Prevalence and Determinants of Postpartum Depression Among Fathers in India: A Cross- Sectional Study

Prevalence and Determinants of Postpartum Depression Among Fathers in India: A Cross- Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prevalence and Determinants of Postpartum Depression Among Fathers in India: A Cross- Sectional Study Annu Antony, Sandhya G. I, Aswini K. V, Anantha Krishnan U. S, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7928563/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Background Postpartum depression (PPD) in fathers (paternal PPD) is under-diagnosed despite its significant personal, familial, and developmental sequelae. While maternal PPD is well-researched, paternal counterparts remain under-recognized, especially in India. Objectives This study aimed to estimate the prevalence and identify risk factors for paternal PPD among fathers in Central Kerala, India, within the first 12 months postpartum. Methods A cross-sectional survey was administered to 280 fathers after calculation sample size using 4PQ/R 2 (aged ≥ 18 years; child aged ≤ 12 months) and 20% nonresponse. Fathers were selected simple randomly form the labour room register of a tertiary hospital. The Edinburgh Postnatal Depression Scale (EPDS, cutoff ≥ 10) adapted for fathers screened depressive symptoms ( 1 ). A structured socio-demographic questionnaire and psychosocial items captured background and perceived risk factors after content, linguistic and face validation through a pilot study. Descriptive statistics quantified prevalence, and chi-square tests identified significant associations (p ≤ 0.05). Ethical approval was obtained from the Institutional Ethics Committee (AAMC/IEC/2023–2024/3–14), and the study was conducted in accordance with the Declaration of Helsinki (Clinical trial number: not applicable). Results Our study had 27% non-response rate due to stigma and unawareness about paternal PPD. Among 203 analysed respondents, 76 (37.44%) screened positive for paternal PPD. The highest prevalence occurred in fathers aged 25–35 years (64%). Marital status, nuclear family setting, middle-low income, lack of sleep, weak social/emotional support, relationship stress, and self-doubt about parenting ability were significantly associated with paternal PPD (p < 0.05). Our results underscore that paternal PPD is shaped less by static demographic characteristics and more by dynamic psychosocial stressors, including financial strain, physical exhaustion, and difficulties in emotional bonding Conclusion A substantial proportion of fathers in this Kerala cohort experienced postpartum depressive symptoms—nearly three times higher than the global pooled estimates (~ 8–12%) [ref]. The primary predictors were economic stress, family structure, and psychosocial strain, while factors such as employment category and area of residence were not significantly associated. Although our study employed a validated screening tool, its generalizability is limited by the single-center design and the absence of diagnostic confirmation. These findings nonetheless highlight the urgent need for routine paternal PPD screening, targeted public health interventions, and further longitudinal research in the Indian context Figures Figure 1 Introduction Postpartum depression (PPD) is well recognized as a mood disorder occurring within one year of child birth( 2 ). The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defines depression "with peripartum onset" as a major depressive episode (MDE) occurring during pregnancy or within four weeks postpartum( 3 ). While maternal PPD has received significant clinical and research attention, paternal postpartum PPD remains comparatively understudied and less understood. Globally, paternal PPD affects approximately 8–12% of fathers, with the highest prevalence observed between 3 to 6 months after childbirth. However, symptoms may develop insidiously and persist up to a year or longer ( 4 , 5 ). Emerging longitudinal evidence indicates that paternal depressive symptoms can extend well into the early developmental years of a child( 6 ). Although diagnostic criteria for MDE are applicable to both sexes, men may experience PPD with differences in symptom onset and presentation, often characterized by emotional suppression, irritability, withdrawal, or substance use, rather than overt sadness ( 7 ). These gender-specific patterns, compounded by cultural norms and stigma, may hinder timely identification and help-seeking among fathers. In a study from New Zealand, 5.3% of first-time fathers screened positive for PPD during the prenatal period, with prevalence decreasing to 2.8% at six weeks postpartum but increasing again to 4.7% at 12 months( 8 ). These findings support the need to extend screening for paternal PPD beyond the immediate postpartum period. Although men do not experience the dramatic hormonal shifts that accompany childbirth, studies suggest that fatherhood is associated with hormonal changes, including reductions in testosterone and changes in cortisol, oestrogen, vasopressin, and prolactin, which may predispose them to PPD( 9 ). Psychosocial stressors such as sleep deprivation, maternal depression, financial strain, poor partner relationships, and low social support further contribute to risk ( 7 ). Despite these vulnerabilities, systematic screening for paternal PPD is rarely implemented, as mental health assessments during the perinatal period remain focused almost exclusively on mothers. Globally, the body of research on paternal PPD has grown over the past two decades; however, studies from India remain limited. A recent meta-analysis estimated a pooled prevalence of 19.4% for paternal PPD in India, with regional estimates reaching as high as 22%( 10 ). The wide variability in study designs, sample sizes, EPDS cut-offs, and contextual factors complicates interpretation. Notably, there is a scarcity of published studies from South India, including Kerala, where socio-cultural norms and healthcare access may influence paternal mental health differently from other regions. A literature search using PubMed and Google Scholar yielded no recent studies exploring paternal PPD in this geographic setting. The Edinburgh Postnatal Depression Scale (EPDS), originally developed for screening maternal PPD, has also been validated for use among fathers( 6 ). It is a brief, self-administered tool that can be completed within five minutes and has shown sensitivity to changes in depressive symptoms over times( 13 ). A meta-analysis of studies using the EPDS in fathers reported satisfactory pooled sensitivity and specificity at cut-off scores of 7–10, and its validity appears unaffected by language translation ( 1 ). In this study, we employed the EPDS with a cut-off of 10, following independent linguistic and content validation by two subject experts. The negative consequences of paternal PPD are multifaceted. Paternal PPD has been linked to lower relationship satisfaction( 14 ), impaired parenting practices ( 15 ),, and adverse emotional and behavioral outcomes in children ( 16 ). Evidence also shows that when mothers are depressed the rates of paternal PPD also increased significantly( 5 ). Paternal PPD can lead to withdrawal from familial interactions, thereby exacerbating maternal feelings of isolation and diminishing the availability of partner support in infant care and household responsibilities.( 17 ). This dynamic can be a risk factor for maternal PPD( 18 ). Evidence from the Avon Longitudinal Study of Parents and Children (ALSPAC), which included over 10,000 fathers, found that paternal PPD is significantly associated with an increased risk of psychiatric disorders in offspring at 7 years of age (adjusted odds ratio [aOR] 1.72; 95% confidence interval [CI], 1.07–2.77) even after adjusting for maternal depression and paternal educational attainment .These associations were particularly strong for oppositional defiant and conduct disorders. Similarly, Ramchandani et al., in a cohort of over 8,000 fathers, found that postnatal paternal depression was linked to adverse emotional and behavioural outcomes in children at 3.5 years (aOR 2.09, 95% CI 1.42–3.08)( 19 ). These findings highlight the importance of early identification of paternal PPD for the overall wellbeing of the family. Given that the family functions as a cohesive unit, interventions aimed at improving maternal and child health should also incorporate strategies to address paternal postpartum mental health( 15 ). This is especially relevant in contexts where the role of fathers is evolving but still underrecognized in perinatal care. Therefore, continuing to increase systematic research on PPD is essential for maternal and child wellbeing aswell. Given the limited research on PPD in India, particularly within South Indian states like Kerala, there is a critical need for context-specific evidence to inform healthcare policy and clinical practice. Although Kerala is recognized for its advancements in education and healthcare, empirical data on paternal PPD remain scarce. This lack of evidence presents a significant challenge to the development and implementation of targeted mental health interventions for new fathers. In this context, the present study aims to assess the burden of paternal PPD and identify associated risk factors among fathers residing in suburban regions of central Kerala, within one year of childbirth. Methods Study design and setting A cross-sectional study was conducted over one year ( August 2023–August 2024) in a tertiary care hospital located in central Kerala, India. Participants were identified through hospital-maintained labour records. Of the 10,000 childbirth records reviewed, fathers were excluded if they had a permanent residence outside Kerala or father of the child is not contactable (contact details missing). After applying exclusion criteria, a sampling frame of 4,003 eligible participants was derived. Inclusion criteria: Fathers aged ≥ 21 years (legal marriage age in India). Having a live child aged between 0 and 12 months. Permanent residents of the study area. Exclusion criteria: History of diagnosed mental health disorders. Fathers separated from the infant or from broken families. Non-consenting participants. Missing contact details of father Fathers whose infants were stillborn or deceased. Sample size and sampling technique The sample size was calculated using the formula n = 4PQ/r² , where P is the expected prevalence of paternal PPD (30%, based on Goyal et al.), Q = 100 − P , and r = 20% relative error . This yielded a minimum sample size of 225. After adjusting for an anticipated 20% non-response rate, the final required sample size was rounded to 280 ( 10 ). Participants were selected using simple random sampling from the eligible sampling frame (n = 4,003). Study tools Paternal PPD was assessed using the Edinburgh Postnatal Depression Scale (EPDS), version 15, a 10-item self-report questionnaire originally developed for postpartum women and validated for use in fathers( 8 ). A cut-off score of ≥ 10 was used to indicate depressive symptoms, based on previous validation studies in paternal populations. The structured questionnaire also included sections on socio-demographic information and perceived psychosocial variables, including financial status, lifestyle, relationship quality, social support, and past psychiatric history. To minimize social desirability bias, the perceived psychosocial variables were framed in a quasi–third-person format (e.g., asking about fathers in general rather than directly about the respondent). This indirect approach encouraged participants to respond more openly without fear of judgment. Pilot testing A pilot test was conducted to assess the feasibility and contextual appropriateness of the questionnaire. Linguistic and content validation of the EPDS and associated questionnaire items was performed by two independent experts. The pilot study revealed a low response rate from home visits due to privacy concerns, unawareness, stigma and unavailability of fathers, leading to modifications in the data collection strategy. Data collection Due to limited success with in-person household visits, participants were contacted via telephone. Each participant was contacted once, and verbal informed consent was obtained. Consenting participants were sent a secure Google Form containing the Participant