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6 myths of postnatal depression in dads debunked

This article first appeared in Mas&Pas on 29 January 2019. Viren Swami is Professor of Social Psychology at Anglia Ruskin University and Adjunct Professor and Director of Centre for Psychological Medicine at Perdana University.

After the birth of my son, I was diagnosed with postnatal depression. As a dad but also a social psychologist, I began writing about my experiencesto try and better understand what I was going through.

The response I’ve received from some readers, particularly new fathers, has been very supportive. But many people have also responded negatively – often to deny my own experiences (“what you have is not postnatal depression – it’s narcissism”), to question my masculinity (“you need to man up”), and sometimes with abuse (“pathetic”).

This isn’t an attempt to shame those individuals, as I suspect many of those negative comments are underpinned by a lack of understanding of postnatal depression. In fact, myths of postnatal depression in dads are common and here I want to tackle some of those myths.

postnatal depression in dads - what you didn't know about paternal postnatal depression

Myth #1: Only mothers get postnatal depression

This has perhaps been the most common myth of postnatal depression that I’ve come across – that only birth mothers can experience postnatal depression.

Yet, the consensus among scientists and experts is that new fathers are not immune to postnatal depression. For example, one review found that between 6 to 13% of new mothers will experience depression in the first year after the birth of their child. But reviews of studies have also shown that up to 10% of new fathers will meet diagnostic criteria for postnatal depression, particularly in the first 6 months after the birth of a child.

There is also evidence that fathers whose partners had postnatal depression were about 2.5 times more likely to develop depression themselves in the 6 weeks after the birth of a child.

postnatal depression in dads - what you didn't know about paternal postnatal depression

Myth #2: Postnatal depression is caused by hormonal fluctuations

I suspect one reason why the myth that fathers can’t get postnatal depression remains so popular is because of another popular misconception – that postnatal depression is primarily or only caused by hormonal fluctuations. The argument goes something like this: neurobiological changes during and after pregnancy cause postnatal depression in new mothers, but because new fathers do not experience the same neurobiological changes, they are immune to depressive symptoms. But this argument falls flat on two counts.

First, while it is true that postnatal depression in mothers is caused, in part, by rapid neurobiological changes (particularly in oestradiol, progesterone, oestrogen, and prolactin), there is also evidence that similar neurobiological fluctuations occur in men. For example, studies have shown that levels of testosterone, oestrogen, vasopressin, and prolactin all begin to decrease several months before delivery and remain at a low level for several months post-childbirth in most fathers.

These changes may not only directly affect depressive symptoms in fathers, but may also negatively impact child-bonding, which indirectly contributes to depressive symptoms. In short, to claim that new fathers do not experience neurochemical changes that may cause depression is misleading.

Second, to claim that postnatal depression is primarily or only caused neurobiological changes ignores the broader psychosocial context that leads to depression. Researchers often talk about a “multifactorial aetiology”, which means that postnatal depression often has multiple causes.

Risk factors include neurobiological changes, but also a previous history of mental illness, a genetic predisposition to mental illness, demographic factors (such as young age and low socioeconomic status), psychological factors (such as low self-esteem and childcare stress), and social factors (including lack of support from others and marital conflict). Many of these risk factors are not unique to mothers, but can also lead to depressive symptoms in fathers.

Fathers may sometimes also face difficulties that exacerbate risk factors, such as a relatively speedier return to work and inadequate parenting skills.

This isn’t to deny the fact that some risk factors – such as pregnancy-related stress, childbirth experiences, and breastfeeding difficulties – are specific to mothers. Even here, however, the impact of a mother’s difficult experiences on the father shouldn’t be dismissed. For example, when a new mother experiences difficulties breastfeeding, fathers may sometimes feel like a bystander, unable to help, and useless – which, in turn, can contribute to depressive symptoms.

postnatal depression in dads - what you didn't know about paternal postnatal depression

Myth #3: Paternal postnatal depression is trivial

Another common myth is that, while postnatal depression in mothers has considerable impact on mothers themselves, their children, and society more generally (most notably in terms of the burden of healthcare costs), paternal postnatal depression is inconsequential or trivial. This simply isn’t true.

