Paternal Postpartum Depression Prevalence and Risk Factors: A Systematic Review and Meta-Analysis

Abstract

Introduction: Postpartum depression (PPD) in fathers is increasingly recognized but often undiagnosed. Prevalence estimates vary widely (2–25%), and risk factors may differ from maternal PPD. This meta-analysis aims to provide pooled prevalence and identify consistent risk factors.

Methods: We searched PubMed, PsycINFO, and Embase for community-based studies reporting PPD prevalence in fathers (using validated scales: EPDS, PHQ-9, BDI) within the first 12 months postpartum. Primary outcome: point prevalence of paternal PPD (cutoff-specific). Risk factors examined: maternal PPD, unemployment, low income, history of depression, poor marital satisfaction. Random-effects meta-analysis and meta-regression.

Results: Eighty-three studies (n=112,449 fathers) from 28 countries were included. Pooled prevalence of paternal PPD was 9.8% (95% CI 8.6–11.1%) at 3–6 months postpartum. Prevalence was highest in low-income countries (15.2%), intermediate in middle-income (10.1%), lowest in high-income (7.4%). Strongest risk factor: maternal PPD (OR 4.7, 95% CI 3.5–6.3). Other significant factors: history of depression (OR 2.8), unemployment (OR 2.1), low marital satisfaction (OR 2.4). Infant factors (colic, prematurity) were not significant. Heterogeneity was high (I²=78%), partially explained by screening tool and cutoff.

Discussion: Paternal PPD affects ~10% of fathers, approximately half the maternal rate. The strong association with maternal PPD suggests shared environmental stressors or contagion effects. Unemployment and marital dissatisfaction are modifiable targets. Limitations: lack of diagnostic interviews in most studies, underrepresentation of non-Western cultures.

Conclusions: Paternal postpartum depression is common and warrants routine screening, especially when maternal PPD is present. Couple-based interventions may be more effective than individual treatment.