Information Sheet (PIS) and Participant Information Consent (PIC) form. One reminder call and two reminder messages were sent to improve response rates. Seven trained interviewers conducted telephonic interviews and assisted in follow-up as needed. All interviewers underwent standardized training in data collection procedures and ethical conduct. Figure 1 shows the study flow chart. Data analysis and Manuscript synthesis Data from Google Forms were exported into Microsoft Excel and subsequently imported into R software for analysis. Descriptive statistics were used to calculate the prevalence of depressive symptoms. Binary logistic regression was conducted to identify factors associated with PPD. Results were reported as odds ratios (OR) with 95% confidence intervals (CI), and a p-value < 0.05 was considered statistically significant. Manuscript synthesis was assisted by Grammarly and ChatGPT. Results Prevalence of Paternal Postpartum Depression Out of the 280 fathers recruited, 203 completed the survey, yielding a response rate of 72.5%. Using an Edinburgh Postnatal Depression Scale (EPDS) cut-off score of ≥ 10, the prevalence of paternal PPD was 37.44% (76/203), while 62.56% (127/203) were not depressed (Table 1 ). The 95% confidence of the prevalence was 30.7 to 44.9. Table 1 Prevalence of paternal postpartum depression among participants (n = 203) Depression status n %(CI) Depressed 76 37.44 (30.7–44.9) Not depressed 127 62.56 Total 203 100.00 Socio-demographic Characteristics The socio-demographic distribution of the respondents is summarised in Table 2 . Most participants (67.82%) were aged 25–35 years, followed by 35–45 years (19.80%). A large majority were married (95.54%), employed full-time (62.87%), and had attained college-level education (70.30%). Regarding income, the largest proportion reported a monthly income of INR 20,000–30,000 (29.95%), followed by INR 30,000–50,000 (26.90%). Hindu participants constituted 41.58% of the sample, followed closely by Muslims (39.60%) and Christians (17.82%). Nuclear families were the most common household type (60.40%), and 44.06% of participants resided in rural areas. Table 2 Socio-demographic characteristics of participants (n = 202 unless otherwise specified) Characteristic Category n % Age group Under 25 14 6.93 25–35 137 67.82 35–45 40 19.80 45–55 8 3.96 ≥ 55 3 1.49 Marital status Married 193 95.54 Unmarried 5 2.48 Separated 1 0.50 Divorced 1 0.50 Unmarried 2 0.99 Employment Full-time 127 62.87 Part-time 11 5.45 Self-employed 52 25.74 Student 7 3.47 Retired 2 0.99 Unemployed 3 1.49 Education Primary 4 1.98 Secondary 24 11.88 Higher secondary 32 15.84 College 142 70.30 Monthly income † 50,000 37 18.78 Religion Hindu 84 41.58 Muslim 80 39.60 Christian 36 17.82 Others 2 0.99 Family type Nuclear 122 60.40 Joint 47 23.27 Extended 33 16.34 Area of residence Rural 89 44.06 Semi-urban 48 23.76 Urban 65 32.18 †n = 197 for income data. Bivariate Analysis: Socio-demographic Characteristics and Paternal Postpartum Depression Bivariate analysis (Table 3 ) showed that certain socio-demographic variables were significantly associated with paternal PPD. Fathers aged < 25 years had a higher proportion of PPD compared to older age groups (p = 0.036). Employment status was significantly associated with PPD (p = 0.021), with unemployed and part-time workers showing higher prevalence. Lower monthly income was also linked to higher PPD prevalence (p = 0.008). Marital status, education level, religion, family type, and area of residence were not significantly associated with PP. We can understand PPD in fathers are primarily associated with the economic stability. Table 3 Association between socio-demographic characteristics and paternal postpartum depression (n = 202 unless otherwise specified) Characteristic Category Depressed n (%) Not Depressed n (%) p-value Age group < 25 9 (64.3) 5 (35.7) 0.036 25–35 55 (40.1) 82 (59.9) 35–45 9 (22.5) 31 (77.5) 45–55 2 (25.0) 6 (75.0) ≥ 55 1 (33.3) 2 (66.7) Marital status Married 72 (37.3) 121 (62.7) 0.892 Others 4 (40.0) 6 (60.0) Employment Full-time 41 (32.3) 86 (67.7) 0.021 Part-time 6 (54.5) 5 (45.5) Self-employed 19 (36.5) 33 (63.5) Student 5 (71.4) 2 (28.6) Retired 1 (50.0) 1 (50.0) Unemployed 3 (100.0) 0 (0.0) Education Primary 3 (75.0) 1 (25.0) 0.118 Secondary 8 (33.3) 16 (66.7) Higher secondary 9 (28.1) 23 (71.9) College 56 (39.4) 86 (60.6) Monthly income† 50,000 10 (27.0) 27 (73.0) Religion Hindu 31 (36.9) 53 (63.1) 0.982 Muslim 30 (37.5) 50 (62.5) Christian 14 (38.9) 22 (61.1) Others 1 (50.0) 1 (50.0) Family type Nuclear 48 (39.3) 74 (60.7) 0.621 Joint 16 (34.0) 31 (66.0) Extended 12 (36.4) 21 (63.6) Area of residence Rural 35 (39.3) 54 (60.7) 0.789 Semi-urban 17 (35.4) 31 (64.6) Urban 24 (36.9) 41 (63.1) History of health issues Yes 0 (0.0) 5 (100.0) 0.007 No – – Family history of mental health issues Yes 4 (25.0) 12 (75.0) 0.001 No – – †n = 197 for income data. Association Between Perceived Psychosocial Factors and Paternal Postpartum Depression In addition to socio-demographic characteristics, perceived psychosocial factors were examined, as these self-reported experiences may directly influence paternal emotional health. Table 4 presents the associations between perceived psychosocial factors and the presence of PPD. A significantly higher prevalence of PPD was observed among fathers with a history of personal health issues (p = 0.007) or a family history of mental health problems (p = 0.001). Factors strongly associated with PPD included financial problems (p < 0.001), lack of emotional support (p < 0.001), stress in family relationships (p < 0.001), less attention/intimacy from the partner (p < 0.001), and feeling excluded from the partner–baby bond (p < 0.001). Fathers reporting worry about being a good parent (p = 0.004), low confidence in parenting skills (p = 0.011), feeling overwhelmed by the paternal role (p < 0.001), lack of social support (p = 0.010), stressful birthing experiences (p = 0.010), and sleep deprivation after childbirth (p < 0.001) were also significantly more likely to be depressed. Table 4 Association between perceived factors and paternal postpartum depression (n = 203) Sl no Perceived factor Not depressed n (%) Depressed n (%) p-value 1 Worry about being a good parent 32 (25.2%) 34 (44.7%) 0.004 2 Low confidence in parenting skills 115 (90.6%) 59 (77.6%) 0.011 3 Overwhelmed by fatherhood role 13 (10.2%) 25 (32.9%) < 0.001 4 Financial problems 22 (17.3%) 50 (65.8%) < 0.001 5 Lack of social support 114 (89.8%) 58 (76.3%) 0.01 6 Lack of emotional support 13 (10.2%) 29 (38.2%) < 0.001 7 Stress in family relationships 9 (7.1%) 22 (28.9%) < 0.001 8 Less attention/intimacy from partner 9 (7.1%) 22 (28.9%) < 0.001 9 Stressful birthing experience 45 (35.4%) 41 (53.9%) 0.01 10 Sleep deprivation after childbirth 41 (32.3%) 49 (64.5%) < 0.001 11 Feeling excluded from partner–baby bond 4 (3.1%) 18 (23.7%) < 0.001 Percentages for 'Not depressed' were calculated using a denominator of 127. Percentages for 'Depressed' were calculated using a denominator of 76. Discussion This study found a striking prevalence of paternal postpartum depression (PPD) at 37%, which is considerably higher than global estimates of 8–12%( 4 ) and the pooled Indian prevalence of approximately 24% ( 20 ). The PPD in fathers is under-researched area in India, especially Kerala. Though, the findings are consistent with mental health data from Kerala, the study setting, which reports one of the highest rates of mental health morbidity in India according to the National Mental Health Survey (NMHS)( 21 ). In Kerala, the weighted average prevalence of mental morbidity is 11.4% compared to the national average of 10.6%, with current morbidity nearly twice as high in males (14.96%) compared to females (8.12%)( 22 ). The elevated prevalence of paternal PPD in our study mirrors state-level mental health morbidity patterns. The high proportion of positive PPD screens contrasts with the very low rate of self-reported prior mental health diagnoses (5/203 participants). This highlights the likelihood of significant underdiagnosis of paternal PPD, consistent with global concerns( 23 ). These findings not only reinforce concerns about the hidden burden of paternal PPD but also expected to have important implications for mental health policy and public health planning in Kerala. In this study, we examined the factors influencing paternal PPD, focusing on both sociodemographic characteristics and perceived psychosocial stressors. Our findings suggest that the subjective perception of stressors plays a more decisive role in shaping paternal mental health outcomes than routine demographic variables. To reduce social desirability bias, psychosocial stressors were assessed using a quasi–third-person format, which enabled fathers to respond more openly and generated insights closely tied to their psychological well-being. From a sociodemographic perspective, economic instability, particularly lack of regular employment and lower monthly income, was strongly associated with paternal PPD. Similar findings have been reported in a meta-analysis, where low income was identified as a key risk factor ( 16 ). Younger fathers (25–35 years) also appeared more vulnerable in our study, likely reflecting the dual pressures of career establishment and new parental responsibilities. Comparable cross-sectional data also demonstrated that social support from friends and family significantly reduced the odds of paternal PPD (OR = 0.227 and 0.133, respectively; p < 0.001) ( 24 ). In the model of paternal PPD by Kim et al, social support is key ecological factor affecting paternal PPD( 7 ). A recent prospective study from Singapore also reported paternal PPD could be predicted from social support and parental self-sufficiency at 1 month post child birth.( 25 ) Notably, marital status, education level, religion, family type, and area of residence showed no significant association with paternal PPD, consistent with Cameron et al.’s meta-analysis, which reported that prevalence was independent of paternal age, education, parity, prior depression, and timing of assessment ( 4 ). Psychosocial stressors emerged as the strongest determinants of paternal PPD in our analysis. Perceived financial strain was the most salient predictor, reported by 65.8% of depressed fathers compared with 17.3% of non-depressed fathers. Financial strain are independent of Income levels and Employment as upper socioecomoic class can also experice financial starin. So we assessed the perceived factors even though we assess income level in sociodemographic variables. These findings are consistent with our own sociodemographic results and with a prospective study that identify financial difficulties as independent risk factors for paternal PPD ( 26 ). Perceived physical exhaustions were also important, with stressful birthing experiences (53.9%) and sleep deprivation (64.5%) significantly more common among depressed fathers. Similar evidence from a prospective study shows that poor sleep quality is an independent risk factor for paternal PPD, particularly among first-time fathers( 26 ). Emotional and relational factors further reinforced these associations. Reduced partner intimacy (28.9% vs. 7.1%) and feelings of exclusion from the partner–infant bond (23.7% vs. 3.1%) were markedly higher in the depressed group. These findings are consistent with reports that fathers often experience a slower trajectory of bonding with their infants and require active informational and emotional support from mothers to facilitate attachment( 27 ). An ecological model for paternal PDD by Kim et al. along with a cohort study noted the importance of early father–infant bonding in relation to paternal PPD ( 7 , 28 ). A qualitative study on paternal lived experience highlight the strain on partner intimacy ( 29 ). Though the temporality of the association cannot be concluded, reduced pattern intimacy is consistently associated with paternal PPD( 30 ). Multiple studies have demonstrated that paternal PPD can exacerbate maternal mental health difficulties, creating a compounded risk for both parents ( 8 , 14 , 18 , 31 ). Evidence from a large U.S. cohort of father–mother dyads demonstrated that maternal postpartum depression significantly increases the risk of paternal postpartum depression, particularly when mothers have no prior history of depression, underscoring the