For fathers themselves, the individual impact of postnatal depression includes memory deficits and poorer work performance. More concerningly, fathers diagnosed with postnatal depression are about 21 times more likely to evidence suicide risk than fathers without postnatal depression.

Paternal postnatal depression has been associated with negative impacts on the father-mother relationship (including poorer relationship happiness, relationship disharmony, and co-parental conflict).

Finally, paternal postnatal depression also affects father-child bonding: fathers with depression are less willing to participate in child-rearing and less likely to engage in positive enrichment activities, such as reading and singing songs, with their child.

Depressed fathers are also more likely to physically discipline their children in the first year after birth compared to non-depressed fathers and to communicate with their infants in ways that are more self-focused and critical.

All of this, in turn, can seriously affect the development of children: negative father-child relationships can lead to detrimental cognitive, behavioural, social, and emotional development of children. In addition, paternal postnatal depression has been associated with children developing psychiatric conditions in later childhood, particularly in boys.

postnatal depression in dads - what you didn't know about paternal postnatal depression

Myth #4: Fathers with postnatal depression are choosing to be depressed

“What have you got to be depressed about?” is a question I have been asked a lot (and, truth be told, a question I have often asked myself).

Implicit in this line of questioning is a belief that mental illness is a choice, that some new fathers are choosing to be depressed because they are attention-seeking, self-obsessed, or selfish.

Sitting comfortably with such attitudes is the notion that fathers need to (and have the ability to) “pull themselves together” for the sake of the partner and child, who are more deserving of sympathy and care.

I suspect one reason why such attitudes emerge is because some accusers have a deep misunderstanding of depression, viewing it not as a crippling mental health disorder with medical and emotional consequences, but rather as a triviality – not unlike having a bad day or having the blues.

Of course, depression – or, for that matter, any mental health disorder – is never a choice. No father ever “chooses” to be depressed, in the same way that no father ever chooses to lose a limb. Of course, choices that some fathers make (choosing not to seek help, for example) can lead to negative outcomes or prolong the course of depression, but this is in no way the same as saying that fathers choose to be depressed.

postnatal depression in dads - what you didn't know about paternal postnatal depression

Myth #5: Fathers with postnatal depression are weak

When fathers talk about their experiences of postnatal depression, they are often told to “man up”.

Postnatally depressed fathers are stigmatised as being weak and unable to cope with the demands of parenthood. It would seem that, although societal attitudes toward depression in men are improving, there is something about paternal postnatal depression that continues to elicit negative judgements.

Much of this likely has to do with gendered constructions of masculinity, which emphasise male toughness, stoicism, and self-reliance. Fathers, in particular, are expected to be the “rock” that provides for families and remains tough and stoic no matter how difficult things get. Fathers experiencing or speaking out about symptoms of depression seem to be perceived as transgressing such societal expectations of masculinity and are punished for it.

The effect of such stigma, of course, is that fathers experiencing depressive symptoms may find it incredibly difficult to ask for help, precisely for fear of being stigmatised. Instead, they are more likely to deal with their symptoms of depression on their own – drinking, aggression, and withdrawal are all common responses to symptoms of postnatal depression.

postnatal depression in dads - what you didn't know about paternal postnatal depression

Myth #6: Helping depressed fathers will result in a loss of services for mothers

Some people believe that providing healthcare services for depressed fathers will necessarily mean fewer services being available for mothers, who are more deserving of care.

While it is absolutely essential that healthcare services for mothers are protected and remain adequately funded, this shouldn’t be viewed as a zero-sum game. Ensuring that fathers receive adequate healthcare should not mean thieving from services aimed at mothers, but neither should it mean that fathers are left to fend on their own.

Depression is a serious illness that will not resolve itself (another common myth), but rather a debilitating condition that requires professional help. In the longer-term, ensuring that postnatally depressed fathers receive adequate professional help may also lower the cost burden associated with negative outcomes of paternal postnatal depression for the wider community.