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Post-natal
depression in dads?
When I started writing this, I thought I was going to
write about one thing: men feeling extreme and sometimes debilitating sadness,
irritability and/or worthlessness after the birth of a child. I thought I was
going to write about how sceptical host Mike Hosking looked in the Seven
Sharp piece on television about post-natal depression in men, and I would write about how real it actually is.
On second review of that television piece, though, I
was spectacularly unimpressed. I forgave Mike his scepticism for two reasons:
firstly, I think he accepts that big
life changes can make people feel bad – but it requires real disruption and
self-examination of the kind that many working dads don’t go through because,
despite a lot of social change, dads’ lives are still less disrupted than mums’
lives. Perhaps he was sceptical because he didn't face the kind of upheaval others do.
Secondly, the story implied that post-natal depression in women and men
is caused by hormonal changes, which arouses my suspicions. Too often we reach
for biological explanations for human suffering, and I think paternal
post-natal depression is almost so self-explanatory that it defies a need for
biological explanation.
A lot of fathers have a really hard time after the birth of a child and I don't think there's a need for me to attempt to prove that. However, aware that there is a lot of misinformation and rumour around, I reviewed some websites, some recent research and some news stories and found a few things I think it’s important to talk about: what is post-natal depression; how is it different in men; what factors make it more likely to happen and is there evidence that it is caused by hormone changes; and does it need to be treated? My answers are below, but first, my overall impression.
A lot of fathers have a really hard time after the birth of a child and I don't think there's a need for me to attempt to prove that. However, aware that there is a lot of misinformation and rumour around, I reviewed some websites, some recent research and some news stories and found a few things I think it’s important to talk about: what is post-natal depression; how is it different in men; what factors make it more likely to happen and is there evidence that it is caused by hormone changes; and does it need to be treated? My answers are below, but first, my overall impression.
The societies I have lived in and the cultures in
which I became a father are not well-equipped to deal with a problem like this.
Fathers can experience powerful and difficult emotions while feeling isolated,
worthless when they can’t find their place in the new relationship and
responsibilities structure, and overwhelmed with responsibility when they can. They may not have anyone to talk to about it even if they can overcome the expectation that they solve it themselves. We still tend to socialise boys in a way that suppresses or denies emotion rather than acknowledging it, and I suspect this is at the heart of the condition discussed here, and it is liberation from this socialisation that is at the heart of treating it: there is almost universal acknowledgement that troubled fathers need to talk more and be heard.
I was told many times over that I needed to provide support for my wife as a new mother but seldom advised to ensure that I had the same – and I got the impression that there is competition for rare sympathetic resources that should really be unlimited: the needs of the mother deserve no less attention when we pay attention to her partner. After reading more about paternal post-natal depression, I urge readers to give more support to dads. Ask how they are and listen to the answer. Share your stories - being a parent is hard work and we need to hear more about the rough side of being a dad. In addition, I'm struck that for all my concern about the lack of information about the paternal version of post-natal depression, it's blatantly obvious that partners of mothers who are not fathers are even more ignored. At the bottom of this piece I invite your stories, and I would encourage everyone who can relate to this as the partner of a mother to respond.
I was told many times over that I needed to provide support for my wife as a new mother but seldom advised to ensure that I had the same – and I got the impression that there is competition for rare sympathetic resources that should really be unlimited: the needs of the mother deserve no less attention when we pay attention to her partner. After reading more about paternal post-natal depression, I urge readers to give more support to dads. Ask how they are and listen to the answer. Share your stories - being a parent is hard work and we need to hear more about the rough side of being a dad. In addition, I'm struck that for all my concern about the lack of information about the paternal version of post-natal depression, it's blatantly obvious that partners of mothers who are not fathers are even more ignored. At the bottom of this piece I invite your stories, and I would encourage everyone who can relate to this as the partner of a mother to respond.
1. What is
post-natal depression (PND)?
