Research report
Common mental disorders in women and men in the first six months after the birth of their first infant: A community study in Victoria, Australia

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Abstract

Introduction

Studies of postpartum mental health have focused predominantly on women and on depression. There is limited evidence regarding men's postpartum mental health and about other common mental disorders, such as anxiety and adjustment disorders, which may also be relevant at this life phase. The main aim of this study was to establish the period prevalence of depression, anxiety, and adjustment disorders in primiparous women and their male partners in the first six months postpartum

Methods

English-speaking couples were recruited in five local government areas in Victoria, Australia. Women and men completed separate telephone interviews which included the Edinburgh Postnatal Depression Scale (EPDS) and selected Depression and Anxiety modules of the Composite International Diagnostic Interview. DSM-IV criteria were used to classify adjustment disorders, based on subclinical symptoms not meeting criteria for diagnoses of major or minor depression or generalised anxiety disorder. The main outcome was any common mental disorder (depression, anxiety or adjustment disorder) in the first six months postpartum

Results

Complete data were available for 172 couples. The 6-month period prevalence of mental health problems was 33% for women and 17% for men. The most common diagnosis in both women and men was adjustment disorder with anxiety symptoms

Limitations

Unpartnered women and men, women whose partners were not willing to participate and those who did not have sufficient English fluency to complete the interviews were excluded from the sample. The results of this study cannot be generalised to these populations.

Conclusion

The most common postnatal mental health problem in both women and men in this community sample was anxiety.

Introduction

Postnatal mental health problems constitute a significant public health problem, contribute substantial costs to the health system (Hayes, 2010), and have negative impacts on both parent and child (Brockington, 2004, Ramchandani et al., 2011). In the past, research on postnatal mental health problems has focused predominantly on women. However, recent reviews (Bradley and Slade, 2011, Paulson and Bazemore, 2010) report an emerging literature on the psychological functioning of men in the first postpartum year. Such studies are often hampered by samples that are small or not representative of the population (Wee et al., 2011). Further, generalisations are limited by low recruitment rates and high drop-out rates of men (Bradley and Slade, 2011, Paulson and Bazemore, 2010, Wee et al., 2011). Some of the most detailed investigations of men's mental health have recruited men who are partners of women who have been diagnosed with postnatal depression or have been admitted to psychiatric services (Dudley et al., 2001, Goodman, 2008, Lovestone and Kumar, 1993, Ramchandani et al., 2005, Roberts et al., 2006, Zelkowitz and Milet, 1996, Zelkowitz and Milet, 2001). These studies result in higher point prevalence estimates than systematically-recruited community samples (Goodman, 2004).

The predominant research and clinical focus in postnatal mental health problems in both women and men has been on depression (Yelland et al., 2010). There is growing recognition that anxiety and adjustment disorders are at least as prevalent among women with infants (Fisher et al., 2010; Matthey et al., 2013; Reck et al., 2008, Rowe et al., 2008) and limited evidence that this may be the case for men too (Matthey et al., 2003). In this paper, we use Goldberg and Huxley's (1992) term ‘common mental disorders’ to refer to depressive, anxiety and adjustment disorders which compromise day-to-day functioning.

The percentage of the population with a diagnosis at a particular point in time is referred to as the point prevalence, while period prevalence refers to the percentage of the population who have had a diagnosis at some time during a specified period (Mann et al., 2010). In Australian studies, the point prevalence of probable major depression in women at 6 months postpartum has been estimated at 6.8% (Woolhouse et al., 2011).

The point prevalence of postnatal depression is estimated to be significantly lower in men than in women, either because men are less likely to experience or report depression, or because psychological distress may be manifested differently in men, for example through alcohol abuse or aggression (Condon et al., 2004, Madsen and Juhl, 2007). The reported point prevalence of postnatal depression for men at assessment points varying from 3 to 6 months postpartum is between 2.1% and 6% (Bradley and Slade, 2011, Matthey et al., 2000, Condon et al., 2004).

Comparisons of point prevalence estimates between studies are problematic as studies use different populations, sampling criteria, screening or diagnostic criteria, and assessment points. In addition, estimates of point prevalence are often based on self-report screening instruments alone, which lead to overestimates of prevalence (Gavin et al., 2005). While clinical assessments by a mental health professional or structured diagnostic interviews are considered to be “gold standard” (Gaynes et al., 2005), most prevalence studies in community settings have used self-report screening instruments. One study which used diagnostic interviews and assessed not only postnatal depression but also anxiety and adjustment disorders in both women and men (Matthey et al., 2003), demonstrated that the point prevalence of diagnoses of common perinatal mood disorders at 6 weeks postpartum increases substantially in both women (25.9%) and men (11.7%) when anxiety and adjustment disorders are also included in the assessment. However, generalisibility was limited as Matthey et al.'s sample was recruited from a single public hospital (2003).

The primary aim of this study was to describe the period prevalence of common postnatal mental disorders in the first 6 months after the birth of a first infant in a community sample of couples in Victoria, Australia. The secondary aims were to:

  • determine whether significant differences existed in the period prevalence of common postnatal mental disorders between women and men;

  • report the proportion (point prevalence) of women and men scoring above their respective, established cut-off points for EPDS scores for major or minor depression; and

  • determine whether significant differences existed in the proportions of women and men scoring above validated sex-specific EPDS cut-off points for probable major or minor depression.

Section snippets

Materials and methods

The data reported here were collected as part of a study evaluating the impact of a mental health intervention for new parents and their first babies on the period prevalence of common mental disorders in women in the first 6 months postpartum (Fisher et al., 2010). Here we report data from both women and men in the control group, who received standard, universal postnatal care but were not exposed to the specific intervention being evaluated in the overall study.

Approval to conduct the study

Results

The recruitment and participation fractions are shown in Fig. 1. Complete data were available for 172 couples, which represents 57.5% of eligible couples. Mean (SD) infant age at follow-up was 27.3 (4.2) weeks.

The sample included people from all categories of occupation, born in Australia and other countries and with English as a first or second language. However, women and men in the sample were more likely than those in the general population to have been born in Australia and to be in

Discussion and conclusion

In this study, a community sample of English-literate, first-time parents with healthy newborns was recruited, and both partners' mental health was assessed at 6 months postpartum. The point prevalence of clinically significant symptoms of minor or major depression (using validated cut-off scores on the EPDS) was significantly higher for women than men. Similarly, based on the CIDI, the period prevalence of depression, anxiety or adjustment disorders in the 6 months since the birth of their

Role of funding source

This research was funded by a competitively awarded grant under the Invest to Grow Initiative from the Australian Government Department of Families, Housing, Community Services and Indigenous Affairs.

The funders had no further role in the study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.

Conflict of interest

The authors declare that they have no conflicts of interest.

Acknowledgements

Members of the Jean Hailes Research Unit critically reviewed the draft and gave valuable feedback. The authors wish to thank all the women and men who participated in this study.

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