Postnatal Depression in Fathers

CHAPTER 1 LO1

1.1 Research specification Outline

Introduction

This project will explain postnatal depression in fathers highlighting some of the causes and symptoms that can lead to Post-Natal Depression (PND) including the effect on dads and relationships. The (NCT.2017) defines that an estimated 10% of new mums suffer from PND and it is now also recognised that dads can experience PND, sometimes called Paternal depression, and either parent is likely to be affected by concerns about the other.

Aim:

This project goal is to find out how does postnatal depression affect fathers and what methods is used to ensure a person-centred approach when it comes to caring for a client with postnatal depression.

Objectives are:

1. What are the Common symptoms?
2. How does postnatal depression affect fathers and relationships?
3. Treatment for Paternal postnatal depression (Recommendations).

Rationale:

The reason for choosing postnatal depression in fathers is because postnatal depression in dad has been overlooked by many practitioners and could have an impact on relationships break-down in families’ relationship. Also, as mum can have the baby blue after pregnancy and noticing that many changes come with having a baby like physically, emotionally, mentally and social changes. Depression in dad can affect relationships after the birth of the baby. Also as a practitioner working with babies and children from 0-5 and their parent and often wonder about the effect postnatal depression can have on mums and dads. Most of the time care professional in health care setting seem to show a lot more interests when it comes to mum and baby, but not so much the into the fathers.

Methods – the use of secondary research with existing evidence in the literature on PND.  I will search Medline, PubMed, Google scholar for articles in English that would fit my topic and objectives.

Data Analysis – I will analyse information about post natal depression from different articles. This will be presented in a tabular format to show similarities and differences between research works.

Plan – To complete this within 6 months

Budget – No financial requirement for this project as all information.

Identify the factors that contribute to the process of research project

Limitations:

First of all, it was really hard to choose the subject of my research project as it was first time I was doing it. I wanted to choose something interesting and new. I was willing to use a primary research project method but unfortunately because of my main aim of research project I could i thought i could do it. To prepare a questionnaire and find appropriate people for the research will be difficult. I would need more than three years to analyse postnatal depression and how it affected the father and relationship. Also, it is hard to analyse relationships and I would need specialists to work with them which would be too expensive and limits me financially. As a result of these limitations at this stage, I prefer secondary research method. However, it also requires some money as I will need to visit libraries and rent journals. For this method, I will need to analyse papers which are already published. Another reason why I chose this method for the subject is statistics. Since the figures already exist, I will not need to do any sophisticated analysis.

Ethical consideration

I do not need ethical permission for this research since i have already publised papers. I need to maintain Confidentiality and respect for cultural differences in any case study I quote from.  In need to follow policies and procedures. (Duijnhoven, 2008).

Other Limitations

There may be significant methodological limitations of existing studies, including small sample sizes; the use of cross-sectional projects; different measures of depression; focus on depression in the postpartum only; and in the few research studies, the addition of only one valuation point. The confines of the current systematic review include the inclusion of only papers written in English and likely publication bias, where studies with null findings are less likely to be published (Johansson, 2016)

Full research specification

Title: Postnatal Depression in fathers.

Aim:

This project goal is to find out how do postnatal depression affect fathers and methods is used to ensure a person-centred approach when it comes to caring for a client with postnatal depression.

Objectives are:

1. What are the Common symptoms?
2. How does postnatal depression affect fathers and relationships?
3. Treatment for Paternal postnatal depression (Recommendations).

Rationale:

The reason for choosing postnatal depression in fathers is because postnatal depression in dad has been overlooked by many practitioners and could have an impact on relationships break-down in families’ relationship. Also, as mum can have the baby blue after pregnancy and noticing that many changes come with having a baby like physically, emotionally, mentally and social changes. Depression in dad can affect relationships after the birth of the baby. Also as a practitioner working with babies and children from 0-5 and their parent and often wonder about the effect postnatal depression can have on mums and dads. Most of the time care professional in health care setting seem to show a lot more interests when it comes to mum and baby, but not so much the into the fathers.

