Obstetricians and pediatricians recently have begun screening all new mothers for signs of postpartum depression (PPD) at their first appointments following the birth of a baby. The idea that new fathers can experience PPD has been largely overlooked and research on the issue is limited. Yet it is not uncommon for new dads to show signs of paternal PPD and their symptoms often go undiagnosed.
Eydie Moses-Kolko, MD, a psychiatrist in the Behavioral Health Clinic at UPMC Magee-Womens Hospital, sees new moms with PPD in her practice, which is integrated into Magee’s Womancare Ob-Gyn office in Wexford. She runs the New and Expectant Mothers Specialized Treatment (NEST) program, an intensive outpatient treatment program for women who are pregnant and up to one year postpartum. Many NEST patients have had a history of depression before or during their pregnancies, which puts them at higher risk of PPD.
Symptoms of Depression Often Overlooked in Dads
“Of the new moms I see in the NEST program, at least half of their male partners show signs of depression or other mental health problems,” she says. “Because the focus of the follow-up appointments is on the mom and baby, and because new dads’ symptoms of depression may not be recognized for what they are, we may be missing a lot more men who have paternal PPD.”
According to a study published in the Journal of the American Medical Association, paternal PPD occurs in 10 percent of men between the first trimester and the first year after delivery, with the highest rate occurring three to six months postpartum. Based on the annual number of U.S. births, that translates into roughly 400,000 fathers with paternal PPD each year.
Making the diagnosis harder is the fact that men often are raised to downplay emotions in a culture of masculinity, so they may not admit that that are dealing with depression issues. Many men also are not as in touch with their feelings as their partners and sometimes can’t identify exactly what is wrong. Further, many men either don’t report these feelings to their primary care physicians or don’t seek help for them at all.
Bringing home a new baby is a stressful life event that changes the dynamics of a household and affects everyone in it. The nature of relationships—between the partners and with their own parents, other children, work colleagues and even friends—changes dramatically. Other factors add to the emotional and social upheaval of a new baby, including sleep deprivation; financial issues; caring for a sick or premature baby; returning to work; and the mother’s own state of mind.
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Symptoms of Paternal PPD
Although symptoms of PPD for new moms and new dads often are similar, they reveal themselves in different ways. The common symptoms of PPD are:
- Depressed mood
- Lack of interest in things
- Low energy
- Lack of sleep or too much sleep
- Changes in appetite
- Poor concentration
- Low sex drive
- Feelings of guilt
- Feelings of hopelessness
- Suicidal ideation
How those symptoms are expressed by new dads differs from new moms. “There are definitely gender-based nuances in how men and women express signs of depression,” adds Dr. Moses-Kolko. “While women may be emotional and upset, men may get angry or avoid the situation by working more or using alcohol and substances.”
Men Express PPD Differently
Expressions that might signal PPD in men include:
- Aggression or anger, such as flying off the handle more easily
- Anxiety, stress or inability to relax
- Increased alcohol or drug use to escape from stress
- Emotional absence, such as not paying attention or being present in the moment
- Physical absence or avoidance, such as working long hours or staying away from home
- Considering self-harm
- Occasional violence, such as punching a wall
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The Importance of Treatment
If you recognize any of these symptoms or expressions in yourself or your partner, don’t ignore it. Call your PCP to describe what you’re feeling. Individual and group therapy can be very effective in helping dads deal with paternal PPD.
“Men-only support groups are a helpful way for dads to talk about what they’re experiencing in a nonjudgmental environment,” says Dr. Moses-Kolko. “Reaching out for support by cashing in on favors offered by friends and family members—such as childcare, cleaning, providing meals—also is beneficial in giving new dads extra time to focus on their self-care and strengthening their relationship with their spouse.”
Taking steps to improve their mental health is not only important for new dads; studies show that their children are likely to have better short-term and long-term emotional development and mental health outcomes, as well.
Healthier Dads = Healthier Children
“Studies have shown an association between a father’s PPD and their infant’s difficult temperament,” says Dr. Moses-Kolko. “Older children of dads with PPD showed increased signs of internalizing, such as anxiety and stomach aches, and externalizing, such as acting out or defiance. Once these children hit adolescence and early adulthood, they themselves had higher rates of depression, and increased incidence of running away and other problem behaviors.”
The evidence is clear that dads’ mental health has important implications on the lives and mental health of their children. More research on paternal PPD and better screening to detect it is needed and may be on the horizon as awareness of the issue increases.
UPMC Magee-Womens Hospital will be starting a paternal PPD therapy program for dads in the fall. The program will consist of group therapy with their partners as well as dads-only breakout groups. For more information, contact Magee Behavioral Health at 412-641-1238.
For more than a century, UPMC Magee-Womens Hospital has provided high-quality medical care to women at all stages of life. The U.S. Department of Health and Human Services recognizes Magee as a National Center of Excellence in Women’s Health. More than 9,000 babies are born each year at Magee. The hospital also treats men for a variety of conditions, including surgical treatment. The Magee-Womens Research Institute was the first center to focus research only on conditions involving women and their infants.