I was walking across the medical centre car park when one of my patients called me over and suddenly asked “Doc, can I ask a question? Can a man have postnatal depression?” I was a little taken aback. On further discussion he told me that he was worried about one of his friends who had recently become a new father so I encouraged him to support his friend to go and see his family doctor. I was pleased that my patient had the courage to speak to me in the car park and I very much hope that this resulted in his friend being more able to seek help. Afterwards I reflected on this encounter and wondered how many family doctors think about postnatal depression in men.
There is a false assumption that postnatal depression only occurs in mothers but research tells us that postnatal depression also occurs in men. In 1994 Ballard and his team found that up to 10 percent of fathers are found to be depressed six weeks after the birth of their child, and a 2010 meta-analysis has shown that the rate of postnatal depression in fathers reaches a peak at between three to six months, with 25 percent of fathers found to be depressed during this period, but this is often not talked about. We should be able to do better in providing adequate help for these fathers.
Postnatal depression in fathers can be difficult to handle. In many cultures men are ashamed to talk about feelings of depression because of fears about being considered a weakling or a failure, so many new fathers often suffer in silence. To make matters worse, although men are increasingly included in antenatal classes, once the baby is born new fathers are no longer routinely included in post-natal services such as the six week baby check because many services are primarily designed around the needs of the mother and child.
A focus on the mother child relationship is very important, and screening for postnatal depression is routine practice in many countries. Taking into account how common postnatal depression is in men, we need to increase our efforts to identify the problem by supporting men to talk because, just like in mothers, postnatal depression in fathers can also lead to long term consequences for the child including behaviour difficulties and conflict with their partner.
How might you recognise the problem?
The symptoms of postnatal depression in men are similar to the symptoms of postnatal depression in women. They may include feelings of distress, sadness, tiredness, poor sleep, forgetfulness, irritable bowel symptoms, appetite disturbance, feelings of rejection, feelings of emptiness, a general loss of interest and loss of interest in sex, feelings of not being a good enough father and feelings of irritability. If it is not caught early enough fathers with postnatal depression may turn to alcohol to cope. Some fathers may even have suicidal ideas and this is especially common in those fathers with postnatal depression who start to believe that their partners are no longer interested in them.
There are many theories to explain why fathers are prone to postnatal depression. It may be due to a change in gender and family roles as result of the new baby and there are even psychological theories saying it is due to castration anxiety.
Whatever the cause of postnatal depression in fathers it is essential is to seek help early. This means that family doctors and community workers such as midwives need to be made more aware of postnatal depression in fathers so that they are aware that this diagnosis exists so that they can make sure that they don’t miss it when it occurs. People who design and pay for health services also need to ensure that there are appropriate pathways in the postnatal period to cater for men, just as we have for women.
It is not a sign of weakness or failure to experience postnatal depression as a new father. Do not bottle up feelings and do not suffer in silence. Please seek help. I am very grateful to the man who spoke to me in the car park because it has enabled me to reflect on postnatal depression in fathers and to share my reflections with others.
References:
- Ballard CG, Davis R, Cullen RN, Mohan RN, Dean C. Prevalence of postnatal psychiatric morbidity in mothers and fathers. British Journal of Psychiatry. 1994; 164: 782-78
- Paulson JF, Bazemore SD. Prenatal and postpartum depression in fathers and its association with maternal depression. A meta-analysis. JAMA. 2010; 303 (19) 1961-1969
- Ballard C, Davis R. Postnatal depression in fathers. International Review of Psychiatry. 1996; 8(1): 65-71
Professor Gabriel Ivbijaro MBE, JP
MBBS, FRCGP, FWACPsych, MMedSci, MA, IDFAPA
President WFMH (World Federation for Mental Health)
Chair The World Dignity Project
Medical Director
The Wood Street Medical Centre│6 Linford Road│ Walthamstow │London E17 3LA │UK
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