Paternal postnatal depression (PPND) is a real but underdiagnosed entity. This may be due to the masculine reluctance to talk about their feelings, to admit failure in their perceived roles as fathers or husbands, or the lack of support.
Paternal PND is more insidious in onset than in mothers. Its incidence is lowest after a child is born, possibly because of minimal involvement in caring for the baby at this time, in addition to the feelings of love and pride associated with having a new baby. Less than 5 percent of fathers are depressed during pregnancy or at 3 months after the birth of their baby. However, some studies suggest that more than 23 percent of them are depressed one year after the baby is born. In contrast, other studies show that depression sets in during pregnancy and remains at a more or less steady level thereafter.
Many studies suggest that lack of support from the female partner is associated with a higher risk of paternal PND. This may be because of failure to return to pre-pregnancy levels of sexual activity, maternal PND, and increased stress to provide financial and domestic support within the family.
The risk factors may be classified as:
Biological Risk Factors
Level of many hormones , including the sex hormones testosterone and estrogen, the stress hormone cortisol, and bonding hormones such as vasopressin and prolactin, fluctuate during the postpartum period. These may contribute to the risk of PND. Reduced testosterone helps to develop a lower aggression level and a greater infant-father bonding, bringing about a greater nurturing response in fathers. However, low testosterone levels are associated with depression in men.
Environmental Risk Factors
The presence of depression in the mother is consistently linked to a 2.5 fold increase in the rate of depression in fathers 6 weeks after childbirth. This is the most closely associated risk factor, and men whose wives suffer from PND have a 24 to 50 percent incidence of depression themselves.
Other factors include:
- The need to earn more to provide for a new baby and possibly a depressed or sick wife
- Lack of sleep
- Loss of free time for recreation, family dates, and building relationships with the partner
- Stress from having to care for sick or fussy babies
- Fear of inadvertently harming the baby
- Fear about the baby’s health
- Lack of social support
- Lack of know-how with respect to baby care
- Increased need to help out at home
Personal or Relationship-Linked Risk Factors
- Sexual frustration due to dramatic changes in the life phase, fatigue, and less sexual interest on the part of the partner, lack of earlier intimacy due to busyness or other obstacles, and possibly having to adjust to the presence of in-laws for a short or long period.
- Slow bonding with the baby - unlike the almost immediate mother-infant bonding, fathers bond to their babies over a longer period, extending over the first two months of postpartum life. During this time, they may feel ‘out of it’, especially when they observe the special bond between their spouses and the new baby. This may lead to the development of depression in fathers.
- Feelings of negativity towards the infant for disrupting the quality of the husband-wife relationship
- Feeling of neglect by the spouse or of one’s needs being over-ridden by those of the baby
- The father may feel jealous or left out because of the long and rewarding time the baby gets to spend with the mother, and the attention the spouse gives to the baby rather than to him.
- Lack of positive feedback from the baby during the times of interaction removes one of the greatest rewards of having a baby. Instead, the relative inexperience and the short time the father gets to spend with the baby may result in the baby appearing distressed when left in his care, which accentuates the negative association in the father’s mind.
- Feelings of inadequacy as a man, especially if the mother is weak or depressed
- Lack of a good role model associated with poor knowledge of parenting skills, despite the need and expectation of engaging in parenting to a greater extent than in earlier generations, may lead to a feeling of incompetence. Lack of a sense of mastery in this role may be associated with anxiety, which is a source of depression
- Other comorbid conditions such as obsessive-compulsive disorder (OCD) or anxiety in the father may prevent them from developing coping skills during new fatherhood. These are the most usual psychiatric disorders which coexist with paternal PND. The postpartum period is associated with increases in anxiety in most fathers, but in fathers who have anxiety disorders, the risk of developing depression increases by 30 to 100 percent. Anxiety and OCD may predispose to pathological worries about dropping the baby, or harming the baby without meaning to, though normal anxiety about these aspects of parenthood occurs in most parents.
- Tiredness, nervousness, and irritability in the early days of fatherhood may also predispose to the development of depression in vulnerable fathers.