Approximately 24% of mothers experience depression in the prenatal and postpartum periods,1 which has negative consequences for children and families. The American Academy of Pediatrics (AAP) recommends that pediatricians screen parents for depression during well-child care visits,2,3 but studies on screening for paternal depression have not been widely performed in pediatric clinics in the United States.

Methods

We estimated the prevalence of paternal depression using the Child Health Improvement Through Computer Automation (CHICA) system, a computer-based decision support system for pediatric health surveillance and management. CHICA operates in 5 community health care centers in Indianapolis, Indiana; most families attending CHICA clinics (72%) are covered by public insurance. In 2017, CHICA served almost 20 000 unique patients across 41 000 clinical encounters. We obtained institutional review board approval from the Indiana University School of Medicine, which granted a waiver of informed consent.

CHICA administers a patient-tailored, 20-item prescreening form (PSF) on a tablet to English- and Spanish-speaking parents in the clinic waiting room. The PSF screens for pediatric health conditions using questions selected from age-appropriate clinical guidelines and based on the child’s existing data. Data obtained through the PSF are merged with the child’s electronic health record data to generate a physician worksheet that consists of 6 personalized prompts designed to call the pediatrician’s attention to the child’s specific health risks during their clinical encounter.

We examined CHICA data from parents of children 15 months or younger from August 1, 2016, through December 31, 2017. During this period, we modified the PSF to include items that identified who answered the PSF and who attended the clinic visit (eg, mother, father, grandparent, or other). To assess maternal postpartum depression, the PSF also administers a modified 3-item version of the Edinburgh Postnatal Depression Scale (EPDS-3) every 90 days during the child’s first 15 months of life. The EPDS-3 has 95% sensitivity and 80% specificity to detect maternal depression in primary care settings.4 We classified respondents who endorsed any of the 3 items as screening positive for depression.

Results

We analyzed parent responses from 9572 clinic visits. Fathers attended 2946 (30.8%) of these visits and were the PSF respondents at 806 visits (8.4%). Fathers were less likely to be present when children were older, non-Hispanic black, and Medicaid eligible. Among fathers who answered the PSF, 36 (4.4%) screened positive for depression. This number was comparable to the overall proportion of mothers who screened positive (273 [5.0%]). Fathers comprised 11.7% of the proportion of parents who screened positive for depression.

Discussion

Guidelines from the AAP2 emphasize the role of pediatricians to detect maternal depression, but fathers have only recently been included in these efforts.3 As with mothers, depression in fathers negatively affects children’s development and behavior,3 making it a worthy target of identification and intervention efforts.

A limitation of our study is that CHICA assesses depression for only one visit attendee and may have missed cases of paternal depression when the father was present at the well-child care visit but not the PSF respondent. In addition, our study population, which was largely publicly insured, may not be representative of broader populations.

In our large population-based cohort, fathers frequently attended well-child care visits with their young children and screened positive for depression almost as often as mothers. The proportion of fathers who screened positive for depression in our cohort coincides with a previous report.1 Pediatric clinics are thus promising settings in which to address depression in both parents as part of a family-centered approach to care. Although studies have not explored a pediatric role in depression screening and referral from the fathers’ perspective, there is evidence that maternal postpartum depression can be adequately managed within pediatric primary care.5 Nevertheless, overall screening rates are low, and 80% of pediatric residents report not receiving any training to manage adult mental health problems.6 This finding underscores opportunities to educate physicians about the importance of depression in both parents and to develop strategies to integrate screening tools into routine care. Addressing these gaps could improve detection and treatment rates of postnatal depression in both mothers and fathers, which could be critical for ensuring the best possible outcomes for children and their families.

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Accepted for Publication: April 24, 2018.

Corresponding Author: Erika R. Cheng, PhD, MPA, Division of Children’s Health Services Research, Department of Pediatrics, Indiana University School of Medicine, 410 W 10th St, Health Information and Translational Sciences Bldg, Ste 2000, Indianapolis, IN 46202 (echeng@iu.edu).

Published Online: July 23, 2018. doi:10.1001/jamapediatrics.2018.1505

Author Contributions: Dr Cheng had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Cheng, Downs.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Cheng.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Cheng, Carroll.

Obtained funding: Downs.

Administrative, technical, or material support: Downs, Carroll.

Supervision: Downs, Carroll.

Conflict of Interest Disclosures: Drs Downs and Carroll are coinventors of the CHICA system. Dr Downs is a co-owner of Digital Health Solutions, a company created to license the Child Health Improvement Through Computer Automation software. No other disclosures were reported.