***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND A father who does not know how to assist the mother in relieving labor pains may experience a sense of powerlessness and anxiety . The objective of this study was to evaluate how an education program for expectant fathers who attended their partners ' labor and birth affected their anxiety . METHODS In a r and omized controlled trial , 87 expectant fathers who attended their pregnant partners through labor and birth at a hospital in central Taiwan were allocated by block r and omization to an experimental ( n = 45 ) and a control ( n = 42 ) group . The men completed their basic personal information , a  childbirth expectations question  naire , and a  Trait Anxiety Inventory  when they were recruited . Two hours after birth of their child , all the expectant fathers completed a  State of Anxiety Inventory .  RESULTS Our results showed no statistically significant differences between the experimental and control groups of fathers in trait anxiety and their prenatal childbirth expectations . After analysis of covariance ( ANCOVA ) was applied to correct for education level , sources of childbirth information , attendance at Lamaze childbirth classes , and childbirth expectations at baseline , the effect of the childbirth program was significant for the postnatal level of anxiety ( F = 3.38 , p = 0.001 ) . CONCLUSIONS The study findings justify the clinical implementation of a birth education program based on the self-efficacy theory as an effective means of reducing anxiety among expectant fathers This cross-sectional study aims to determine the prevalence and determinants of depressive symptoms in  first-time expectant fathers during their partner ’s third trimester of pregnancy . As part of a prospect i ve study examining depressive symptoms in men over the first postnatal year , 622 men ( mean age = 34.3 years , ±5.0 years ) completed st and ardized online self-report question naires measuring depressed mood , physical activity , sleep quality , social support , marital adjustment , life events , financial stress , and demographics during their partner ’s third trimester of pregnancy . The Edinburgh Depression Scale  was used to assess depressed mood . Partners also completed the  Edinburgh Depression Scale  in the third trimester . The results revealed that 13.3 % of expectant fathers exhibited elevated levels of depressive symptoms during their partner ’s third trimester of pregnancy . Significant independent factors associated with antenatal depressive symptoms in men were poorer sleep quality , family history of psychological difficulties , lower perceived social support , poorer marital satisfaction , more stressful life events in the preceding 6 months , greater number of financial stressors , and elevated maternal antenatal depressive symptoms . These findings highlight the importance of including fathers in the screening and early prevention efforts targeting depression during the transition to parenthood , which to date have largely focused only on women . Strategies to promote better sleep , manage stress , and mobilize social support may be important areas to address in interventions tailored to new fathers at risk for depression during the transition to parenthood OBJECTIVE to describe first-time-expectant fathers ' experiences of pregnancy . DESIGN an inductive method using narrative interview form and qualitative content text analysis . The text of the transcripts was coded and categorised . SETTING S AND PARTICIPANTS seven first-time-expectant fathers living in a multicultural industrial town in southern Sweden were interviewed individually when their partner was in the 38th to 39th week of pregnancy . MEASUREMENTS AND FINDINGS all the fathers-to-be experienced some psychological , social and /or physical change during the pregnancy . The main category , was ' time of transition ' . Eight categories were found under this . They were : ' feelings of unreality , ' insufficiency and inadequacy ' , ' exclusion ' , ' reality ' , ' social changes ' , ' physical changes ' , ' responsibility , and development ' . KEY CONCLUSION the fathers'-to-be special needs for support and encouragement during pregnancy may be as important as those of the mothers'-to-be . The caregiver needs to be as aware of and sensitive to these needs . However , before any interventions can be recommended more research is needed OBJECTIVE To examine the effects of early maternal and paternal depression on child  expressive language  at age 24 months and the role that parent-to-child reading may play in this pathway . PARTICIPANTS AND METHODS The 9-month and 24-month waves from a national prospect i ve study of children and their families , the Early Childhood Longitudinal Study - Birth Cohort ( ECLS-B ) , provided data on 4,109 two-parent families .  Depressive symptoms were measured with a short form of the Center for Epidemiologic Studies Depression Scale ( CES-D ) . Parents reported on positive parent-infant interactions , child expressive vocabulary , and demographic and health information at child age 9 and 24 months . Linear regression was used to estimate associations between depression , parenting , and child vocabulary .  Structural equation modeling was used to test the hypothesis that parent reading behavior mediates the parent depression to child vocabulary pathway . These models were adjusted for demographic indicators . RESULTS As previously reported from this national sample , 14 % of mothers and 10 % of fathers exhibited elevated levels of depressive symptoms at 9 months . For both mothers and fathers , depression at 9 months was negatively associated with contemporaneous parent-to-child reading . Only for fathers , however , was earlier depression associated with later reading to child and related child expressive vocabulary development . A model describing this pathway demonstrated a significant indirect pathway from depression to vocabulary via parent reading to child . CONCLUSIONS Depression is a significant problem among both mothers and fathers of young children , but has a more marked impact on the father 's reading to his child and , subsequently , the child 's language development Prenatally depressed women ( N=47 ) were r and omly assigned to a group that received massage twice weekly from their partners from 20 weeks gestation until the end of pregnancy or a control group .  