Is having a new child associated with increased antidepressant treatment in men?

In a recent article published in JAMA Network Open, researchers conducted a cohort study in the United Kingdom (UK) among men aged 15 to 55 to determine whether recent fatherhood was associated with an increased inclination to seek antidepressant treatment.

They considered antidepressant drugs, such as serotonin reuptake inhibitors, monoamine oxidase inhibitors, and mirtazapine, to name a few.

Study: Association of Recent Fatherhood With Antidepressant Treatment Initiation Among Men in the United Kingdom. Image Credit: GroundPicture/Shutterstock.com

Background

Studies have shown that nearly one in 10 men experience depression immediately after childbirth, likely due to changes in their emotional state and social and relationship roles.

In the first year after childbirth, i.e., the postnatal period, some men might also have to manage additional work and financial stress. Studies have also shown an association between paternal and maternal mental health post-birth of a child.

While it is well-established that men experience depression during the postnatal period, it is less clear whether they need antidepressant therapies immediately after childbirth than at any other time of their lifespan.

About the study

In the present study, researchers used primary care electronic health records (EHRs) from the IQVIA Medical Research Database (IMRD), which, as of December 2016, covered 16 million registered patients from 730 practices across the UK.

In the UK, general practitioners (GPs) are the first point of contact (POC) for all people facing mental health issues.

Upon diagnosis, GPs also initiate antidepressant treatment. During consultations, they gather patient-level information, including their demographics, lifestyle, diseases, etc., which they save in IMRD.

IMRD is broadly representative of the UK population but overrepresents more affluent people. It categorizes prescribing information per the British National Formulary (BNF) classification and captures the socioeconomic information via the Townsend score, a measure of material deprivation.

Using a household identification number from the IMRD, the researchers identified men who fathered a child between January 1, 2007, and December 31, 2016. They also selected up to five men (for each father) who did not father a child in the same year but matched on GP practice and age to draw comparisons.

These men met the same data quality criteria as fathers during recruitment in this study; for instance, they provided complete social deprivation information.

The team followed up with all men for 12 months after their index date if they received an antidepressant prescription. They followed up with all participants at risk of exposure from the index date to their first antidepressant drug prescription or the end of one year.

The researchers stratified study analysis by the history of antidepressant treatment, paternal age, Townsend score, and two-year calendar bands.

A random-effects Poisson regression model helped the researchers determine associations between fur patient characteristics and having an antidepressant prescription in the first year after the index date in fathers only.

They estimated and presented the time to the first prescription as the median number of days. The estimates derived using three study models, unadjusted, adjusted, and fully adjusted models, were presented as prevalence risk rates (PPRs) and 95% confidence intervals (CIs).

The team conducted the study analyses between January 2022 and March 2023 and repeated them after covering the comparison and study cohorts as variables.

Results

The authors identified 90,736 fathers between January 1, 2007, and December 31, 2016, and the comparison cohort comprised 453,632 men who did not father a child in the index year.

Most men in the study cohort were aged 25 to 44 years, and most lived in minor socially-deprived areas, i.e., around 130,277, while 72,268 men lived in the most deprived areas.

The study cohort was less likely to have a recent antidepressant treatment history than the comparison cohort (3,840 vs. 26,109); thus, less likely to have received previous treatment (1,206 vs. 7,516).

Overall, 5.5% of fathers and 7.5% of men in the comparison group had some history of antidepressant treatment. Indeed, previous antidepressant treatment and social deprivation were key determinants associated with antidepressant treatment in the first year after having a child.

The IMRD database had more individuals between 2007 and 2008; thus, most men in this study cohort were from these years.

The father cohort had a lower proportion of men with any past treatment than men in the comparison cohort (5.5% vs. 7.5%), and accounting for this difference nullified all differences in antidepressant prescriptions of both cohorts during the follow-up.

Contrary to what researchers hypothesized, men who recently fathered a child were 17% less likely to be prescribed antidepressants than men in the comparison cohort. However, increasing material deprivation increased the likelihood of receiving an antidepressant prescription in fathers.

Even after accounting for all contributing factors, a history of antidepressant treatment remained strongly correlated to receiving an antidepressant treatment prescription after having a child.

In this study, only 4.9% of fathers had an antidepressant prescription in the first year after having a child.

However, since this study included only those men who engaged with primary care services, they likely represented a subset of all men experiencing depression. In the future, survey studies should investigate all men experiencing depression.

Conclusions

According to the authors, this is one of the first studies to evaluate antidepressant treatments in a large cohort of men who recently became fathers and an equally sizeable comparative cohort of men, and data for both was retrieved using the same source and methods.

The study results suggested that it is crucial to understand the effect of previous and recent antidepressant treatment and financial and social deprivation to identify men potentially requiring different antidepressant therapy after having a child.

It is also likely that men treated with an antidepressant were less likely to become fathers. However, more research is warranted to determine whether antidepressant treatment could hamper men from becoming fathers.

Nonetheless, the study highlighted that seeking mental health treatments are still considered a stigma by men, especially when the focus is on the health of the newborn and mother. T

hus, there is a need to promote mental health check-ups among men who recently became fathers, live in more deprived areas, and have a history of antidepressant treatment. Future studies could further explore the benefits of such interventions.