Male postnatal depression is due to a variety of interacting factors, but is often little recognized. This may be because of the typical male reluctance to admit emotional struggles, or incompetence in an area of expected achievement, as well as the lack of male supportive resources within a family or the society.
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Paternal PND and Maternal Depression
Fathers need to take up a new role for which they are often not socially prepared, and for which they lack a good role model. Anxiety about how they can best fulfil this expectation as fathers may build up, even when unexpressed, predisposing to depression in new dads.
Again, coping with a new baby when the mother is already depressed, or goes into the postpartum blues, can cause many seemingly overwhelming demands on the father.
Paternal PND is consistently linked with the presence of maternal depression. Thus, fathers in a relationship where the female partner is depressed have a 2.5 times higher risk of becoming depressed postpartum. Such men compose between a quarter to half of all fathers with depressed partners.
Men seek intimate support mainly from their female partners. They depend heavily on the cooperation of their wives in an atmosphere of love and acceptance to cope with the new experiences and expectations that accompany new fatherhood. When their wives are unable to provide this support and balance, the fathers may often experience increasing frustration and stress, leading to the development of postnatal depression.
Coping becomes more difficult if social and family support is lacking or minimal.
Paternal PND and the Family
A father who is depressed has a negative and significant impact on the spouse as well as on the children in the family. This applies even to the newborn infant. Thus, it is becoming recognized that it is essential to pay attention to the mental health of fathers as well, in order to facilitate the normal healthy development of the infant in terms of cognition, emotional development, and behavioral maturation.
Fathers and Babies
Mothers, of course, usually spend much more time with their babies in early infant life. However, fathers spend about 7 hours a day focused on their babies, and research shows that they are occupied at such times with thoughts of their unity with the infant, its perfection, and in receiving feedback from the infant in various ways. Smiles and gurgles by the baby, or the inadvertent touch of the baby, are among the greatest rewards felt by the father during his time of interaction with the infant.
These thoughts help them become adapted to the heavy demands of childcare, and to feel in control of the situation. However, they also feel anxious lest they unwittingly harm or drop the baby. A lack of positive feedback by the baby may occur, as in the form of crying when the father cuddles or takes up the baby, or the appearance of distress in some way. This removes the reward element and may contribute to PND in fathers.
In addition, persistent and unwelcome thoughts of anxiety or compulsive behaviors based on anxiety may lead to postpartum obsessive compulsive disorder, which in turn may result in paternal depression.
Husbands and Wives
New fathers take up to 2 months to bond with their babies, in the usual scenario. This is because they are with their offspring for less time, need to develop the nurturing response, and may lack an appropriate male role model.
At the same time, they often experience less intimacy with their partners, who are often busy with the baby, and may be tired or stressed as a result. Less time for sharing and poor insight into the state of each other’s feelings drives a wedge between them. In addition, it contributes to less sexual fulfilment within the relationship. This frustration is enhanced by the observation of the highly fulfilling and prolonged time the baby spends with the mother, especially during breastfeeding. The special bonding they have may be resented by the ‘neglected’ father, who often feels left out at first. This has been observed to be one factor which promotes the development of PND in fathers. Distressingly, this may manifest as violent behavior towards the spouse in a quarter of cases, and usually this is the first instance of aggression within the relationship. This further reduces the mother’s support level and makes her vulnerable to stress and depression. The overall health of the family declines as a result.
Thus the mental and emotional health of fathers should be optimized for a family to grow normally rather than develop dysfunctionally. This involves social and family support, paid paternity leave, practical help with infant care, preparing a couple for pregnancy, childbirth, and infant care. These go a long way in helping men cope successfully with the drastic life changes that they undergo during this period, while maintaining a feeling of mastery and competence.
Reviewed by Susha Cheriyedath, MSc