July 6, 2021 -- Postpartum depression isn’t just something new mothers can get. Turns out it can affect new fathers, too, according to a new study.
Michael W., a 38-year-old New Jersey-based attorney, and his wife had been excitedly planning for the birth of their baby and were overjoyed when she was born.
But after that, "I found that parenting a newborn was shockingly exhausting. I felt unprepared for the task, overwhelmed by the burden of the 24-hour-schedule and lack of sleep, and I struggled with feelings of inadequacy," he tells WebMD.
Michael never thought he had postpartum depression (PPD), perhaps because the condition is more commonly associated with women. But a new study published in the American Journal of Men’s Health suggests that PPD also affects men.
A team of Danish investigators led by researcher Sarah Pedersen, of the Department of Public Health, Aarhus University, extensively interviewed eight fathers with PPD and found their primary experiences involved feelings of being overwhelmed and powerless or inadequate, which sometimes turned into anger and frustration.
Ultimately, all the men interviewed for the study sought formal help from a health care provider, but six went through several months of depressive symptoms before seeking or getting help.
"I think one of the most important take-home messages is that practicing clinicians working with new parents should invite fathers to your consultations and engage the fathers as much as possible," Pedersen tells WebMD.
The findings also contained a message for parents, she says.
"I hope you will support each other and talk about your feelings and how you experience the transition to parenthood -- know that it will take time to adjust to your new role,” she says.
Not Enough Attention
There’s been too little focus on fathers when it comes to PPD, according to Pedersen.
"During the last decade, several studies have examined the prevalence of PPD in men, and there is rising evidence that paternal PPD is associated with increased risk of long-term adverse behavioral and emotional outcomes in children," she says.
Nevertheless, only three studies have been based on interviews with fathers who had personal experience with PPD.
"The purpose of our study was, first of all, to explore the lived experience of fathers who had PPD and, secondly, to gain deeper understanding of their help-seeking behavior -- barriers to seeking help and facilitators of help-seeking," Pedersen says.
The study was based on "semistructured" interviews with eight Danish fathers (ages 29 to 38 years) who had had PPD, none of whom had a previous history of depression.
All participants had received a formal diagnosis of PPD by a general practitioner or psychologist, and all had sought or received mental health care and considered themselves recovered from depression at the time of the interview.
The researchers used a technique called interpretative phenomenological analysis to analyze the interviews.
This method "aims to produce in-depth examinations of certain phenomena by examining how individuals make meaning of their own life experiences," the authors wrote.
A ‘Radical Change’
Of the fathers, five described the period of pregnancy as a "time of happiness, full of positive expectations about fatherhood."
But "the fathers’ great expectations were later replaced by a very different reality of fatherhood," the authors wrote, noting that the transition to fatherhood was, in the words of one participant, a "radical change that you just can’t imagine."
Most fathers expressed a feeling of being overwhelmed, and three felt unready for the task, which added to their depression.
"The participants wanted to be emotionally and physically present in their child’s life, but during the time of their depression, these kind-hearted intentions changed into feelings of guilt and inadequacy, as the participants did not feel they had enough energy and mental strength to become the kind of fathers they wanted to be," the authors wrote.
Participants mentioned stressors they believed contributed to their PPD, including complications during their partner’s pregnancy, unplanned cesarean birth (three fathers), the partner’s difficulties with breastfeeding (five fathers), and employment-related concerns. Five reported that their partners had postpartum emotional distress.
A second focus of the research was to examine fathers’ help-seeking behaviors, Pedersen says.
Ultimately, all the participants sought formal help, either from their general practitioner or from a health visitor, with two seeking help right after birth.
Although participants were able to recognize changes in mood and behavior in retrospect, many did not regard them as signs of depression before their diagnosis.
Most participants had heard of PPD, but primarily as it affects women. Three sought information online about paternal PPD but couldn’t find any.
Four participants described experiencing PPD as "taboo," based on a "combination of false beliefs, stigma, and masculine norms," the authors stated, since men "are supposed to be big and strong and take care of everything, and suddenly you can’t."
The authors reported that seven participants were screened for PPD or depression by a health care professional.
"The screening was an important part of the help-seeking process, as this was the first time two of the fathers were introduced to PPD," the authors said.
Although the screening "had the potential to spark conversation" about PPD, it was geared toward women, and some participants did not feel it was relevant to them.
"Future research should focus on identification of educational needs about paternal PPD among both parents, health care professionals, and other professionals taking care of new families," Pedersen says.
Michael W. says it would have been helpful if someone had prepared him and his wife for what to expect, or if there had been some type of screening. Also, he advises expectant parents to "get some real-life experience by spending time around a newborn to see what’s involved."
"We often talk about mothers suffering from PPD, so it is more normalized for mothers to bring it up or for loved ones to ask mothers about how they are doing physically and psychologically after the birth,” Craig Garfield, MD, an attending physician and founder/director of Family and Child Health innovations at Ann and Robert H. Lurie Children’s Hospital, Chicago, tells WebMD.
For fathers, "it is not discussed as commonly, so friends and families don’t often ask dads, and dads don’t know where to turn," says Garfield, who is also a professor of pediatrics and medical social sciences at Northwestern University Feinberg School of Medicine, Chicago, and was not involved with the study.
He notes that symptoms in fathers might differ from those of mothers.
"I have seen fathers who are anxious or more moody than they had been prior, or more angry, and I have seen fathers who throw themselves into work or begin drinking more -- all related to changes in mood and depressive symptoms in the postnatal period,” he says.
Symptoms in men may last longer than in women. Garfield’s group published a study in which they surveyed 400 mothers and fathers of premature infants in the neonatal intensive care unit (NICU) about depressive symptoms around the time of NICU admission, at discharge home, and then after 30 days at home.
Roughly one-third of mothers screened positive for depressive symptoms around NICU admission, as did 17% of fathers. But the mothers’ depression scores improved by discharge and 30 days after being home, while the fathers’ remained "essentially unchanged," he says.
"Further, we found that if doctors were to screen mothers and fathers during the NICU stay -- at admission or even at discharge -- that would greatly improve their ability to predict who would still have depressive symptoms 1 month after going home."
Pedersen agrees clinicians should incorporate screening for PPD into their practice and be proactive in encouraging fathers to get help.
"Keep pushing," she advises, as "men rarely seek help, compared to women, in matters of mental health."