The longitudinal effects of paternal perinatal depression on internalizing symptoms and externalizing behavior of their children: A systematic review and meta-analysis

Background: Perinatal depression is a major health issue which negatively affects individuals and families. Existing research has focused largely on maternal perinatal depression. Paternal perinatal depression (PDD) is similarly prevalent and warrants empirical attention. The objective of this systematic review and meta-analysis was to consolidate and quantify the longitudinal association between PPD and internalizing symptoms and externalizing behaviors in children. Method: In accordance with the PRISMA 2020 statement, we searched the databases PsycINFO, PubMed and CINAHL for articles reporting longitudinal associations between PPD and internalizing symptoms and externalizing behaviors in children aged between 1.5-18 years (PROSPERO reference CRD42020155527). Results: We included 10 publications, reporting 20 associations between PPD and internalizing symptoms and externalizing behavior in children (pooled father-child dyads: internalizing N = 45,512, externalizing N = 45,668). A random-effects model meta-analysis was used to analyze the associations. Internalizing symptoms in children (measured predominantly with the Child Behavior Checklist and the Strengths and Difficulties Questionnaire) was positively correlated with PPD (r = 0.24, 95% CI [.12, 0.35], p < .001). Externalizing behavior of children was also positively correlated with PPD (r = 0.14, 95% CI [.09, 0.19], p = .000) Limitations: This review is limited by the substantial heterogeneity that was found in both meta-analyses. We did not find any significant moderators. The depression measures used to assess PPD may not capture its unique presentation, which may have resulted in the pooled effect size estimates being higher or lower than the true effects. Conclusion: The current research finds that PPD is associated with later internalizing symptoms and externalizing behaviors in children. Interventions for depressed fathers as early as the antenatal period could assist in mitigating this effect.