We’re used to hearing that postnatal depression can affect new mothers, but what about new fathers?

Research is stacking up to show that they, too, can find the transition to parenthood difficult.

One in 12 fathers screened positive for paternal postnatal depression (PPND) in the first year after their child was born. That’s according to research done in a study by UCC lecturer Lloyd Philpott – Paternal Postnatal Depression (PPND): Prevalence and Associated Factors.

The Cork-based lecturer became interested in how fathers were transitioning to fatherhood when, as a public health nurse working in the community in 2009-2010, he visited mothers and their babies, as required of an area PHN, within 48 hours of them arriving home from hospital.

“While the mother and child is the main focus and that is correct, I noticed that fathers seemed to be in the background. This got me thinking about what the role of the father was,” he says. “Many seemed to be observers rather than participants, and I wondered if this lack of participation had an impact on their emotional wellbeing.”

Many dads not equipped for the role

His research showed that many fathers find the transition complex and demanding.

“Many don’t feel adequately equipped as they begin their journey,” he says. “While there is evidence internationally that fatherhood has a long-term positive effect on men’s health, for some the postnatal period can be difficult.”

This is because the period after a baby is born is one of significant change, with normal routine going out the window.

“While most of these changes are expected and welcome, others can be unanticipated and can have a negative effect on the health of fathers,” he continues.

“Fathers experience sleep disturbance, fatigue, relationship strain and financial worries just like mothers. Some fathers may also not have had a role model to learn fathering skills from. They may have grown up in a time when men weren’t involved or only minimally involved in child-rearing. Feeling ill-equipped for the role then causes distress, anxiety and an increased risk of depression.”

Underdiagnosed

The Cork-based lecturer believes that PPND is a significant public health issue that should be properly acknowledged.

A recent review of 43 international studies found that paternal postnatal depression affected up to 10% of new fathers worldwide, but the figure could be higher, he believes.

“That’s because men can be reluctant to report mental health problems. Our conclusion is that men are under-screened, under-diagnosed and under-treated for PPND.”

Chefs most prone to PPND

In the Cork study which included men in 40 different occupations, chefs were found to be most prone to PPND.

“66% of the chefs who took part in the study were at risk of depression. They work split shifts, long hours, nights and in a very stressful environment, not unlike farmers, which may add to the problem,” the author says.

Those who had infants with sleep problems or colic or who showed failure to thrive were most at risk of depression, but new mothers experiencing depression is the most common predictor for fathers having PPND.

“Fathers are more likely to be depressed if their partner is depressed. In that situation, they can feel helpless, confused, frustrated and very uncertain about the future.”

While it is not known exactly how paternal postnatal depression manifests itself, it is known that men manifest depression differently than women, he says.

“While low mood, lack of interest and tearfulness can be symptoms of depression in women – women internalise their depression – men instead tend to externalise their depression. This could mean alcohol abuse, gambling and overworking, which is a form of escapism from whatever the problem is. However, we don’t have enough evidence to say that this is how paternal postnatal depression manifests itself, but the symptoms listed are for general depression in men.”

Manifestations of depression in men

  • Anger attacks.
  • Failure to express emotions.
  • Self-criticism.
  • Alcohol and drug abuse.
  • Unhealthy sexual relationships or infidelity.
  • Reckless behaviour such as unsafe driving.
  • Abusive behaviour.
  • Escapist behaviour such as spending excessive time watching TV, on the internet or at work.

    • (Veskrna, 2010)

    Daddy needs to be looked after

    Lloyd Philpott believes that raising awareness that men can suffer from mental health issues after the birth of their baby is important.

    “While the focus is on the mother and child, yes the father needs to be looked after too,” he says. “By looking after the father, you’re looking after the mother and baby. It’s important that we understand that as a society.”

    The three- to six-month stage after the baby is born seems to be the time most men are likely to be at risk of depression.

    “This could be that there is talk about childcare and the mother going back to work. Depression risk could be at any time during the first year but the evidence at present shows that 26% of men can be at risk during that stage while it goes down to 9% in the six- to 12-month period. By then the situation may have settled and the new parents may have adjusted more to their new roles.”

    What increases risk of PPND

    Fathers in traditional marital relationships, ie in their first marriage and living with their children, have a lower prevalence of PPND.

    Single fathers and men living in stepfamilies are at an increased risk. Having lots of support is a protective factor while a lack of choice and preparation inherent in unplanned pregnancies increases the risk of PPND.

    Depressed fathers display fewer positive behaviours like sensitivity, warmth and responsiveness, and increased negative behaviours such as hostility and disengagement.