Self-reported leg pain , back pain , depression , anxiety and anger decreased more for the massaged pregnant women than for the control group women . In addition , the partners who massaged the pregnant women versus the control group partners reported less depressed mood , anxiety and anger across the course of the massage therapy period . Finally , scores on a relationship question naire improved more for both the women and the partners in the massage group . These data suggest that not only mood states but also relationships improve mutually when depressed pregnant women are massaged by their partners BACKGROUND The aim of this study was to explore the prospect i ve relationship between depressive symptoms and anxiety across pregnancy and the early postpartum . METHODS Participants ( N=207 ) completed the  State-Trait Anxiety Inventory Trait subscale , Beck Depression Inventory , and social support and sleep quality measures  at two time points during pregnancy and once in the early postpartum period . RESULTS After accounting for the relative stability of anxiety and depression over time , depressive symptoms earlier in pregnancy predicted higher levels of anxiety in late pregnancy and anxiety in late pregnancy predicted higher depressive symptomatology in the early postpartum . A bi-directional model of depression and anxiety in pregnancy was supported . LIMITATIONS Data were based on self-reports and participating women were predominantly tertiary educated with high family incomes . CONCLUSION Our findings suggest that depressive symptoms precede the development of higher levels of anxiety and that anxiety , even at non- clinical levels , can predict higher depressive symptoms . Clinicians are advised to screen for anxiety and depression concurrently during pregnancy OBJECTIVE To identify determinants of the initiation and duration of  breastfeeding amongst Australian women . METHODS A prospect i ve cohort study of 556 women in Perth , Western Australia and 503 women from the Darling Downs area , Queensl and , Australia . RESULTS Breastfeeding at discharge was most strongly associated with perceived paternal support of breastfeeding  with an adjusted odds ratio of 9.13 ( 95 % CI 4.83 - 17.26 ) , using multivariate logistic regression analysis . Duration of breastfeeding was most strongly associated with the length of time a mother intended to breastfeed with an adjusted relative risk of 4.18 ( 95 % CI 2.81 - 6.22 ) for > or = 4 months relative to < 4 months . CONCLUSIONS Interventions which aim to increase the length of time a woman intends to breastfeed , and which highlight the role of the father in successful breastfeeding , are recommended to help achieve recommended targets for breastfeeding initiation and duration BACKGROUND Although anxiety disorders are documented in the literature for new mothers ( but less so for fathers ) , rates of postpartum caseness tend to include only those with depression when diagnostic interviews or self-report measures vali date d on such interviews are used . This methodology therefore underestimates the true percentage of women and men who experience significant psychological difficulties postpartum . This has implication s for assessment , treatment and screening for postnatal mood disorders . METHOD Two studies were conducted on a total of 408 women and 356 men expecting their first child . They were recruited antenatally , and interviewed at 6 weeks postpartum using the Diagnostic Interview Schedule . DSM-IV criteria were applied to determine the presence since birth of depression ( major or minor ) , panic disorder , acute adjustment disorder with anxiety ( meeting the criteria for generalised anxiety disorder except for the duration criterion ) , and phobia . RESULTS The inclusion of diagnostic assessment for panic disorder and acute adjustment disorder with anxiety increased the rates of caseness by between 57 and 100 % for mothers , and 31 - 130 % for fathers , over the rates for major or minor depression . Inclusion of assessment for phobia further increased the rates of disorder in both sample s. Couple concordance rates were between 6.6 and 11.1 % , with no significant difference between rates for depressive or depressive and anxious caseness . For women , a previous history of an anxiety disorder appears to be a greater risk factor for a postnatal mood disorder ( i.e. depression or anxiety ) than a history of a depressive disorder . CONCLUSIONS These results clearly show the need to assess for both depression and anxiety  in new and expectant parents , and we believe the term ' postnatal mood disorder ' ( PMD ) , rather than postnatal depression , more accurately reflects significant adjustment difficulties in new parents OBJECTIVE To examine incidence , trends , and correlates of  parental depression  in primary care from 0 to 12 years of child age . DESIGN Prospect i ve cohort study . SETTING Primary care records from more than 350 general practice s in The Health Improvement Network data base from 1993 to 2007 . PARTICIPANTS A total of 86 957 mother , father , and child triads identified in The Health Improvement Network data base by linking mothers and babies and then identifying an adult household man . Depressed parents were identified using Read code entries for depression and antidepressant prescriptions . MAIN EXPOSURES Child age , parental age at the birth , and area deprivation quintile . MAIN OUTCOME MEASURES Incidence rates for maternal and paternal episodes of depression . RESULTS Overall incidences of depression from the birth of the child up to age 12 years were 7.53 per 100 person-years for mothers and 2.69 per 100 person-years for fathers . Depression was highest in the first year post partum ( 13.93 and 3.56 per 100 person-years among mothers and fathers , respectively ) . By 12 years of child age , 39 % of mothers and 21 % of fathers had experienced an episode of depression . A history of depression , lower parental age at the birth of the child , and higher social deprivation were associated with a higher incidence of parental depression . CONCLUSIONS Parents are at highest risk for depression in the first year after the birth of their child . Parents with a history of depression , younger parents , and those from deprived areas are particularly vulnerable to depression . There is a need for appropriate recognition and management of  parental depression  in primary care 
    Output:
    
Conclusions : Based on the synthesized findings , three main factors that affect first time fathers ’ mental health and wellbeing during their transition to fatherhood were identified : the formation of the fatherhood identity , competing challenges of the new fatherhood role and negative feelings and fears relating to it .
The role restrictions and changes in lifestyle often result ed in feelings of stress , for which fathers used denial or escape activities , such as smoking , working longer hours or listening to music , as coping techniques .
Fathers wanted more guidance and support around the preparation for fatherhood , and partner relationship changes .
Better preparation for fatherhood , and support for couple relationships during the transition to parenthood could facilitate better experiences for new fathers , and contribute to better adjustments and mental wellbeing in new fathers