Symptoms of depression found in 6.3% of the fathers and 12.0% of the mothers and the point prevalence of major depression in fathers were 1.3%. The strongest correlates of depressive symptoms in fathers were problems in the partner relationship, a low educational level, previous depression, stressful life events and low partner support (Johansson et al. 2016).

Literature review

In this study, systematic research reviews were carried out by searched available publications on electronic databases. The review includes qualitative or quantitative methods to investigate postnatal depression in fathers. According to Thomas (2016), Postnatal depression (PND) refers to the onset of depression after the birth of a child in the family. It may occur after the first or subsequent births. However postnatal depression takes place in 1.25-25 percent of fathers, and it can contribute to poor outcomes in fathering and in the child’s health.

However postnatal depression can also affect man from the birth of the baby associated with the increased independent risk of adverse in the outcome of the child. Father with depression scored higher of a father of no depression fathers (Edmoridson et al.,2010). Also, fathers increasingly involved in infant also depression in postnatal father hurt the child development and behaviour. All high scoring father and a random sample of fathers scoring low were invited for a diagnostic interview to assess the presence of any depression or anxiety disorder Hwang, (Massouoli and Wickbery, 2013)

However, the most common correctable of paternal depressive symptoms pre-and post-birth was having a partner with elevated depressive symptoms of depression poor relationship satisfaction was also frequently associated with elevated depression symptoms of depression in men (Milgrom et al., 2011).

 The substantial heterogeneity observed among rates of paternal depression, with a meta-estimate of 10.4% (95% confidence interval [CI], 8.5%-12.7%). Higher rates of depression reported during the 3- to the 6-month postpartum period (25.6%; 95% CI, 17.3%-36.1%). The correlation between paternal and maternal depression was positive and moderate in size (r = 0.308; 95% CI, 0.228-0.384). No evidence of significant publication bias was detected (Paulson. et al. 2010).

The death of Child L in 2012 at Hull Royal Infirmary provides a background upon which the issue of maternal depression and its effect on child development should be studied. According to Cantrill (2013), Child L was only five weeks old upon death and the post-mortem revealed that death had occurred as a result of a severe fracture of the skull. Nevertheless, the police considered the death of Child L to be suspicious and arrested the mother (Adult N) on suspicion of murder. As the investigation and court proceeding progressed, Adult N accepted the charge of infanticide caused by maternal depression. Later investigations revealed that Child L’s mother had previously reported to her GP that she was undergoing stress and could barely manage her duties as a mother. Under the circumstances, the GP had diagnosed her condition to be depression (Beck, 2013). Unfortunately, the GP did not escalate the issue, and Child L died in the hands of her mother. Therefore, maternal depression was to blame for the death of Child L.

Mother – child relationship and emotional development

The relationship an infant has with its mother has a support on intellectual and personality development of the child (Cogill et al. 1986). Psychiatric disturbances in the parent can thus contribute to how children begin to develop behavioral disorders. When women experience childbirth, they face the highest likelihood of going through psychiatric disturbances; in the home is the possibility of marital discord, other children in the house, and even social disadvantage.

Women who are depressed and concurrently have infants to care for are likely to be immobilised and unable to conduct their duties as mothers (Cogill et al. 1986). Mothers provide very critical influences that are essential for a child’s development, e.g. conversation and play, but these may be severely lacking in situations of maternal depression. In essence, maternal depression can have a significant effect on the interactions mothers have with their children. This can affect child’s development (Cogill et al. 1986).

