WASHINGTON — Children of fathers with postpartum depression were significantly more likely to experience at least one adverse childhood experience (ACE) at age 5, according to data from the Future of Families and Child Wellbeing Study.
Among 1,933 father and child pairs, 9% of fathers experienced depression within the year after their children were born and 70% of the children experienced at least one ACE at 5 years, reported Kristine Schmitz, MD, of Rutgers Robert Wood Johnson Medical School in New Brunswick, New Jersey, during the American Academy of Pediatrics annual meeting.
In models adjusted for maternal postpartum depression, low birth weight, and other sociodemographic factors, fathers with depression were more likely to have children with ACEs at age 5:
- At least one ACE: adjusted OR 2.35, 95% CI 1.45-3.81
- At least two ACEs: aOR 1.89, 95% CI 1.35-2.63
- At least three ACEs: aOR 2.04, 95% CI 1.42-2.93
ACEs were broken down into two categories: child maltreatment (psychological, physical, and sexual abuse and neglect) and household dysfunction (maternal depression, substance use, incarceration within the family, violence toward mothers, and father’s absence).
The ACE most commonly experienced by children in this study was father’s absence (aOR 2.65, 95% CI 1.74-4.04), followed by neglect (aOR 1.63, 95% CI 1.08-2.46), and substance use (aOR 1.60, 95% CI 1.08-2.38).
Schmitz pointed out that previous research has shown that fathers can still be actively involved in their children’s lives even if they live separately. “In this case, even when we looked at dads who are not married or cohabiting, if he had depression, he was more likely to be absent than if he did not,” she said.
Paternal depression is underrecognized and rates may be as high as 25%, she noted, emphasizing that the take-away message for pediatricians is to pay attention to paternal mental health.
From a policy perspective, there’s also more work to be done, Schmitz told MedPage Today.
“If we want to be able to engage dads effectively and create good father-focused interventions, we need both research to ask dads what they want and how they engage,” she said, “and then we need payment models that are going to support those [best] practices.”
Schmitz and her colleagues used data from the Future of Families and Child Wellbeing Study, a national birth cohort involving 75% non-marital births from large cities between 1998 to 2000.
They looked at 1,933 father/child dyads through six different waves of data collection to examine ACEs reported by mothers at age 5.
Roughly half (48%) of the fathers were Black, 64% had a high school education or lower, and 50% of the births in the study sample were paid for by Medicaid.
Limitations to the study included the fact that “father’s absence” as an ACE may be directly related to depression or it may also reflect a loss to follow-up. In addition, the low odds of sexual abuse as an ACE may reflect difficulties in reporting the measure.
Schmitz also stressed that this is an observational study and the associations here should not be misinterpreted as causal.
Future studies could examine the impact of paternal postpartum depression on children’s behavioral outcomes and school performance, she suggested. Studies could also investigate the impact of protective factors or “positive childhood experiences” on mitigating the effects of paternal depression, and such research could extend to caregiver mental health beyond just 1 year.
The study was supported by the NIH, the Health Resources and Services Administration, and the Robert Wood Johnson Foundation.
American Academy of Pediatrics
Source Reference: Schmitz K, et al “Paternal postpartum depression and children’s adverse childhood experiences at age 5” AAP 2023.