Postnatal depression (PND) in fathers, or paternal PND, is becoming increasingly recognized as a cause of dysfunctional paternal-infant bonding and defective infant development. This affects a child’s growth in terms of cognitive, emotional, and relational maturity.
PND has been estimated to occur in a large percentage of new fathers, from less than 2 to over 30 percent. Its onset is slower in males than in females, in whom the incidence is much higher as well. On the other hand, the condition is more prolonged and tends to be hidden from the public or from healthcare and social workers when it affects new fathers.
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Causes of PND
PND is known or thought to be due to a wide range of factors, including biological variations, ecological factors, and relational disturbances. Contributing factors include depression in the spouse, comorbid psychiatric conditions in the father, and lack of support or educational services for fathers or families.
Just as PND is due to a spectrum of causative factors, its prevention and treatment also encompasses a variety of measures.
Depression in the mother increases the risk of paternal PND by a factor of 2.5, leading to an incidence of 24-50 percent in fathers. Thus, it is important to provide support for both parents in a family where maternal PND is present, and to actively explore the possibility of PND in the father in such settings. Men are less likely to speak about or even recognize such feelings, and they may therefore need more assistance to seek intervention in a timely manner.
Men who have obsessive-compulsive disorder (OCD) or anxiety disorders often find it difficult to cope well with the transition to parenthood. This is linked to worry and fear, which is present in 1 of every 10 expectant fathers. Depression, however, may occur at a 30-100 percent increased rate in men who have anxiety disorders.
Other factors which predispose to the development of depression include:
- worrying thoughts about harming their baby
- high levels of stress
- physical tiredness or irritability
For this reason, fathers should be asked directly about such symptoms and worries in order to offer them timely counseling and therapy as required. Ensuring that proper psychological and psychiatric services are available in case of need, and providing guidance to fathers at risk, will go a long way in preventing and mitigating paternal PND.
Paternal PND is postulated to result partly from a greater-than-normal drop in testosterone levels during a spouse’s pregnancy and in the postpartum period. Other hormonal disturbances also occur during this time. Testing for these might provide a future basis for diagnosis and prevention of PND in fathers.
Slow or defective bonding
Unlike the almost immediate bonding that occurs between a mother and her baby, the father often seems to develop a bond more slowly, within the first two months after the baby is born. This may stress the father, and create jealousy of the mother and the baby, because he seems to be excluded from their special relationship. Paid paternity leave is an important factor in helping fathers to achieve more time with their babies, and so developing a stronger bond earlier in their lives.
The positive feedback that fathers get in the form of smiles and playful gestures from their babies plays a powerful role in building up good feelings and a sense of reward during the early days of fatherhood.
Feelings of incompetence
Lack of a suitable role model while the father is growing up may also contribute to a feeling of incompetence in his new role as a father. This is known to predispose towards depressive feelings. It is, therefore, important to invest resources in providing proper education about baby behavior, feeding, care, and dealing with routine or minor problems of babyhood. This will help them feel in control of the situation and to do what is needed at various stages.
Changes in relationships
Relational changes also affect the incidence of depression in men following childbirth. This may stem from the postpartum blues in their wives, as well as the slow resumption of sexual interest in the new mothers. This prolonged period of relative sexual deprivation may both result from and cause depressive symptoms in the male partners following childbirth. Providing adequate family and social support for new parents is beneficial in helping the partners enjoy free time together, relax periodically, and grow into stronger relationship together.
Overall, a strong supportive network for fathers, starting from their partners and extending into society, will help them adapt more easily to the challenges and stimuli of parenthood. This requires both awareness of the condition on the part of both parents and health or social workers, and changes in work-related laws to allow earlier and longer bonding between fathers, mothers, and the new baby, in the first days of the baby’s life.
New parents and families require social and family support. Such measures are bound to improve paternal emotional and psychological health as well as the health of the family as a whole. Social services can help to avert or mitigate the effects of these risk factors.
Reviewed by Susha Cheriyedath, MSc