importance of family-cantered approaches to screening and intervention( 31 ). Taken together, our results underscore that paternal PPD is shaped less by static demographic characteristics and more by dynamic psychosocial stressors, including financial strain, physical exhaustion, and difficulties in emotional bonding. Our study represents a novel attempt to explore the relatively under-researched phenomenon of paternal PPD in a southern state of India, a region with one of the higher mental health morbidities nationally. We employed a validated screening tool, ensured methodological rigor through probability sampling and a pilot study, and achieved a considerable sample size, thereby supporting the generalizability and validity of our findings. However, we encountered notable challenges, particularly fathers’ limited acceptance of PPD screening, which contributed to a relatively high non-response rate. The non-response observed among fathers highlights that addressing this important public health issue requires greater awareness, reduction of stigma, and exploration of alternative, more discreet methods of screening to improve participation and acceptability. It should also be noted that we utilized a screening tool rather than diagnostic interviews, which may have contributed to higher observed prevalence rates. Diagnostic interviews generally yield lower estimates, yet consistent evidence suggests that both approaches offer valuable insights into mood disorders among new parents. Additionally, our cross-sectional design assessed only the current mood state of fathers without evaluating recurrent or prior episodes of depression. Consequently, differentiation between de novo and recurrent PPD, as highlighted by Cooper and Murray (1995), was not possible( 32 ). To address this limitation, future longitudinal studies employing diagnostic interviews are recommended to establish more robust prevalence estimates in Central Kerala. In summary, our study demonstrates that paternal PPD is present in central Kerala and is closely associated with financial strain, physical exhaustion, social support and poor emotional bonding with the infant and partner. Although child outcomes were not assessed, previous evidence highlights the adverse impact of paternal depression on children’s emotional and behavioral development, underscoring the need for early detection. As one of the first systematic studies from this region, our findings bring attention to a neglected area of fathers’ mental health in the postnatal period. The high non-response rate further indicates stigma surrounding paternal mental health. These findings have clear implications for practice and policy: integrating paternal screening into routine postnatal care, implementing psychoeducation to reduce stigma and increase awareness, fostering peer-support networks, and promoting family-based interventions. The postpartum period should be managed with the family as the unit of care, rather than focusing solely on the mother and newborn. Declarations Ethical considerations Ethical approval for the study was obtained from the Institutional Ethics Committee of Al Azhar Medical College, approval number AAMC/IEC/2023–2024/3–14. The study was conducted in accordance with the principles of the Declaration of Helsinki. All participants provided informed consent prior to participation. Data confidentiality and participant anonymity were strictly maintained throughout the study. Clinical trial number: not applicable. Competing Interests The authors declare that they have no competing interests as defined by BMC Psychiatry , or any other interests that could be perceived to influence the results and/or interpretation of this manuscript. Research Funding This research was investigator-initiated and did not receive any internal or external funding. Consent for publication Not applicable Author Contribution AA conceptualised and designed the study, performed the data analysis, and drafted the main manuscript. AKU, AGN, AH, JJ, AS, MSD, and KA contributed to the study design and were responsible for data collection. AA and SG conducted the pilot testing and validation of the study tools. SG and AKV provided critical guidance throughout the study, contributed to data interpretation, and substantively revised the manuscript for important intellectual content. All authors read and approved the final version of the manuscript and agreed to be accountable for all aspects of the work. Acknowledgements Not applicable Data Availability The dataset used and analyzed during the current study is not publicly available due to privacy and institutional policy restrictions, but it can be made available from the corresponding author upon reasonable request. References Shafian AK, Mohamed S, Nasution Raduan NJ, Hway Ann AY. A systematic review and meta-analysis of studies validating Edinburgh Postnatal Depression Scale in fathers. Heliyon. 2022;8(5):e09441. Carlson K, Mughal S, Azhar Y, Siddiqui W. Perinatal Depression. In: StatPearls [Internet] [Internet]. StatPearls Publishing; 2025 [cited 2025 June 12]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519070/ Diagnostic. and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR ™ . Cameron EE, Sedov ID, Tomfohr-Madsen LM. Prevalence of paternal depression in pregnancy and the postpartum: An updated meta-analysis. J Affect Disord. 2016;206:189–203. Paulson JF, Bazemore SD. Prenatal and postpartum depression in fathers and its association with maternal depression: a meta-analysis. JAMA. 2010;303(19):1961–9. Garfield CF, Duncan G, Rutsohn J, McDade TW, Adam EK, Coley RL, et al. A longitudinal study of paternal mental health during transition to fatherhood as young adults. Pediatrics. 2014;133(5):836–43. Kim P, Swain JE. Sad Dads: Paternal Postpartum Depression. Psychiatry Edgmont. 2007;4(2):35. Matthey S, Barnett B, Ungerer J, Waters B. Paternal and maternal depressed mood during the transition to parenthood. J Affect Disord. 2000;60(2):75–85. Zarrouf FA, Artz S, Griffith J, Sirbu C, Kommor M. Testosterone and Depression: Systematic Review and Meta-Analysis. J Psychiatr Pract. 2009 July;15(4):289. Rp U, None RC, Sk ASKS. S, B S, Postpartum depression in India: a systematic review and meta-analysis. Bull World Health Organ [Internet]. 2017 Oct 1 [cited 2025 July 16];95(10). Available from: https://pubmed.ncbi.nlm.nih.gov/29147043/ Matthey S, Barnett B, Kavanagh DJ, Howie P. Validation of the Edinburgh Postnatal Depression Scale for men, and comparison of item endorsement with their partners. J Affect Disord. 2001;64(2–3):175–84. Edmondson OJH, Psychogiou L, Vlachos H, Netsi E, Ramchandani PG. Depression in fathers in the postnatal period: Assessment of the Edinburgh Postnatal Depression Scale as a screening measure. J Affect Disord. 2010 Sept;125(1–3):365–8. Detection of Postnatal Depression. | The British Journal of Psychiatry | Cambridge Core [Internet]. [cited 2025 June 12]. Available from: https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/abs/detection-of-postnatal-depression/E18BC62858DBF2640C33DCC8B572F02A Don BP, Mickelson KD. Paternal postpartum depression: The role of maternal postpartum depression, spousal support, and relationship satisfaction. Couple Fam Psychol Res Pract. 2012;1(4):323–34. Wilson S, Durbin CE. Effects of paternal depression on fathers’ parenting behaviors: A meta-analytic review. Clin Psychol Rev. 2010;30(2):167–80. Ramchandani PG, Stein A, O’connor TG, Heron J, Murray L, Evans J. Depression in Men in the Postnatal Period and Later Child Psychopathology: A Population Cohort Study. J Am Acad Child Adolesc Psychiatry. 2008;47(4):390–8. Musser AK, Ahmed AH, Foli KJ, Coddington JA. Paternal Postpartum Depression: What Health Care Providers Should Know. J Pediatr Health Care. 2013;27(6):479–85. Paulson JF, Bazemore SD. Prenatal and Postpartum Depression in Fathers and Its Association With Maternal Depression: A Meta-analysis. JAMA. 2010;303(19):1961–9. Ramchandani P. Paternal depression in the postnatal period and child development: a prospective population study. Lancet 2005 June 25;365(9478):2201–5. Shil HND. R. Prevalence of Postnatal Depression in Fathers: A Systematic Review and Meta-Analysis. J Health Allied Sci NU. 2023;14. Report2.pdf [Internet]. [cited 2025 Sept 23]. Available from: https://indianmhs.nimhans.ac.in/phase1/Docs/Report2.pdf Jyrwa S, Shibukumar TM, Thavody J, Anish PK, Bina T, Rajith KR, et al. Mental health morbidities in Kerala, India: Insights from National Mental Health Survey, 2015–2016. Indian J Psychiatry. 2023;65(12):1289–96. Paternal depression. an examination of its links with father, child and family functioning in the postnatal period - Ramchandani – 2011 - Depression and Anxiety - Wiley Online Library [Internet]. [cited 2025 Sept 24]. Available from: https://onlinelibrary.wiley.com/doi/ 10.1002/da.20814 Younis AS, Julaidan GS, Alsuwaylimi RA, Almajed BM, AlShammari RT, AlFirm RB, et al. Prevalence of Paternal Prenatal Depression and Its Associated Factors in Saudi Arabia. Risk Manag Healthc Policy. 2024;17:1083–92. Chua JS, Ng JQX, Chee CYI, Shen L, Dennis CL, Chong YS, et al. Struggles of Fatherhood: A Prospective Study on the Incidence of Paternal Postpartum Depression and Associated Factors. J Clin Nurs. 2025 June;34(6):2248–61. Da Costa D, Danieli C, Abrahamowicz M, Dasgupta K, Sewitch M, Lowensteyn I, et al. A prospective study of postnatal depressive symptoms and associated risk factors in first-time fathers. J Affect Disord. 2019;249:371–7. Factors Influencing the Father-Infant Relationship -, Anderson AM. 1996 [Internet]. [cited 2025 Sept 24]. Available from: https://journals.sagepub.com/doi/abs/10.1177/107484079600200306 Nasreen HE, Pasi HB, Aris MAM, Rahman JA, Rus RM, Edhborg M. Impact of parental perinatal depressive and anxiety symptoms trajectories on early parent-infant impaired bonding: a cohort study in east and west coasts of Malaysia. Arch Womens Ment Health. 2022;25(2):377–87. Schmitz RE. The Lived Experiences of Fathers with Postpartum Depression: A Qualitative Study. AJN Am J Nurs. 2025;125(8):e1. Condon JT, Boyce P, Corkindale CJ. The First-Time Fathers Study: a prospective study of the mental health and wellbeing of men during the transition to parenthood. Aust N Z J Psychiatry. 2004;38(1–2):56–64. Wain KF, Daley MF, Perraillon MC. Temporal Association Between Maternal Depression and Paternal Postpartum Depression. Am J Prev Med. 2025 June;68(6):1061–71. Cooper PJ, Murray L. Course and recurrence of postnatal depression. Evidence for the specificity of the diagnostic concept. Br J Psychiatry J Ment Sci. 1995;166(2):191–5. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 18 Feb, 2026 Reviewers invited by journal 31 Oct, 2025 Editor assigned by journal 31 Oct, 2025 Editor invited by journal 31 Oct, 2025 Submission checks completed at journal 30 Oct, 2025 First submitted to journal 30 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7928563","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":542228846,"identity":"1124f010-5430-458a-aae1-be64776c140a","order_by":0,"name":"Annu Antony","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9UlEQVRIiWNgGAWjYJADxgcfKoAUM3MDUcolQGoNZ5wBUYzEa2GT5m0D24ZfC//s3mMSDDV36vile8wkeOfVRvO3A7X8qNiG2/Q759IkGI49k5Ccc8bYQnLb8dwZhxkbGHvO3MZtzY0cMwkGtsMSBjdyDG8YbjuW2wDUwszYhluLPFjLP7AWA4nEOcdy5xPSYgDSwtgG1mIkcbChJncDIS2GN3KMLRL7DkvOnJFWbNhw7EDuRqCWg/j8Igfywodvh/n5JZI3Pv5TU5c77/zhgw9+VODxPggkgEkOAyBxGMw8gF89HLA/ABJ1RCoeBaNgFIyCkQQANmlb252D1D8AAAAASUVORK5CYII=","orcid":"","institution":"Al Azhar Medical College and Super specialty Hospital","correspondingAuthor":true,"prefix":"","firstName":"Annu","middleName":"","lastName":"Antony","suffix":""},{"id":542228847,"identity":"322354c4-da34-4aa7-a53b-f770c1ae6f69","order_by":1,"name":"Sandhya G. I","email":"","orcid":"","institution":"Al Azhar Medical College and Super specialty Hospital","correspondingAuthor":false,"prefix":"","firstName":"Sandhya","middleName":"G.","lastName":"I","suffix":""},{"id":542228851,"identity":"8670e258-5931-4b69-b16d-b8e02a3d5867","order_by":2,"name":"Aswini K. V","email":"","orcid":"","institution":"Al Azhar Medical College and Super specialty Hospital","correspondingAuthor":false,"prefix":"","firstName":"Aswini","middleName":"K.","lastName":"V","suffix":""},{"id":542228852,"identity":"aaf98229-30cd-47c1-80a7-efb505723317","order_by":3,"name":"Anantha Krishnan U. S","email":"","orcid":"","institution":"Al Azhar Medical College and Super specialty Hospital","correspondingAuthor":false,"prefix":"","firstName":"Anantha","middleName":"Krishnan U.","lastName":"S","suffix":""},{"id":542228853,"identity":"6b56888b-b96c-40d2-b685-c30c629539d6","order_by":4,"name":"Ashith G. N","email":"","orcid":"","institution":"Al Azhar Medical College and Super specialty Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ashith","middleName":"G.","lastName":"N","suffix":""},{"id":542228854,"identity":"2cc5cc4f-1b87-47e7-912c-088a9f279707","order_by":5,"name":"Amal Harish","email":"","orcid":"","institution":"Al Azhar Medical College and Super specialty Hospital","correspondingAuthor":false,"prefix":"","firstName":"Amal","middleName":"","lastName":"Harish","suffix":""},{"id":542228855,"identity":"d9b5bf20-bddb-4443-bf79-96dfa18fabc7","order_by":6,"name":"Joshil K. Joseph","email":"","orcid":"","institution":"Al Azhar Medical College and Super specialty Hospital","correspondingAuthor":false,"prefix":"","firstName":"Joshil","middleName":"K.","lastName":"Joseph","suffix":""},{"id":542228856,"identity":"c36b9710-28eb-4798-b2e1-45df7603a16a","order_by":7,"name":"Amina S","email":"","orcid":"","institution":"Al Azhar Medical College and Super specialty Hospital","correspondingAuthor":false,"prefix":"","firstName":"Amina","middleName":"","lastName":"S","suffix":""},{"id":542228857,"identity":"9c6b67a5-acc4-434a-8ed5-8ec1525e67ee","order_by":8,"name":"Mobi Sahadevan Dev","email":"","orcid":"","institution":"Al Azhar Medical College and Super specialty Hospital","correspondingAuthor":false,"prefix":"","firstName":"Mobi","middleName":"Sahadevan","lastName":"Dev","suffix":""},{"id":542228858,"identity":"eb811a97-78f8-4407-9692-8d1229c1e32e","order_by":9,"name":"Krishma Akhilesh","email":"","orcid":"","institution":"Al Azhar Medical College and Super specialty Hospital","correspondingAuthor":false,"prefix":"","firstName":"Krishma","middleName":"","lastName":"Akhilesh","suffix":""}],"badges":[],"createdAt":"2025-10-23 05:38:04","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7928563/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7928563/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":95632320,"identity":"b4af93c6-b390-48c3-82bd-fc49ba680853","added_by":"auto","created_at":"2025-11-11 11:43:49","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1073883,"visible":true,"origin":"","legend":"","description":"","filename":"MansucriptPPDfathersrev.docx","url":"https://assets-eu.researchsquare.com/files/rs-7928563/v1/878a12a994a809f6d2f98d34.docx"},{"id":95632322,"identity":"fde8f579-bcb4-416a-ab23-41e3cdeaea84","added_by":"auto","created_at":"2025-11-11 11:43:49","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":9423,"visible":true,"origin":"","legend":"","description":"","filename":"2483edf6822e49f5bdd49c2268c74a2d.json","url":"https://assets-eu.researchsquare.com/files/rs-7928563/v1/83081c20f48b5adb1510d950.json"},{"id":95632331,"identity":"473aa10a-8296-4694-a279-842c979621f2","added_by":"auto","created_at":"2025-11-11 11:43:49","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":117379,"visible":true,"origin":"","legend":"","description":"","filename":"2483edf6822e49f5bdd49c2268c74a2d1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7928563/v1/54bf81af87ccc66603e7d9ba.xml"},{"id":95632314,"identity":"281f06e4-8c24-4fe1-8a51-1940c94134ba","added_by":"auto","created_at":"2025-11-11 11:43:48","extension":"png","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":997165,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7928563/v1/4f940e09bfcd2820152b1ec3.png"},{"id":95632329,"identity":"fe0a006f-71d3-41d1-a480-2420b7e9b03d","added_by":"auto","created_at":"2025-11-11 11:43:49","extension":"png","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":43102,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7928563/v1/9c41be442cd0034241af99fa.png"},{"id":95632318,"identity":"8af56214-1d33-42aa-bfef-e5a5bdc2db77","added_by":"auto","created_at":"2025-11-11 11:43:49","extension":"xml","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":113939,"visible":true,"origin":"","legend":"","description":"","filename":"2483edf6822e49f5bdd49c2268c74a2d1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7928563/v1/946af4d5000772aabf731875.xml"},{"id":95632328,"identity":"7e489a54-3244-47eb-ae1b-2a7156d0f773","added_by":"auto","created_at":"2025-11-11 11:43:49","extension":"html","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":127517,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7928563/v1/af30db63d2bd63210db163e5.html"},{"id":95656798,"identity":"df070d46-e76f-4dfc-868c-dec40c8ec071","added_by":"auto","created_at":"2025-11-11 16:19:36","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":88920,"visible":true,"origin":"","legend":"\u003cp\u003eStudy Flow chart\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7928563/v1/72bf6ea5dedb9e7b9f2a0890.png"},{"id":95657204,"identity":"f342361d-37e4-4cdc-af22-abe4ca765e03","added_by":"auto","created_at":"2025-11-11 16:20:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1228683,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7928563/v1/acbe98ce-27cf-4ddb-b60c-043ddc511857.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence and Determinants of Postpartum Depression Among Fathers in India: A Cross- Sectional Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePostpartum depression (PPD) is well recognized as a mood disorder occurring within one year of child birth(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The \u003cem\u003eDiagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)\u003c/em\u003e defines depression \"with peripartum onset\" as a major depressive episode (MDE) occurring during pregnancy or within four weeks postpartum(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). While maternal PPD has received significant clinical and research attention, paternal postpartum PPD remains comparatively understudied and less understood. Globally, paternal PPD affects approximately 8\u0026ndash;12% of fathers, with the highest prevalence observed between 3 to 6 months after childbirth. However, symptoms may develop insidiously and persist up to a year or longer (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eEmerging longitudinal evidence indicates that paternal depressive symptoms can extend well into the early developmental years of a child(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Although diagnostic criteria for MDE are applicable to both sexes, men may experience PPD with differences in symptom onset and presentation, often characterized by emotional suppression, irritability, withdrawal, or substance use, rather than overt sadness (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). These gender-specific patterns, compounded by cultural norms and stigma, may hinder timely identification and help-seeking among fathers. In a study from New Zealand, 5.3% of first-time fathers screened positive for PPD during the prenatal period, with prevalence decreasing to 2.8% at six weeks postpartum but increasing again to 4.7% at 12 months(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). These findings support the need to extend screening for paternal PPD beyond the immediate postpartum period.\u003c/p\u003e\u003cp\u003eAlthough men do not experience the dramatic hormonal shifts that accompany childbirth, studies suggest that fatherhood is associated with hormonal changes, including reductions in testosterone and changes in cortisol, oestrogen, vasopressin, and prolactin, which may predispose them to PPD(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Psychosocial stressors such as sleep deprivation, maternal depression, financial strain, poor partner relationships, and low social support further contribute to risk (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Despite these vulnerabilities, systematic screening for paternal PPD is rarely implemented, as mental health assessments during the perinatal period remain focused almost exclusively on mothers.\u003c/p\u003e\u003cp\u003eGlobally, the body of research on paternal PPD has grown over the past two decades; however, studies from India remain limited. A recent meta-analysis estimated a pooled prevalence of 19.4% for paternal PPD in India, with regional estimates reaching as high as 22%(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). The wide variability in study designs, sample sizes, EPDS cut-offs, and contextual factors complicates interpretation. Notably, there is a scarcity of published studies from South India, including Kerala, where socio-cultural norms and healthcare access may influence paternal mental health differently from other regions. A literature search using PubMed and Google Scholar yielded no recent studies exploring paternal PPD in this geographic setting.\u003c/p\u003e\u003cp\u003eThe Edinburgh Postnatal Depression Scale (EPDS), originally developed for screening maternal PPD, has also been validated for use among fathers(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). It is a brief, self-administered tool that can be completed within five minutes and has shown sensitivity to changes in depressive symptoms over times(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). A meta-analysis of studies using the EPDS in fathers reported satisfactory pooled sensitivity and specificity at cut-off scores of 7\u0026ndash;10, and its validity appears unaffected by language translation (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). In this study, we employed the EPDS with a cut-off of 10, following independent linguistic and content validation by two subject experts.\u003c/p\u003e\u003cp\u003eThe negative consequences of paternal PPD are multifaceted. Paternal PPD has been linked to lower relationship satisfaction(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), impaired parenting practices (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e),, and adverse emotional and behavioral outcomes in children (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Evidence also shows that when mothers are depressed the rates of paternal PPD also increased significantly(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Paternal PPD can lead to withdrawal from familial interactions, thereby exacerbating maternal feelings of isolation and diminishing the availability of partner support in infant care and household responsibilities.(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). This dynamic can be a risk factor for maternal PPD(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Evidence from the Avon Longitudinal Study of Parents and Children (ALSPAC), which included over 10,000 fathers, found that paternal PPD is significantly associated with an increased risk of psychiatric disorders in offspring at 7 years of age (adjusted odds ratio [aOR] 1.72; 95% confidence interval [CI], 1.07\u0026ndash;2.77) even after adjusting for maternal depression and paternal educational attainment .These associations were particularly strong for oppositional defiant and conduct disorders. Similarly, Ramchandani et al., in a cohort of over 8,000 fathers, found that postnatal paternal depression was linked to adverse emotional and behavioural outcomes in children at 3.5 years (aOR 2.09, 95% CI 1.42\u0026ndash;3.08)(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). These findings highlight the importance of early identification of paternal PPD for the overall wellbeing of the family.\u003c/p\u003e\u003cp\u003eGiven that the family functions as a cohesive unit, interventions aimed at improving maternal and child health should also incorporate strategies to address paternal postpartum mental health(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). This is especially relevant in contexts where the role of fathers is evolving but still underrecognized in perinatal care. Therefore, continuing to increase systematic research on PPD is essential for maternal and child wellbeing aswell. Given the limited research on PPD in India, particularly within South Indian states like Kerala, there is a critical need for context-specific evidence to inform healthcare policy and clinical practice. Although Kerala is recognized for its advancements in education and healthcare, empirical data on paternal PPD remain scarce. This lack of evidence presents a significant challenge to the development and implementation of targeted mental health interventions for new fathers. In this context, the present study aims to assess the burden of paternal PPD and identify associated risk factors among fathers residing in suburban regions of central Kerala, within one year of childbirth.