According to Murray and Cooper (1997), three aspects of infant development have been examined in relation to postnatal depression in their mothers. Firstly, the quality of communication between an infant and its mother has been the subject of study. In mothers with postnatal depression, it has been found that their children are less sociable, had reduced levels of interactive behaviours, as well as low levels of affective sharing compared to children of mothers without prenatal depression. Secondly, infant attachment has been measured using the Ainsworth strange situation procedure (Murray and Cooper 1997). Through this method, insecure infant attachment has been evidenced among infants of mothers with prenatal depression. Thirdly, behavioural problems have been reported among mothers with prenatal depression; they include temper tantrums, difficulty eating and sleeping, and difficulties with separation. Thus, the emotional development of children of mothers with prenatal depression has been found to be poor. The fact that maternal depression may predict depressive disorder among infants has prompted studies to understand the biological mechanisms causing one generation to affect another. Such studies have targeted the hypothalamic pituitary adrenal (HPA) axis, what is known to play a role in how human responds to stress, especially depression (Barry et al. 2015). Since the HPA axis regulates the concentration of basal cortisol (hormone), such levels may rise when there is depression in both adults and children. Not surprisingly, a twenty-two-yearlong study among participants raised by mothers suffering from postnatal depression found that cortisol reactivity to be higher in the group undergoing the test than in the control group. In essence, exposure to maternal depression at an early age can lead to a higher likelihood of more biological sensitivity resulting from social stress during adult years (Barry et al. 2015). The death of Child L in 2012 at Hull Royal Infirmary provides a background upon which the issue of maternal depression and its effect on child development should be studied. According to Cantrill (2013), Child L was only five weeks old upon death and the post-mortem revealed that death had occurred as a result of a severe fracture of the skull. Nevertheless, the police considered the death of Child L to be suspicious and arrested the mother (Adult N) on suspicion of murder. As the investigation and court proceeding progressed, Adult N accepted the charge of infanticide caused by maternal depression. Later investigations revealed that Child L’s mother had previously reported to her GP that she was undergoing stress and could barely manage her duties as a mother. Under the circumstances, the GP had diagnosed her condition to be depression (Beck, 2013). Unfortunately, the GP did not escalate the issue, and Child L died in the hands of her mother. Therefore, maternal depression was to blame for the death of Child L.

Mother – child relationship and emotional development

The relationship an infant has with its mother has a support on intellectual and personality development of the child (Cogill et al. 1986). Psychiatric disturbances in the parent can thus contribute to how children begin to develop behavioural disorders. When women experience childbirth, they face the highest likelihood of going through psychiatric disturbances; in the home is the possibility of marital discord, other children in the house, and even social disadvantage.

Women who are depressed and concurrently have infants to care for are likely to be immobilised and unable to conduct their duties as mothers (Cogill et al. 1986). Mothers provide very critical influences that are essential for a child’s development, e.g. conversation and play, but these may be severely lacking in situations of maternal depression. In essence, maternal depression can have a significant effect on the interactions mothers have with their children. This can affect child’s development (Cogill et al. 1986).

According to Murray and Cooper (1997), three aspects of infant development have been examined in relation to postnatal depression in their mothers. Firstly, the quality of communication between an infant and its mother has been the subject of study. In mothers with postnatal depression, it has been found that their children are less sociable, had reduced levels of interactive behaviour, as well as low levels of affective sharing compared to children of mothers without prenatal depression. Secondly, infant attachment has been measured using the Ainsworth strange situation procedure (Murray and Cooper 1997). Through this method, insecure infant attachment has been evidenced among infants of mothers with prenatal depression. Thirdly, behavioural problems have been reported among mothers with prenatal depression; they include temper tantrums, difficulty eating and sleeping, and difficulties with separation. Thus, the emotional development of children of mothers with prenatal depression has been found to be poor.

The fact that maternal depression may predict depressive disorder among infants has prompted studies to understand the biological mechanisms causing one generation to affect another. Such studies have targeted the hypothalamic pituitary adrenal (HPA) axis, what is known to play a role in how human responds to stress, especially depression (Barry et al. 2015). Since the HPA axis regulates the concentration of basal cortisol (hormone), such levels may rise when there is depression in both adults and children. Not surprisingly, a twenty-two-yearlong study among participants raised by mothers suffering from postnatal depression found that cortisol reactivity to be higher in the group undergoing the test than in the control group. In essence, exposure to maternal depression at an early age can lead to a higher likelihood of more biological sensitivity resulting from social stress during adult years (Barry et al. 2015