One of the striking differences about this particular
phenomenon is that the trigger of the
emotions is identified in the name of
the condition. You don’t get ‘post-spousal death depression’ etc. and I wonder
if people more readily accept a diagnosis like this when it includes a specific
reference to an understandable cause. My first step was to look at formal
diagnosis. The American Psychiatric Association produce a Diagnostic and
Statistical Manual that is now in its 5th major edition, which,
although eternally controversial, contains up-to-date psychiatric thinking on
symptoms for a very big range of conditions. In the latest edition, for
example, a bereavement exclusion was removed from the diagnosis of major
depression. Previously, it was not recommended to diagnosis depression in a
person suffering from grief for up to two months after the death of a loved
one. Some viewed this as a
move to further medicalise human experience and encourage
the unnecessary prescription of medication, and others viewed it
as more liberating. It was not until the previous
major edition of the DSM that post-partum was introduced as a specifier, in
a sense establishing it as a type of depression. Now it is possible to diagnose
major depression with peripartum (i.e. around the time of giving birth, not
just after) onset, and up to 4 weeks after birth. So the basic story is that
depression following childbirth is not considered different in terms of
symptoms, but giving birth is recognised as a specific trigger. After 4 weeks,
though, it’s regular major depression. None of that seems to have any bearing
on the situation in New Zealand and in the UK, though, where any number of
websites alert parents to the problems of PND and PPND (the paternal version)
and dispense advice and warnings. Estimates in my quick sampling of websites
dealing with the topic range from 10 to 20% of women and 3 to 10% of fathers to
26% at the peak time for this condition at 3-6 months after delivery.
2. What does PPND
look like?
This is clearly a tough question because most of the available
information available is about mothers. Some information is rather weak –
inviting any reader to panic instantly as Babycenter.com
defines PPD as, well… having a baby:
a woman with PPD may be:
sleep-depriveda woman with PPD may be:
transitioning to motherhood and dealing with the psychological adjustment
hormonally unsteady
breastfeeding or weaning
experiencing worrisome thoughts about her baby or her ability to be a good mother
consumed with guilt and disappointment about what's supposed to be the "best time of her life."
Some of the New Zealand websites are better. The Ministry of Health offers a sometimes gender-neutral set of symptoms:
always feel tired
cry a lot
feel that you are a bad mother
have aches and pains
think bad thoughts
do not sleep well, even when your baby is asleep
feel that you can’t cope with anything, such as housework
feel anxious or uncertain all of the time
don’t care about how you or things around you look
get angry with other people around you, such as your partner, other children or your whānau.
Four sites I looked
at, the Mental Health Foundation, Plunket, the Health Promotion Agency’s
depression site and Kiwi Families, don’t mention that men or partners can suffer
from it, and there is only passing mention at The Postnatal Distress Centre. It takes quite some time before I
get to a specific explanation of what the paternal version looks like. Parents.com’s Sad Dads post mentions some specifics, including irritability, anxiety, feelings
of worthlessness, and engaging in risky behaviour, particularly related to
alcohol and other drugs, gambling, or infidelity. And then there’s losing
your sense of humour and being miserable a lot of the time. Everything is much clearer after I
find an expert on the topic: Lloyd Philpott. With an already substantial body of work on PPND,
he offers most of the answers I’m seeking and this guide for primary healthcare professionals is, in contrast to everything else
I’ve seen, remarkably clear and focused. Two additions to the list of male
symptoms worth noting here are excessive self-criticism and increased escapist
behaviours, such as television watching and work. In sum, it seems like a lot
of common addictive and risky behaviour tendencies are exacerbated with the
arrival of a new baby and a possible deterioration in their relationship with
the mother. The importance of PPND is also clarified: it is a major health risk
for men, and may have long-term impact on relationships in the family, with
knock-on effects for the child’s development.
Note: after writing this post, I found a champion website that somehow nailed it. Look at Well Women Franklin for good info. Not only do they recognise the male form of PND, they do their best to describe it and provide links to the limited services available.
Note: after writing this post, I found a champion website that somehow nailed it. Look at Well Women Franklin for good info. Not only do they recognise the male form of PND, they do their best to describe it and provide links to the limited services available.
3. What factors predict the
occurrence of PPND?
Although a history of depression is frequently identified as
a very important predictor, for women, being single or unemployed at the time
of birth, and bottle-feeding are identified as increasing risk in an Irish study. A meta-analysis
considering more than 80 studies adds self esteem, social support, infant
temperament and socioeconomic status to the list along with the pregnancy being
unplanned – but note that these are all predictors, not necessarily causes.
Such social and psychosocial factors, along with personality, have been found
to be more important than any birth complications in predicting symptoms at 8
weeks after delivery in an Australian study. Likewise,
the Growing Up in New
Zealand study has yielded some important results, and is one of few
studies explicitly attempting to address the problem for men: the key
predictors for fathers are stress and relationship troubles. If relationship
troubles seem to be so important, you have to wonder to what extent it makes
sense to look at post-natal depression as an individual phenomenon; perhaps
it’s more sensible to look at it as a feature of the transition to parenthood
(the title of a book by Jay
Belsky) experienced by several people together, as seen in this more dynamic model that looks
at the partnership as both a possible cause of distress and a possible target
for improvement.
