Dads and depression: Paternal PND

The transition to parenthood can be a very challenging time for many new parents, as they learn to cope with the around-the-clock care needs of their newborn and the associated sleep deprivation and upheaval to established routines. At this time, the mother and baby are often the prime focus of attention and the emotional health and wellbeing of new fathers can easily be overlooked. New mums have many opportunities to talk through their feelings with their midwife, health visitor and/or GP. Routine screening for depression is part of maternity care provision and can detect the signs and symptoms during pregnancy and post birth. Fathers however, often do not have the same level of contact or opportunities to discuss their concerns. Many also often find it difficult to talk about their feelings about their partner’s pregnancy and becoming a father.

Background

It has been estimated that around 10 per cent of all new mothers experience postnatal depression (PND). More recently however, studies have found that three to 10 per cent of new fathers also develop depression during pregnancy and post birth. This is referred to as ‘Paternal PND’ and has been found to affect men regardless of their personality, age, or economic status. A study undertaken by the Medical Research Council a few years ago showed that one in 28 fathers experienced depression during the first year following their baby’s birth. However, society’s general expectations of men to remain strong and cope can make it difficult for some fathers to open up and talk honestly about how they are really feeling. Consequently, one of the most important steps is to ensure that where a father is considered to be showing signs of paternal PND, that they are encouraged to seek help and support and talk to someone that they trust.

Research has found that new fathers develop depression before their baby’s birth and that it often worsens between six weeks and six months post birth, with only minimal recovery by the time of their baby’s first birthday. Studies have also highlighted an association between depression and fathers’ anxiety before and after their baby’s birth.

Why do some dads develop PND?

As with maternal PND, fathers’ experience of PND can be triggered by a range of social, emotional and physical factors; many of which apply equally to both genders. These include the following:

1. Poor social and emotional support
2. Low self esteem
3. An individual’s personality/characteristics
4. Previous history of depression
5. Sleep deprivation
6. History of loss and grief
7. Emotional trauma from witnessing the birth

Research has also shown that there are a number of additional factors that are specifically associated with fathers’ developing PND. Studies have found that men find early pregnancy to be the most anxious time. This is believed to be associated with the normal pregnancy-related changes to their partner’s body shape; their feelings of involvement/non-involvement in their partner’s pregnancy and maternity care, as well as, their thoughts about impending fatherhood. Other influencing factors include the following:

a). Relationship stress and changes – Fathers have been found to be at an increased risk of developing paternal PND, particularly where a couple’s relationship is strained during the woman’s pregnancy. There can also be additional stress post birth where expectations about resuming sexual intercourse with their partner do not come about

b). Difficulties adjusting to parenthood – new dads can struggle to adjust to the inevitable changes associated with the transition to parenthood. Couples’ lived experience of life with their newborn baby can be very different to what they had anticipated. This can be particularly so where this relates to their baby’s temperament/excessive crying

c). Where the father’s partner has PND – Research has found a high correlation between a father developing paternal PND and his partner having PND. Where a father has concerns about his partner’s health and wellbeing, this is likely to impact on his own mental health and wellbeing. Fathers have reported that their partner’s PND brings disruption to their lives and their relationship. However, it should be noted that dads can experience paternal PND independently of their partner

d). A negative or traumatic birth experience – Research has found that a father’s experience of their partner’s labour and birth can impact on the dad’s subsequent emotional health and wellbeing. Studies have shown that some fathers who were made/felt obliged to attend their baby’s birth went on to develop mild forms of post traumatic stress disorder (PTSD)

e). Paternal age – Younger dads have been found to experience more anxiety and increased rates of depression. Paternal PND has been found predominantly in dads aged 30 years of age and under

f). First-time dads – Research has shown a higher incidence of paternal PND amongst first-time fathers. New dads can often feel overwhelmed and lack confidence in their new role as a parent. Dads have reported feelings of being ineffective and incompetent in taking on the parenting role

g). Financial concerns – Research has found an association between new dads who are on a low-income or unemployed and an increased risk of their developing paternal PND

h). Feeling excluded – Dads often work hard to bring in an income and can feel pressured, left out and excluded from their baby’s care and/or their relationship with their partner. Where these feelings aren’t discussed openly and honestly, men can sometimes experience feelings of resentment towards their new baby

What are the signs and symptoms of paternal PND?

