also noted that his investigative group at the MRC "has always had a special interest in mental health problems in primary care" and that this particular study resulted from 8 years of research work undertaken by lead study author Shreya Davé, PhD, MSc, BSc.
For this study, the investigators evaluated data from between 1993 and 2007 from The Health Improvement Network database, which includes information on almost 5 million primary care patients from the United Kingdom. They then identified a cohort of 86,957 mother-father-child units.
Patient records and read code entries were also assessed for unipolar depression, antidepressant prescriptions, and sociodemographic information, including follow-up data up to the child's 12th birthday.
Both Parents Experience Depression
The investigators found that 19,286 of the mothers and 8012 of the fathers had an episode of depression during the period between their child's birth up to the age of 12 years.
Of these moms, 77% experienced 1 episode of depression, 18% had 2 episodes, and 5% had 3 or more episodes. Of the depressed fathers, 83% had 1 episode, 14% had 2, and 3% had 3 or more.
The overall incidences of depression during this same period for mothers were 7.53 per 100 person-years vs 2.69 per 100 person-years for fathers.
However, the depression rates were highest for both parents during the first year after the child's birth at 13.93 per 100 person-years for mothers and 3.56 for fathers.
"What was striking in this study was the extent of the depression in fathers vs mothers and how the first year of the birth of the baby was in particular a risk period for both parents," said Dr. Nazareth.
The researchers write that in addition to such things as poor parental sleep and change in responsibilities, the high rates of depression found during the first year postpartum may be partly due "to a resumption of antidepressant use following a break during pregnancy and breastfeeding."
Finally, both mothers and fathers who were between the age of 15 and 24 years at the birth of their child were significantly more likely to be depressed than parents older than 25 years, as were those who had a history of depression and were in the highest quintile for deprivation.
Dr. Nazareth noted that this link was particularly interesting. "This informs general practitioners on the need to consider closer monitoring of these at risk groups from early pregnancy and soon after."
In addition, the study authors write that future research should examine other factors potentially associated with parental depression, such as the couple's relationship quality and stressful events, as well as the effects of this depression on the child's health and development.
Awareness, Screenings Needed
"This was an interesting study that addresses an important issue that hasn't been clearly resolved in research and, in fact, has been the subject of some debate over the past 10 years," James Paulson, PhD, associate professor and clinical psychologist in the Department of Pediatrics at Eastern Virginia Medical School at Children's Hospital of the King's Daughters in Norfolk, told Medscape Medical News, when contacted for comment.
"That issue is depression in mothers during the first year postpartum, which clearly has negative connotations for the family," he added. "This study works strongly in favor of the argument that depression is something that's happening in postpartum — not only in mothers but also in fathers — more than at any other time point during parenthood."
Dr. Paulson, who was not involved with this study, recently conducted a meta-analysis looking specifically at prenatal and postpartum depression in fathers.
"I thought it was great that these investigators included paternal depression in their methodology, which I think we'll find in more and more studies. This article really underscores the point that depression is happening more often in fathers."
He noted that, due to continuing stigma, men often do not admit to having depression and often do not seek help. "I also think they're less likely to recognize depression as depression when they experience it. So I think increasing awareness will really help ring that bell for more people."
Although Dr. Paulson had no concerns with this study, he said that he would have liked to have seen more about what was going on within the family and not just an exclusive focus on the individual parents.
"Turning the focus more toward the family is very important for moving this field forward, and it gives us a lot more traction in terms of what we can do for catching depression, for intervening, and for minimizing its effect on the family and the child," he explained.
"For clinicians, I think the number 1 takeaway is that when working with expecting new parents — and I think we need to start thinking about this during the pregnancy — realize that this a situation where depression is a much higher risk than it is at any other time point," concluded Dr. Paulson. "Take whatever steps are needed to screen for depression in both mothers and fathers because clearly this is a risk that occurs in both parents."
This study was funded in part through a grant from the MRC. The study authors and Dr. Paulson have disclosed no relevant financial relationships.
Arch Pediatr Adolesc Med. Published online September 6, 2010.

Clinical Context

Postpartum depression has been extensively studied among women, but the subject of paternal depression and its potential consequences is less understood. Davé and colleagues performed a cross-sectional study to better understand these issues, and their results were published in the March 2009 issue of the British Journal of General Practice. They found that the prevalence of major depression among fathers was 3%. Children of fathers with a major depressive syndrome were almost 9 times more likely to have an evaluation for speech and language problems, and they were also nearly 7 times more likely to have a history of externalizing behavioral problems.
Given these potentially severe consequences for families, it is important to understand the epidemiology of parental depression. The current study uses a large database to address this issue.

Study Highlights

  • Researchers used The Health Improvement Network database to evaluate parental depression. This database contains information on approximately 5 million patients from more than 350 UK practices. The current study focuses on data accumulated between 1993 and 2007.
  • Children up to age 12 years in the database were linked to their mothers and an adult man in the household, who was presumed to be the father unless there was an age difference of more than 20 years between the mother and the adult man.
  • Researchers used database Read codes, which measure diagnoses, symptoms, prescriptions, and referrals to secondary care, to identify parental depression. Read codes for bipolar illness and depression with psychosis were excluded, as were codes for depressive symptoms without a diagnosis of depression.
  • The use of antidepressants was used to identify parental depression, but not when there was a concomitant diagnosis that could explain the use of antidepressants.
  • 86,957 mother-father-child triads were identified, and 19,286 mothers experienced depression, as did 8012 fathers. Most adults with depression were treated with antidepressants. The median length of antidepressant prescriptions was 105 days.
  • The overall incidence rates of depression were 7.53 episodes per 100 person-years among mothers and 2.69 episodes per 100 person-years among fathers for the period between a child's birth and age 12 years.
  • The incidence of parental depression was highest in the first year postpartum (13.93 episodes per 100 person-years among mothers and 3.56 episodes per 100 person-years among fathers).
  • Rates of paternal depression increased between 1993 and 2007, whereas the incidence of maternal depression remained fairly stable with time.
  • By age 12 years, 39% of mothers and 21% of fathers had experienced an episode of depression.
  • A history of depression and higher social deprivation predicted a higher risk for depression among mothers and fathers. In addition, parents were more likely to be depressed if they were 15 to 24 years old at the time of delivery vs older parents.

Clinical Implications

  • Paternal depression is associated with a higher risk for speech and language problems as well as externalizing behavioral problems among children.
  • The current study finds a significant rate of depression among mothers and fathers, particularly in the first year after delivery of their child.

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