A Systematic Review and Meta-Analysis: Paternal Anxiety and the Emotional and Behavioral Outcomes in Their Offspring

Abstract

Objective: Anxiety disorders are highly prevalent worldwide; however, the literature lacks a meta-analytic quantification of the risk posed by fathers' anxiety for offspring development. This systematic review and meta-analysis aimed to provide a comprehensive estimate of the magnitude of the association between paternal anxiety and emotional and behavioral problems of offspring.

Method: In February 2022, Web of Science, Ovid (Embase, MEDLINE, PsycINFO), Trip Database, and ProQuest were searched to identify all quantitative studies that measured anxiety in fathers and emotional and/or behavioral outcomes in offspring. No limits were set for offspring age, publication language, or publication year. Summary estimates were extracted from the primary studies. Meta-analytic random-effects 3-level models were used to calculate correlation coefficients. Quality was assessed using the Newcastle-Ottawa Scale. The study protocol was preregistered with PROSPERO (CRD42022311501) and adhered to PRISMA reporting guidelines.

Results: Of 11,746 records identified, 98 were included in the meta-analysis. Small but significant associations were found between paternal anxiety and offspring emotional and behavioral problems overall (r = 0.16, 95% CI [0.13, 0.19]) and behavioral (r = 0.19, 95% CI [0.13, 0.24]), emotional (r = 0.15, 95% CI [0.12, 0.18]), anxiety (r = 0.13, 95% CI [0.11, 0.16]), and depression (r = 0.13, 95% CI [0.03, 0.23]) problems. Some significant moderators were identified.

Conclusion: Paternal mental health is associated with offspring development, and the offspring of fathers with anxiety symptoms or disorders are at increased risk of negative emotional and behavioral outcomes, in line with the principles of multifinality and pleiotropy. The substantial heterogeneity among studies and the overrepresentation of White European American groups in this literature highlight the need for further research.

Plain language summary: In this meta-analysis of 98 studies and ∼55,000 unique participants, the authors examined the associations between fathers' anxiety and offspring mental health difficulties. The study found small but significant associations between paternal anxiety and offspring emotional and behavioral problems (Pearson r ranging between .13 and .19). Findings from the study highlight the importance of paternal mental health in offspring development, with paternal anxiety associated with a generalized offspring vulnerability to psychopathology. The results of the study are limited by the heterogeneity among studies and overrepresentation of White European American groups highlighting the need for further research.

Clinical guidance: DIVERSITY & INCLUSION STATEMENT: While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list.

Keywords: anxiety; emotional and behavioral outcomes; fathers; intergenerational transmission; offspring.