Strengths and limitations
This is a unique study reported the prevalence of paternal perinatal depression during the COVID-19 pandemic in Wuhan, China. And the result novelty reveled that traffic restriction in Wuhan was associated with decreased risk of paternal perinatal depression.
This study has several limitations. First, this cross-sectional design couldn’t reveal the causal relationships among factors. Second, this study was self-reported, thus the measurement accuracy of paternal depression and other related fathers was compromised. Third, the findings of this study targeted on fathers in hospitals and cannot be generalized to fathers during the entire perinatal period. Moreover, this study draw conclusion based on one hospital in Wuhan, multi-center studies was necessary to further address the risk factors of paternal depression.
The prevalence of paternal perinatal depression in Wuhan was higher than the global level of 5-10% (14, 15). Firstly, this variation of paternal perinatal depression prevalence might be explained by the different depression tool. On the other hand, fathers in different perinatal period and in different geographical distribution might also have contributed to the unequal prevalence of paternal perinatal depression. Moreover, the COVID-19 epidemic might have partly resulted in the high prevalence of paternal perinatal depression in Wuhan.
Critically, our study revealed that the prevalence of paternal perinatal depression before the announcement of human to human transmission comprised the highest proportion during the COVID-19 epidemic, and traffic restriction associated with relatively decreased risk of paternal perinatal depression in Wuhan. The elevated risk of paternal perinatal depression before the announcement of human to human transmission might be partly due to the concern of the obscure and uncertainty of COVID-19 epidemic. Traffic restriction as effective measures of COVID control, it might help to lower the paternal depression by gain more confidence on maternal and child protection from COVID-19 infection. This result possibly indicated that effective control measures adopted by officials might have positive effect to alleviate paternal depression.
Previous studies have found that family dysfunction is an important contributor to a wild range of depression among adolescents (16), students (17), caregivers and patients (18), and the elders (19). Women’s satisfaction from the family function was proved to be a significant factor protect against the occurrence of mental health disturbances (20). It was demonstrated that paternal depression was associated with an increased risk of family dysfunction of disharmony in partner relationships (21). This study further supported the point that fathers reported poor or fair of family function have a negative effect on the prevalence of perinatal depression during the COVID-19 epidemic. Further longitudinal studies are necessary to investigate the causal relationship on the effect of family function on paternal perinatal depression.
As another predictive factor of paternal depression, fathers reported low household incomes have a higher risk of paternal depression, which was in line with previous studies (22, 23). The coming of new baby might aggregate the financial pressure on fathers. However, this study demonstrated a relative low percent of fathers reported poor family income. This factor is dynamic and the income of maternal partners during pregnancy is often lower than the average level. With the improving in family income, the negative effect on paternal perinatal depression might considerably reduce.
E Juulia Paavonen et al reported that sleep disorders associated with 1.9 times of elevated risk of male depression during pregnancy (24). Deborah Da Costa et al demonstrated poor sleep quality was associated with postpartum depressive symptoms among first-time fathers (25). This study was further confirmed that sleep was a strong predictor of paternal depression in Wuhan. Paternal sleep quality might be compromised by pregnant partners’ irregular sleep behavior and extra caring for maternal health.
The relationship of maternal depression and smoking prepregnancy and prenatally was firmly established previously (26-28). This study interestingly showed that fathers have smoking or passive smoking behavior showed an elevated risk of perinatal depression. This relationship could be partly explained that the intake of nicotine by smoking or passive smoking has neurobiologic impact on the brain which related with depression (29).