News Release

Psychiatric problems of fathers may be as important as those of mothers in child outcomes

Peer-Reviewed Publication

The Lancet_DELETED

While the issue of psychiatric problems of mothers affecting children is much discussed, mental health problems of fathers can be just as important for child outcomes. The issues are discussed in a Review published Online First and in an upcoming edition of The Lancet, written by Dr Paul Ramchandani and Dr Lamprini Psychogiou, Department of Psychiatry, University of Oxford, UK. The research was funded by the Wellcome Trust.

Several reasons exist for this focus on mothers. In many societies, women are the primary care givers for children, and thus have a greater role than men in their children's early development and socialisation. However, the role of men is sometimes underemphasised. In most countries and cultures, fathers have an active role in child care; moreover, fathers seem to have more influence on their children's development than previously thought.

Men differ from women in their distribution of psychiatric disorders, yet all the main categories of these disorders exist in men of parenting age — and for most of them, peak onset is between 18 and 35 years of age. Depression affects about 3𔃄% of men, which is about half of its prevalence in women. Paternal depression during the postnatal period (measured at 8 weeks after birth) has been associated with a doubling of the chance of subsequent behavioural and emotional problems in children—from 10% to nearly 20%. Also, adolescent offspring of depressed fathers have an increased risk of various psychological problems including depression and suicidal behaviour.

Some 2% of men are affected by generalised anxiety disorder. Children whose parents have anxiety disorders have a two-fold increased risk of developing anxiety disorders. Rates of substance abuse vary from 4% to 14% for alcohol abuse, and from 1% to 5% for substance abuse. Studies have shown consistent associations between paternal alcoholism and an increased risk of conduct disorder, and substance abuse and dependence in children, with a possible higher risk in the sons than in the daughters of affected fathers. Paternal alcoholism is also associated with an increased risk of mood disorders and depressive symptoms in adolescents, and increased academic underachievement, low self-esteem, and relational difficulties. Adolescents whose parents have bipolar disorder are up to 10 times more likely than adolescents with mentally health parents to develop bipolar disorder, and 3—4 times more likely to develop other psychiatric illness.

The authors discuss the possibility of child-to-parent effects, whereby child characteristics such as a difficult temperament can increase the risk of psychiatric disorder in the parents. However, disease transmission tends to go predominantly from parent to child, which tallies with evidence that improvements in maternal depression are followed by improvements in child mental health.

A mixture of genetic and environmental factors contribute to parental psychiatric disorders. Parental disorders can affect the child environment — eg, if a father loses his job, the socioeconomic hardship can result in an increased risk that his child will develop a psychiatric disorder. Parental disorders, such as depression, are associated with an increased risk of marital conflict and unhappiness, exposure to which, in turn, is associated with an increased risk of childhood behavioural problems.

Boys seem to be more vulnerable than girls to the effects of their fathers' depression, especially early during development. Similarly, sons of alcoholic fathers are at risk of developing conduct disorder, delinquency, and substance abuse. If a child has a difficult temperament, the risk of anxiety and depression in adults and children can increase. Children of mothers with depression are more likely to suffer it themselves if they are from a poor family. There is also interest in the effects of an absent father on a child. Research suggests that the presence of an antisocial father is associated with worse behavioural outcomes for children than if the antisocial father is absent.

The authors say that research is needed in four areas. Studies should be undertaken on fathers to assess the relation between their psychiatric disorders and their children's development; research is also needed to understand the mechanisms by which paternal psychiatric disorders affect families and children; the couple or marital relationship, which is often affected when one or the other partner has a psychiatric disorder, should be investigated; finally, more international and cross-cultural research is needed to clarify those areas in which risk and transmission are similar, and those where they are different.

The authors conclude: "Recent findings have suggested that paternal psychiatric disorders can be associated with increased risk of adverse child outcomes, independent from maternal psychiatric wellbeing. In some children, the patterns of risk associated with paternal disorders are different from those associated with maternal disorders, with boys potentially at increased risk. Additional focus on the mental health of fathers is likely not only to benefit them, but to create an opportunity to help improve the lives of their children."

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Dr Paul Ramchandani, Department of Psychiatry, University of Oxford, UK T) +44 (0) 1865 226491 E) paul.ramchandani@psych.ox.ac.uk

For full Review see: http://press.thelancet.com/parentalpsych.pdf


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