James F. Paulson

Prenatal and Postpartum Depression in Fathers and Its Association With Maternal Depression: A Meta-analysis

CONTEXT It is well established that maternal prenatal and postpartum depression is prevalent and has negative personal, family, and child developmental outcomes. Paternal depression during this period may have similar characteristics, but data are based on an emerging and currently inconsistent literature. OBJECTIVE To describe point estimates and variability in rates of paternal prenatal and postpartum depression over time and its association with maternal depression. DATA SOURCES Studies that documented depression in fathers between the first trimester and the first postpartum year were identified through MEDLINE, PsycINFO, EMBASE, Google Scholar, dissertation abstracts, and reference lists for the period between January 1980 and October 2009. STUDY SELECTION Studies that reported identified cases within the selected time frame were included, yielding a total of 43 studies involving 28 004 participants after duplicate reports and data were excluded. DATA EXTRACTION Information on rates of paternal and maternal depression, as well as reported paternal-maternal depressive correlations, was extracted independently by 2 raters. Effect sizes were calculated using logits, which were back-transformed and reported as proportions. Random-effects models of event rates were used because of significant heterogeneity. Moderator analyses included timing, measurement method, and study location. Study quality ratings were calculated and used for sensitivity analysis. Publication bias was evaluated with funnel plots and the Egger method. DATA SYNTHESIS Substantial heterogeneity was 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 were reported during the 3- to 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. CONCLUSIONS Prenatal and postpartum depression was evident in about 10% of men in the reviewed studies and was relatively higher in the 3- to 6-month postpartum period. Paternal depression also showed a moderate positive correlation with maternal depression.

Individual and Combined Effects of Postpartum Depression in Mothers and Fathers on Parenting Behavior

BACKGROUND. Pediatric anticipatory guidance has been associated with parenting behaviors that promote positive infant development. Maternal postpartum depression is known to negatively affect parenting and may prevent mothers from following anticipatory guidance. The effects of postpartum depression in fathers on parenting is understudied. OBJECTIVE. Our purpose with this work was to examine the effects of maternal and paternal depression on parenting behaviors consistent with anticipatory guidance recommendations. METHODS. The 9-month-old wave of data from a national study of children and their families, the Early Childhood Longitudinal Study, provided data on 5089 2-parent families. Depressive symptoms were measured with a short form of the Center for Epidemiologic Studies Depression Scale. Interviews with both parents provided data on parent health behaviors and parent-infant interactions. Logistic and linear regression models were used to estimate the association between depression in each parent and the parenting behaviors of interest. These models were adjusted for demographic and socioeconomic status indicators. RESULTS. In this national sample, 14% of mothers and 10% of fathers exhibited levels of depressive symptoms on the Center for Epidemiologic Studies Depression Scale that have been associated with clinical diagnoses, confirming other findings of a high prevalence of postpartum maternal depression but highlighting that postpartum depression is a significant issue for fathers as well. Mothers who were depressed were ∼1.5 times more likely to engage in less healthy feeding and sleep practices with their infant. In both mothers and fathers, depressive symptoms were negatively associated with positive enrichment activity with the child (reading, singing songs, and telling stories). CONCLUSIONS. Postpartum depression is a significant problem in both mothers and fathers in the United States. It is associated with undesirable parent health behaviors and fewer positive parent-infant interactions.

