Can Fathers Suffer From Postpartum Depression?

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When you think about postpartum depression, what image comes to mind? Likely the image is a new mom who is sad demonstrated through outward emotional expressions, such as crying. What likely did not come to mind was an image of a new father suffering from depressive symptoms following the transition to parenthood. However, men can also experience postpartum depression.

About 1 in 10 fathers experience paternal postpartum depression (PPD). This is twice the rate of depression for men in the general population. Not only do we typically associate postpartum depression with women, but symptoms in fathers can present differently than those displayed in mothers, which further contributes to fathers being underdiagnosed and left untreated.

PPD Symptom Presentation

A formal method of diagnosing and documenting maternal postpartum depression did not occur until 1994, with the release of the fourth edition Diagnostic and Statistical Manual of Mental Disorders (DSM). However, there is not yet an official set of diagnostic criteria for PPD. While maternal postpartum depression can be defined utilizing the DSM’s criteria for major depressive disorder with postpartum onset occurring within four weeks of birth, this symptom presentation and onset might not be appropriate for diagnosing fathers. Fathers are less likely to present with “traditional” postpartum depression symptoms such as a sad mood exhibited by outward crying. Instead, symptoms in fathers might include the following:

• irritability, hostility, and anger
• isolation, withdrawal, and detachment, such as throwing oneself into work
• risky behaviors, such as increased substance use
• physical symptoms, such as pain, changes in appetite and weight, and difficulty sleeping
• negative relational and parenting behaviors

Additionally, while maternal postpartum depression symptoms typically have an earlier onset, PPD symptoms tend to develop more slowly and gradually over the first year, postpartum with peak onset three to six months after childbirth.

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Risk Factors

There are a variety of factors that can contribute to the development of PPD:

• Hormonal changes, such as decreases in testosterone thought to promote parent-infant bonding
• Environmental stressors, such as lack of social support and financial stress
• Pregnancy complications and birth trauma
• Sleep deprivation
• History of mental illness

Of particular importance, maternal depression is the most influential risk factor for the onset of PPD in new fathers. This is different than maternal postpartum depression in which her own mental health history is the strongest risk factor, demonstrating yet another way in which PPD differs from maternal depression.

Prevention and Treatment

Fathers’ involvement in their children’s lives, starting in early childhood, has important consequences for children’s development and well-being; however, fathers’ physical and mental health also plays an important role in marital and childhood outcomes. Research shows higher levels of marital stress and negative parenting behaviors (for example, less likely to read, more likely to spank) when a father suffers from PPD; in contrast, a healthy father can lessen the effects of maternal depression on the infant. Prevention and treatment approaches for PPD are paramount.

Engaging fathers in perinatal services positively affects fathers’ mental health and overall family well-being. The engagement of fathers creates opportunities for screening and PPD treatment; however, because most services are designed for mothers and babies this can be challenging. Considering ways to increase father engagement is particularly important because men generally have more difficulty reaching out for help. One study found that only 3.2 percent of new fathers sought out mental health services, with depression predicting a reduction in mental health-seeking behaviors. This data suggests we must think about the unique barriers and ways in which treatment is offered to new fathers struggling with PPD.

• While mothers have frequent interaction with the healthcare system through pregnancy and postpartum, fathers generally have less healthcare interaction during the perinatal period and are not the focus of attention. Additionally, while there are established mental health screening guidelines for pregnant and postpartum mothers, no such guidelines exist for fathers. Universal screening should be done not just on mothers, but all parents attending appointments during pregnancy, postpartum, and newborn pediatrician appointments. Primary care doctors should also be alerted to this life transition to monitor and treat mental health changes in fathers. Similar to maternal mental health disorders, PPD can be successfully treated by medication and psychotherapy.
• Societal messages men receive about what it means to be both a man and father, a source of stability and support, are likely another barrier for men seeking mental health services. Research demonstrates that men are more likely to adopt norms modeled by other men. Given the present low utilization rates of traditional mental health services and the positive outcomes demonstrated for peer support programs, efforts should be made to expand the engagement and support of new fathers through various methods of peer support (for example, groups and one-on-one; in-person, virtual, and telephone).
• Finally, if you’re a new father and any of this information resonated with you, please talk to a trusted loved one or your healthcare provider to take the first step in finding additional support.

Postpartum Depression Essential Reads

The Potential Cost of Honesty in Perinatal Screening

Maternal Minds Matter

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