Man up / Man down: depression in new fathers

It’s finally happened. The pain is over, and all that remains for both of you is joy. After nine months and many excruciating hours for you and your partner, you cradle a newborn in your arms, overcome with wonder and love. This child is yours, and all you want to do is keep it safe and happy.

Except if you don’t. Except if, as happens to one in every 10 fathers, you feel isolated, angry and overwhelmed, either before or after the birth. You may withdraw from family, friends and your new child, working late and staying out drinking to avoid seeing loved ones.

Postnatal depression (PND), when acknowledged at all, is almost exclusively associated with mothers. Its effects are debilitating, ranging from sadness and low energy to guilt and suicidal thoughts, but acknowledgement for the disease has become much more prevalent in recent times.

However, what has not yet been accepted across society is that PND affects both mothers and fathers, often simultaneously. Unfortunately, paternal postnatal depression (PPND) is neglected, receiving little attention in research and struggling to make a dent on the public’s collective psyche.

Consequences

As a result, PPND often goes untreated, which can lead to the relationship between a father and his partner deteriorating. It can also affect their newborn child, as Dr James Paulson, whose meta-analysis looked at 43 studies encompassing more than 28,000 participants, explains.

“Depressed fathers tend to be out of the home more and interact less with their children when they are home. They engage in few babycare tasks and they sing, read and talk to their children less.”

Dr Craig Garfield, a professor at Chicago’s Northwestern University who released a study on PPND in April, warns that depressed dads can be both a passive and active danger to their children.

“We know that fathers who are depressed are less likely to engage in positive behaviours with their children and are more likely to use corporal or physical punishments, which can affect the self-esteem of children.”

Dr Paulson says that children raised by depressed fathers already have more behavioural problems by the time they’re three or four years old. And the problems don’t stop there. According to Dr Paul Ramchandani, who teaches Child and Adolescent Psychiatry at Imperial College, once they reach their teens these children are one and a half times more likely to get anxiety or depression than those who didn’t have a depressed father growing up.

For fathers, untreated depression at such a turbulent period of their lives can result in everything they’ve worked for slipping away. Symptoms such as constant tiredness, anger and a tendency to take risks have led men to lose their job, their family and even their life to the disease.

Mark Williams, who started the PND charity Fathers Reaching Out after he and his wife both got the condition, has listened to many fathers’ stories of what they went through.

“I’ve had emails since 2012 from dads around the world, and there are a lot of families splitting up because of their changes in personality. There are also a lot of cases of domestic violence and self-harm, as well as drugs and drink where people have never consumed any of them before.

“One gentleman with postnatal depression, who had never taken drugs, was 37 and worked in the health industry. He ended up taking amphetamines just to function.”

One in 10 men suffer from post-natal depression.

Stigma

So why has society been so slow to recognise that 10 per cent of men — double the amount for any other stage of life — go through depression in the postnatal period? As with so many areas of male health, gender stereotypes have much to answer for.

Men, and fathers in particular, are expected to be physically and mentally strong for their families, and thus feel pressure to appear invulnerable to harmful psychological conditions. Dr Christina Hibbert, a clinical psychologist who founded the Arizona Postpartum Wellness Coalition for both mothers and fathers, says this is an integral part of many men’s identity.

“There’s definitely a stigma about women being a bad mum, but a father who can’t be there for their partner, who feels like he’s not strong, they’re seen as not being a man. My uncle, who’s had six kids, once came up to me and asked: ‘Do men get postnatal depression?’ I said: ‘Yes, they do,’ and he was like: ‘Yeah, I’m pretty sure I have that,’ but then he just walked away! Men have a harder time admitting it.”

Not only are men taught to deny their emotions to ensure a tough facade, they are also expected to play a distinct, limited part in their child’s life. In a long-standing system of parenting, the mother has responsibility for the child throughout their early years, and for their emotional development long afterwards. The father, in contrast, is supposed to earn money so that the children may survive and have a better chance to succeed in life.

This is not to say that mothers, who still face numerous forms of discrimination both in the professional sphere and the home, have had it easier. Strict gender roles benefit no-one. Despite this fact, as Dr Paulson points out, scientific research is still under the influence of an outdated view of family life.

“We’re coming out of a history of development science which has viewed parenting almost exclusively from the mother’s perspective all the way through to the 1980s. It’s still changing to include fathers, and still poor to deal with it. Those biases are deep-rooted, as most folks my age had parents with very a traditional breakdown of roles, so it’ll take some time to change the way we look at this.”

It’s tempting to explain away this traditional view of masculinity and fatherhood as a generational concept. After all, men are becoming equal or primary caregivers in many modern families, which indicates that parental roles are becoming less pre-determined. Society has also taken huge cultural steps towards gender equality and diversity in the last three decades, so it would be logical to assume that progress in mental health is inevitable.

Not so fast. The outdated image of fatherhood lingers, shaping how men and those who judge them see the world. Dr Paulson says how he still sees this status quo being upheld whenever he tries to inform the public about PPND.

“The comments sections on articles and videos are really instructive about why this is hard to talk about. What I typically see is that ‘the fathers are being selfish and we should de-emphasise any focus on fathers because it’s a challenge that only mothers are allowed to struggle with.’ We need to recognise that fathers struggle too.”

