Paternal Perinatal Depression, Anxiety, and Stress and Child Development: A Systematic Review and Meta-Analysis

Abstract

Importance: This systematic review and meta-analysis comprehensively synthesizes the extant literature on the association of paternal perinatal mental distress (ie, depression, anxiety, and stress) with offspring development from birth to adolescence.

Objective: To provide a meta-analytic synthesis of the literature on the association between paternal perinatal depression, anxiety, and stress and offspring development during the first 18 years of life.

Data sources: We searched MEDLINE Complete, Embase, PsycINFO, CINAHL Complete, and the gray literature for studies published up to November 2024.

Study selection: Inclusion criteria included availability in English, a human sample, quantitative data, longitudinal design, and having a measure of paternal perinatal mental distress and offspring development.

Data extraction and synthesis: Of the 9572 studies identified, 48 cohorts (from 84 studies) with 674 effect sizes met criteria for quantitative synthesis (including 286 unpublished associations sourced from doctoral theses or through contact with authors of eligible studies). Univariate random-effects models were used to quantitatively synthesize the associations between paternal perinatal mental distress and offspring development. Study quality was assessed using the US National Institutes of Health quality assessment tool for observational, cohort, and cross-sectional studies. Data analysis was completed in January 2025.

Main outcomes and measures: The primary outcomes were global, social-emotional, adaptive, cognitive, language, physical, and motor development in offspring in the first 18 years of life.

Results: Paternal perinatal mental distress was associated with poorer global (r = -0.12; 95% CI, -0.22 to -0.01), social-emotional (r = 0.09; 95% CI, 0.07-0.11), cognitive (r = -0.07; 95% CI, -0.13 to -0.01), language (r = -0.15; 95% CI, -0.25 to -0.05), and physical development (r = 0.04; 95% CI, 0.00-0.08) in offspring. No evidence was found for adaptive and motor outcomes. Associations were generally stronger for postnatal than antenatal mental distress, suggesting that a father's mental state may exert a more direct influence on the developing child after birth.

Conclusions and relevance: Evidence from this systematic review and meta-analysis indicates that paternal mental distress is a potentially modifiable predictor of child development. Reducing mental distress in fathers perinatally is thus an important target for preventative interventions aiming to support fathers during the transition to parenthood and promote the health and well-being of next-generation offspring.