الفهرس 
Aim of the workOnly 14 pages are availabe for public view
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Abstract
Introduction:
Recently research has focused on paternal perinatal psychiatric disorders and media recognition has been slowly started to detect and focus on it (Condon, 2006; Kim et al., 2007). Fathers experience significant changes in life after children and many of which are similar to the experiences of the mothers (Bielawska et al., 2006). The effect of paternal depression during the early months of their children’s lives has received little attention (Goodman et al., 2004). Adolescent children of depressed fathers have increased rates of psychopathology, but less is known about the possible effects of paternal depression on earlier lives of their children (Kane et al., 2004).
Rationale, hypothesis and aim of the work:
Research about men in the perinatal period is scarce, so there is need for more researches on this area. Our hypothesis suggests that PPD is more prevalent than expected and children developmental outcomes and behaviors are affected by PPD. The aim of this work is to review the available literature on PPD and to shed light on the effect of PPD on the family.
Methodology:
After collecting data from available studies on PPD, the findings has been summarized and compared to MPD and recommendations were generated.
Review of literature:
• Risk factors:
Paternal postnatal depression is a one of the mood disorders that affects fathers after their childbirth within the first 12 postnatal months for at least two weeks (Cox, 2004) with wide range of incidence from 4 % to 25% (Goodman, 2004; Ramchandani et al., 2005; Paulson et al., 2006). It occurs due to biopsychosocial factors (Verkerk et al., 2005). Low levels of testosterone, cortisol, prolactin, vasopressin & estrogen may increase the risk for PPD (KIM, 2007).
Also, young age of fathers, low income status, low educational level, poor marital relationships, unintended pregnancies and lack of social support are the social risks for PPD.
Moreover, psychological risk factors like lack of sleep, traumatic birth experience, previous psychiatric disorders and neurotic personalities may lead to PPD (Weinman et al., 2005). MPD is the most important risk factor for PPD and increases the risk 2 times (Harvey & McGrath, 1988).
• Diagnosis:
There is no official diagnostic criteria for diagnosis of PPD, but those of major depressive disorder with postnatal onset are used currently to diagnose PPD (Cox, 2004; Gruenberg et al., 2008). Depressed fathers may be presented with aggressive behavior, hostility, substance abuse, overwork and risk taking behaviors (Wang, 2010).
Screening of fathers whose partners are depressed is a beneficial for early detection of those who suffer from PPD, but there is no specific tool for this (Goodman, 2004). Although, some may be used like EPDS, BDI, EPDS-P & GMDS to assess PPD (Matthey et al., 2001).
For differentiating PPD from adjustment disorder as both are related to change, the onset of PPD is within 4 weeks postnatal meanwhile the onset of adjustment disorder occur within 3 months of the onset of the stressor and it’s duration is shorter than PPD (American Psychiatric Association, 2000). Also, PPD needs the diagnostic criteria of major depressive disorder to be diagnosed which is different from the criteria of adjustment disorder.
• Impact of PPD and it’s management:
PPD may has a comorbidity with OCD or anxiety. OCD symptoms are in the form of intrusive thoughts like harming their infant or compulsions of checking their baby (Abramowitz et al., 2003).
The postnatal depression, both in mothers and fathers, hugely affects the life of the child and the functioning of the family (Goodman, 2004). It may increase the risk of depression in the partner due to lack of emotional support which needed in this period, also it may causes violence between parents (Lundberg et al., 2000). The mental health of fathers has an impact on children’s psychosocial development as insecure attachment and increase risk of their behavioral problems at age of three (Eiden et al., 2002).
The most effective treatment plan is to deal with the cause of PPD, also, anti depressants is useful if needed with IPT and CBT (Nazareth, 2011). For prevention of PPD, identification of those in risk group and effective protective program must be available for them (Tuszynska-Bogucka et al., 2012).
Discussion:
• PPD versus Adjustment disorder
The fathers can experience PD which is different from adjustment disorder in severity of symptoms, functioning of the patient. In adjustment disorder, there is a conflict in fathers between their feelings of self-doubt and their desire for being a perfect father that lead to helplessness and distress and those feelings could be normal transition to parenthood, also adjustment disorder has many stressors to precipitate it other than child birth like father’s or child’s illness, separation between partners or getting a new job within months of the childbirth. Some of those who suffer from adjustment disorder may develop clinical depression (Kleiman, 2017).
• PPD versus MPD
Fathers concerns are different from those of the mothers as fathers concerned with fears from lack of involvement and about finances (Cochran & Rabinowitz, 2003). Furthermore, men underreport their symptoms of depression due to cultural concepts and have lower levels of positive and higher levels of negative parenting behaviors (Sethna et al., 2009).
Anxiety may be present in fathers prior to the birth of their baby and reduced at six weeks (Tohotoa et al., 2012). Symptoms of postnatal depression are similar for fathers and mothers and others are specific to fathers such as violent behavior and substance abuse (Melrose, 2010).
Fathers as well as mothers have an impact on their child development. While mothers exhibit helplessness, more irritability toward her infants, both of them could lead to insecure attachment in infants with their postnatal depression. Fathers could have an impact on long term on children in form of conduct problems and hyperactivity (Ramchandani et al., 2005).
Fathers receive much less social support than mothers due to newness of the topic and less seeking medical help attitude of the fathers (Capuozzo et al., 2010). EPDS is validated to be a screening tool for PPD (Matthey et al., 2001), but it has different cut off scores mostly lower than mothers as there is different presentation from fathers and they have difficulty expressing their symptoms (Edmondson et al., 2010).
Conclusion:
PPD is a mood disorder like MPD in it’s diagnosis and has EPDS-P as a screening tool for those who have depressed partners as MPD is one of the major risk factors for PPD. It differs from MPD in some specific symptoms for fathers like angry, impulsivity, violence and substance use. It’s an issue that need treatment due to it’s effect on the family and children.
Recommendations:
Identification of risk groups and providing them with prophylactic measures and careful management and need for more researches about impact of PPD on the family.
Limitations:
Lack of references as a whole.