Paternal Postpartum Depression: Understanding and Addressing a Father's Mental Health

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Paternal Postpartum Depression: Understanding and Addressing a Father's Mental Health

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Postpartum depression (PPD) is often associated with mothers, but did you know that it can also affect fathers?

The emotional toll of welcoming a new child doesn't just skip the other parent, and experts whom AsiaOne spoke to noted that while many dads might go through a temporary period of feeling either overwhelmed by stress or feeling 'blue', for some, it can manifest as paternal postpartum depression (PPPD).

But what exactly is PPPD and what causes it?

Speaking to AsiaOne, Dr Teng Jia Ying, psychiatrist from Mount Elizabeth Novena Hospital, explained that the condition is an episode of depression that occurs in a father following the birth of a child, and there are many factors that can lead to the development of it.

Some examples include having to navigate change and adjusting to new responsibilities and roles for first-time fathers, being in a marital relationship with pre-existing strain and therefore increasing the risk of conflicts after childbirth. Experienced fathers who already have children may also struggle with increased caregiving responsibilities.

Dr Teng also shared that in addition to these factors, things like shifting societal norms and even hormonal changes may contribute to the development of PPPD.

"The role of the husband and father has shifted over time. Modern fathers are expected to be involved in childcare and parenting, and also work and provide for the family. The pressure to fulfil these expectations can be stressful for both first-time and experienced fathers," Dr Teng explained.

"Studies have also found that fathers experience hormonal changes during their partner's pregnancy, and for several months after the birth of the baby. These include a reduction in testosterone levels, oestrogen, prolactin and cortisol," she added, explaining that while these changes in hormones help fathers to become more "emotionally responsive to their babies and develop a strong attachment with them", it may also increase the risk of PPPD.

Paternal postpartum depression might occur due to a number of reasons. PHOTO: Pexels/Anna Shvets

Is PPPD underdiagnosed?

While it's a very real issue, PPPD isn't talked about much, and can be easier to miss due to a variety of factors ranging from a lack of awareness to societal pressures.

According to experts like Dr Teng, PPPD is a condition that's "under-recognised and underdiagnosed".

"Mental wellness services and awareness campaigns tend to focus on maternal postpartum depression, with a strong emphasis on its profound impact on the baby and family. Fathers who are having symptoms of postpartum depression may be less likely to seek help due to lack of awareness, or because of the fear of stigma and discrimination," she said.

Dr Precelia Lam, general practitioner at Raffles Medical, also agreed that the limited discussion on the topic is a reason why PPPD is not diagnosed as often.

"Unfortunately, there is little awareness of PPD in men because it is not as common as PPD in women. As a result, the condition often goes underdiagnosed and untreated," she shared with AsiaOne.

Societal pressures and expectations

According to experts, it may also be tougher for many fathers to speak up about, or seek help for mental health issues like PPPD due to societal pressures and expectations.

Dr Teng explained that many men find it tough to talk about their mental health difficulties due to the fact that they're often expected to be "strong and silent" about their internal struggles.

They may also worry about being seen as "weak" or "sensitive" if they talk about their emotions, which discourages them from seeking help.

Dr Fong Yang, obstetrician and gynaecologist (OBGYN) from Aspire Centre for Women and Fertility, seconds this, telling AsiaOne: "Most men feel they have to be strong for themselves and their wives, because it is a known and acceptable condition for women to have postnatal blues, but in men it would them appear weak and ineffective as the head of a family."

Speaking about how the expectations of how a father is supposed to carry out his role throughout the pre and postnatal journey can also contribute to the fear of sounding out.

"In heterosexual childbearing couples, the message usually given to a dad is that pregnancy and birth are a woman's realm. Fathers can be excluded from prenatal appointments, classes or even the labour itself. When they are present, they're often told that their only job is to be supportive. Emphasis is always placed on instructing the husband to be strong while he is supporting his wife. They are often expected to 'be the rock'. Men's depression can be stigmatised and when they do feel depressed, they live with the fear of letting their wife down," Dr Lam explained.

If left untreated, PPPD can cause real distress for those suffering from it.

"Undiagnosed and prolonged paternal depression usually leads to men distancing and isolating themselves from their families and newborn. There may be poorer child bonding in the longer term, and a lack of interest in the development of these babies," explained Dr Fong.