Methodology for data collection

There are a number of methods that are used in qualitative research for data collection. They include being an active participant in the research setting, being and observer, conducting interviews, or collecting and analyzing articles on the subject under study (Marshal & Rossman 2006). This study has elected to do the latter; collect and analyse secondary data through a narrative review of the literature

Secondary data collection through review of literature

According to Andrews, Higgins, Andrews and Lalor (2012), secondary data is data which is already in existence. This makes the job of a secondary analyst simpler because participants do not have to be recruited and the researcher does not have to be involved in the collection of data. In effect, analysing secondary data is a method which uses data already in existence either in quantitative or qualitative form to verify previous research or examine new research questions. It may not be necessary that secondary data is used for its previous purpose. Rather, it may be utilised for another purpose.

Secondary data collection can be used to aggregate a number of studies so that key issues can be understood and to use the results to arrive at new ways of conceptualizing the issue under study (Andrews et al. 2012). Through a literature review, therefore, new research questions can be applied. In addition, existing research can be refined, refuted, and verified. Significantly, the same data obtained from the literature review can be used to analyse an issue from a different viewpoint.

An important reason for selecting the secondary data collection method is the fact that a sample which is difficult to reach or an issue which is sensitive is better analysed through secondary data analysis (Andrew et al. 2012). In addition, this method is beneficial because original research may be easier to verify thus controlling for quality, and enhancing trustworthiness, transparency, and credibility of the original research results.

Most of all, collecting secondary data saves time and resources that are usually needed in primary data collection methods (Andrew et al. 2012). For example, primary data collection may involve the use of a devise for recording, transport, as well as costs associated with transcription. Most importantly for this study, analysing secondary data enables beginners’ researchers to learn and be taught. In fact, learners can experiment through experiential learning, thus protecting live participants while engaged in the learning (Andrew et al. 2012).

Data analysis – Synthesising and analysing the data

According to Cronin, Ryan & Coughlan (2008), it is a requirement for nurses to conduct a literature review sometime in their career, either in school or in a research process, or when involved policy and development of clinical practice. Conducting a literature review means that the subject must be searched and retrieved, and the resulting data should be synthesised and analysed in a short period of time. The latter is one reason that a review of the literature has been preferred in this study. Accordingly, data analysis will be conducted in the following manner.

• The data will first be indexed and summarised. This involves compiling the following data from each article:

• Author
• Title of the article
• Findings and outcomes
• Purpose of research
• Methodology of research

• The research objective will be applied for each article

A summary of the findings from these researches will be used to generate a discussion around the topic with recommendations for improvement.

Scope

This study will be conducted to determine the extent to which PND affects fathers and relationship. The issues that will be addressed include statistics of women who experience postnatal depression in the UK, the behaviours mothers’ exhibit to their children when undergoing postnatal depression, incidents resulting from postnatal depression, and long-term effects of postnatal depression on the father. Notably, all these issues will be confined to postnatal depression occurring in the UK within the last ten years.

Limitations

There are several limitations in this study. Firstly, the study relies on secondary data to analyse and draw conclusions; secondary data can be perceived to be second hand data and the selection of articles to include can similarly be perceived as subjective. Secondly, as in all types of qualitative research, a review of the literature relies on the conclusions the researcher will draw. This is also subjective. Thirdly, a narrative review does not allow for synthesis of a large number of studies. If it were possible; more generalisable conclusions can be drawn from a large number of articles. In this review, the number of articles is fourteen. It also required financial resources to buy some of those articles. In researching independent for qualitative/ quantitative research and collect data from my place of work on policies and procedure around potential depression. There were significant methodological limitations of existing studies, including small sample sizes; the use of cross-sectional projects; different measures of depression; focus on depression in the postpartum only; and in the few research studies, the addition of only one valuation point. The confines of the current systematic review include the inclusion of only papers written in English and likely publication bias, where studies with null findings are less likely to be published. (Johansson, 2016)

PLAN OF ACTIVITIES

Planned cost/Budget

This research was part of a college project which widens my understanding of post-natal depression in fathers. I may not incur any cost except if i need to get access to full articles that may not be online. I have budgetted about £100 for this. All the printing and online article will be given by the school at no extra cost. I will conduct this work on my own and will not require the assistance of any specialist.

