A sad dad: paternal postpartum depression.

Fathers with postpartum depression can seriously affect the child’s development, yet researchers and policymakers have overlooked them. 

Although there is no specific definition for paternal postpartum depression, researchers have adopted the one used to describe maternal postpartum depression: the occurrence of depression within 12 months after childbirth [1]. While most men have no trouble becoming a father, others may struggle with their new role.

Researchers report that 1 in every 4 fathers will suffer from depression after their child’s birth [2]. Moreover, the incidence rate increases up to 1 in every 2 fathers when their partner has also developed postpartum depression [3]. Despite some similarities between maternal and paternal depression, fathers display unique characteristics. For instance, paternal depression has been associated with anger, irritability and increased marital conflicts, and in some cases, there are episodes of violence [4]. Needless to say, that there is a negative impact on the father-child relationship. 

By no means, I intend to compare female and male difficulties in becoming a parent, whether that is through a biological or adoption process. The goal is to raise awareness to paternal postpartum depression, which negatively affects the father, his partner and the child, and researchers and parents often overlook it. It is in everyone’s interest to understand the impact of paternal postpartum depression.

The onset

Usually, fathers have little, if any, understanding of their new role during the pregnancy. As a consequence, men display their first psychiatric symptoms after childbirth. Conversely, females have the chance to prepare themselves through the physiological, anatomical and psychological changes of pregnancy for 40 weeks. Thus, men are unable to experience similar changes. As a result, the absence of a transition period may compromise men’s interpretation and acceptance of the responsibilities of becoming a father.

Nevertheless, there is a gradual shift in gender roles, and often new fathers choose to take paternal leave to take care of their babies.

Symptoms

There is evidence to suggest that the birth of a new child equally affects the father and the mother [3]. For example, new fathers display behavioural changes, such as social withdrawal and irritability. Moreover, partners often notice these symptoms, as the father’s interaction with the child begins to change upon increasing depressive symptoms.

Furthermore, symptoms include indecisiveness, cynicism, emotional rigidity, self-criticism, and substance use. Interestingly, there are also some somatic symptoms (e.g. indigestion, changes in weight, diarrhoea, constipation, headache, and insomnia) and psychological symptoms (e.g. concentration issues, other cognitive deficits such as memory issues and forgetfulness, anhedonia, and guilt. All of which negatively interfere with the family’s daily life.

Risk factors

Interestingly, maternal postpartum depression is a crucial risk factor that predicts paternal postpartum depression in the first year after childbirth [3]. Male individuals who have female partners suffering from depression feel less supported and more stressed during the postpartum period. The pressure on male individuals increases not only because of the demanding task of raising a child and commitments at work but also because they have to care for his depressed partner. Ultimately, there is a negative impact on the father-child relationship.

Additionally, the lack of social support is an underestimated risk factor for paternal postpartum depression, as the focus of attention is almost exclusively to the mother who has to breastfeed and temporarily leave her job. Consequently, both parents are emotionally unstable to offer care and support to their partner.

Stress factors

I have briefly written about the neuroscience of stress here and here, and how stress links to depression you can read here. Nevertheless, stress increases levels of cortisol—a stress hormone associated with anxiety—and could influence paternal behaviour. For example, lower levels of cortisol may contribute to positive stress-responses, as an increase in cortisol levels high levels of stress show positive correlation [6]. Therefore, low levels of cortisol may build a father-child connection.

Paternal Leave

Moreover, paid paternal leave has been an incentive and social support to new fathers, who have more time to develop and participate in a healthy family unit. Unfortunately, not all developed countries have family-friendly policies when it comes to paid paternal leave, such as the United States. The Organisation for Economic Cooperation and Development has ranked countries by paid paternal leave [7].

Perhaps with increasing awareness for the impact of male (and female) postpartum depression policymakers will address paid parental leave as a fundamental right.

Implications

Depressed fathers show less involvement with their child [3]. For example, males with postpartum depression have less contact with their newborn child (e.g. playing or bathing the baby). These are essential developmental tasks that enable stronger attachment between the father and the baby. However, in the absence of these father-child contact, fathers feel more guilty, less involved in parenthood and more isolated from the family unit. More importantly, there is a positive correlation between depressed fathers and poor developmental outcomes in newborn babies.

For example, researchers reported that males with postpartum depression displayed emotional issues, conduct and hyperactivity [8]. They suggest that paternal postpartum depression correlates with high scores in all three categories. In turn, these categories can have a long-term effect on the baby’s development.

Interestingly enough, another study done by the same group found that 12% of the children of fathers who suffered from postpartum depression were diagnosed with attention deficit hyperactivity disorder (ADHD), conduct disorder and anxiety and depressive disorders [9]. However, bear in mind that mood disorders have genetic factors triggering its expression. Nevertheless, when both parents suffer from depression, children display poor intellectual development, such as reading skills [3].

Next steps

In my opinion, there is still a lot of work around the sad dad issue. Male postpartum depression if largely overlooked both by scientists and policymakers alike, let alone how men do not want to acknowledge they are also vulnerable human beings. Not talking about male postpartum depression is a severe issue with negative implications. Hopefully, by reading this post, you will relate to the problem and help build a more scientifically literate society, where science facts do make a difference in our lives.

References

[1] American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.

[2] Koch, S., De Pascalis, L., Vivian, F., Meurer Renner, A., Murray, L., & Arteche, A. (2019). Effects of male postpartum depression on father–infant interaction: The mediating role of face processing. Infant mental health journal, 40(2), 263-276.

[3] Misri, S. (2018). Paternal Postnatal Psychiatric Illnesses. Springer.

[4] Kim, P., & Swain, J. E. (2007). Sad dads: paternal postpartum depression. Psychiatry (edgmont), 4(2), 35.

[5]deMontigny, F., Girard, M. E., Lacharité, C., Dubeau, D., & Devault, A. (2013). Psychosocial factors associated with paternal postnatal depression. Journal of affective disorders, 150(1), 44-49.

[6] Sapolsky, R. M. (2004). Why zebras don’t get ulcers: The acclaimed guide to stress, stress-related diseases, and coping-now revised and updated. Holt paperbacks.

[7] Organisation for Economic Cooperation and Development (2016). Father’s leave entitlement. Retrieved from OECD website.

[8] Ramchandani, P., Stein, A., Evans, J., O’Connor, T. G., & ALSPAC Study Team. (2005). Paternal depression in the postnatal period and child development: a prospective population study. The Lancet, 365(9478), 2201-2205.

[9] Ramchandani, P. G., O’Connor, T. G., Evans, J., Heron, J., Murray, L., & Stein, A. (2008). The effects of pre‐and postnatal depression in fathers: a natural experiment comparing the effects of exposure to depression on offspring. Journal of Child Psychology and Psychiatry, 49(10), 1069-1078.

Image by Freestock.org

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