Written by Dr. Shruti Nathwani
Paediatrician and founder of The Children’s Medic
The family network no longer follows a singular division between maternal and parental roles. The progression of shared parenting demands for an updated ante-natal and post-natal system whereby the focus extends to fathers alike. Care provision is still very ‘mother-centric.’
According to the National Childbirth Trust Study, 1 in 3 fathers are concerned about their mental health. Paternal Postpartum Depression (PPD), in particular, requires more attention and research.
What is paternal post-partum depression and why does it occur?
Paternal postpartum depression is currently underscreened, underdiagnosed, and undertreated. It is estimated that 4-25% of dads experience PPD in the first two months postpartum.
The definition of paternal PPD is largely based upon the maternal PPD definition:
A major depressive episode occurring within 4 weeks of delivery including:
-depressed or sad mood
-marked loss of interest in virtually all activities
-significant weight loss or gain
-insomnia or hypersomnia
-fatigue or loss of energy
-feelings of worthlessness or guilt
-diminished ability to think or concentrate
-recurrent thoughts of death
It could present as the following:
-withdrawal/avoidance (from social situations, work or family)
-increased marital conflict
-negative parenting behavior
Many studies have shown the highest rates of paternal PPD at 3 to 6 months postpartum.
What can contribute to paternal post-partum depression?
“The woman may be bearing the child but it is the couple that are expecting the baby”
The transition to fatherhood can be an extremely stressful time for men. Around 20% of new fathers do not feel an immediate attachment or bond with their newborn baby.
The father-infant relationship can be influenced by the partner relationship, the psychological well-being of the father as well as preparedness for fatherhood. Feeling guilty about lack of attachment, not feeling ready to be a father or wanting the baby can all contribute to PPD.
Paternal PPD has been proven to have a strong association with maternal PPD. Partners of those with post-partum depression are more likely to develop the condition themselves.
It has also been speculated that changes in hormones during the postpartum period in fathers may be a biological risk factor for paternal PPD. Fathers who have ecological risk factors, such as financial pressure, lack of social support, and isolation from mother-infant bonding, may also be more likely to develop paternal PPD.
How does this impact the family?
Poor paternal mental health can adversely impact the family unit and can directly impact infant care, bonding and child development. Studies have shown that there is an increased risk of childhood conduct disorders including hyperactivity and anxiety and depression.
What can be done to support fathers?
It is crucial during the perinatal period to engage and include the father. Preparing him for the psychological changes that both him and his partner might experience, will reduce the ‘emotional load’ when either are struggling. Healthcare professionals that place an importance on the role of a father can increase paternal confidence and reinforce the attachment to the growing baby.
Fathers need to be screened just as mothers are. If fathers can attend ante-natal appointments, health practioners should make a point of assessing their mental health status alongside the mothers. If fathers are not able to be present, mothers should be asked about their partner’s well-being.
Education about paternal PPD is vital. If fathers do not know about the condition and its signs and symptoms, then how can they seek help? Providing both mothers and fathers with anticipatory guidelines may help with symptom recognition and further care if required. This support could be obtained from their partner, health care professionals or peer-accredited support groups such as PANDAS Dads. Health care professionals can offer treatment such as cognitive behavioral therapy or anti-depressants when needed. The overall impact on the family unit could be huge.
The traditional outlook of fathers as sole providers for the family are largely outdated. Fathers are found to be more active and interested in their role as a new parent. Recognition of this transition and the affect it can have on fathers is crucial in encouraging positive, healthy parenting.
Musser AK, Ahmed AH, Foli KJ, Coddington JA, Paternal Postpartum Depression: What Health Care Providers Should Know, J Pediatric Health Care, 2013 Nov-Dec, 27(6): 479-85