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design and setting\u003c/h2\u003e\u003cp\u003eA cross-sectional study was conducted over one year ( August 2023\u0026ndash;August 2024) in a tertiary care hospital located in central Kerala, India. Participants were identified through hospital-maintained labour records. Of the 10,000 childbirth records reviewed, fathers were excluded if they had a permanent residence outside Kerala or father of the child is not contactable (contact details missing). After applying exclusion criteria, a sampling frame of 4,003 eligible participants was derived.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eInclusion criteria:\u003c/h3\u003e\n\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eFathers aged\u0026thinsp;\u0026ge;\u0026thinsp;21 years (legal marriage age in India).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eHaving a live child aged between 0 and 12 months.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003ePermanent residents of the study area.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\n\u003ch3\u003eExclusion criteria:\u003c/h3\u003e\n\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eHistory of diagnosed mental health disorders.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eFathers separated from the infant or from broken families.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eNon-consenting participants.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eMissing contact details of father\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eFathers whose infants were stillborn or deceased.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\n\u003ch3\u003eSample size and sampling technique\u003c/h3\u003e\n\u003cp\u003eThe sample size was calculated using the formula \u003cb\u003en\u0026thinsp;=\u0026thinsp;4PQ/r\u0026sup2;\u003c/b\u003e, where \u003cb\u003eP\u003c/b\u003e is the expected prevalence of paternal PPD (30%, based on Goyal et al.), \u003cb\u003eQ\u0026thinsp;=\u0026thinsp;100\u0026thinsp;\u0026minus;\u0026thinsp;P\u003c/b\u003e, and \u003cb\u003er\u0026thinsp;=\u0026thinsp;20% relative error\u003c/b\u003e. This yielded a minimum sample size of 225. After adjusting for an anticipated 20% non-response rate, the final required sample size was rounded to 280 (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Participants were selected using simple random sampling from the eligible sampling frame (n\u0026thinsp;=\u0026thinsp;4,003).\u003c/p\u003e\n\u003ch3\u003eStudy tools\u003c/h3\u003e\n\u003cp\u003ePaternal PPD was assessed using the Edinburgh Postnatal Depression Scale (EPDS), version 15, a 10-item self-report questionnaire originally developed for postpartum women and validated for use in fathers(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). A cut-off score of \u003cb\u003e\u0026ge;\u0026thinsp;10\u003c/b\u003e was used to indicate depressive symptoms, based on previous validation studies in paternal populations. The structured questionnaire also included sections on socio-demographic information and perceived psychosocial variables, including financial status, lifestyle, relationship quality, social support, and past psychiatric history. To minimize social desirability bias, the perceived psychosocial variables were framed in a quasi\u0026ndash;third-person format (e.g., asking about fathers in general rather than directly about the respondent). This indirect approach encouraged participants to respond more openly without fear of judgment.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003ePilot testing\u003c/h2\u003e\u003cp\u003eA pilot test was conducted to assess the feasibility and contextual appropriateness of the questionnaire. Linguistic and content validation of the EPDS and associated questionnaire items was performed by two independent experts. The pilot study revealed a low response rate from home visits due to privacy concerns, unawareness, stigma and unavailability of fathers, leading to modifications in the data collection strategy.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eDue to limited success with in-person household visits, participants were contacted via telephone. Each participant was contacted once, and verbal informed consent was obtained. Consenting participants were sent a secure Google Form containing the Participant Information Sheet (PIS) and Participant Information Consent (PIC) form. One reminder call and two reminder messages were sent to improve response rates. Seven trained interviewers conducted telephonic interviews and assisted in follow-up as needed. All interviewers underwent standardized training in data collection procedures and ethical conduct. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the study flow chart.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\n\u003ch3\u003eData analysis and Manuscript synthesis\u003c/h3\u003e\n\u003cp\u003eData from Google Forms were exported into Microsoft Excel and subsequently imported into R software for analysis. Descriptive statistics were used to calculate the prevalence of depressive symptoms. Binary logistic regression was conducted to identify factors associated with PPD. Results were reported as odds ratios (OR) with 95% confidence intervals (CI), and a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant. Manuscript synthesis was assisted by Grammarly and ChatGPT.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003ePrevalence of Paternal Postpartum Depression\u003c/h2\u003e\u003cp\u003eOut of the 280 fathers recruited, 203 completed the survey, yielding a response rate of 72.5%. Using an Edinburgh Postnatal Depression Scale (EPDS) cut-off score of \u0026ge;\u0026thinsp;10, the prevalence of paternal PPD was 37.44% (76/203), while 62.56% (127/203) were not depressed (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The 95% confidence of the prevalence was 30.7 to 44.9.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePrevalence of paternal postpartum depression among participants (n\u0026thinsp;=\u0026thinsp;203)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDepression status\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%(CI)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDepressed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e37.44 (30.7\u0026ndash;44.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot depressed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e127\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e62.56\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e203\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e100.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eSocio-demographic Characteristics\u003c/h2\u003e\u003cp\u003eThe socio-demographic distribution of the respondents is summarised in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Most participants (67.82%) were aged 25\u0026ndash;35 years, followed by 35\u0026ndash;45 years (19.80%). A large majority were married (95.54%), employed full-time (62.87%), and had attained college-level education (70.30%). Regarding income, the largest proportion reported a monthly income of INR 20,000\u0026ndash;30,000 (29.95%), followed by INR 30,000\u0026ndash;50,000 (26.90%). Hindu participants constituted 41.58% of the sample, followed closely by Muslims (39.60%) and Christians (17.82%). Nuclear families were the most common household type (60.40%), and 44.06% of participants resided in rural areas.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSocio-demographic characteristics of participants (n\u0026thinsp;=\u0026thinsp;202 unless otherwise specified)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge group\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnder 25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.93\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25\u0026ndash;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e137\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e67.82\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35\u0026ndash;45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e19.80\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e45\u0026ndash;55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.96\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.49\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e193\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e95.54\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnmarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.48\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSeparated\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDivorced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnmarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.99\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEmployment\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFull-time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e127\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e62.87\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePart-time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5.45\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSelf-employed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e25.74\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStudent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.47\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRetired\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.99\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnemployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.49\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrimary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.98\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSecondary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e11.88\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigher secondary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e15.84\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCollege\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e142\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e70.30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMonthly income\u003c/b\u003e\u0026dagger;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;10,000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.09\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10,000\u0026ndash;20,000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e18.27\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20,000\u0026ndash;30,000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e29.95\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30,000\u0026ndash;50,000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e26.90\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;50,000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e18.78\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eReligion\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHindu\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e41.58\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMuslim\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e39.60\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChristian\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e17.82\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.99\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFamily type\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNuclear\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e122\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e60.40\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eJoint\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e23.27\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExtended\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e16.34\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eArea of residence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e44.06\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSemi-urban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e23.76\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e32.18\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u0026dagger;n\u0026thinsp;=\u0026thinsp;197 for income data.