DENVER – Living with a father who has depressive symptoms or other mental health problems is independently associated with increased rates of emotional or behavioral difficulties in their children, a study of more than 20,000 U.S. youths shows.
These study data identify paternal mental health problems as a previously unrecognized threat to children’s mental health, David G. Rosenthal declared in presenting the results at the meeting.
David G. Rosenthal
Extensive literature has documented that maternal depression has multiple adverse impacts on child outcomes, including low birthweight, anxiety and depression, behavioral problems, and poor school performance.
"In contrast, there is a profound paucity of research regarding possible associations between paternal mental health and depressive symptoms and childhood health functioning," commented Mr. Rosenthal, a medical student at New York University. "In this study, we have documented that fathers are extremely important to the behavioral and emotional well being of the child, but they remain absent in many policy decisions about child health. This must be addressed."
His study also demonstrated that the adverse impact on children’s behavioral and emotional functioning is compounded when both the mother and father have mental health problems. For example, in homes where both parents experienced depressive symptoms, fully 25% of children had emotional or behavioral problems, a rate more than fourfold greater than when neither parent was affected.
The study used data from the Medical Expenditure Panel Survey – a nationally representative sample of the U.S. population – for the years 2004-2008 on 20,260 children aged 5-17 years and their parents. The Columbia Impairment Scale (CIS) was used to measure emotional and behavioral problems in the children, Short Form-12 (SF-12) was used to assess parental mental and physical health, and parental depressive symptoms were evaluated via the Patient Health Questionnaire-2 (PHQ-2).
As seen in other studies, higher rates of significant behavioral or emotional problems, as defined by a CIS score of 16 or higher, were seen in children who were older, male, and white.
The major new contribution of this study concerns the impact of paternal mental health problems on the child. In households where the father had clinically significant depressive symptoms, as defined by a PHQ-2 score of 3 or greater, 15.5% of children had behavioral or emotional problems, compared with a 7% rate in homes without paternal depressive symptoms.
Similarly, children whose father had poor mental health as reflected in a mental component of the SF-12 score more than 1 standard deviation below average had a 10.4% prevalence of significant behavioral or emotional problems. In contrast, if their father’s score on the SF-12 was average or above, a child had a 5.4% rate of behavioral or emotional problems. And if the father had an abnormal SF-12 score less than 1 standard deviation below average, children had a 9% rate of emotional or behavioral problems, Mr. Rosenthal continued.
In a multivariate analysis, the adjusted odds ratio for emotional or behavioral problems in children whose father had depressive symptoms was 1.72, while for those whose mother had depressive symptoms it was 3.3. Children whose father had an abnormal SF-12 score less than 1 standard deviation below normal had an adjusted 1.33-fold increased risk for behavioral or emotional problems, with that risk climbing to 1.48 for children whose father scored more than 1 standard deviation below normal. The corresponding increases in risk for children whose mothers were similarly affected were 2.1- and 3.4-fold.
Viewing this large data set another way, in almost 90% of families, neither parent had a PHQ-2 score of 3 or more; in those households, 6% of children exhibited behavioral or emotional problems. This figure rose to 11% in families where the father alone had depressive symptoms, to 19% if the mother alone had such symptoms, and to 25% where both parents had depressive symptoms.
"The role of paternal mental health in child health needs to be recognized by clinicians," Mr. Rosenthal said. "Strategies for educating the pediatric workforce about this are needed, as are strategies aimed at implementing aspects of this into clinical practice, which will take changes in health care organization, reimbursement, and referral strategies."
A limitation of this study is that the data are applicable only to families in which both the mother and father are present in the home.
Mr. Rosenthal earned an Academic Pediatric Association Student Research Award for his work. He declared having no conflicts of interest.