Men and postnatal depression

• Facts about men who have PND
• Contributing factors to paternal PND
• Risk factors
• Symptoms
• Fathers’ experiences
• Effects on child development
• Seeking help

Facts about men who have PND

Around 3-10% of men will experience depression during the antenatal and postnatal period. Many people think that men experience postnatal depression (PND) as a result of, or in conjunction with, their partner’s depression, but men can experience this independently from their partners. Although PND in mothers is the strongest predictor of partners having it too, it doesn’t always happen this way. 

Depression in new fathers has been found to begin before the birth of their child, with minimal recovery by the end of the first year. There’s also evidence to suggest that men’s depression increases between six weeks and six months after childbirth. For example, one study found that three out of 10 men were depressed at six weeks, and that their depression got worse during the next six months. There is also growing evidence that anxiety might be a problem for some men during the antenatal and postnatal period.

New fathers don’t access the sort of services that new mothers do. They don’t tend to see their doctor, maternal and child health nurse or midwife, which is where problems are often picked up in women.

Contributing factors to paternal PND

As with all forms of depression, there’s a range of physical, social and emotional factors that contribute to the development of paternal PND. 

Some factors that contribute to men experiencing PND are the same for women. Factors common to men and women can include:

• a lack of social and emotional support
• personality characteristics
• stress and changes in relationships (particularly the couple relationship)
• a lack of sleep
• loss and grief issues
• difficulty adjusting to the changes associated with the transition to parenthood
• unmet prenatal expectations
• a negative or traumatic birth experience (the way men experience childbirth might have some influence on their subsequent emotional wellbeing).

Other factors are specific to men. These can include:

• the impact of changing social roles for fathers in the family
• attitudes towards fatherhood and masculinity – men are less likely to talk about how they feel, and it’s important to them that they seem like they’re coping
• a change in family dynamics – some men might feel excluded from the parenting role or from the relationship with their partner, which can result in resentment towards the baby
• worries about extra responsibilities, financial burdens and managing the stress of work
• unmet expectations about having sex again in the early postnatal period
• pregnancy, particularly early on – this appears to be the most stressful period for a man in the transition to fatherhood. This might be because of the changes in his partner’s body, how supported and included he feels, concern about the impending changes to his life, and feelings of uncertainty about his role in caring for his partner
• a lack of opportunities to bond with the baby until after birth, unlike mothers, who can bond during the pregnancy.

Some men experience PND in conjunction with their partner’s depression, and studies have shown that maternal and paternal depression are highly correlated. Men report that their partner’s PND causes disruption in their lives and their relationship with their partner. Male partners can experience fear, confusion and a sense of helplessness that they’re unable to help the baby’s mother overcome her depression. They can also feel a sense of disconnection and alienation from their partner.

Risk factors

Some of the known risk factors associated with paternal PND include:

• a man’s partner experiencing PND
• a previous history of depression
• marital problems
• low self-esteem
• feelings of incompetence in the parenting role
• first-time fatherhood
• infant irritability.

Symptoms

Symptoms of PND in men include:

• tiredness, headaches and pain
• irritability, anxiety and anger
• loss of libido
• changes in appetite
• feelings of being overwhelmed, out of control and unable to cope
• a tendency to take risks
• changes to sleep patterns, especially a lack of sleep
• feelings of isolation and disconnection from partner, friends or family
• withdrawal from intimate relationships and from family, friends and community life
• increased hours of work as a part of the withdrawal from family
• increased use of drugs or alcohol instead of seeking treatment for depression.

Note: paternal PND is still unrecognised in psychiatric diagnostic literature. It’s assumed that some of the symptoms of paternal PND are similar to those in maternal PND. But it’s believed that paternal PND is much more variable and inconsistent than maternal PND.

Fathers’ experiences

Some fathers describe their experience of PND as feeling trapped, almost like pacing in a cage. They feel extremely alone in their situation and don’t know how to get out.

Other fathers experience PND as being overcome with anger and rage. They feel angry at their partners, children or other family members. They can feel confused about their feelings and are often shocked at their own behaviour.

Some are overwhelmed by feelings of hopelessness and helplessness. They feel their lives and sense of self might never return to normal.

Some fathers feel disappointed by their experience of fatherhood. They feel they’ve failed in their role as a father, and that they’ve let themselves, their children or partners down. They might feel that fatherhood hasn’t been what they expected and feel let down themselves. 

Effects on child development

Paternal PND can have specific and long-lasting negative effects on children’s development if the PND symptoms remain untreated over a long period of time.

Research has shown that depression in fathers in the postnatal period is associated with poorer social and emotional behavioural outcomes in children at age three – particularly in boys – even when the mother doesn’t have PND.

Men with depression are also less likely to read to or play with their children.

Seeking help

If you’re a man experiencing PND, some strategies and treatment options are available:

• Contact support organisations or referral services for men experiencing PND and their families.
• Visit your doctor for a full medical and mental health assessment, to clearly establish what’s going on.
• Ask your doctor for a referral to a psychologist or psychiatrist who specialises in PND – you might be eligible for Medicare rebates.
• Seek extra support – go along to your baby’s next maternal and child health nurse appointment and discuss your situation with the nurse. She might be aware of other local services.
• Seek support groups. It’s very common for women experiencing PND to attend support groups, but there are very few groups established for men. These groups can be immensely beneficial, so it might be worth alerting your community health care centre to this gap, or talking to PANDA (Post and Antenatal Depression Association) about setting one up in your area.
• Consider antidepressant medication to help reduce some of the symptoms. These medications are effective for many people, especially in conjunction with counselling. They are preferable to the use of alcohol or illicit drugs. Your doctor, pharmacist or a drug information helpline will be able to provide more information.
• Seek emotional and practical support from your partner, family and friends, work colleagues, and anyone who is willing to help. The nature of depression will probably mean you feel isolated and alone. Asking for help, talking things through, and even just spending more time with the people you love – these things can help you reconnect with your positive feelings again.
• Remember to be kind to yourself.
• Keep in mind that there is a way out and you’re not alone. There is help available. With the appropriate treatment, you can begin to feel better and start to enjoy being a new father.

Video: how fathers' roles are changing

30mb

One of the factors specific to men’s experience of PND is the changing roles of modern fathers.

In this short video, men talk about how the experience of being a dad has changed from their fathers’ generation. They say that although being a moden dad brings lots of magical moments with their children, there are also lots of pressures. For example, dads often need to balance work and family, and they sometimes feel they have to be both protectors and nurturers. The dads and experts in this video agree that it’s important for men to talk about how they want to be a dad.

 

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