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eBivariate Analysis: Socio-demographic Characteristics and Paternal Postpartum Depression\u003c/h2\u003e\u003cp\u003eBivariate analysis (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) showed that certain socio-demographic variables were significantly associated with paternal PPD. Fathers aged\u0026thinsp;\u0026lt;\u0026thinsp;25 years had a higher proportion of PPD compared to older age groups (p\u0026thinsp;=\u0026thinsp;0.036). Employment status was significantly associated with PPD (p\u0026thinsp;=\u0026thinsp;0.021), with unemployed and part-time workers showing higher prevalence. Lower monthly income was also linked to higher PPD prevalence (p\u0026thinsp;=\u0026thinsp;0.008). Marital status, education level, religion, family type, and area of residence were not significantly associated with PP. We can understand PPD in fathers are primarily associated with the economic stability.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAssociation between socio-demographic characteristics and paternal postpartum depression (n\u0026thinsp;=\u0026thinsp;202 unless otherwise specified)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDepressed n (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNot Depressed n (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge group\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9 (64.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (35.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.036\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25\u0026ndash;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55 (40.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e82 (59.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35\u0026ndash;45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9 (22.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e31 (77.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e45\u0026ndash;55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (25.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 (75.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (33.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (66.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e72 (37.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e121 (62.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.892\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (40.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 (60.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEmployment\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFull-time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41 (32.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e86 (67.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.021\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePart-time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (54.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (45.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSelf-employed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19 (36.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33 (63.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStudent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (71.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (28.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRetired\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnemployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (100.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrimary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (75.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (25.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.118\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSecondary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (33.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16 (66.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigher secondary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9 (28.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23 (71.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCollege\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e56 (39.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e86 (60.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMonthly income\u0026dagger;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;10,000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (66.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4 (33.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.008\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10,000\u0026ndash;20,000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19 (52.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17 (47.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20,000\u0026ndash;30,000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20 (33.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e39 (66.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30,000\u0026ndash;50,000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14 (26.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e39 (73.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;50,000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (27.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e27 (73.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eReligion\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHindu\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31 (36.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e53 (63.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.982\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMuslim\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30 (37.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e50 (62.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChristian\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14 (38.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22 (61.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFamily type\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNuclear\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e48 (39.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e74 (60.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.621\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eJoint\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16 (34.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e31 (66.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExtended\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12 (36.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21 (63.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eArea of residence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35 (39.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e54 (60.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.789\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSemi-urban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17 (35.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e31 (64.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24 (36.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e41 (63.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHistory of health issues\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (100.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.007\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFamily history of mental health issues\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (25.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12 (75.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u0026dagger;n\u0026thinsp;=\u0026thinsp;197 for income data.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eAssociation Between Perceived Psychosocial Factors and Paternal Postpartum Depression\u003c/h2\u003e\u003cp\u003eIn addition to socio-demographic characteristics, perceived psychosocial factors were examined, as these self-reported experiences may directly influence paternal emotional health. Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e presents the associations between perceived psychosocial factors and the presence of PPD. A significantly higher prevalence of PPD was observed among fathers with a history of personal health issues (p\u0026thinsp;=\u0026thinsp;0.007) or a family history of mental health problems (p\u0026thinsp;=\u0026thinsp;0.001). Factors strongly associated with PPD included financial problems (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), lack of emotional support (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), stress in family relationships (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), less attention/intimacy from the partner (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and feeling excluded from the partner\u0026ndash;baby bond (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Fathers reporting worry about being a good parent (p\u0026thinsp;=\u0026thinsp;0.004), low confidence in parenting skills (p\u0026thinsp;=\u0026thinsp;0.011), feeling overwhelmed by the paternal role (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), lack of social support (p\u0026thinsp;=\u0026thinsp;0.010), stressful birthing experiences (p\u0026thinsp;=\u0026thinsp;0.010), and sleep deprivation after childbirth (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were also significantly more likely to be depressed.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAssociation between perceived factors and paternal postpartum depression (n\u0026thinsp;=\u0026thinsp;203)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSl no\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePerceived factor\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNot depressed\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDepressed\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWorry about being a good parent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e32 (25.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e34 (44.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow confidence in parenting skills\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e115 (90.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e59 (77.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.011\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOverwhelmed by fatherhood role\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13 (10.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e25 (32.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFinancial problems\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e22 (17.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e50 (65.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLack of social support\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e114 (89.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e58 (76.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLack of emotional support\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13 (10.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e29 (38.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStress in family relationships\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9 (7.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e22 (28.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLess attention/intimacy from partner\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9 (7.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e22 (28.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStressful birthing experience\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e45 (35.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e41 (53.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSleep deprivation after childbirth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e41 (32.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e49 (64.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFeeling excluded from partner\u0026ndash;baby bond\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4 (3.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e18 (23.