Postpartum depression is a familiar rite of new parenthood. Feelings of emptiness, sadness and anxiety settle in after the birth of a child, and in severe cases last for months. It turns out that this common condition, once considered the province of the mother, may affect many new fathers too.
Researchers at Eastern Virginia Medical School, publishing an analysis of 43 past studies in the Journal of the American Medical Association on Tuesday, report that up to 10% of fathers may experience postpartum depression (PPD) after the birth of a child. That figure comes as a surprise, even to the authors, who had been studying paternal PPD for several years, especially because it doubles the average risk of depression found in the male population in general — which is only about 5%. "It is surprising and novel that the rate is much higher than most people would guess or expect," says study author James Paulson. "This is a condition that is not recognized by many folks. Postpartum in men is an alien concept to most people."
But it shouldn't be, he says, since fathers are just as susceptible to factors that tend to trigger PPD in mothers — especially in first-time parents. In new moms, postpartum depression typically stems from feelings of stress and anxiety associated with fatigue, lack of sleep, changes in the marital relationship and concerns about finances and work. Fathers experience the same stresses and the same overwhelming emotions that accompany the life-changing event of becoming a parent, Paulson notes. While his analysis does not isolate the specific factors that were responsible for the feelings of depression in the studies' fathers, he theorizes that they mirrored known risk factors in new mothers and probably even included others that were unique to dads. "A lot of changes are going on with fathers too, so it's reasonable to expect that they might not recognize depression when they experience it," he says.
In the report, which involved an analysis of data on 28,004 men around the world, new fathers were most likely to score high for depressive symptoms between the third and sixth months after birth (that was also found to be true for mothers) and least likely to have depressive symptoms in the first three months postpartum. Interestingly, the authors also found that symptoms of PPD were more common among American men than their international counterparts, a disparity that Paulson speculates may reflect cultural differences and varying paternity-leave policies in the workplace.
The mothers included in some of the studies showed patterns of PPD similar to the men, but Paulson says it isn't clear whose depression came first or whether one caused the other. "Our study found a clear, consistent moderate correlation between Mom's depression and Dad's depression, but what the study doesn't say is what direction the causality might be," he says. "There's no clear pattern in the research we have so far."
It's worth noting that most of the studies did not track cases of clinical depression diagnosed by a physician, but instead recorded the incidence of depressive symptoms through questionnaires or interviews. Some experts believe these measures tend to overestimate the actual rate of depression; others believe they are often a useful harbinger of underlying, undiagnosed illness.
Dr. Paul Ramchandani, a consultant in child and adolescent psychiatry at Warneford Hospital in Oxford, England, who conducted one of the previous studies on the subject, says Paulson's findings warrant a greater awareness and need for depression screening in new fathers, particularly since a person's well-being can have a profound effect on their loved ones. "Depressive symptoms have an impact on the [fathers] and also potentially on their developing babies," he says.
Also critical is early awareness. Studies of PPD in new mothers show that the greatest predictor of postpartum depression is previous depression — either during pregnancy or before — not giving birth itself. But if depression often goes undiagnosed and untreated in women during pregnancy, it goes doubly so for fathers, who are not often asked about their mental state during pre- or postnatal visits. If more physicians and new parents could be educated about potential problems, however — hopefully leading to more open conversations among couples — it may very well help parents cope better with the new addition to their family, Paulson says. "Awareness of this issue needs to be increased," he says.
Along with greater awareness, Paulson and his colleagues seek better data that will help them understand the factors that may drive paternal PPD as well as the best ways to identify and address it. "Of course, there is little point in screening unless there are services to provide treatment and support for fathers and their families, so this is a critical part of the picture," says Ramchandani.