John Condon

First-Time Fathers’ Study: Psychological Distress in Expectant Fathers During Pregnancy:

Objective: High levels of distress have previously been reported among expectant fathers, with the level of distress for new fathers falling after the birth and during the first year of their infants’ lives. The aim of the present study was to report on the associations with the fathers’ initial high levels of distress. Method: The men completed a series of questionnaires on various aspects of their psychological functioning at a baseline assessment when their partners were in the late first trimester of their pregnancy. The General Health Questionnaire-28 (GHQ-28) was the key measure of psychological distress for the present study. Men scoring >5 on the GHQ were considered to be cases of distress. The cases and non-cases were contrasted on the baseline psychosocial measures. Results: A total of 312 men completed the questionnaires, of whom 18.6% were designated as cases. GHQ caseness was associated with high levels of symptoms on other measures of psychological distress, higher levels of alcohol consumption, poorer quality of their current intimate relationship, poorer social support, a lower quality of life, high levels of neuroticism and the use of immature ego defences. Multiple regression analysis identified the key variables associated with psychological distress to be high levels of neuroticism, dissatisfaction with social support and an excess number of additional life events. Conclusions: Psychological distress among expectant fathers is associated with a range of psychological variables, particularly poor marital relationship and poor social networks. This is consistent with a general vulnerability model for psychological distress. Fathers who had insufficient information about pregnancy and childbirth were also at risk of being distressed, suggesting that more attention needs to be paid to providing information to men about their partners pregnancy, childbirth and issues relating to caring for a newborn infant.

The psychological sequelae of miscarriage: a critical review of the literature

Miscarriage, although a common event in pregnancy, has been frequently overlooked in psychological research. This paper reviews the literature on the psychological sequelae of miscarriage, including the shortcomings of that literature. Best understood against the background of psychological changes in early pregnancy, the literature reveals aspects of grief specific to miscarriage. Important components of this grief comprise high levels of guilt, the loss of part of the self and a large impact upon personal identity. The psychological sequelae impact upon other family members, including partners and surviving children. Psychiatric consequences include depression, anxiety and posttraumatic stress disorder. Given the potentially serious nature of these sequelae, it behoves the psychiatrist to enquire routinely about pregnancy loss in all female patients.

Assessment of postnatal paternal–infant attachment: development of a questionnaire instrument

This paper focuses on the father‐to‐infant relationship, and in particular on an approach to measuring the construct of father‐to‐infant attachment using a 19‐item self‐report questionnaire. Data are presented from a sample of approximately 200 Australian fathers assessed at 6 and 12 months after the birth of their first child. A factor analysis yielded three interpretable factors, namely: ‘patience and tolerance’, ‘pleasure in interaction’ and ‘affection and pride’, accounting for 45% of the variance. Coefficient Alpha measures were in the range 0.7–0.8, indicating acceptable levels of internal consistency. A high level of continuity of attachment scores was observed between the 6‐ and 12‐month assessments. Correlations between fathers attachment scores and other study variables were highly significant, which is indicative of construct validity. The instrument complements previously published antenatal (maternal and paternal) and postnatal maternal instruments, and has the advantage of being easily administered to large samples, facilitating early identification of fathers having possible attachment deficits. Cut‐off scores for identifying such men are presented.

Anxiety and depression in fathers in teenage pregnancy

OBJECTIVEnIt is recognized that pregnant teenagers have higher levels of psychological symptomatology compared to older pregnant women. However, there are limited data on fathers in the setting of teenage pregnancy. The aim of this study was to compare levels of psychological symptomatology in fathers in the setting of teenage as compared to non-teenage pregnancy.nnnMETHODnA cross-sectional cohort study was undertaken. Data from interviews with consecutive fathers in the setting of teenage (Teenage) and non-teenage (Control) pregnancy were compared during the antenatal period. Subjects were interviewed to obtain information covering demographic and family information, the Hospital Anxiety and Depression Scale (HADS) and General Health Questionnaire-28 (GHQ-28).nnnRESULTSnSignificantly more fathers in the setting of teenage pregnancy met the case criteria for HADS-A and HADS-D subscales compared to older fathers. They had significantly higher GHQ-28 totals and all subscale scores and were more likely predictive of a young age of death compared to older fathers. However, formal contact with psychiatric services was similar between groups. Interestingly, 14% of fathers in the setting of teenage pregnancy reported losing their own father as a child. In multivariate analysis, a high HADS score was significantly associated with younger age of onset of fatherhood and exposure to domestic violence as a child, whereas having their own father alive was significantly protective against a high HADS score.nnnCONCLUSIONnFathers, in the setting of teenage pregnancy, have unrecognized psychological symptomatology and require services along with teenage mothers.

A longitudinal study of father-to-infant attachment: antecedents and correlates

Objective: Using data from the Australian First-Time Fathers Study, this article investigates the relationship between a father’s antenatal attachment to his foetus and his subsequent attachment to his infant at 6 and 12 months postnatally. Method: 204 first-time expectant fathers were assessed, and subsequently reassessed at 6 and 12 months postpartum on a large number of measures (including attachment). Results: Findings highlight the strong continuity of attachment across these three assessment points, as well as the important influence of the man’s partner relationship and mental well-being on his attachment. Conclusion: Pregnancy provides a potential window of opportunity for enhancing antenatal attachment in expectant fathers, with potential long-term benefits for the future father–child relationship.