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003ePercentages for 'Not depressed' were calculated using a denominator of 127. Percentages for 'Depressed' were calculated using a denominator of 76.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study found a striking prevalence of paternal postpartum depression (PPD) at 37%, which is considerably higher than global estimates of 8\u0026ndash;12%(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) and the pooled Indian prevalence of approximately 24% (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). The PPD in fathers is under-researched area in India, especially Kerala. Though, the findings are consistent with mental health data from Kerala, the study setting, which reports one of the highest rates of mental health morbidity in India according to the National Mental Health Survey (NMHS)(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). In Kerala, the weighted average prevalence of mental morbidity is 11.4% compared to the national average of 10.6%, with current morbidity nearly twice as high in males (14.96%) compared to females (8.12%)(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). The elevated prevalence of paternal PPD in our study mirrors state-level mental health morbidity patterns. The high proportion of positive PPD screens contrasts with the very low rate of self-reported prior mental health diagnoses (5/203 participants). This highlights the likelihood of significant underdiagnosis of paternal PPD, consistent with global concerns(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). These findings not only reinforce concerns about the hidden burden of paternal PPD but also expected to have important implications for mental health policy and public health planning in Kerala.\u003c/p\u003e\u003cp\u003eIn this study, we examined the factors influencing paternal PPD, focusing on both sociodemographic characteristics and perceived psychosocial stressors. Our findings suggest that the subjective perception of stressors plays a more decisive role in shaping paternal mental health outcomes than routine demographic variables. To reduce social desirability bias, psychosocial stressors were assessed using a quasi\u0026ndash;third-person format, which enabled fathers to respond more openly and generated insights closely tied to their psychological well-being.\u003c/p\u003e\u003cp\u003eFrom a sociodemographic perspective, economic instability, particularly lack of regular employment and lower monthly income, was strongly associated with paternal PPD. Similar findings have been reported in a meta-analysis, where low income was identified as a key risk factor (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Younger fathers (25\u0026ndash;35 years) also appeared more vulnerable in our study, likely reflecting the dual pressures of career establishment and new parental responsibilities. Comparable cross-sectional data also demonstrated that social support from friends and family significantly reduced the odds of paternal PPD (OR\u0026thinsp;=\u0026thinsp;0.227 and 0.133, respectively; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). In the model of paternal PPD by Kim et al, social support is key ecological factor affecting paternal PPD(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). A recent prospective study from Singapore also reported paternal PPD could be predicted from social support and parental self-sufficiency at 1 month post child birth.(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) Notably, marital status, education level, religion, family type, and area of residence showed no significant association with paternal PPD, consistent with Cameron et al.\u0026rsquo;s meta-analysis, which reported that prevalence was independent of paternal age, education, parity, prior depression, and timing of assessment (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003ePsychosocial stressors emerged as the strongest determinants of paternal PPD in our analysis. Perceived financial strain was the most salient predictor, reported by 65.8% of depressed fathers compared with 17.3% of non-depressed fathers. Financial strain are independent of Income levels and Employment as upper socioecomoic class can also experice financial starin. So we assessed the perceived factors even though we assess income level in sociodemographic variables. These findings are consistent with our own sociodemographic results and with a prospective study that identify financial difficulties as independent risk factors for paternal PPD (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Perceived physical exhaustions were also important, with stressful birthing experiences (53.9%) and sleep deprivation (64.5%) significantly more common among depressed fathers. Similar evidence from a prospective study shows that poor sleep quality is an independent risk factor for paternal PPD, particularly among first-time fathers(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eEmotional and relational factors further reinforced these associations. Reduced partner intimacy (28.9% vs. 7.1%) and feelings of exclusion from the partner\u0026ndash;infant bond (23.7% vs. 3.1%) were markedly higher in the depressed group. These findings are consistent with reports that fathers often experience a slower trajectory of bonding with their infants and require active informational and emotional support from mothers to facilitate attachment(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). An ecological model for paternal PDD by Kim et al. along with a cohort study noted the importance of early father\u0026ndash;infant bonding in relation to paternal PPD (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). A qualitative study on paternal lived experience highlight the strain on partner intimacy (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Though the temporality of the association cannot be concluded, reduced pattern intimacy is consistently associated with paternal PPD(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Multiple studies have demonstrated that paternal PPD can exacerbate maternal mental health difficulties, creating a compounded risk for both parents (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Evidence from a large U.S. cohort of father\u0026ndash;mother dyads demonstrated that maternal postpartum depression significantly increases the risk of paternal postpartum depression, particularly when mothers have no prior history of depression, underscoring the importance of family-cantered approaches to screening and intervention(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Taken together, our results underscore that paternal PPD is shaped less by static demographic characteristics and more by dynamic psychosocial stressors, including financial strain, physical exhaustion, and difficulties in emotional bonding.\u003c/p\u003e\u003cp\u003e Our study represents a novel attempt to explore the relatively under-researched phenomenon of paternal PPD in a southern state of India, a region with one of the higher mental health morbidities nationally. We employed a validated screening tool, ensured methodological rigor through probability sampling and a pilot study, and achieved a considerable sample size, thereby supporting the generalizability and validity of our findings. However, we encountered notable challenges, particularly fathers\u0026rsquo; limited acceptance of PPD screening, which contributed to a relatively high non-response rate. The non-response observed among fathers highlights that addressing this important public health issue requires greater awareness, reduction of stigma, and exploration of alternative, more discreet methods of screening to improve participation and acceptability.\u003c/p\u003e\u003cp\u003eIt should also be noted that we utilized a screening tool rather than diagnostic interviews, which may have contributed to higher observed prevalence rates. Diagnostic interviews generally yield lower estimates, yet consistent evidence suggests that both approaches offer valuable insights into mood disorders among new parents. Additionally, our cross-sectional design assessed only the current mood state of fathers without evaluating recurrent or prior episodes of depression. Consequently, differentiation between \u003cem\u003ede novo\u003c/em\u003e and recurrent PPD, as highlighted by Cooper and Murray (1995), was not possible(\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). To address this limitation, future longitudinal studies employing diagnostic interviews are recommended to establish more robust prevalence estimates in Central Kerala.\u003c/p\u003e\u003cp\u003eIn summary, our study demonstrates that paternal PPD is present in central Kerala and is closely associated with financial strain, physical exhaustion, social support and poor emotional bonding with the infant and partner. Although child outcomes were not assessed, previous evidence highlights the adverse impact of paternal depression on children\u0026rsquo;s emotional and behavioral development, underscoring the need for early detection. As one of the first systematic studies from this region, our findings bring attention to a neglected area of fathers\u0026rsquo; mental health in the postnatal period. The high non-response rate further indicates stigma surrounding paternal mental health. These findings have clear implications for practice and policy: integrating paternal screening into routine postnatal care, implementing psychoeducation to reduce stigma and increase awareness, fostering peer-support networks, and promoting family-based interventions. The postpartum period should be managed with the family as the unit of care, rather than focusing solely on the mother and newborn.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cb\u003eEthical considerations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eEthical approval for the study was obtained from the Institutional Ethics Committee of Al Azhar Medical College, approval number AAMC/IEC/2023\u0026ndash;2024/3\u0026ndash;14. The study was conducted in accordance with the principles of the Declaration of Helsinki. All participants provided informed consent prior to participation. Data confidentiality and participant anonymity were strictly maintained throughout the study. Clinical trial number: not applicable.\u003c/p\u003e\u003ch2\u003eCompeting Interests\u003c/h2\u003e\u003cp\u003eThe authors declare that they have no competing interests as defined by \u003cem\u003eBMC Psychiatry\u003c/em\u003e, or any other interests that could be perceived to influence the results and/or interpretation of this manuscript.\u003c/p\u003e\u003ch2\u003eResearch Funding\u003c/h2\u003e\u003cp\u003eThis research was investigator-initiated and did not receive any internal or external funding.\u003c/p\u003e\u003cp\u003e\u003ch2\u003eConsent for publication\u003c/h2\u003e\u003cp\u003eNot applicable\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAA conceptualised and designed the study, performed the data analysis, and drafted the main manuscript. AKU, AGN, AH, JJ, AS, MSD, and KA contributed to the study design and were responsible for data collection. AA and SG conducted the pilot testing and validation of the study tools. SG and AKV provided critical guidance throughout the study, contributed to data interpretation, and substantively revised the manuscript for important intellectual content. All authors read and approved the final version of the manuscript and agreed to be accountable for all aspects of the work.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e\u003cp\u003eNot applicable\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe dataset used and analyzed during the current study is not publicly available due to privacy and institutional policy restrictions, but it can be made available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eShafian AK, Mohamed S, Nasution Raduan NJ, Hway Ann AY. A systematic review and meta-analysis of studies validating Edinburgh Postnatal Depression Scale in fathers. Heliyon. 2022;8(5):e09441.