There are a wide range of signs and symptoms that can indicate that a father is experiencing paternal PND:

1. Altered sleep patterns; particularly, difficulty in sleeping
2. Fatigue and headaches
3. Being irritable, easily angered
4. Feeling anxious, overwhelmed and unable to cope
5. Lack of interest in sex (loss of libido)
6. Changes to appetite – could be loss of appetite or comfort eating
7. Feelings of being ‘trapped’ or becoming socially withdrawn/isolated from their partner, friends and family
8. Apathy and loss of interest in activities, hobbies and leisure pursuits
9. Working longer hours to distance or withdraw themselves from the family and home life
10. Exhibiting risk-taking behaviour
11. Increased dependency on alcohol, tobacco or drugs as a coping mechanism, rather than seeking treatment for their depression.

What is the impact of paternal PND?

Research has shown that where dads’ experience paternal PND this can adversely affect their relationship and social interactions with their partner, family and friends as well as their relationship with their children. Studies have shown that fathers experiencing depression do not play with their children or read books to them to the same extent as those dads who are unaffected. Where PND remains untreated, this can adversely impact on children’s social and emotional development and behaviour at three years’ of age – particularly in boys. This can be the case even where the child’s mother is not suffering from PND.

Is there anything fathers can do to help themselves?

Parents tend to be their own toughest critics – life with a newborn baby isn’t always the idyll that new parents often anticipate and can often be hugely challenging. As a new dad, it is important that you understand that it is perfectly okay to sometimes feel low or disappointed in your new role as a parent. It is very important that you talk openly about how you are feeling with your partner, family and friends and/or your mates. ‘Me’ time is as important for new dads as it is for new mothers – maintaining your interests, hobbies and leisure activities is also very important. While finances and childcare responsibilities often mean these activities are undertaken less often, it is still important to ring-fence time just for ‘you’; away from work and family. Even on those days and nights when things aren’t going as smoothly as you’d hoped; trying to focus on the positive aspects of being a father and having a young family can help. Your partner can help too, by supporting you in how you parent your new baby. We all have our own approaches and styles of parenting and these can differ between mother and father. However, where you are supported by your partner in your preferred parenting style/approach, this can increase your self-confidence, give protection against developing PND and can also promote a strong bond between you and your new baby.

Talking openly and honestly about how you are feeling as a new father with your partner, family, friends or a trusted mate/work colleague is, as we’ve previously mentioned, very important. Bottling up your feelings and emotions isn’t healthy and it’s important that you use the emotional and practical support that is available to you. Family and friends can also offer a support network that enables you to have protected time to be yourself, whether this means playing a game of five-a-side football after work, taking a trip to the gym or enjoying a drink at ‘your local’ with the lads. If, however, you find that the above coping strategies still aren’t helping and you continue to feel low or feel that your depression is worsening, it is important that you seek help and support from your GP.

Treating Paternal PND

It is very important that paternal PND is recognised early and treated promptly so that fathers’ longer term mental health is not adversely affected. Where paternal PND is not treated promptly, there is the potential for their depression to negatively impact on their relationships with their partner, the new baby, family and friends. There are a range of approaches to the treatment of PND and your GP will discuss which approach is most appropriate for you. Counselling and therapy is often the first line of treatment; however, your GP may also prescribe this therapy in conjunction with antidepressants. Although, there aren’t as many specialist services providing support to fathers with paternal postnatal depression, your GP should be able to provide you with information on what support is available in your area. Increasingly, there can be opportunities for dads to meet up locally before their baby’s birth and afterwards. These dads’ groups provide opportunities for new dads to talk about their experiences of parenthood, share practical advice and support each other.

Finally

Couples will often find that they become both ‘time’ and ‘money’ poor when they start a family, and changes to their relationship and lifestyle are inevitable. See also our article, ‘From partners to parents’. It is not unusual for many new dads to feel under immense pressure in being the main provider for their family and you can easily feel overworked, overwhelmed and overlooked. Feeling this way can have an adverse impact on your mental health and wellbeing. Increasingly, research is showing us that the transition to parenthood is a significant life-changing event and equally challenging for both mothers and fathers. Admitting that you are struggling with the challenges of becoming a father and your new lifestyle does not make you a failure or weak. Maternity services are increasingly recognising the needs of new fathers and dads-to-be and your midwife and health visitor should actively encourage you to talk about how you are feeling and will encourage you to be involved in your baby’s care.