Postnatal depression (PND) refers to the onset of depression after the birth of a child in the family. It may occur after the first or subsequent births. While the incidence of postnatal depression is higher and better-recognized in women, affecting about 13 percent of mothers, it is also a significant factor in men. PND may occur in 1.25-25 percent of fathers, and it can contribute to poor outcomes in fathering and in the child’s health.
The child’s cognitive, emotional, and behavioral development may all be impaired as a result of paternal PND. This was found to be so even if the mother was not affected by depression. This means that it is important to identify and support fathers at risk of PND, and to offer appropriate treatment, if required.
The recognition of this condition is fairly recent, but it is now found that the rate of depression is highest in the first year after the birth of a new baby. In men, this accounted for 3.56 per 100 person-years. The incidence showed a steep fall at one year after birth. Some studies show that the onset of PND in fathers is highest around 3 months after the birth of a child. Estimates of incidence vary from just above 1 to 30 percent. The differences in the instruments and scales used to diagnose depression in various studies may account for this wide range of incidence. However, a meta-analysis estimates that about 10 percent of fathers suffer from PND, which would make it a significant disorder.
Factors which Cause PND in Men
Several studies have showed that fathers who are at increased risk of PND are from a background of social deprivation, often have a history of depressive episodes previously, and are likely to be younger when their child is born (between 15 and 24 years). When the female partner is depressed, the incidence of male PND goes up.
The ratio of males to females with respect to PND is usually constant at around 2 to 4:1. Around 5% of men suffer from PND.
Male PND may not manifest in the same way as maternal PND. Thus the symptoms may range over a wide spectrum:
- Mood disorders
- Loss of interest in previously attractive activities
- Sleep disturbances
- Loss of appetite
- Lack of sexual interest
- Abuse of alcohol or illegal substances
- Poor academic or work performance
- Expressions of anger or hostility
- Excessive worry or anxiety
- Physical symptoms which have no identifiable somatic cause
Course of PND
It is a remarkable finding in some studies that PND is more or less stationary during the postnatal period, and is often a continuation of the stressful emotional and physical adjustment that began during the gestational period. This was often defined by unfulfilled expectations as to their competence as a father and husband. Relationship problems that predated childbirth were found to predict postnatal depressive symptoms.
PND in new fathers is often not recognized or thought to deserve treatment. However, it is a significant cause of psychological distress and may result in physical symptoms, deterioration in family relationships, negative father-baby bonding, and domestic violence, as well as substance abuse and addiction.
Since men are often reluctant to talk about how they feel, they may need to be encouraged to open up to a counselor or competent friend about how they are coping with the demands of fatherhood. Many supportive services may be available, and one’s healthcare provider will usually be able to provide guidance in accessing these services.
Taking time out to do something you like by yourself, preferably something which gives you a sense of achievement and gives tangible results, is important in relieving some of the stress.
Regular exercise, and avoiding negative behaviors such as substance abuse, are equally important both in making you feel better and preventing feelings of guilt and incompetence.
Medication and psychotherapy may be necessary if the person is suffering from major depression which doesn’t respond to other approaches.
Reviewed by Susha Cheriyedath, MSc