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).