Elsevier

The Lancet

Volume 374, Issue 9690, 22–28 August 2009, Pages 646-653
The Lancet

Review
Paternal psychiatric disorders and children's psychosocial development

https://doi.org/10.1016/S0140-6736(09)60238-5Get rights and content

Summary

Psychiatric disorders of parents are associated with an increased risk of psychological and developmental difficulties in their children. Most research has focused on mothers, neglecting psychiatric disorders affecting fathers. We review findings on paternal psychiatric disorders and their effect on children's psychosocial development. Most psychiatric disorders that affect fathers are associated with an increased risk of behavioural and emotional difficulties in their children, similar in magnitude to that due to maternal psychiatric disorders. Some findings indicate that boys are at greater risk than girls, and that paternal disorders, compared with maternal disorders, might be associated with an increased risk of behavioural rather than emotional problems. Improved paternal mental health is likely to improve children's wellbeing and life course.

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

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

References (108)

  • D Currier et al.

    Sex differences in the familial transmission of mood disorders

    J Affect Disord

    (2006)
  • LC Dierker et al.

    Influence of parental concordance for psychiatric disorders on psychopathology in offspring

    J Am Acad Child Adolesc Psychiatry

    (1999)
  • PJ Cooper et al.

    Affective disorder in the parents of a clinic sample of children with anxiety disorders

    J Affect Disord

    (2006)
  • SL Harter

    Psychosocial adjustment of adult children of alcoholics: a review of the recent empirical literature

    Clin Psychol Rev

    (2000)
  • HC Steinhausen et al.

    Psychopathology in the offspring of alcoholic parents

    J Am Acad Child Adolesc Psychiatry

    (1984)
  • ML Kelley et al.

    Psychiatric disorders of children living with drug-abusing, alcohol-abusing, and non-substance-abusing fathers

    J Am Acad Child Adolesc Psychiatry

    (2004)
  • A Henin et al.

    Psychopathology in the offspring of parents with bipolar disorder: a controlled study

    Biol Psychiatry

    (2005)
  • C Hammen et al.

    Family discord and stress predictors of depression and other disorders in adolescent children of depressed and nondepressed women

    J Am Acad Child Adolesc Psychiatry

    (2004)
  • M Rutter

    Environmentally mediated risks for psychopathology: research strategies and findings

    J Am Acad Child Adolesc Psychiatry

    (2005)
  • G Downey et al.

    Children of depressed parents: an integrative review

    Psychol Bull

    (1990)
  • L Murray et al.

    Intergenerational transmission of affective and cognitive processes associated with depression: infancy and the preschool years

  • S Goodman et al.

    Risk for psychopathology in the children of depressed mothers: a developmental model for understanding mechanisms of transmission

    Psychol Rev

    (1999)
  • M Cassano et al.

    The inclusion of fathers in the empirical investigation of child psychopathology: an update

    J Clin Child Adolesc Psychol

    (2006)
  • CR Gale et al.

    Critical periods of brain growth and cognitive function in children

    Brain

    (2004)
  • J Bowlby

    Attachment and Loss: Attachment

    (1997)
  • NJ Cabrera et al.

    Fatherhood in the twenty-first century

    Child Dev

    (2000)
  • ME Lamb et al.

    The development and significance of father–child relationships in two-parent families

  • V Phares et al.

    Still looking for Poppa

    Am Psychol

    (2005)
  • E Flouri

    Fathering and adolescents' psychological adjustment: the role of fathers' involvement, residence and biology status

    Child Care Health Dev

    (2008)
  • E Flouri et al.

    Early father's and mother's involvement and child's later educational outcomes

    Br J Educ Psychol

    (2004)
  • SR Jaffee et al.

    Life with (or without) father: the benefits of living with two biological parents depend on the father's antisocial behavior

    Child Dev

    (2003)
  • C Lewis et al.

    Fatherhood: connecting the strands of diversity across time and space

    (2006)
  • A Sarkadi et al.

    Fathers' involvement and children's developmental outcomes: a systematic review of longitudinal studies

    Acta Paediatr

    (2008)
  • ME Lamb

    The role of the father in child development

    (2004)
  • PL Engle et al.

    Fathers' involvement with children: perspectives from developing countries

  • AM Connell et al.

    The association between psychopathology in fathers versus mothers and children's internalizing and externalizing behavior problems: a meta-analysis

    Psychol Bull

    (2002)
  • A Stein et al.

    Impact of parental illness or mental disorder

  • PD Gluckman et al.

    Environmental influences during development and their later consequences for health and disease: implications for the interpretation of empirical studies

    Proc Biol Sci

    (2005)
  • P Bateson et al.

    Developmental plasticity and human health

    Nature

    (2004)
  • D Sinclair et al.

    Effects of postnatal depression on children's adjustment to school. Teacher's reports

    Br J Psychiatry

    (1998)
  • DF Hay et al.

    Intellectual problems shown by 11-year-old children whose mothers had postnatal depression

    J Child Psychol Psychiatry

    (2001)
  • L Murray et al.

    Depressed mothers' speech to their infants and its relation to infant gender and cognitive development

    J Child Psychol Psychiatry

    (1993)
  • DG Blazer et al.

    The prevalence and distribution of major depression in a national community sample: the National Comorbidity Survey

    Am J Psychiatry

    (1994)
  • WR Beardslee et al.

    A family-based approach to the prevention of depressive symptoms in children at risk: evidence of parental and child change

    Pediatrics

    (2003)
  • WR Beardslee et al.

    Children of affectively ill parents: a review of the past 10 years

    J Am Acad Child Adolesc Psychiatry

    (1998)
  • DN Klein et al.

    Psychopathology in the adolescent and young adult offspring of a community sample of mothers and fathers with major depression

    Psychol Med

    (2005)
  • PM Lewinsohn et al.

    Psychosocial impairment in offspring of depressed parents

    Psychol Med

    (2005)
  • R Jenkins et al.

    The National Psychiatric Morbidity surveys of Great Britain—initial findings from the Household Survey

    Int Rev Psychiatry

    (2003)
  • KR Merikangas et al.

    Psychopathology among offspring of parents with substance abuse and/or anxiety disorders: a high-risk study

    J Child Psychol Psychiatry

    (1998)
  • L Murray et al.

    The effects of maternal social phobia on mother-infant interactions and infant social responsiveness

    J Child Psychol Psychiatry

    (2007)
  • Cited by (283)

    • Sex differences in fetal programming: Antenatal origins of health and disease (AOHD)

      2023, Principles of Gender-Specific Medicine: Sex and Gender-Specific Biology in the Postgenomic Era
    View all citing articles on Scopus
    View full text