SAN FRANCISCO -- When it comes to postpartum depression, most people think of the mother's well-being, but research suggests that a similar proportion of men experience some form of depression after the birth of a child, according to presentations at the annual convention of the American Psychological Association.
"Much has been written about women's experiences of pregnancy and postpartum, most of it exploring negative reactions, ranging from clinical depression to postpartum psychosis, and attributing them to unique physical changes women experience during pregnancy," said Dan Singley, PhD, of the Center for Men's Excellence in San Diego. "But the incidence rate of depression is comparable between new mothers and fathers. Postpartum depression can no longer be seen as primarily a pathological variant of female reproductive processes. The existing paradigm must be modified."
"The predominant narrative has attributed these experiences to hormonal changes and fluctuations specifically related to pregnancy and birthing," said Sara Rosenquist, PhD, of the Center for Reproductive Health Psychology, in Cary, North Carolina, who presented in the same session. "It is highly unlikely that the hormonal disruptions of pregnancy and birthing would explain the whole picture if fathers and adoptive parents all experience postpartum depression at the same rates."
Until recently, mental health surrounding childbirth has been perceived as a topic relevant only to women. Although much research has been devoted to maternal stress and postpartum depression, little has been devoted to identifying prevalence rates, causes, consequences and treatment of mental health issues in new fathers, according to Singley.
"Recent research has shown that roughly 10 percent of new dads experience postpartum depression, and up to 18 percent have some type of anxiety disorder," Singley said. "Unfortunately, few psychologists receive focused training regarding identifying, assessing or treating common men's issues in the period from conception to a year or so post-childbirth. Because men tend not to seek mental health services during this period, the lack of scholarly attention to this vulnerable group reflects a commonly overlooked public health disparity."
And that rate of 10 percent is about in line with what adoptive mothers experience, according to Rosenquist.
Anthropologists have long observed that men sometimes exhibit symptoms reminiscent of pregnancy when their partner is pregnant, such as nausea, heartburn, abdominal pain, bloating or appetite changes. There is also evidence, in both human and animal studies, that close contact with a pregnant partner can induce hormonal changes that enhance and accelerate the onset of fatherly instincts in some men, according to Rosenquist. Men who experience sympathetic pregnancies also have measurably higher levels of prolactin (the hormone that allows women to produce milk) and experience a temporary drop in testosterone just after birth. But this only seems to occur in cultures where men and women have emotionally close, companionate partnerships and less so in more traditional cultures where men and women have separate domains. Taken together, this suggests that cultural variables are overlooked and hormonal variables are over emphasized in the current paradigm.
There are a variety of other factors that can contribute to depression and anxiety in new dads. In fact, sleep deprivation has been shown to be the single most predictive risk factor for anyone, at any time, said Rosenquist. The father's lack of sleep and the needs of an infant are exhausting, and time spent away from work can contribute to anxiety. New fathers can sometimes struggle with gender role conflict, should they have trouble conforming to what society says is the traditional role of a father, and may also question their ability to be a competent parent.
In calling for increased awareness of the problem, Rosenquist and Singley both recommended regular screening of new and expectant fathers for signs of depression, especially if the father or mother has any history of mental health problems.
"But screening is not enough," said Rosenquist. "Screening does not distinguish between major depressive disorder, which sometimes requires treatment with medications in addition to psychotherapy, and adjustment disorder, which is more commonly better treated with psychotherapy alone."
Identifying depression in men can be a challenge, though, because the symptoms are different for men, according to Rosenquist. "Women are more likely to report feelings of sadness and frequent crying, whereas men are more likely to feel irritable and socially disconnected," she said.
Another thing men can do to help prevent postpartum depression is rely on friends for support during pregnancy and post-childbirth, according to Singley. "Fathers who maintain solid social support networks experience a buffer from the conflicts and demands associated with parenting while also providing role models which facilitate a sense of competence as a parent," he said.
Session 1206: "Postpartum Depression in Men: Evidence That Calls for Refining a Paradigm," and "Fathers' Postpartum Mental Health: A Women's Issue," Symposium, Thursday, Aug. 9, 12-12:50 p.m. PDT, Room 104, Lobby Level - South Building, Moscone Center, 747 Howard St., San Francisco, Calif.
Presentations are available from the APA Public Affairs Office.
The American Psychological Association, in Washington, D.C., is the largest scientific and professional organization representing psychology in the United States. APA's membership includes nearly 115,700 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance the creation, communication and application of psychological knowledge to benefit society and improve people's lives.