Mental health problems of expectant fathers have been found to be associated with emotional and behavioral problems in their kids as toddlers.

The mental health of a child’s mother during pregnancy is widely considered a risk factor for emotional and behavioral problems later in the child’s life. Now a new study finds that the father’s mental health during the pregnancy also plays a role.

The study of nearly 32,000 children in Norway, reported today in Pediatrics, is the largest yet to suggest that a risk for future mental health problems in young kids may be identified early on by examining the prenatal mental health of the fathers.

It found that children whose fathers scored highly for psychological distress, depression and anxiety at week 17 or 18 of the baby’s gestation had higher levels of emotional and behavioral difficulties at age 3, including disruptive behavior, anxiety and problems getting along with other children.

Information was collected from fathers who answered questions on a screening questionnaire about their mental health status during the pregnancy. Mothers later answered questions about their children’s development and difficulties.

Even after controlling for factors such as the father’s age, marital status, physical ailments, alcohol use, cigarette smoking and the mother’s mental health status, researchers found the same association between expectant fathers’ mental health and problems developing later in the child, says lead study author Anne Lise Kvalevaag of Helse Fonna Hospital in Haugesund, Norway.

The data collected did not address how or why this association exists, but several “possible mechanisms” could be at work, she says. One possibility is a genetically transmitted risk to the child, she says. Or depression in the father could affect the mental health of the mother in such a way that the neonatal development of the child is affected. Another possibility: The father’s prenatal mental state could predict his mental state after the child’s birth, which “may also account for some of the associations found,” she says.

Only 3% of the fathers in the study had high levels of mental health problems, so these findings don’t mean that every child with a depressed father will have problems, says James Paulson,​ an associate professor of psychology at Old Dominion University in Norfolk, Va. “But when this is viewed across a large population, the effects of prenatal paternal distress are a substantial public health problem.” Paulson, who studies depression in families, was not involved in the new study.

In the past decade, “Researchers have learned that paternal postpartum depression presents many of the same risks to developing children that are well-documented in maternal postpartum depression,” says Paulson. The new study “found that depression in fathers during pregnancy poses risks that are similar to postpartum depression — a finding that mirrors what we know about depression in pregnancy for mothers, but which hasn’t previously been documented in fathers.

“For parents and physicians, the message should be clear,” says Paulson. “We need to be aware of depression (in) both parents from the time a pregnancy is realized. This study suggests that physicians should screen for depression early and often, and make the appropriate referral as soon as it’s detected.”

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Michelle Healy, USA TODAY