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCarlson K, Mughal S, Azhar Y, Siddiqui W. Perinatal Depression. In: StatPearls [Internet] [Internet]. StatPearls Publishing; 2025 [cited 2025 June 12]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ncbi.nlm.nih.gov/books/NBK519070/\u003c/span\u003e\u003cspan address=\"https://www.ncbi.nlm.nih.gov/books/NBK519070/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDiagnostic. and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR\u003csup\u003e\u0026trade;\u003c/sup\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCameron EE, Sedov ID, Tomfohr-Madsen LM. Prevalence of paternal depression in pregnancy and the postpartum: An updated meta-analysis. J Affect Disord. 2016;206:189\u0026ndash;203.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePaulson JF, Bazemore SD. Prenatal and postpartum depression in fathers and its association with maternal depression: a meta-analysis. JAMA. 2010;303(19):1961\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGarfield CF, Duncan G, Rutsohn J, McDade TW, Adam EK, Coley RL, et al. A longitudinal study of paternal mental health during transition to fatherhood as young adults. Pediatrics. 2014;133(5):836\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKim P, Swain JE. Sad Dads: Paternal Postpartum Depression. Psychiatry Edgmont. 2007;4(2):35.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMatthey S, Barnett B, Ungerer J, Waters B. Paternal and maternal depressed mood during the transition to parenthood. J Affect Disord. 2000;60(2):75\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZarrouf FA, Artz S, Griffith J, Sirbu C, Kommor M. Testosterone and Depression: Systematic Review and Meta-Analysis. J Psychiatr Pract. 2009 July;15(4):289.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRp U, None RC, Sk ASKS. S, B S, Postpartum depression in India: a systematic review and meta-analysis. Bull World Health Organ [Internet]. 2017 Oct 1 [cited 2025 July 16];95(10). Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/29147043/\u003c/span\u003e\u003cspan address=\"https://pubmed.ncbi.nlm.nih.gov/29147043/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMatthey S, Barnett B, Kavanagh DJ, Howie P. Validation of the Edinburgh Postnatal Depression Scale for men, and comparison of item endorsement with their partners. J Affect Disord. 2001;64(2\u0026ndash;3):175\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEdmondson OJH, Psychogiou L, Vlachos H, Netsi E, Ramchandani PG. Depression in fathers in the postnatal period: Assessment of the Edinburgh Postnatal Depression Scale as a screening measure. J Affect Disord. 2010 Sept;125(1\u0026ndash;3):365\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDetection of Postnatal Depression. | The British Journal of Psychiatry | Cambridge Core [Internet]. [cited 2025 June 12]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/abs/detection-of-postnatal-depression/E18BC62858DBF2640C33DCC8B572F02A\u003c/span\u003e\u003cspan address=\"https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/abs/detection-of-postnatal-depression/E18BC62858DBF2640C33DCC8B572F02A\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDon BP, Mickelson KD. Paternal postpartum depression: The role of maternal postpartum depression, spousal support, and relationship satisfaction. Couple Fam Psychol Res Pract. 2012;1(4):323\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWilson S, Durbin CE. Effects of paternal depression on fathers\u0026rsquo; parenting behaviors: A meta-analytic review. Clin Psychol Rev. 2010;30(2):167\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRamchandani PG, Stein A, O\u0026rsquo;connor TG, Heron J, Murray L, Evans J. Depression in Men in the Postnatal Period and Later Child Psychopathology: A Population Cohort Study. J Am Acad Child Adolesc Psychiatry. 2008;47(4):390\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMusser AK, Ahmed AH, Foli KJ, Coddington JA. Paternal Postpartum Depression: What Health Care Providers Should Know. J Pediatr Health Care. 2013;27(6):479\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePaulson JF, Bazemore SD. Prenatal and Postpartum Depression in Fathers and Its Association With Maternal Depression: A Meta-analysis. JAMA. 2010;303(19):1961\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRamchandani P. Paternal depression in the postnatal period and child development: a prospective population study. Lancet 2005 June 25;365(9478):2201\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShil HND. R. Prevalence of Postnatal Depression in Fathers: A Systematic Review and Meta-Analysis. J Health Allied Sci NU. 2023;14.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eReport2.pdf [Internet]. [cited 2025 Sept 23]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://indianmhs.nimhans.ac.in/phase1/Docs/Report2.pdf\u003c/span\u003e\u003cspan address=\"https://indianmhs.nimhans.ac.in/phase1/Docs/Report2.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJyrwa S, Shibukumar TM, Thavody J, Anish PK, Bina T, Rajith KR, et al. Mental health morbidities in Kerala, India: Insights from National Mental Health Survey, 2015\u0026ndash;2016. Indian J Psychiatry. 2023;65(12):1289\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePaternal depression. an examination of its links with father, child and family functioning in the postnatal period - Ramchandani \u0026ndash;\u0026thinsp;2011 - Depression and Anxiety - Wiley Online Library [Internet]. [cited 2025 Sept 24]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://onlinelibrary.wiley.com/doi/\u003c/span\u003e\u003cspan address=\"https://onlinelibrary.wiley.com/doi/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/da.20814\u003c/span\u003e\u003cspan address=\"10.1002/da.20814\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYounis AS, Julaidan GS, Alsuwaylimi RA, Almajed BM, AlShammari RT, AlFirm RB, et al. Prevalence of Paternal Prenatal Depression and Its Associated Factors in Saudi Arabia. Risk Manag Healthc Policy. 2024;17:1083\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChua JS, Ng JQX, Chee CYI, Shen L, Dennis CL, Chong YS, et al. Struggles of Fatherhood: A Prospective Study on the Incidence of Paternal Postpartum Depression and Associated Factors. J Clin Nurs. 2025 June;34(6):2248\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDa Costa D, Danieli C, Abrahamowicz M, Dasgupta K, Sewitch M, Lowensteyn I, et al. A prospective study of postnatal depressive symptoms and associated risk factors in first-time fathers. J Affect Disord. 2019;249:371\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFactors Influencing the Father-Infant Relationship -, Anderson AM. 1996 [Internet]. [cited 2025 Sept 24]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://journals.sagepub.com/doi/abs/10.1177/107484079600200306\u003c/span\u003e\u003cspan address=\"https://journals.sagepub.com/doi/abs/10.1177/107484079600200306\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNasreen HE, Pasi HB, Aris MAM, Rahman JA, Rus RM, Edhborg M. Impact of parental perinatal depressive and anxiety symptoms trajectories on early parent-infant impaired bonding: a cohort study in east and west coasts of Malaysia. Arch Womens Ment Health. 2022;25(2):377\u0026ndash;87.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSchmitz RE. The Lived Experiences of Fathers with Postpartum Depression: A Qualitative Study. AJN Am J Nurs. 2025;125(8):e1.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCondon JT, Boyce P, Corkindale CJ. The First-Time Fathers Study: a prospective study of the mental health and wellbeing of men during the transition to parenthood. Aust N Z J Psychiatry. 2004;38(1\u0026ndash;2):56\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWain KF, Daley MF, Perraillon MC. Temporal Association Between Maternal Depression and Paternal Postpartum Depression. Am J Prev Med. 2025 June;68(6):1061\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCooper PJ, Murray L. Course and recurrence of postnatal depression. Evidence for the specificity of the diagnostic concept. Br J Psychiatry J Ment Sci. 1995;166(2):191\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7928563/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7928563/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003ePostpartum depression (PPD) in fathers (paternal PPD) is under-diagnosed despite its significant personal, familial, and developmental sequelae. While maternal PPD is well-researched, paternal counterparts remain under-recognized, especially in India.\u003c/p\u003e\u003ch2\u003eObjectives\u003c/h2\u003e\u003cp\u003eThis study aimed to estimate the prevalence and identify risk factors for paternal PPD among fathers in Central Kerala, India, within the first 12 months postpartum.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA cross-sectional survey was administered to 280 fathers after calculation sample size using 4PQ/R\u003csup\u003e2\u003c/sup\u003e (aged\u0026thinsp;\u0026ge;\u0026thinsp;18 years; child aged\u0026thinsp;\u0026le;\u0026thinsp;12 months) and 20% nonresponse. Fathers were selected simple randomly form the labour room register of a tertiary hospital. The Edinburgh Postnatal Depression Scale (EPDS, cutoff\u0026thinsp;\u0026ge;\u0026thinsp;10) adapted for fathers screened depressive symptoms (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). A structured socio-demographic questionnaire and psychosocial items captured background and perceived risk factors after content, linguistic and face validation through a pilot study. Descriptive statistics quantified prevalence, and chi-square tests identified significant associations (p\u0026thinsp;\u0026le;\u0026thinsp;0.05). Ethical approval was obtained from the Institutional Ethics Committee (AAMC/IEC/2023\u0026ndash;2024/3\u0026ndash;14), and the study was conducted in accordance with the Declaration of Helsinki (Clinical trial number: not applicable).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eOur study had 27% non-response rate due to stigma and unawareness about paternal PPD. Among 203 analysed respondents, 76 (37.44%) screened positive for paternal PPD. The highest prevalence occurred in fathers aged 25\u0026ndash;35 years (64%). Marital status, nuclear family setting, middle-low income, lack of sleep, weak social/emotional support, relationship stress, and self-doubt about parenting ability were significantly associated with paternal PPD (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Our results underscore that paternal PPD is shaped less by static demographic characteristics and more by dynamic psychosocial stressors, including financial strain, physical exhaustion, and difficulties in emotional bonding\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eA substantial proportion of fathers in this Kerala cohort experienced postpartum depressive symptoms\u0026mdash;nearly three times higher than the global pooled estimates (~\u0026thinsp;8\u0026ndash;12%) [ref]. The primary predictors were economic stress, family structure, and psychosocial strain, while factors such as employment category and area of residence were not significantly associated. Although our study employed a validated screening tool, its generalizability is limited by the single-center design and the absence of diagnostic confirmation. These findings nonetheless highlight the urgent need for routine paternal PPD screening, targeted public health interventions, and further longitudinal research in the Indian context\u003c/p\u003e","manuscriptTitle":"Prevalence and Determinants of Postpartum Depression Among Fathers in India: A Cross- Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-11 11:43:43","doi":"10.21203/rs.3.rs-7928563/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"152287261147184860759396318286982237035","date":"2026-02-18T18:54:54+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-31T07:07:56+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-31T06:44:42+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-31T05:59:13+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-30T04:41:06+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychology","date":"2025-10-30T04:38:24+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cd76b42b-8b3d-48dc-a1dc-b27981842e28","owner":[],"postedDate":"November 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-11-11T11:43:44+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-11 11:43:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7928563","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7928563","identity":"rs-7928563","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}