Early parental depression and child language development

OBJECTIVE To examine the effects of early maternal and paternal depression on child expressive language at age 24 months and the role that parent-to-child reading may play in this pathway. PARTICIPANTS AND METHODS The 9-month and 24-month waves from a national prospective study of children and their families, the Early Childhood Longitudinal Study - Birth Cohort (ECLS-B), provided data on 4,109 two-parent families. Depressive symptoms were measured with a short form of the Center for Epidemiologic Studies Depression Scale (CES-D). Parents reported on positive parent-infant interactions, child expressive vocabulary, and demographic and health information at child age 9 and 24 months. Linear regression was used to estimate associations between depression, parenting, and child vocabulary. Structural equation modeling was used to test the hypothesis that parent reading behavior mediates the parent depression to child vocabulary pathway. These models were adjusted for demographic indicators. RESULTS As previously reported from this national sample, 14% of mothers and 10% of fathers exhibited elevated levels of depressive symptoms at 9 months. For both mothers and fathers, depression at 9 months was negatively associated with contemporaneous parent-to-child reading. Only for fathers, however, was earlier depression associated with later reading to child and related child expressive vocabulary development. A model describing this pathway demonstrated a significant indirect pathway from depression to vocabulary via parent reading to child. CONCLUSIONS Depression is a significant problem among both mothers and fathers of young children, but has a more marked impact on the fathers reading to his child and, subsequently, the childs language development.

Identifying the “Tipping Point” Age for Overweight Pediatric Patients

According to the National Health and Nutrition Examination Survey in 2007, nearly half of all American children are either overweight or obese. Retrospective chart review identified patients with the diagnostic codes for overweight, obese, and/or excessive weight gain. Inclusion criteria were current age between 2 and 20 years, a minimum of 5 visits with weight and height measurements, and a body mass index (BMI) at or above the 85th percentile. A total of 184 patients met inclusion criteria. More than half the children became overweight before age 2, and all patients were obese or overweight by age 10. The rate of gain is approximately 1 excess BMI unit/year, therefore causing most children to be overweight by age 2 (R 2 = .53). This study indicates that the critical period for preventing childhood obesity in this subset of identified patients is during the first 2 years of life and for many by 3 months of age.

Increasing severity of pectus excavatum is associated with reduced pulmonary function

OBJECTIVE To determine whether pulmonary function decreases as a function of severity of pectus excavatum, and whether reduced function is restrictive or obstructive in nature in a large multicenter study. STUDY DESIGN We evaluated preoperative spirometry data in 310 patients and lung volumes in 218 patients aged 6 to 21 years at 11 North American centers. We modeled the impact of the severity of deformity (based on the Haller index) on pulmonary function. RESULTS The percentages of patients with abnormal forced vital capacity (FVC), forced expiratory volume in 1 second (FEV(1)), forced expiratory flow from 25% exhalation to 75% exhalation, and total lung capacity findings increased with increasing Haller index score. Less than 2% of patients demonstrated an obstructive pattern (FEV(1)/FVC <67%), and 14.5% demonstrated a restrictive pattern (FVC and FEV(1) <80% predicted; FEV(1)/FVC >80%). Patients with a Haller index of 7 are >4 times more likely to have an FVC of ≤80% than those with a Haller index of 4, and are also 4 times more likely to exhibit a restrictive pulmonary pattern. CONCLUSIONS Among patients presenting for surgical repair of pectus excavatum, those with more severe deformities have a much higher likelihood of decreased pulmonary function with a restrictive pulmonary pattern.

Multicenter Study of Pectus Excavatum, Final Report: Complications, Static/Exercise Pulmonary Function, and Anatomic Outcomes

BACKGROUND A multicenter study of pectus excavatum was described previously. This report presents our final results. STUDY DESIGN Patients treated surgically at 11 centers were followed prospectively. Each underwent a preoperative evaluation with CT scan, pulmonary function tests, and body image survey. Data were collected about associated conditions, complications, and perioperative pain. One year after treatment, patients underwent repeat chest CT scan, pulmonary function tests, and body image survey. A subset of 50 underwent exercise pulmonary function testing. RESULTS Of 327 patients, 284 underwent Nuss procedure and 43 underwent open procedure without mortality. Of 182 patients with complete follow-up (56%), 18% had late complications, similarly distributed, including substernal bar displacement in 7% and wound infection in 2%. Mean initial CT scan index of 4.4 improved to 3.0 post operation (severe >3.2, normal = 2.5). Computed tomography index improved at the deepest point (xiphoid) and also upper and middle sternum. Pulmonary function tests improved (forced vital capacity from 88% to 93%, forced expiratory volume in 1 second from 87% to 90%, and total lung capacity from 94% to 100% of predicted (p < 0.001 for each). VO2 max during peak exercise increased by 10.1% (p = 0.015) and O2 pulse by 19% (p = 0.007) in 20 subjects who completed both pre- and postoperative exercise tests. CONCLUSIONS There is significant improvement in lung function at rest and in VO2 max and O2 pulse after surgical correction of pectus excavatum, with CT index >3.2. Operative correction significantly reduces CT index and markedly improves the shape of the entire chest, and can be performed safely in a variety of centers.

