Paternal Postpartum Depression: Why We Need To Talk About It
By Charlotte Serrano
Since the 1970’s, fathers in Western countries have become increasingly more involved in the upbringing of their children. Despite this increased involvement, the psychological health of fathers is rarely discussed. Fathers have a lot to deal with during this life-changing experience and may have difficulties adapting to their new role. This is generally due to feelings of incompetency in their new role and a lack of previous knowledge, especially if they are first-time fathers. In fact, fathers report high levels of anxiety and depression during their transition to parenthood. But to date, paternal postpartum depression (PPD) remains underscreened, underdiagnosed, and undertreated.
What is Paternal Postpartum Depression (PPD)?
The perinatal period, which includes the pregnancy period and a year after birth, is a very complex and stimulating period with a myriad of lifestyles adjustment that can affect fathers’ mental health. They must adjust physically, emotionally, socially and financially. These challenges can outstrip resources, trigger new problems or amplify vulnerabilities and inadequacies. Fathers also experience a change in estrogen, cortisol, vasopressin and prolactin levels during this period. These changes can lead to anxiety and postpartum depression, especially in the period between the first trimester and the first year of life. During this period, 10% of new fathers experience PPD, twice what the general parenting age population usually experiences.
Symptoms of PPD include low mood and despondency, difficulties concentrating and making decisions, lethargy and lack of motivation. Compared to what their partner is going through, they feel guilty and unable to provide enough help and support, especially during the birth. Because of societal pressures, they may not express their difficulties and instead may express themselves through irritation or aggressive outbursts. Health professionals must be vigilant to these symptoms, which can be misinterpreted and lead to the father being rejected by the medical team, during the pregnancy, the delivery and after during appointments. Lack of education, accessible and adapted information, and support during the pregnancy will make fathers feel isolated, increasing their sense of incompetence in their parenting skills.
Why do we need to talk about PPD?
Through these different perinatal phases, the father’s mental health may indirectly impact the health of their child and their partner. For fathers, postpartum depression can have long-term impacts. This is mainly because they tend not to report and express their emotional distress. To cope with their resentment, they may engage in avoidant coping strategies (such as spending more time at work, or avoiding home), aggressive and anti-social behaviours, or self-medication (alcohol or illicit drugs). When the father is severely depressed and doesn’t find the support he needs, the risk of suicide is high.
Paternal and maternal depression are comorbid and can be associated with relationship dissatisfaction. PPD can affect parents’ relationship, by exacerbating issues such as increasing tensions, marital problems and ongoing struggles. In extreme cases, this may escalate into cases of domestic violence and abuse. Therefore, taking care of fathers’ mental health can help to reduce violence against women.
Paternal depression can lead to maladaptive parenting behaviours, such as psychological control, hostility, and intrusiveness, which can lead to negative outcomes for the child. A recent study observed a decrease in positive parenting behaviours (affection, positive involvement, supportiveness) when fathers experienced PPD. Children with fathers who reported poor mental health were more likely to experience poor general health including mental, emotional, and developmental disabilities. They may also be more exposed to violence, family disruptions and poverty. The risk of a child’s behavioural disorders increases when the father has severe PPD.
PPD can also threaten the development of a secure attachment, increasing the risk of difficulties in social interactions and lower cognitive development in the child.
How can we support fathers?
First, we need to be able to identify PPD. This can be done with the use of screening tools. The Edinburgh Postnatal Depression Scale is recommended because it is one of the only validated scales for fathers. However, the Surrey Parenting Education and Support and the Fatherhood Institute have proposed a new tool for evaluating and supporting new fathers’ mental health.
We also need to raise awareness raise awareness in the healthcare system so that health professionals can accurately identify PPD. Research suggests that the healthcare system is not father-friendly. For example, fathers cannot stay over the night after the birth and pediatricians most often address the mother for any child health concerns. This leads to fathers being less likely to seek and find help. Knowledge of paternal mental health can help address these challenges. Health professionals should encourage and support the father in his role because involvement in the child's care and perceived social support are predictors of paternal self-efficacy (assessment of his competence in the role of father) at six months postpartum, decreasing risks of PPD.
We must also be able to take care of them and give them the necessary support. Therapeutical techniques are available such as mindfulness or web-based therapy. Support groups and psychoeducation have also been proven to be beneficial. Professionals should include fathers in antenatal and postnatal care to help them find their place in the family and improve their parenting skills. In addition to therapy, in cases of severe depression, antidepressants can be prescribed.
In parallel to improving the clinical aspects, research needs to make progress on studying fathers' mental health with more appropriate assessment tools and more varied participant profiles. Also, it is necessary to better integrate fathers into research studies, including fathers in same-sex relationships or single fathers which are often not included.
There is an urgent need to raise awareness of the effects of the father’s lack of consideration in the perinatal period from an individual, family, and community perspective. Fathers are less likely to report symptoms of depression because of conceptions of masculinity. The terms used in maternal child health care also need to be revised as they exclude the father. Paternal postpartum depression is a significant public health issue that we need to be aware of. It is vital to promote fathers' mental health so that they can feel legitimate and considered in their suffering and find the appropriate support.
Charlotte is soon-to-be PhD student researching the interactions between premature babies and fathers and the needs of fathers with premature babies at the Université de Picardie Jules Vernes. She also possesses a Masters in Developmental Psychology in the same university and is currently pursuing a Master of Public Health at McGill University. She is passionate about exploring the issue of father involvement in psychology research and researching a methodology that would allow for greater involvement at UQAM.