 Chapter 2 Research Methodology: LO2

I am looking at postnatal depression in fathers.In this study, systematic research reviews were carried out by searched available publications on several electronic databases (Hick, 2006).

 The reference lists included studies were also examined to identify studies found in the electronic database search. The databases used are, PubMed, CINAHL, Web of Science, science direct and PsycINFO, Medline and AMED, EBSCOhost and Wiley online library, were searched. The literature review included studies with using either qualitative or quantitative method to investigate issues related to postnatal depression in men. Recent research from 2005–2017 included, and the review comprised the policies and other applicable confidential documents, articles, journals, books and internet resources to provide up-to-date information on postnatal depression (Hicks, 2006). The advantage of using qualitative research methods is that they provide flexibility in combining observation and analysis of facts; moreover, they allow behaviour, experience and meaning to explored in the literature. They allow insight into individuals’ experience in investigating the chosen topic. Another advantage of using qualitative methods in primary research is that they allow exploration of the subject (May and Pope, 2006). They can be used to separate attitudes, opinions, behaviours and other defined variables and generalise result from a sample to a wider population (May and Pope 2006).

This is a narrative review which has searched for academic articles and other relevant sources such as books. The intent of this study is to find peer reviewed journal articles and other academic sources focusing on postnatal depression among fathers in the UK.

Inclusion Criteria

The following are the inclusion criteria:

• All articles must be in the English language
• Articles are not limited in study design; they can be quantitative or qualitative
• The key words postnatal depression and paternal depression are utilised in different combinations as search terms
• Articles must have a bearing on depression among fathers in UK and/or its impact on offspring and family relationships

Exclusion criteria

• Articles which do not indicate from the abstract or title that they are focused on depression in fathers are excluded
• Articles which have a focus on depression; post-partum but do not originate from the UK are eliminated
• Articles older than 15 years are excluded

The process above is illustrated below:

Validity and reliability

According to Noble and Smith (2015), findings of a study can be assessed for reliability if the methods that have been used and the conclusions reached are judged to be appropriate. Qualitative research is usually criticised for little scientific rigor, poor justification of methodology, opaque procedures of analysis, and the fact that conclusions reached are subjective and prone to researcher bias. Even though measures and tests applied in quantitative research for validity and reliability cannot be used in qualitative research, these terms are contextually applicable. In that sense, validity is a measure of the reliability of methods that have been used and the relationship of findings with data. On the other hand, reliability is a measure of how consistent the procedures for analysis have been (Noble & Smith, 2015).

These views are supported by Brink (1993) who argues that a qualitative study will be found to be trustworthy and credible if attention is paid to issues of validity and reliability. In his view, validity and reliability are very important in qualitative studies because they are prone to a researcher’s subjectivity which can possibly cloud how data is interpreted. In such a situation, the findings can be taken sceptically by academics. As such, it is imperative that strategies for overcoming factors that pose risk to the validity and reliability of conclusions are implemented. However, Brink (1993) posits the view that qualitative research uses descriptions such as trustworthiness, credibility, and consistency in place of the terms validity and reliability.

In this study, therefore, risks to validity and reliability have been overcome in the following way: Since the researcher can be a source of error through researcher bias (Brink 1993), the researcher in this study has attempted to be as objective as possible. This researcher has also spent some time in the clinical setting as suggested by Brink (1993) as a means to understand the phenomenon under study prior to collecting data. Importantly, the methods used in this study have been explained clearly, including how data has been collected. In addition, a number of data sources have been used. These include journal articles, other scholarly sources, government websites, and credible news articles.

This study has used a “thick description”, described by Brick (1993) as that which gives a detailed account of the procedures used from the beginning to the end. In that respect, this author has explained initial interest in the study, the aims, and objectives of the study, and how the data has been collected.

