Is paternal depression associated with subsequent offspring depression?

In a study recently published in the journal JAMA Network Open, researchers conducted a large-scale systematic review and meta-analysis of published observational studies investigating depression in fathers and their children.

This work, aimed at investigating the association between paternal depression and the subsequent risk of depression in offspring, identified 16 publications comprising 7,153,723 father-child pairs for analyses. Results elucidate the strong association between depression in fathers and subsequently increased depression risk in their children.

It runs in the family

‘Depression’ is an umbrella term for a group of conditions characterized by negative alterations to individuals’ mood, thought processes, or behavior. It is a common and severe medical ailment that affects about 3.8% of the global human population, is slightly more common in females (6%) compared to males (4%), and is more prevalent in adults older than 60.

Neurodevelopmental depression theory implies that depression risks and factors experienced in early life may significantly increase depression risk later. While the associations between maternal depression and offspring depression risk is well documented, few studies explore the links between a father’s depression and the potential for depression in his children.

The few studies examining this relationship have theorized that the association may be a combination of genetic inheritance and the influence of the developmental environment the child is exposed to.

The results from these scant studies remain inconsistent, with some reporting positive correlations between depression in fathers and children while others show no such association.

Given that depression among fathers is a common condition, and male parents’ involvement in their offspring’s upbringings is increasingly prevalent, unearthing and elucidating paternal depression may reveal avenues by which offspring’s mental health may be protected and improved.

About the study

The present study was designed respecting the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) reporting guidelines.

Researchers began by collating literature pertaining to depression associations between fathers and their children from five electronic databases, namely PsycInfo, Web of Science, Embase, Scopus, and PubMed. Databases were searched from database inception until December 15, 2022, which yielded 16,699 potential publications.

Title, abstract, and full-text screening was conducted on these potential publications, using the following inclusion criteria: “(1) was based on humans; (2) written in the English language; (3) conducted using observational study design—case-control, cohort, and cross-sectional study designs; (4) examined the association between paternal depression and risk of depression in offspring; and (5) estimated the association using odds ratio (OR) or relative risks (RR) or reported data to calculate the effect estimates.”

Title and abstract screening identified 34 potential citations. Full-text screening resulted in 16 studies for the systematic review and 14 for the meta-analysis. Data from these studies was extracted following PRISMA guidelines by two independent researchers. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of included citations.

Data synthesis and analysis were done using summary ORs where available and derived ORs where they were not. First, conventional meta-analysis was employed on pooled summary ORs, following which a cumulative meta-analysis was employed to determine how pooled data changed over time.

Cochrane Q and I² tests were used to measure the degree of heterogeneity across included studies. For downstream analysis, researchers considered I² values of 25%, 50%, and 75% as low, medium, and high heterogeneity, respectively.

The Egger test and funnel plots were used to investigate any potential inherent publication bias. Subgroup analyses wherein the influence of confounding variables (study design, outcome diagnosis, timing of exposure) was investigated and adjusted for, and study quality assessment was computed.

Finally, study sensitivity analyses were performed using the leave-one-out methodology. Studies were excluded individually, and pooled effects for the remaining studies were reassessed.

Study findings

The present study included 16 observational studies comprising 7,153,723 father-child dyads published between 2002 and 2021 as the final dataset. Of these, 14 were cohort studies, with the remaining two cross-sectional studies excluded from the meta-analysis. Sample sizes in included studies varied from 220 to 4,138,151 dyads.

Results from the NOS tool revealed that 12 included studies were high quality, while the remaining two were moderate quality. Parental age and the child’s sex were identified as the most frequently adjusted confounding variables.

Meta-analysis results suggest that 11 studies reported significant correlations between paternal depression and increased depression risk in their offspring. The random effects models elucidated that depression risk was 42% higher in children exposed to paternal depression than in those without paternal depression exposure. These results were confirmed by and consistent with cumulative meta-analysis results.

Stratified analyses revealed that fathers clinically diagnosed with depression showed stronger positive associations with subsequent offspring depression (OR = 1.65) compared to fathers self-diagnosed using symptoms (OR = 1.12).

However, irrespective of diagnosis methodology, paternal depression was always found to be related to the subsequent risk of offspring depression. Exposure duration analyses revealed that lifetime exposure to a father with depression (OR = 1.58) had larger effect sizes than when exposure was just postpartum (OR = 1.05) or during early childhood (OR = 1.22).

Sensitivity analyses revealed that between 35% and 45% of fathers with depression had children who also suffered from the condition.

Paternal depression was associated with subsequent offspring depression. This finding shows the intergenerational transmission of mental health problems and suggests that mental health interventions benefit not only the patient but also the family as a whole, including both parents.

Dachew et al. (2023)

Conclusions

While the relationship between maternal health conditions and offspring depression risk has been extensively investigated, the association between paternal depression has been left understudied, with the few available results being confounding in their outcomes.

In the present study, researchers used a large-scale systematic review and meta-analysis to evaluate the association between depression in fathers and the subsequent risk of depression in their offspring.

Their dataset included 16 studies with a combined sample population of 7,153,723 father-child dyads. Random mixed effect models revealed a 42% higher risk of depression in offspring whose fathers were also depressed. The strength of this interaction increased based on diagnosis type (clinical versus self) and exposure duration (lifetime versus postpartum or early childhood).

These findings suggest the importance of addressing maternal and paternal mental health issues using a family-focused approach to reduce the adverse effects on offspring mental health and cognitive development rather than the conventional gender-focused approach limited to maternal prenatal and postnatal mental health issues or individual treatment of the offspring. The potential underlying mechanisms linking paternal depression with offspring depression warrant further studies.

Dachew et al. (2023)