New study emphasizes the need to screen for postpartum depression in fathers

Recent research suggests that fathers, just like their partners, can suffer from postnatal depression (PPD). Most experts estimate that about 10% of fathers experience the condition, while among mothers the figure is about 14%.

A pilot study from the University of Illinois at Chicago (UIC) suggests that men should be screened regularly for PDD. It is part of a growing movement to change the approach to men's mental health by offering more comprehensive support for the whole family.

"It's clear to me that we've created gender barriers in caregiving, and that's led to fathers being excluded from this period," said Sam Wainwright, lead author of the study and an assistant professor of internal medicine and pediatrics at UIC.

Until recent decades, PND was associated only with women who experience more obvious physical and hormonal changes in the postpartum period. Treatment for a depressive episode that lasts several months typically involves counseling or antidepressants. In August, the FDA also approved a first-of-its-kind oral medication to treat PND.

However, men are also subject to the emotional stress of fatherhood. Research shows that fathers may experience a drop in testosterone levels after the birth of their child, which is associated with mood changes. The onset of PND in fathers typically begins three to six months after birth.

PND in fathers is also a risk factor for poor quality of life and harm to family development and relationships, according to the study.

"A lot of fathers feel overwhelmed by the new experience," said Sheehan Fisher, a psychologist at Northwestern Memorial Hospital. "They're trying to figure out how to adapt, but they don't have a blueprint for how to be a father."

Research results

A study of 24 new fathers found that 30 percent tested positive for PPD. Wainwright suspects that rate is higher than average because 87 percent of the participants identified as racial or ethnic minorities, which may predispose them to mental health problems due to institutionalized economic inequities.

Regular screening of men during child check-ups could prevent the development of PPD, Wainwright believes.

"For me, it's a matter of saying, 'You matter, your health matters,' and not just because it's some maternal health goal," he said.

A comprehensive support approach

Wainwright’s previous work has focused primarily on women’s health. The UI Two-Generation Clinic, which conducted the study, offers one-time postpartum care for mothers and pediatric checkups. It primarily serves economically marginalized communities of color.

But clinic staff soon noticed that fathers were being overlooked, despite the fact that their well-being was vital to the health of the family. In fact, the only conversations about babies' fathers during checkups centered on domestic violence, Wainwright said.

"The vast majority of men will never do anything other than love their partner and their child, even if they are not married," he said. "It's as if the system assumes that men are the source of violence and nothing more."

Research methods and further actions

The fathers in the study were between one and 15 months postpartum. The researchers used the Edinburgh Postnatal Depression Scale, which is used for mothers.

Social workers also interviewed fathers, many of whom were young, first-time parents who feared they did not have adequate parenting skills. Most experienced significant sleep deprivation and reported feeling very tired. Several reported that demands for economic support conflicted with the desire to support mother and child.

"They're really focused on making sure she's OK, and so they're actually neglecting their own well-being and mental health," Fisher said.

Conclusion

PDD is also thought to manifest differently in men than in women, with men more likely to exhibit irritability and aggression. One study found that depressed fathers may be less likely to read to their 1-year-olds and more likely to spank them. Experts believe the true number of fathers with PDD may be higher than 10% due to differences in symptoms.

"I think if we can just normalize PPD as a society, we'll be more mindful of it," Atkins said.

For Wainwright, the study highlights the need for a radical change in healthcare, where fathers are actively included in postnatal checks. A system like the one used at the Two-Generation Clinic could provide sufficient support for the whole family.

Screening for PDD also serves as an opportunity to connect with young men about other aspects of their health, Wainwright said. More than half of the participants did not have a primary care provider before the study. However, after the study, two sought mental health services and three established a primary care relationship with a doctor.

"Fathers are an integral part of children's lives, of families' lives, and they are important in their own right. And this is a time when you can reach them," Wainwright said.