Chapter 3 Results and Discussion

Information from various researches has revealed that depression was present not only in mothers but also in fathers. The most important correlates of depressed mood in men were as follows: the level of women’s depression, the high discrepancy between prenatal expectations and experiences related to family and social life after childbirth, and low satisfaction with the marital relationship.

Looking at research on the common symptoms the effect it has on relationships and treatments for postnatal depression. Postnatal Depression (PND) However, new fathers, are often not recognised or thought to deserve treatment. However, it is a significant cause of psychological distress and may result in physical symptoms, deterioration in family relationships, negative father-baby bonding, and domestic violence, as well as substance abuse and addiction. (Thomas. 2016)

The causes of PPND are varied, ranging from the presence of marital dissatisfaction before the birth of the baby to comorbid mental health conditions such as obsessive-compulsive disorder. These may hinder proper father-infant bonding, contribute to increased stress after the baby’s birth, result in negative thoughts about the baby, and lead to an overall decline in the functioning of the father in the family. (Thomas. 2016)

Moreover, sex: For most couples, intimacy and the frequency of intercourse changes or weeks or months after having a baby. After delivery, there is common discomfort and pain with intercourse for women, and most couples are exhausted after sleepless days and nights of caring for a newborn. Combine that with the demand of breastfeeding for those who go this route, and many couples will spend much less time being intimate. In fact, one study showed that 50% women and 20% men report reduced sexual responsiveness for 6-12 months postpartum (NHS Choice 2015).  Moreover, one-third of couples with a report this 2/3 years after birth. Women who are struggling with depression will have an extra challenge here as lowered libido is one of the general symptoms of depression and at times a side effect of antidepressant medication. (Kripke, 2011)

Depression in the mother increases the risk of paternal PND by a factor of 2.5, leading to an incidence of 24-50 percent in fathers. Thus, it is important to provide support for both parents in a family where maternal PND is present and to actively explore the possibility of PND in the father in such settings. Men are less likely to speak about or even recognise such feelings, and they may, therefore, need more assistance to seek intervention promptly (Thomas, 2016)

According to (Ramachandran et al., 2008) What symptoms to look for and how long after and during pregnancy does it affect fathers. Children whose fathers were depressed in both the prenatal and postnatal periods had the highest risks of subsequent psychopathology, measured by total problems at age 3½ years Odds Ratio 3.55; 95% confidence interval 2.07, 6.08 and psychiatric diagnosis at age seven years or 2.54; 1.19, 5.41.  Therefore, few differences emerged when prenatal and postnatal depression exposure directly compared, but when compared to fathers who were not depressed (Bazemore, 2010).

Boys whose fathers had postnatal depression had higher rates of conduct problems aged 3½ years or 2.14; 1.22, 3.72 whereas sons of the prenatal group did not or 1.41; .75, 2.65. These associations changed little when controlling for maternal depression and other potential confounding factors. Postnatal depression is most likely to affect dads during the first year of parenthood (Bazemore, 2010)

Dads appear to be most vulnerable to depression when their baby is between three months and six months’ age of dad can play a part as a young dad are a more likely to become depressed (Baby Centre Medical Advisory Board, 2014). However, the hypothesis is more than 10% of fathers suffer from psychiatric morbidity in the postnatal period. Depression amongst fathers associated with having depressed partners, having an unsupportive relationship and being unemployed (Baby Centre Medical Advisory Board, 2014)

Paternal postpartum depression may affect not only the mental health and wellbeing of fathers but their partners and children. We investigated the point and period prevalence of paternal postpartum depression and its association with factors measured during pregnancy in a regional longitudinal study in Nishio City, Aichi Prefecture, Japan, between December 1, 2012, and April 30, 2013. Data were collected once in pregnancy and five times in the first three months postpartum (Suto et al., 2016).