Impact of education on women with perinatal depression

Objective. To assess the impact that education through participation in a depression screening program has on mental health literacy and help seeking behavior in perinatal women. Methods. Responses to a hypothetical case of depression, help seeking behavior, and screening levels for risk of depression using the Edinburgh Postnatal Depression Scale were compared between two groups of postnatal women; one group who had participated in a screening program and the other who had not. Those who participated in the screening program were also asked to evaluate the educational material they had received. Results. A total of 1309 women, broadly representative of postnatal women, answered one or more questionnaires. Those who had participated in the screening program were better able to recognize depression in a hypothetical case, and also assess their own mental state more appropriately. Those women who had been part of the program and did not score high on the EPDS were less likely to seek help, were more satisfied when they did and tended to benefit more from the educational booklet. Conclusions. Participation in a screening program with educational material had significant benefits for mental health literacy and the health service use for perinatal women at risk for depression.

Women's mental health: a "wish-list" for the DSM V.

This article highlights four areas of mental health affecting women in the reproductive age group which, in the author’s opinion, are poorly dealt with in the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM IV) (American Psychiatric Association 1994). These are depression occurring during pregnancy; childbirth-related post-traumatic stress disorder; disorders of parent-to-infant attachment and perinatal bereavement. It is suggested that, if these could be better addressed in the forthcoming DSM V, this would provide a very significant impetus for improved education of health professionals, as well as better recognition and earlier intervention in these disorders. As these are relatively common disorders, a very large number of women and their families would potentially benefit.

Factors that adolescent males take into account in decisions about an unplanned pregnancy

Little is known about what factors adolescent males consider important when making decisions concerning the resolution of an unplanned pregnancy with a teenage partner. Young mens influence on pregnancy outcome decisions can play an important part in the subsequent psychological adjustment of the female. The present report draws on data from a larger study with teenage males [Condon, J. T., Corkindale, C. J., Russell, A., & Quinlivan, J. A. (2006). Processes and factors underlying adolescent males attitudes and decision-making in relation to an unplanned pregnancy. Journal of Youth and Adolescence, 35, 447-458], and extends the findings of that study. Using a 25-item scale embedded in an electronic role-play, data were obtained from 330 male Australian school students on their priorities and concerns in relation to possible outcomes of a partners pregnancy. Common factors taken into account by almost the entire adolescent sample related to the negative effects of becoming a teenage father. The differences between participants were identified using cluster analysis, which produced three groupings. The majority group was characterised as well-balanced (80.6%), and the two minority groups as unwilling/unready (10.9%) and family-centred (8.5%). Group membership was strongly predictive of the males final decision regarding the hypothetical pregnancy outcome. Understanding adolescent attitudes and beliefs when faced with this decision may assist practitioners in their guidance of the young couple and help prevent negative psychological sequelae.

A randomised controlled trial of the Flinders Program™ of chronic condition management in Vietnam veterans with co-morbid alcohol misuse, and psychiatric and medical conditions:

Objective: To evaluate the efficacy of the Flinders Program™ of chronic condition management on alcohol use, psychosocial well-being and quality of life in Vietnam veterans with alcohol misuse. Method: This 9-month wait-list, randomised controlled trial used the Alcohol Use Disorders Identification Test (AUDIT) score ≥ 8 as the entry criterion. Intervention veterans received the Flinders Program plus usual care and controls received usual care. The primary outcome measure was AUDIT score at baseline, 3, 6 and 9 months. Secondary measures included quality of life, alcohol dependence (DSM-IV), anxiety and depression. All measures were repeated at variable trial end dates between 9 and 18 months in the intervention group. Results: Randomisation resulted in 46 intervention and 31 control participants. Intent-to-treat analyses showed AUDIT scores improved significantly from baseline to 9-month follow-up (p = 0.039) in the intervention group compared to control group. The control group had 1.46 times the risk of alcohol dependence than the intervention group at 9 months (p = 0.027). There were no significant differences between groups for secondary measures. Within-group analyses showed that both groups significantly improved in AUDIT (p < 0.001), anxiety and depression (p < 0.01), anger (p < 0.001), and post-traumatic stress (p < 0.01). Improvements in AUDIT (p < 0.001) and alcohol dependence were maintained in the intervention group to 18 months. Conclusions: Use of the Flinders Program in addition to usual care resulted in reduced alcohol use, reduced alcohol dependence, and global clinical improvement in Vietnam veterans with risky alcohol behaviours and chronic mental health problems. The findings demonstrate that the Flinders Program provides a structured framework for delivering self-management support, case management and coordinated care for people with chronic conditions. This clinical approach has the potential to bridge the gap between physical and mental illness service delivery for people with long-term conditions in Australia.

The Australian First‐time Grandparents Study: Time spent with the grandchild and its predictors

Aim:u2002 This paper presents data on the amount of contact a large cohort of first‐time Australian grandparents have with their grandchild, and the amount of child care they provide. It compares these with grandparents expectations and desired levels.