Joshua Rutsohn

A Longitudinal Study of Paternal Mental Health During Transition to Fatherhood as Young Adults

BACKGROUND AND OBJECTIVE: Rates of paternal depression range from 5% to 10% with a growing body of literature describing the harm to fathers, children, and families. Changes in depression symptoms over the life course, and the role of social factors, are not well known. This study examines associations with changes in depression symptoms during the transition to fatherhood for young fathers and whether this association differed by key social factors. METHODS: We combined all 4 waves of the National Longitudinal Study of Adolescent Health to support a 23-year longitudinal analysis of 10 623 men and then created a “fatherhood-year” data set, regressing age-adjusted standardized depressive symptoms scores on fatherhood status (nonresidence/residence), fatherhood-years, and covariates to determine associations between Center for Epidemiologic Studies Depression Scale scores and fatherhood life course intervals. RESULTS: Depressive symptom scores reported at the entry into fatherhood are higher for nonresident fathers than nonfathers, which in turn are higher than those of resident fathers. Resident fathers have a significant decrease in scores during late adolescence (β = –0.035, P = .023), but a significant increase in scores during early fatherhood (β = 0.023, P = .041). From entrance into fatherhood to the end of early fatherhood (+5 years), the depressive symptoms score for resident fathers increases on average by 68%. CONCLUSIONS: In our longitudinal, population-based study, resident fathers show increasing depressive symptom scores during childrens key attachment years of 0–5. Identifying at-risk fathers based on social factors and designing effective interventions may ultimately improve health outcomes for the entire family.

Health Literacy and Patient-Reported Outcomes: A Cross-Sectional Study of Underserved English- and Spanish-Speaking Patients With Type 2 Diabetes

This study examined associations between patient characteristics, health behaviors, and health outcomes and explored the role of health literacy as a potential mediator of outcomes. English- and Spanish-speaking adults with Type 2 diabetes used a bilingual multimedia touchscreen to complete questionnaires. The behavioral model for vulnerable populations guided multivariable regression and mediation testing. Dependent variables were diabetes self-care, health status, and satisfaction with communication. Independent variables included sociodemographic and clinical characteristics, health literacy, health beliefs, and self-efficacy. Spanish speakers had lower health literacy and poorer physical, mental, and overall health compared to English speakers. Higher health literacy was associated with less social support for diet, fewer diet and medication barriers, younger age, higher diabetes knowledge, and talking with health care professionals to get diabetes information. In contrast to expectations, health literacy was not associated with diabetes self-care, health status, or satisfaction with communication, and it did not mediate the effects of other factors on these outcomes. Diabetes self-efficacy was significantly associated with health behaviors and outcomes. The association between Spanish language preference and poorer health was not mediated by this groups lower health literacy. Increasing health-related self-efficacy might be an important clinical strategy for improving outcomes in underserved patients with Type 2 diabetes.

Longitudinal study of body mass index in young males and the transition to fatherhood

Despite a growing understanding that the social determinants of health have an impact on body mass index (BMI), the role of fatherhood on young men’s BMI is understudied. This longitudinal study examines BMI in young men over time as they transition from adolescence into fatherhood in a nationally representative sample. Data from all four waves of the National Longitudinal Study of Adolescent Health supported a 20-year longitudinal analysis of 10,253 men beginning in 1994. A “fatherhood-year” data set was created and changes in BMI were examined based on fatherhood status (nonfather, nonresident father, resident father), fatherhood years, and covariates. Though age is positively associated with BMI over all years for all men, comparing nonresident and resident fathers with nonfathers reveals different trajectories based on fatherhood status. Entrance into fatherhood is associated with an increase in BMI trajectory for both nonresident and resident fathers, while nonfathers exhibit a decrease over the same period. In this longitudinal, population-based study, fatherhood and residence status play a role in men’s BMI. Designing obesity prevention interventions for young men that begin in adolescence and carry through young adulthood should target the distinctive needs of these populations, potentially improving their health outcomes.