Men are constantly told they can’t have mental health issues because it makes them weak, and that’s not allowed because women and children in their family need their protection. As a result, dads typically avoid seeing healthcare professionals before or after the birth, as Dr Paulson goes on to explain.

“In prenatal care, fathers are not involved often in pediatrician appointments, but even after the birth they’re often too detached to be identified. If the father or mother is depressed, both parents need education about what depression means and how it affects their parenting.”

Parents who go by societal restrictions and suffer silently don’t receive treatment or learn that they may not be the only ones feeling this way. But it’s even harder to admit to having depression when bringing up your new baby is supposed to be one of the happiest times of your life.

The weeks after your child is born can be hectic, overwhelming and sleep-deprived. With the constant presence of a baby who relies on you entirely, existential crises are inevitable, particularly if it’s your first child. And yet, our culture implicitly informs new parents that their homes will be peaceful and loving, with only brief interruptions to change or feed the mewling infant. There is nothing to prepare you for the sacrifices you will have to make for the screaming, needy creature you have had to turn your life upside-down for.

Dr Hibbert acknowledges the difficulties when a new parent’s behaviour goes against the accepted norm: “You want to be your best when you have a baby, and when you’re not happy it’s very hard to take, and leads to feelings of guilt and shame.”

Everybody hurts

The truth is: all parents are in the same boat, and the same goes for PND. Dr Helen Poole, a Health Psychology lecturer at Liverpool John Moores University, says feeling different and worse than other parents is common.

“There’s a sense when you speak to postnatal depression sufferers that they think everyone else is doing it well or great, and it’s just them who’s not. It’s coupled with feelings of guilt and being judged, which is part of the condition, and the condition can exacerbate those feelings.”

This can be a dangerous spiral of negative emotions, and affects mothers and fathers in the same way. One enduring fallacy about PND is that new mothers become depressed because of a change in hormones, but experts have found no conclusive proof on this point. Dr Paulson passionately denies this socially accepted notion.

“That’s a bias that’s been present for a long time, and many refer to hormonal and biological causes. The fact is that it’s been studied for many years and there has yet to be a study which shows women have hormonal changes which result in depression. These hormone ideas, these sex-linked changes form a bias that folks widely hold, but it doesn’t bear out in the research.”

Rather than viewing it as simply a maternal disease, Dr Paulson is calling for the scientific community and society in general to think of PND as “a generic parenting problem, instead of something that’s tied to one gender.” He’s not alone, either. Dr Hibbert is also hoping to expand perceptions of the disease’s horizons, so that the whole family can be seen as victims of PND.

“It’s a familial disease. If a mum’s depressed, there’s a 50 per cent chance a dad will be too, and that makes it worse for the children. I see a lot of mums come in for depression, but often you find that the dad has it too but is dealing with it differently and hiding it. It affects everybody. It’s so highly correlated between couples.”

The way in which PND can spread from one partner to the other highlights how important a holistic approach is for this condition. Professor Irwin Nazareth, a professor at University College London who spearheaded this PPND study in 2010, says: “don’t consider parents as individuals; consider them as a family.”

The future of PND

If society doesn’t accept PND as a legitimate disease which can affect all parents, research into the condition will continue to be stymied. Dr Paulson lays out the current situation regarding PPND: “the risk factors and routes to treatment with paternal depression are still poorly understood.”

This is because, as Prof Nazareth observes, “Research into fathers’ conditions is a very low priority; maternal research gets the main focus.”

Education is the answer to spreading awareness of the condition, which in turn should open doors for experts to conduct more research on the topic. Dr Hibbert’s Arizona Postpartum Wellness Coalition is one of the organisations which teaches influential figures about PPND.

“People who are working with families affected by postnatal depression still don’t know about it, so then how are the families going to know? If you don’t learn about it in school or your profession, you’re not going to know it even exists. Education is how we break down the stigma. That’s why we focus on it.”

Mr Williams’ Fathers Reaching Out group also educates the public, and he goes further in highlighting people’s ignorance over PPND: “I would compare it to the lack of information about HIV and cancer in the past.”

Another way in which awareness of the condition can be spread is depression screenings for fathers-to-be — and this would also help with identifying potential victims and preparing treatment plans. The current situation, as Dr Ramchandani points out, is that “whenever a woman becomes pregnant, they’ll get screened for depression at some point during the pregnancy. There’s nothing parallel for dads.”

Experts such as Dr Paulson and Dr Hibbert stand behind the idea of screenings for new fathers, but the National Institute for Health and Care Excellence (NICE) has thus far rejected all proposals. Prof Nazareth is one of those who has tried and failed to change the minds of those who advise the NHS on treatment and prevention methods.

“I believe the NICE guidance committee should consider screening fathers as well as mothers during pregnancy. I made the case as soon as my paper was published in 2010, but have received no reply.”

NICE has declined to comment.

On the plus side, scientists’ understanding of PND has already come a long way in a relatively short amount of time, and is finally starting to receive recognition. As far as Dr Garfield is concerned, this is the start of a bright new dawn for new fathers with depression.

“I think it’s an exciting time to be studying and trying to understand paternal depression. Over the last 20 years we’ve done a really good job researching maternal depression, and we’re just now at the beginning of that course in understanding paternal depression.”