We did a comprehensive literature search of bibliographic databases (ie, Medline and PsycInfo, including dissertation abstracts) up to July, 2008. We used search terms, including “father(s)”, “paternal”, “psychiatric”, “psychopathology”, “depression”, “anxiety”, “alcohol”, “drug”, “substance”, “child(ren)”, and “infant(s)”. We also included related terms, and used no restrictions by language or date. We retrieved and reviewed 1664 separate citations. We gave more importance to robust
ReviewPaternal psychiatric disorders and children's psychosocial development
Introduction
Research evidence indicates that psychiatric disorders of parents are associated with an increased risk of psychological and developmental problems in their children. For example, parental depression has been associated with an increased risk of emotional and behavioural problems in children, and delay in cognitive development and infant growth.1, 2, 3 The prevalence of psychiatric disorders affecting adults of parenting age is high and increasing worldwide.
Much research has focused on maternal psychiatric disorders. This is especially the case when research has examined the early years of children's lives4—a time of enormous cognitive and emotional development.3, 5 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).6 Furthermore, several influential theories of child development—including psychodynamic theories and, recently, attachment theories7—emphasise the key role of mothers. Practical reasons could also exist for research to focus on mothers, because they might be more readily available than fathers and more willing to participate in research.8
Despite the dearth of research on paternal psychiatric disorders and, consequently, their effect on child development, they should be seriously considered.9, 10, 11 Fathers' roles vary widely between different social and cultural groups, and substantial variability also exists both within any society and over time. For example, in intact families in the USA, fathers are now more overtly involved in child care than they were previously, although the absence of non-residential fathers from their children's lives has increased.4, 9 On the whole, however, 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.12, 13, 14, 15, 16, 17 Therefore, the potential effects of psychiatric disorders on their ability to care for, and nurture, their children are important.
In most societies, parenting roles of mothers and fathers differ.18 Men also have a different distribution of psychiatric disorders from that of women (eg, they have higher rates of alcoholism and lower rates of depression); psychiatric disorders labelled identically may affect men and women differently. Overall, these factors suggest that paternal psychiatric disorders could differ greatly from maternal disorders in their effect on children; some research supports this hypothesis.19, 20
Our aim was to review research publications on paternal psychiatric disorders, and children's health and psychosocial development. The effect of physical disorders is beyond the scope of this article, but reviews are available.21 We first describe the research that has examined the associations between paternal disorders and child problems, focusing on paternal depression because it has been more thoroughly studied than other conditions. We then consider some mechanisms by which risk is transmitted from fathers to children (causal pathways), and whether some factors (effect modifiers) might exist that place some groups of children at high risk. Finally, we draw conclusions on clinical practice, service provision, and future research directions.
Section snippets
Paternal psychiatric disorders
Men differ from women in their distribution of psychiatric disorders. Here, we consider depression, anxiety, alcohol and substance abuse, bipolar disorder, and schizophrenia. These disorders are the most common, and most serious, mental illnesses affecting men; they all affect adults of parenting age; for most, peak onset is between 18 and 35 years of age.
Mechanisms of risk transmission
Before considering the mechanisms by which paternal disorders might affect children, we should acknowledge that other factors could account for some of the associations described above. These include not only shared environmental stressors such as poverty, but also the possibility of child-to-parent effects, whereby child characteristics, such as a difficult temperament or behavioural problems, increase the risk of psychiatric disorder in the parent. No research has been done to study these
Groups at risk
The relation between paternal psychiatric disorders and an increased risk of adverse child outcomes is not linear. Several key effect modifiers exist, including characteristics of the child, such as sex, age, and temperament; and other contextual factors, such as socioeconomic status. These elements lead some children to be more vulnerable to the effects of paternal psychiatric disorders, and others to be more resilient.
Clinical and research implications
How can clinicians use these findings? First, it is important to be aware of the possibility that some fathers might suffer from serious psychiatric disorders. This fact is often overlooked. For example, women are actively screened for postnatal depression in many countries; however, the possibility that men might also be depressed during this time has, until recently, been almost entirely ignored.100 Findings that children could be at increased risk of behavioural problems when their fathers
Conclusion
Psychiatric disorders commonly affect adults of parenting age. Exposure to parental psychiatric disorders is associated with an increased risk of emotional, behavioural, and cognitive problems in children. Most research has been undertaken in the context of maternal psychiatric disorders. Although fathers—similarly to mothers—have mainly a positive influence in their children' lives,13, 16 recent findings have suggested that paternal psychiatric disorders can be associated with increased risk
Search strategy and selection criteria
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