Personality Predicts Mortality Risk: An Integrative Data Analysis of 15 International Longitudinal Studies

This study examined the Big Five personality traits as predictors of mortality risk, and smoking as a mediator of that association. Replication was built into the fabric of our design: we used a Coordinated Analysis with 15 international datasets, representing 44,094 participants. We found that high neuroticism and low conscientiousness, extraversion, and agreeableness were consistent predictors of mortality across studies. Smoking had a small mediating effect for neuroticism. Country and baseline age explained variation in effects: studies with older baseline age showed a pattern of protective effects (HR<1.00) for openness, and U.S. studies showed a pattern of protective effects for extraversion. This study demonstrated coordinated analysis as a powerful approach to enhance replicability and reproducibility, especially for aging-related longitudinal research.

Supporting parents of premature infants transitioning from the NICU to home: A pilot randomized control trial of a smartphone application

Objective To determine whether parents of Very Low Birth Weight (VLBW) infants in the Neonatal Intensive Care Unit (NICU) transitioning home with the NICU-2-Home smartphone application have greater parenting self-efficacy, are better prepared for discharge and have shorter length of stay (LOS) than control parents. Methods A four-week pilot randomized controlled trial during the transition home with 90 VLBW parents randomized to usual care (n = 44) or usual care plus NICU-2-Home (n = 46), a smartphone application designed for VLBW parents. Parenting Sense of Competence Scale (PSOC) was assessed at baseline, day after discharge, and two weeks post-discharge. Preparedness for discharge and length of stay (LOS) were secondary outcomes. Analyses by usage were also included. Results While parents of VLBW infants in the intervention group did not show an improvement in PSOC during the transition when compared directly to controls, after accounting for actual mean app usage, PSOC improved 7% (2.71 points/time greater; 95% CI = 1.45, 6.27) for intervention versus controls. Compared to controls, above-average users increased their PSOC score by 14% (6.84 points/time; 95% CL = 5.02, 8.67), average users by 11% (4.58 points/time; 95% CL = 2.89, 6.27) and below-average users by 6% (2.41 points/time; 95% CL = 0.04, 4.79). Moderate evidence showed LOS was shorter for above-average users compared to the control group (β = 12.2. SE = 6.9, p = 0.085). Conclusion A smartphone application used by parents of VLBW infants during the transition home from the NICU can improve parenting self-efficacy, discharge preparedness, and LOS with improved benefits based on usage.

Physical function metric over measure: An illustration with the Patient‐Reported Outcomes Measurement Information System (PROMIS) and the Functional Assessment of Cancer Therapy (FACT)

Measuring patient‐reported outcomes (PROs) is becoming an integral component of quality improvement initiatives, clinical care, and research studies in cancer, including comparative effectiveness research. However, the number of PROs limits comparability across studies. Herein, the authors attempted to link the Functional Assessment of Cancer Therapy‐General Physical Well‐Being (FACT‐G PWB) subscale with the Patient‐Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) calibrated item bank. The also sought to augment a subset of the conceptually most similar FACT‐G PWB items with PROMIS PF items to improve the linking.

Stress From the Neonatal Intensive Care Unit to Home: Paternal and Maternal Cortisol Rhythms in Parents of Premature Infants

To examine cortisol diurnal rhythms over the transition from the critical care setting to home for fathers and mothers of very low-birth-weight infants, including how cortisol is associated with psychosocial stress and parenting sense of competence. This cohort study in a level III neonatal intensive care unit and the general community had 86 parents complete salivary collection and self-reported psychosocial measures. Salivary samples were collected 3 times a day on the day before discharge, and on 3 subsequent days at home. Self-report measures included the Perceived Stress Scale and the Parenting Sense of Competence Scale, which measure parenting satisfaction. Fathers showed increased physiologic stress over the transition home, reflected by flattening of slopes, lower wakeup, and higher bedtime cortisol. Mothers reporting increases in perceived stress over the transition home had higher bedtime cortisol, suggesting a link between higher perceived stress and higher physiologic stress. Results were significant after controlling for breastfeeding, insurance status, and gestational age. This study examined a physiologic marker of stress in parents with very low-birth-weight infants, finding sex disparities in diurnal cortisol patterns during the transition from neonatal intensive care unit to the community. Fathers may be especially susceptible to stressors during this transition.