The Edinburgh Postnatal Depression Scale was used to assess parental depression, and data collected in pregnancy on demographic and psychosocial factors. Of 215 fathers who returned at least one of the five postpartum assessments, 36 (17%) reported symptoms of depression in the first three months after birth. In logistic regression analyses, among some demographic and psychosocial characteristics that previously had linked to paternal postpartum depression, only fathers’ history of psychiatric treatment and depressive symptoms during pregnancy were associated with paternal depressive symptoms in the postnatal period. (YiongWee, 2010)

The results add to the growing body of evidence on the prevalence of paternal postnatal depression and indicate that assessment and support for fathers are necessary starting in pregnancy (Massoudi et al., 2016). It most likely that parents who are affected by postnatal depression occurred within the first year of parenthood. Between three months and six months, it plays a big part where the dad needs to adjust everyday life which can make them feel overwhelmed.

They can become stress because of increased responsibility, and they take on more pressure with supporting their families. They have less spare time for them self because they need to develop a new routine around the baby. Which then affect their social life, they then feel isolated. Spending less time with their partners because mums are more focussing on baby and they start to feel life out and becoming unsure of their roles as dads. Also, can bring changes in the relationship which leads to arguments and stress (Edmondson, 2010).

Therefore, in some changes that fathers may experience in their body are a loss of appetite, tearfulness, poor sleep, restlessness, poor memory or concentration. Therefore, may also notice changes in their behaviour like finding it difficult to bond with their baby and participating in everyday family activities. Because of how they feel, cutting himself away from their families and friends, finding it difficult to see the fun side of the situation, getting obsessive with certain routine around the house like cleaning and doing physical activities (Massoudi et al., 2016).

 Also putting a plan in action, take a timeout for 20-30 minutes a day, going for walks with mum and baby as a family who can help to settle the baby and can be therapeutic for both dad and mum. Also talking to the family general practitioner (GP) who can offer guidance and help to the family . also can prescribe medication if needed,  such as antidepressant that can help with symptoms of depression. Also getting counselling or seeking therapy contribute who also can underline the factors that contribute to postnatal depression and aid to changes in feeling. (NHS Choice, 2015)

Project Outcomes: postnatal depression is most likely to affect dads during the first year of parenthood. Dads appear to be most vulnerable to depression when their baby is between three months and six months’ however the age of dad can play a part as a young dad are more likely to become depressed (Baby Centre Medical Advisory Board. 2014).

The most common correlate of paternal depressive symptoms pre- and post-birth was having a partner with elevated depressive symptoms, depression and poor relationship satisfaction was also frequently associated with elevated depressive symptoms and depression in men. (Milgrom et al., 2011)

Recommendations for the future

In using a planning outcome for this project is to develop an approach that encourages a person-centred approach in dealing with dads that have postnatal depression. Moreover, to provide staff with the information to prevent outburst behaviour in the work setting.

This project will enable my development, more understanding and awareness of postnatal depression in men and explores what risk associated with the support needed for dads. Also, to give guidance to help dads and the role the early year practitioner plays in the deterrence of postnatal depression.

I would also evaluate my understanding to develop my knowledge around this project, and my learning needs enhance strategies to support dad who use our childcare provision to prevent further currents in depression.

Also by completing a self-evaluation of an understanding of my development needs to give further support where needed however to review the resources of myself learning needs, and the use of advice and tip from my tutors to prepare me for independent study. Also by using a structured time frame, and use a planning solution to any problem risen. By use of articles, books, the internet, booklets, library facilities, feedback from the class teacher, journals, manager assistance, trainer input, discussion with colleagues. Considering Policies and the well-being of families. Eventually to encourage staff to be a life-long learner.

Also, to develop and gather more in-depth information, in widen the understanding and support the emotional side of this topic, and the way in going forward in promoting a good standard of service. Also using of my development tools through supervision and appraisals, working practice, communication within the multi-disciplinary team. Moreover, the practice based evidence of parent in postnatal depression issues.

Also, to use some of this research information to help and support our new fathers in the future and my current workplace. Working together with information centres to gather feedback information to parents who are having difficulty in working together in picking up the children and having confrontation regard relation. Also, to identifying training needs for staff so they can have better knowledge and understanding of postnatal depression so they can support dads and inform them where to access help.

