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

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