Development and Validation of a Father Involvement in Health Measure

Father involvement has been associated with positive social, emotional, psychological, developmental, and health outcomes in a child. However, tools for measuring father involvement have not kept pace with the expanding understanding of the roles of fathers, and in the area of child health, are blunt. The purpose of this study was to develop and validate a self-report measure of father involvement in preschooler’s health, the Father Involvement in Health–Preschool (FIH-PS). In Phase 1 (item generation), 47 items were developed based on previous qualitative work and vetted through cognitive interviews with 21 fathers of children ages 3–5 years (preschool). In Phase 2 (psychometric validation), 560 fathers of 3- to 5-year-olds (n = 392 resident, n = 168 nonresident) completed the FIH-PS item bank. Participants were predominantly White (64%), had private health insurance (53%), had a mean age of 33 years, and half of them were married. Item response theory was used to determine measurement scoring. The FIH-PS Scale was reduced from a 47-item bank to a total of 20 items supporting a 4-factor scale made up of Acute Illness, General Well-Being, Emotional Health, and Role Modeling. Following exploratory (n = 280) and confirmatory factor (n = 280) analyses, the scale followed a bifactor structure, was internally consistent (Cronbach’s &agr; = .953), and discriminated among fathers with lower involvement. A sum-to-T score crosswalk table was produced to standardize the scores along a normal distribution (M = 50, SD = 10, range = 10.8–71.3). Future research and clinical applications of the FIH-PS are discussed.

Hispanic Young Males’ Mental Health From Adolescence Through the Transition to Fatherhood

The objective of the current study was to examine the associations between the transition to fatherhood and depressive symptoms scores among Hispanic men. Using the sample of Hispanic men included in the National Longitudinal Study of Adolescent to Adult Health, depressive symptom scores were examined from 1994 to 2008. A “fatherhood-year” data set was created that included the men’s Center for Epidemiologic Studies Depression Scale (CES-D) scores as well as residency status with the child. By regressing age-adjusted standardized depressive symptom scores, associations between mental health scores of Hispanic men and their transition to fatherhood were identified. Among the 1,715 Hispanic men, resident (n = 502) and nonresident (n = 99) Hispanic fathers reported an increase in depressive symptom scores (CES-D) during the first 5 years after entrance into fatherhood (β = 0.150, 95% CI [0.062, 0.239] and β = 0.153, 95% CI [0.034, 0.271], respectively) compared to non-fathers (n = 1,114), representing an increase of 10% for resident fathers and a 15% for nonresident fathers. Hispanic non-fathers reported a decrease in depressive symptom scores (CES-D) during parallel ages. Hispanic fathers, regardless of residency status, reported increased depressive symptoms in the first 5 years after the transition into fatherhood, a period critical in child development.

Paternal and maternal testosterone in parents of nicu infants transitioning home

Lower testosterone during the transition to new parenthood is considered beneficial to help parents better engage with their infants. No data currently exist studying salivary testosterone of parents with infants in neonatal intensive care units (NICUs) during the transition to home. We examine testosterone levels for parents of very low-birth-weight infants, including links between salivary testosterone and infant factors (such as breast-feeding), psychosocial stress, and changes over time. Testosterone salivary samples were assayed after self-collection by 86 parents (43 fathers and 43 mothers) with NICU infants at wakeup and bedtime prior to discharge and at 3 additional times at home. Self-reported survey measures, including psychosocial reports, were also collected at these times. Using multilevel modeling approaches, we report significant associations between paternal testosterone by time and psychosocial adjustment and between both paternal and maternal testosterone and infant feeding mode (P < .05). Results were significant after accounting for covariates. Our study is the first to examine the time course of diurnal testosterone for parents of premature infants over the transition home; as such, we suggest further research into better understanding parental physiology in this vulnerable parent population.