1 Hopcroft RL

Dana Burr B The sex difference in depression across 29 countries. 2 Underwood L

Waldie KE

Peterson E

et al. Paternal depression symptoms during pregnancy and after childbirth among participants in the Growing Up in New Zealand Study. 3 Ramchandani PG

Stein A The impact of parental psychiatric disorder on children. Avoiding stigma, improving care. Almost one in ten men will experience depression at some time in their life. Although there is evidence that partnered (and particularly married) men are at lower risk of depression than are the general male population,rates of depression among fathers are difficult to estimate on the basis of existing evidence.Fathers might not be exposed to the same risk factors for depression as mothers, but they do experience a range of biopsychosocial stressors that might affect their mental health and also have indirect effects on their partners, their children, or both.

4 Stein A

Pearson RM

Goodman SH

et al. Effects of perinatal mental disorders on the fetus and child. , 5 Ramchandani P

Stein A

Evans J

O'Connor TG Paternal depression in the postnatal period and child development: a prospective population study. , 6 Ramchandani PG

O'Connor TG

Evans J

Heron J

Murray L

Stein A The effects of pre- and postnatal depression in fathers: a natural experiment comparing the effects of exposure to depression on offspring. 6 Ramchandani PG

O'Connor TG

Evans J

Heron J

Murray L

Stein A The effects of pre- and postnatal depression in fathers: a natural experiment comparing the effects of exposure to depression on offspring. 7 Hancock KJ

Mitrou F

Shipley M

Lawrence D

Zubrick SR A three generation study of the mental health relationships between grandparents, parents and children. 8 Pihlakoski L

Sourander A

Aromaa M

et al. Do antenatal and postnatal parental psychological distress, and recognized need of help predict preadolescent's psychiatric symptoms? The Finnish Family Competence Cohort study. Regardless of prevalence or risk, there is now an increasing awareness of the role that paternal depression can have in child development and later psychosocial outcomes.That being said, high quality evidence to support the development of effective policy and intervention remains scarce. The effect of perinatal paternal depression on early childhood was shown by research with longitudinal data from the Avon Longitudinal Study of Parents and Children (ALSPAC) in the UK. Children (n=6449) whose fathers were depressed during the antenatal or postnatal periods had higher risk of emotional and behavioural problems than did those whose fathers did not have depression, when they were assessed at age 3·5 and 7 years.Similarly, in different samples of Australian 5–6-year-olds (n=4253) and 8–9-year-olds (n=4196), childhood social and emotional wellbeing was negatively associated with paternal psychological distress (as well as mental health problems among mothers and grandparents).A Finnish study of 1247 pre-adolescents found an association between paternal postnatal distress and internalising behaviour problems among their children at age 12 years.

9 Lewis G

Neary M

Polek E

Flouri E

Lewis G The association between paternal and adolescent depressive symptoms: evidence from two population-based cohorts. 8 Pihlakoski L

Sourander A

Aromaa M

et al. Do antenatal and postnatal parental psychological distress, and recognized need of help predict preadolescent's psychiatric symptoms? The Finnish Family Competence Cohort study. In this issue of The Lancet Psychiatry, Gemma Lewis and colleaguesprovide evidence that associations between paternal mental health and child outcomes persist and affect adolescents, as well as younger children.Adolescents from the Millennium Cohort Study (MCS; n=7768) and Growing Up in Ireland (GUI; n=6070) were assessed at age 13–14 years. After adjusting for child emotional symptoms, paternal depression symptoms were significantly associated with symptoms of depression in adolescents, as noted by an increase in Short Mood and Feelings Questionnaire score (GUI 0·24 points, 95% CI 0·03–0·45, p=0·023; MCS 0·18, 0·01–0·36, p=0·041). This study explores the clinical significance of the findings, reporting an increase of 0·03–0·04 of an SD in adolescent depression scores for each 1 SD increase in paternal depressive symptoms. This association was of a similar magnitude to that between maternal depressive symptoms and adolescent depression scores.

10 Underwood L

Waldie K

D'Souza S

Peterson ER

Morton S A review of longitudinal studies on antenatal and postnatal depression. 7 Hancock KJ

Mitrou F

Shipley M

Lawrence D

Zubrick SR A three generation study of the mental health relationships between grandparents, parents and children. It is notable that much of the research on the influence of parental mental health on child wellbeing has used data from population-based longitudinal studies from around the world(eg, ALSPAC, the Finnish Family Competence Study, GUI, Growing Up in New Zealand, the Longitudinal Study of Australian Children, and MCS). The design and execution of these studies provides high-quality, well-powered data that allow for a wide range of multi-generational moderators, mediators, and confounding variables from across the lifespan to be taken into account (especially when loss to follow-up is low).

9 Lewis G

Neary M

Polek E

Flouri E

Lewis G The association between paternal and adolescent depressive symptoms: evidence from two population-based cohorts. 11 Giallo R

Cooklin A

Wade C

D'Esposito F

Nicholson JM Fathers' postnatal mental health and child well-being at age five. , 12 Nath S

Russell G

Kuyken W

Psychogiou L

Ford T Does father-child conflict mediate the association between fathers' postnatal depressive symptoms and children's adjustment problems at 7 years old?. 2 Underwood L

Waldie KE

Peterson E

et al. Paternal depression symptoms during pregnancy and after childbirth among participants in the Growing Up in New Zealand Study. As Lewis and colleaguesacknowledge, the precise onset of depression symptoms in the adolescent participants and their fathers is not clear. This finding reflects a gap in the broader evidence base, resulting from methodological differences between studies that have measured paternal and child symptoms at different life stages and ages. Research that combines high quality data from these studies, and meta-analyses, which are able to investigate the complex longitudinal links between parental mental health, the parent–child relationship, and child mental health, are much needed.Underwood and colleaguesfound that, 9 months after childbirth, fathers who were no longer in a relationship with their child's mother were at increased risk of having postnatal depression symptoms. As such, it is important that studies do not exclude fathers who do not always live with their children.

Mothers have traditionally been seen as the vital nurturing influence on developing children, whereas fathers have been more commonly ascribed roles of the power figure, disciplinarian, or breadwinner for the family as a whole. Only relatively recently has the influence and input of fathers in children's early development been seen as essential for adaptive psychosocial and cognitive outcomes. There is increasing evidence that fathers' mental health affects their children's development, both directly and indirectly, from infancy. As such, it is crucial that depression symptoms are recognised and treated early in fathers as well as mothers. Understanding who is most at risk of developing depression symptoms could help health professionals design better methods to help the whole family. Particularly, relationship quality and the family environment appear to be key factors in parental depression, and therefore interventions for parents or their children should be family focused. Understanding the role of social support for fathers (another key area for intervention) and its potential to improve paternal mental health and, therefore, outcomes for children, is essential.

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