Typologies of Alcohol Use in White and African American Adolescent Girls

This study examined typologies of alcohol use among 2,948 White and African American adolescent girls using data from the National Longitudinal Study of Adolescent Health. Self-report data were collected on frequency and quantity of alcohol use, negative consequences, and high-risk drinking behaviors, as well as co-occurring internalizing and externalizing problems. Latent class analysis revealed a four-group typology for White girls and a three-group typology for African American girls. Problematic drinkers reported having more internalizing and externalizing problems in both racial groups. The studys limitations and implications are discussed.

Parental Depression, Relationship Quality, and Nonresident Father Involvement With Their Infants:

The role of depression in nonresident fathers’ involvement with their infant children is poorly understood. A three-factor model of father involvement was evaluated, and its association with parental relationship quality and depressive symptoms in both parents were tested. Data on 569 families from the Early Childhood Longitudinal Study were used. Confirmatory factor analysis supported a three-factor model of nonresident father involvement, which was then examined in a model consistent with Belsky’s determinants of parenting framework. Noncohabitating mothers and fathers evidenced a significant correlation between their quantitative levels of depression. Relationship quality predicted all factors of father involvement and was negatively associated with depression in either parent. Disruptions in relationship quality mediated the link between depression in both parents and reduced father involvement. Perhaps because of depression’s association with relationship quality, depressive severity was significantly correlated between nonresident mother and father.

Social Rejection and ADHD in Young Adults: An Analogue Experiment

Poor outcomes in ADHD may be related to problematic social functioning and consequences of social rejection. This study examines how ADHD symptom expression affects mood and social rejection. Working from findings in depression that describe maintenance through negative interpersonal interactions, the authors seek to examine this theory’s applicability to poor outcomes in ADHD. In a completely randomized design, 130 participants are exposed to one of several videotape segments that include displays of ADHD, depression, and social anxiety. A normal control is also used. All abnormal videotapes are met with greater rejection than the control. Displays of ADHD elicit similar levels of rejection to those elicited by displays of depression. Additionally, ADHD elicits greater levels of hostile mood, whereas depression elicits high levels of depression and fatigue. Implications for an interpersonal theory of vulnerability in ADHD are discussed along with implications for future research, prevention, and intervention.

Norfolk QOL‐DN: validation of a patient reported outcome measure in transthyretin familial amyloid polyneuropathy

The Norfolk Quality of Life‐Diabetic Neuropathy (QOL‐DN) questionnaire is an instrument to assess QOL in diabetic polyneuropathy. The objective of this observational, cross‐sectional study in 61 patients with V30M transthyretin familial amyloid polyneuropathy (TTR‐FAP) and 16 healthy volunteers was to validate the Norfolk QOL‐DN for assessment of QOL in TTR‐FAP. Comparisons were conducted to identify the best items to discriminate disease stages and assess which individual Norfolk domains (symptoms, large fiber, small fiber, autonomic, and activities of daily living) would be most affected by disease stage. Analysis of individual items revealed a significant pattern of discrimination among disease stages (p < 0.001). Total QOL scores increased (indicating worsening) with duration of symptoms, with a steeper increase observed earlier in the course of disease. Significant correlations were observed between each Norfolk domain and other measures of neurological function. Limitations include cross‐sectional study design, low patient numbers in this rare disease, and the ordinal‐based character of the metric used; future areas to explore include item response theory approaches such as Rasch analysis. These results suggest the Norfolk QOL‐DN is a reliable indicator of the impact of disease severity on QOL in patients with TTR‐FAP.