Dr Teng cautioned that untreated PPPD can lead to an "increase in frequency and severity of symptoms, and of particular concern would be the increase in risk of suicide and risk of aggression towards others".

And it doesn't just affect the fathers.

"Past research has found that PPPD affects parenting behaviours. Fathers were reported to be less sensitive and more hostile towards their children. Untreated PPPD can affect the children's development of secure attachment with their fathers," she explained, adding that children of fathers with PPPD also have an increased risk of emotional and behavioural problems at a later age.

Dr Lam shares the same sentiment, stating that untreated PPPD can "have several negative effects on the father, the child and the family as a whole".

She also shared that children "living with depressed fathers are far more likely to develop anxiety, depression or other mental health issues later in life".

"Marital tension or conflict can arise, followed by reduced family functioning as household responsibilities and parenting duties may become unbalanced, [hence] worsening the strain," she stated.

What are the signs?

Now that we know that PPPD can go undetected easily, how do we identify the symptoms?

According to Dr Lam, PPPD symptoms are more severe and long-lasting (not to be confused with the common 'baby blues' that many new parents face).

They often do not go away on their own, and include things like:

Social withdrawal
Low energy, fatigue and lack of motivation
Loss of interest in hobbies and regular activities
Changes in sleep pattern, weight and appetite
Alcohol and substance abuse
Headaches
Irritability
Violent, aggressive, impulsive or risky behavior

The GP also stated that these symptoms may occur at any point during the first year after the baby is born.

"There is also a severe form of PPD called postpartum psychosis, which can result in paranoia, delusions and hallucinations. This form is much more common in women, but can also occur in men," she stated.

Dr Teng also cautioned that symptoms of PPPD can cause suicidal thoughts in serious cases.

Who does PPPD affect?

Experts say that some people are more prone to PPPD due to a variety of factors.

Some examples include poor relationships with in-laws and/or spouses, lack of support, a history of mental illness and financial stress.

More notably, they also shared that having a spouse with PPD is also a risk factor.

"Having a spouse with PPD has been found to be the most important and consistent risk factor for PPPD. A previous study reported that fathers whose partner has PPD have a 2.5 times higher risk of developing depression themselves at six weeks post-delivery, compared to fathers whose partners do not have depression," shared Dr Teng.

On the topic, Dr Lam also stated that the "risk factors of PPPD include PPD in the mother", and that "half of all men with a partner suffering from PPD will show signs of depression as well".

'You're allowed to be vulnerable'

But it's not all doom and gloom.

Help is available, and fathers shouldn't be afraid to reach out for it.

Speaking up and seeking support is crucial when dealing with PPPD. PHOTO: Emma Bauso

Dr Fong advised fathers to be willing to speak up when they have difficulties coping with the newborn, family and work responsibilities [or] difficulties juggling the different roles, or when their wives may also be experiencing depression.

"In this day and age, equality of genders also applies to mental health problems, and the need for help in such circumstances does not stop at maternal blues or postnatal depression," he added.

"Like every aspect of health, it is important to remember that there is help available for men as well. You are allowed to be vulnerable and to require support if you suspect you may have PPPD," stated Dr Lam.

Acknowledging that fathers are often pillars of support for mothers during the early postpartum period, Dr Teng stated that it is "therefore crucial for a father to take care of his mental wellbeing, so that he can care for his partner and family".

"I would encourage fathers who are experiencing symptoms of PPPD to seek support from their parents, other family members or friends. They can consider reaching out to other fathers, who may be more than happy to share similar experiences and offer useful advice," shared the psychiatrist.

She also added that fathers should utilize their paid paternal leave benefits and spend time during the postpartum period to bond with their child and support their spouses.

Additionally, they should set aside time for themselves like engaging in hobbies and other activities they enjoy while ensuring that they get enough sleep and have regular meals to maintain good physical and mental health.

For dads who are looking for resources or support for PPPD, Dr Teng shared that there are increasing numbers of educational programs on mental wellness and parenting targeted at fathers, like ones from Centre for Fathering and Dads for Life, which offer support for fathers in Singapore through workshops, events, and educational resources.

"Professional help is available in the form of counseling services and psychiatric care. Early treatment of postpartum depression can reduce a father's distress, improve the quality of life, functioning at work and at home, and most importantly, improve relationships with loved ones," she encouraged.