Recommendations Several general principles underpin the process of postnatal depression in men, and some have studied in randomised trials and systematic reviews. Substantial evidence supports multidisciplinary team in support men with postnatal depression. Research on integrated care pathways is limited by the lack of randomised trials in postnatal depression in men, suggesting that such formal paths might be no more effective than support from a well-functioning multidisciplinary team. Good support outcomes seem to associate with high patient motivation and engagement firmly in working together in parental partnership. Setting goals that replicate the specific aims of an individual may improve outcome, although no extensive published work yet exists on goal setting in postnatal depressive support for men.

Conclusion

In conclusion to this research in general, about one to ten fathers have postnatal depression which can sometimes be hard to find so to make improvements on supporting dads in general, health visitors, and midwives should develop a care plan where it supports both mums, dads within the first year of baby life. They should implement transferability strategy into the training and home visiting to guide staff of awareness of postnatal depression in fathers.

Reference list

Baby Centre Medical Advisory Board. 2014. Postnatal Depression in dads. http://www.babycentre.co.uk/a1046187/postnatal-depression-in-dads. Access online 17.02.17

James F. Paulson, PhD; Sharnail D. Bazemore, MS JAMA. 2010;303(19):1961-1969. doi:10.1001/jama.2010.605

Johansson, Maude, et al. “Depressive symptoms and parental stress in mothers and fathers 25 months after birth.” Journal of Child Health Care (2016): 1367493516679015.

Johansson

 M, Svensson I, Stenström U, Massoudi P. (2016) Depressive symptoms and parental stress in mothers and fathers 25 months after birth. Journal of Child Health Care. 2016:1367493516679015.

Maiko Suto, Emi Isogai, Fumino Mizutani, Naoko Kakee, Chizuru Misago, Kenji Takehara, Prevalence and Factors Associated with Postpartum Depression in Fathers: A Regional, Longitudinal Study in Japan, Research in Nursing & Health, 2016, 39, 4, 253

Pamela Massoudi. C. Philip Hwang. Birgitta Wickberg. 2016 Fathers’ depressive symptoms in the postnatal period: Prevalence and correlates in a population-based Swedish study. Scandinavian Journal of Public Health.journals.10.1177/1403494816661652

NCT 1^st 1,000 Days new Parent. 2017.Postnatal depression in Fathers. https://nct.org.uk/parenting/postnatal-depression-dads. Access online 01/08/17

NHS Fife Department of Psychology. 2015.Depression in Dads. http://www.moodcafe.co.uk/media/14163/Rv%20Post%20Natal%20Depression%20in%20Dads%20pdf.pdf. Access online 01/08/17

Liji Thomas. 2016. News medical life sciences. Can postnatal depression occur in fathers? https://www.news-medical.net/health/Can-Postnatal-Depression-Occur-in-Fathers.aspx. Access online 07/08/2017

Kate Kripke. 2011. How Postpartum Depression Affects your marriage or partnership. http://www.postpartumprogress.com/how-postpartum-depression-affects-your-marriage-or-partnership. Access online 07/08/17

Pope, C. and Mays, N.(eds) (2006) Qualitative research in health care. 3^rd ends. Malden, MA: Wiley-Blackwell (an imprint of John Wiley & Son Ltd).

Hicks, C.M. (1999) ‘Research Methods for Clinical Therapists: Applied project design and analysis. 3^rd edn. Edinburgh, Churchill Livingstone.

Kim YiongWee.2010. Correlates of ante- and postnatal depression in fathers: A systematic review .https://doi.org/10.1016/j.jad.2010.06.019. 22.08.2017

Pamela Massoudib. 2013. How well does the Edinburgh Postnatal Depression Scale identify depression and anxiety in fathers? A validation study in a population based Swedish sample. https://doi.org/10.1016/j.jad.2013.01.005.  Access online 22.0.2017

Olivia J.H. Edmondson.2010. Depression in fathers in the postnatal period: Assessment of the Edinburgh Postnatal Depression Scale as a screening measure. https://doi.org/10.1016/j.jad.2010.01.069. Access online 22.0.2017