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Symptoms of Paternal Postnatal Depression (PPND)

By Liji Thomas, MD

Paternal postnatal depression (PPND) is a syndrome that is receiving increasing attention among social and medical professionals today. Postpartum depression has been well-characterized among mothers, who consistently show a higher incidence of the condition. However, in recent studies, it has been found to occur among new fathers as well, and to affect family bonding and emotional health significantly.

The causes of PPND are varied, ranging from the presence of marital dissatisfaction prior to the birth of the baby to comorbid mental health conditions such as obsessive-compulsive disorder. These may hinder proper father-infant bonding, contribute to increased stress after the baby’s birth, result in negative thoughts in relation to the baby, and lead to an overall decline in the functioning of the father in the family.

Symptoms of PPND

Men are slow to recognize and express depression and other emotional conditions as a rule, though many exceptions do occur. Thus, it often happens that fathers struggle with PND and, indeed, succumb to it, abandoning the family or becoming dysfunctional fathers as a result. The condition needs to be diagnosed and treated early. For these reasons, knowing the symptoms is essential to offering the support that these men need.

Diagnostic Criteria

Diagnosis of the condition is hampered by the lack of validated diagnostic criteria. Some common measures used in studies so far include:

Diagnostic and Statistical Manual of Mental Disorders This refers to the classical DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) definition of depression. The symptoms which are assessed include:

  • low or sad mood
  • significant loss of interest in living
  • loss or gain of weight to a significant degree
  • sleep disturbances
  • hyperactivity or listlessness
  • persistent fatigue
  • feelings of worthlessness or guilt
  • reduced cognitive and memory functions
  • repetitive thinking about death

These criteria were used to diagnose maternal PND if five of these symptoms occur within two weeks, always including either depressed mood or lack of interest in almost all activities. Their onset should be within four weeks of childbirth. These criteria may not apply in PPND, however, which is suspected to be of a more insidious and prolonged character lasting over the first postpartum year.

Also, men are less likely to seek help, and instead resort to negative coping strategies such as alcohol abuse, domestic violence, workaholism, or risky behaviors.

Edinburgh Postnatal Depression Scale

A validated tool in diagnosing PPND is the Edinburgh Postnatal Depression Scale (EPDS), which explores the presence of depressive and self-blame symptoms in fathers. These include:

  • worry
  • sadness
  • agitation
  • anger
  • hostility
  • fear
  • phobic symptoms

It is important to note that cut-off scores for the diagnosis of depression in fathers are lower than that in women, usually by about 2 points. Since this level is correlated with minor PND in mothers, it may be wrongly thought that PPND is also of minor significance. However, this is because of lower male expressiveness about their feelings, especially when related to loss of competence in some field, rather than the lower level of depression.

Reviewed by Susha Cheriyedath, MSc

References

Further Reading

Last Updated: Nov 27, 2016

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