What Postpartum Depression Looks Like in New Dads

By Grant H. Brenner

Pregnancy, and the time following the birth of a child, is for many a time of joy, great expectation, and of course also increased stress and anxiety. The strain placed on the family is considerable, and is a time of increased risk for a variety of problems. Postpartum depression and anxiety are better studied in women than men, as authors Dennis, Marini, Dol, Vigod, Grigoriadis, and Brown note in their recent article in Depression and Anxiety (2021) investigating paternal postpartum difficulties.

Scope of the Problem

They report that approximately 17 percent of women develop postpartum depression, and 15 percent anxiety, with almost 10 percent experiencing both. Risk factors included prior history of mental illness, low support, higher levels of fatigue, and disrupted infant sleep.

For fathers, research has been less robust, though as we recognize the importance of fatherhood, this is shifting. Recent research highlighting the role of father-child attachment and the development of paternal identity, for instance, has outlined how men become fathers—from the moment when they realize the baby is actually real, rather than an abstract idea, to recognizing how much responsibility they have, to taking on the role of father, to navigating complex and often conflicting emotions.

The study authors note that the existing literature finds variable rates of paternal postpartum problems, with depression ranging from 8 percent shortly following childbirth, rising over 25 percent with the first 6 months, and then falling again toward the end of the first year. Rates of anxiety range from 2 to 18 percent, with risk factors including paternal history of mental illness, maternal postpartum problems, economic strain, and newborn health problems.

Postpartum Depression and Anxiety in the First Two Years Following Childbirth

However, no study has systematically looked at anxiety and depression, along with related risk factors, together. To address these questions, Dennis and colleagues used long-term data collected between 2015 and 2019 with over 2,500 fathers, 75 percent of whom completed time points over the two years of the study. Questionnaires were sent every three months for the first year, and then twice a year for the second year to develop a longitudinal view. Although not all fathers completed all time points, the pooled data were analyzed to draw valid conclusions about the overall population.

Measures included the Edinburgh Postnatal Depression Scale, subscales of the State-Trait Anxiety Inventory, and six domains potential risk factors based on existing research:

1. demographic factors
2. pregnancy-related factors
3. psychiatric and substance/alcohol use problems
4. paternal childhood adversity
5. perceived quality of relationship and support with their partners
6. parent and baby-related factors.

Each of these six domains included a number of relevant sub-factors—for example, under "parent-child relationship," there was breastfeeding quality, co-sleeping, parental sleep quality, parental satisfaction, parental role orientation, and outside childcare support.

They found that in the first year, 569 fathers reported mild to moderate co-occurring anxiety and depression. In the second year, 323 fathers reported mild to moderate depression and anxiety. Three percent of fathers reported more severe symptoms, which tended to start within the first year and persist into the second year. Depression rates started at 4 percent, rose to over 11 percent within 3 months, and then leveled off to around 10 percent over the remainder of the study period. Anxiety followed a similar pattern, starting lower at 8.8 percent, rising to over 20 percent over 3-6 months, and then leveling out at 20.4 percent at the 24-month study endpoint.

Risk factors for co-occurring depression and anxiety included low or fair perceived infant health within the first 4 weeks, a prior paternal depression history, elevated paternal anxiety during the pregnancy, a history of intimate partner violence, a need for greater guidance, and prior history of paternal attention-deficit/hyperactivity disorder (ADHD). Protective factors included better partner alliance and adjustment, better social integration, greater attachment, more hours of uninterrupted sleep, and higher paternal satisfaction. Risk and protective factors were similar for the first and second years, with differences in the second year including financial strain as a risk factor, and loss of significance of uninterrupted sleep as a protective factor.

Lessons Learned

Postpartum paternal depression and anxiety occur together for a significant percentage of fathers—almost 25 percent in the first year and almost 10 percent continuing into the second year following childbirth, on par with rates of maternal depression and anxiety. Many of the risk factors identified could be addressed through psychosocial interventions, including quality of relationship with mother and baby, treatment of prior anxiety, depression and ADHD, support- and sleep-related factors, and recognition of the role of fathers’ own childhood adversity during the postpartum period.

Biological, psychological, and relationship factors play a role, and providing good support and possibly therapeutic interventions for fathers would be expected to reduce rates of depression and anxiety. Prior psychiatric conditions should be identified and treated, and fathers who experienced maltreatment during their own childhoods likely would benefit from addressing how these issues get stirred up when they have children of their own, as such adverse childhood experiences may both predispose to anxiety and depression.

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Paternal developmental trauma may also interfere with father-infant bonding, leading to emotional detachment, feelings of inadequacy, and disruption of protective attachment to mother and child. Interventions to help fathers experiencing depression and anxiety also would be expected to reduce maternal depression and anxiety, and strengthen the overall family system. Future research will look at what interventions are most effective, and how to integrate them into healthcare settings both to identify and assist at-risk fathers, as well as to bolster the overall effectiveness of parent education and preparation for pregnancy, childbirth, and the postpartum period.

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