4. What about hormones?
The theme of
hormone change is certainly quite prevalent through the various websites I’ve
been looking at. At parents.com
there are unreferenced claims that women’s PPD is triggered by hormonal
fluctuations and unnamed ‘studies show’ that men’s hormones also shift, with
testosterone and prolactin levels going down and cortisol going up. The same
page also mentions that it is probably no coincidence that the typical onset of
PPND at 3-6 months after birth is around the time that maternity leave typically
ends and women return to work, and that the current generation of fathers might
be experiencing more PPPD as they are more likely to be involved in household
tasks than previously. With such a weight of evidence that psychosocial factors
are the key to understanding this, is there a need to talk about hormones at all?
Another site, run
by psychologist Christina
Hibbert, claims that hormones are one of the causes, specifying decreasing
testosterone and increasing estrogen as the culprits, with a reference to a USA Today article
in which Dr William Courtenay says that men’s hormone levels change and that
testosterone changes are linked to depression in men. Curiously, there is no
direct link mentioned between these two ideas: Courtenay did not say that reduced
testosterone has been found in PPND dads. He has referred interested readers to
a study by Kim
and Swain (2007) for a discussion of hormones, but those authors explicitly
conjecture that there might be a
relationship that needs to be tested. Their suggestion is based on a study of
older men with depressed mood and low testosterone and studies that suggest
testosterone levels decrease in men after the birth of a child with the effect
of making them more sensitive and attached fathers. They also suggest that maybe increased estrogen has a role
because more involved dads have been found to have higher levels of estrogen
(even among rats), but offers no link to depression. They go on to speculate
about four other possible hormonal explanations. However, I did not find any evidence of a link, even among
articles that have cited it.
The California
Psychologist published a
piece by Daniel Singley, PhD, which cites the same references for the same
purposes but explicitly states no clear link has been found. It does refer to
another study mentioned by Courtenay – by Ramchandani
et al. (2005), which apparently offered early evidence for a link. I tried
and tried, but I can’t find any reference to hormones at all in that paper.
So the rather
underwhelming conclusion I have to make is that everything I’ve read about
hormones as a cause of paternal post-natal depression is simply conjecture or
bad referencing. At worst, it’s an idea that’s made up. Why would a hormonal
explanation for male depression be necessary? That’s a question for another
time.
5. Does it need to treated? Does it
go away?
By now I’m a fan of the ‘family’ approach to understanding
PPD. So as I look through treatment advice, that’s on my mind. So advice like this:
Depression
isn’t something a guy can simply “get over.” It’s a health condition that needs
to be treated – just like a bad heart or injured knee.
just doesn’t sound right. Fair enough, without treatment, it
can last
for months or years. And it’s true one place to start is your GP or the
Plunket nurse. But remember the Plunket website didn’t address men or partners.
Lots of sites suggest you should talk to someone as soon as possible. The Father
and Child Trust, featured in the Seven Sharp piece mentioned above goes a step further
by running drop-in groups and offering telephone numbers without focusing on ‘treatment’.
Christina Hibbert’s site is quite helpful with a number of options but the
focus on men disappears in this section. Aside from this, there seems to be
almost universal agreement that the interventions necessary for men are
intimately bound with the likely cause. This
article by Anna Whyte in the BOP Times appears to be the most informative
and least judgmental and I recommend it.
Collecting
stories of PPND
You don’t need to have been diagnosed or treated. Do the
emotions mentioned above sound familiar to you? If so, please send an email to editor@hashtagpsychology.com
with a brief version of your story if you are willing to feature anonymously in
a bank of stories that will help better inform our understanding of
paternal feelings after the birth of a child.
Notes
Post-natal is a more generally used term. Because
it refers to birth it could be used
in reference to the baby, the mother, or anyone around. Postpartum specifically
refers to after giving birth and as
such tends to be narrowly focused towards the mother. In practice, they are
used interchangeably.
If you are seeking advice or support, please use the following contacts as supplied by the Mental Health Foundation:
If you are seeking advice or support, please use the following contacts as supplied by the Mental Health Foundation:
- Depression helpline. freephone 0800 111 757
- Healthline: 0800 611 116. (Available 24 hours, 7 days a week and free to callers throughout New Zealand, including from a mobile phone).
- Lifeline 0800 543 35
- Samaritans – 0800 726 666 (for callers from the Lower North Island, Christchurch and West Coast) or 04 473 9739 (for callers from all other regions)
Follow Lloyd Philpott on Twitter
This article was written by Alan Law for Hashtagpsychology.com
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