Let's connect: How fathers can improve outcomes for children when there is poor mental health in the family

Symptoms of depression often co-occur between parents – when one parent experiences symptoms, the other is at increased risk. Parental depression has been shown to put children at heightened risk of experiencing emotional difficulties. In order to prevent the transmission of depression between parents and their children, it is important to, first, understand how this transmission occurs and, second, identify protective factors that reduce the risk of transmission.

With changes in family roles, fathers may have a crucial protective role to play in improving child wellbeing.

The COVID-19 pandemic: the impact on mental health

The pandemic had a widespread impact on mental health. Data from the UK Household Longitudinal Study reported that the number of adults aged 18 and over reporting a clinically significant level of psychological distress increased from 20.8% in 2019 to 29.5% in April 2020. But these large increases in distress did not occur equally across the population. Research suggests that women and people living with young children were particularly at risk of experiencing poor mental health during the peak of the pandemic.

The long-term effects of this crisis are largely unknown. However, parental mental health difficulties in the early years can have serious and long-lasting consequences for the child as they grow up.

Symptoms of depression can ‘run in families’

Postnatal depression is common, with one in 10 mothers experiencing clinical levels of depression during the first year after childbirth. This condition is rarely considered in relation to fathers, yet it can occur equally as commonly. Many would be surprised to know that as many as one in 10 fathers also experience clinical levels of depression in the postnatal period.

In families, depression often co-occurs between parents – when one parent is experiencing symptoms of depression, the other is at increased likelihood of also experiencing symptoms. Parental depression is reported to be one of the strongest risk factors for emotional difficulties in children. When it co-occurs in both parents, this risk is heightened. Nonetheless, little is known about the symptom-level mechanisms that explain co-occurring depression symptoms between parents and the association with emotional difficulties in children.

Our recent research, published in the British Journal of Psychiatry, investigated how mothers’ and fathers’ individual symptoms of depression help to explain how the condition can ‘run in families’. We used data from the Avon Longitudinal Study of Parents and Children, a large cohort of 14,000 families in England. Using a technique called network analysis – a method which identifies clusters of symptoms and analyses how they influence one another – we examined the co-occurrence of depression symptoms between parents early in their child’s development, and the association between these parental symptoms with child emotional difficulties as they approached adolescence.

We found that specific symptoms, including self-harm ideation and feeling guilty, mutually ‘activated’ depression symptoms between both parents when the child was an infant. We also found evidence of symptom ‘cascades’. When one parent reported high levels of a symptom, this symptom cascaded from one parent to the next, and onto the child. A key symptom which acted in this way was feeling guilty, but also anhedonia - the inability to feel pleasure.

These findings raise an important question: can fathers support their children when there is poor mental health in the family? Surprisingly, this is a seriously understudied question.

How can fathers support child wellbeing?

Although maternal postnatal depression symptoms are associated with adverse mental health outcomes in children, research has shown that child mental health outcomes are not solely determined by mothers – fathers also play a crucial role.

Symptoms of depression are sometimes associated with interpersonal difficulties (the ability to form relationships or communicate effectively). When mothers experience these difficulties it can be harder to form supportive mother-infant relationships, such as attachment and co-regulation (the process by which infants develop the ability to manage distressing sensations and emotions through connection with their caregiver), which are crucial for healthy development. It is well-documented that poor mother-infant relationships are associated with later child emotional difficulties (Guo et al., 2020; Lyons-Ruth et al., 1986; Verde-Cagiao et al., 2022). Fathers, of course, are also caregivers. This poses the question: can fathers compensate for the parental challenges a mother may face when experiencing symptoms of depression?

Our team investigated whether the relationships between fathers and their partners (father-mother relationship), and fathers and their children (father-child relationship), can reduce the risk of adverse mental health outcomes in children when mothers are experiencing postnatal depression symptoms. We found that the answer was yes. Both the father-mother AND the father-child relationships were important. When both relationships were strong, risk of emotional and behavioural outcomes in children was reduced by around 10%.

Importantly, and perhaps surprisingly, we found this protective effect even when fathers themselves were depressed, and even when they did not live full-time with their children and the child’s mother (own-household fathers). Although, it must be noted that the number of own-household fathers was low in the families we studied, so this finding needs further validation. This echoes a problem with the research field in general; despite the transition away from ‘traditional’ families, different family structures remain woefully under-represented in research cohorts, and therefore remain understudied.

These findings highlight that, despite being understudied in developmental research until recently, fathers can play a key positive role in their children’s development. Forming a strong connection with their child – and with the child’s mother – during the early years can protect the child from the negative impact associated with maternal postnatal depression and may have a long-lasting positive impact on their child’s wellbeing.

What needs to be done?

The increasing rates of mental health difficulties among young people are particularly concerning. Rates of probable mental health disorder have risen from one in nine in 2017 to one in six between 2020 to 2022. For young people aged 17-19 this has increased further to one in four in 2022.

Given these current mental health statistics, we would also like to see the importance of fathers for positive child development better represented in research and policy. There are several initiatives aiming to transform society through early childhood. The Princess of Wales’s Royal Foundation Centre launched a major new awareness raising campaign last week, highlighting the critical importance the first five years of our lives have on shaping the adults we become. Meanwhile, charities such as the Fatherhood Institute are working hard to raise the profile of ‘involved fathers’ and their crucial role in children’s lives during these early years.

The UK Government published The best start for life: a vision for the 1,001 critical days in 2021. The policy paper recognises the importance of “piloting new ways of working to address specific priorities such as engaging with fathers” (page 93). However, the focus remains predominantly on mothers. As researchers, we need to continue to find ways to engage fathers in our research, especially those who are more likely to be missing such as own-household fathers and those from ethnic minority communities.

We hope that researchers and policymakers put their words into action, and we see research on fathers and their children blossom over the coming years. 

This blog was written by Alex Martin, Research Associate at the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London. Her research was completed in the Developmental Psychopathology lab at King’s, under the supervision of Professor Ted Barker and Professor Barbara Maughan.

Updated 21/03/2023.