As Mike*, a 30-year-old cable technician, walked out of the hospital with his newborn, he felt overwhelmed and inadequate. Mike, who lives in the Quad Cities, Illinois, had already struggled with depression for years. Becoming a dad only made it worse.
“Media presents us with the idea that as soon as a child is born, you instantly fall in love,” he says. “It just isn’t true for some of us.”
The concept of postpartum depression surfaced in the medical literature in the 1850s. After that, the condition received virtually no attention from experts until the early 1960s, when Dr. James Alexander Hamilton wrote extensively about “postpartum psychiatric illness.” He assumed physiological changes related to giving birth were responsible for depression in new mothers. He didn’t consider that dads might be experiencing similar symptoms. Accordingly, postpartum depression (PPD) has typically been thought of as a maternal health issue. This belief isn’t wrong, per se. But it doesn’t tell the whole story. While PPD remains extremely common and underdiagnosed in moms, more and more evidence indicates it’s also fairly common among dads. A new movement fueled by healthcare professionals is focusing on how to diagnose and treat postpartum depression in parents who give care but don’t give birth.
Recently, researchers at Northwestern University and Lurie Children’s Hospital of Chicago launched a pilot program to investigate PPD-management strategies for dads. The study, focused on men entering fatherhood. Simply acknowledging that fathers are integral to the parenthood equation, the study found, can help them get treatment for depression instead of suffering in silence.
Roots of the problem
Today, most doctors agree that PPD is triggered both by hormonal changes and the emotional toll of becoming a parent. Dads feel that toll too, and like new mothers, some studies suggest they experience hormonal fluctuations to help them bond with their children. While an estimated 7% to 20% of women develop PPD after giving birth, studies suggest the rate is about 10% among new dads, but they’re even less likely to report depression symptoms.
PPD has been treated as a maternal health issue for as long as it’s been a diagnosable condition.This conventional understanding of PPD has impeded efforts to spread awareness of it as a both-parent problem and get men to realize when it’s happening to them. Plus, societal expectations that men should be stoic about their emotions and their tendency to isolate when things feel off deter men from speaking up.
There’s an important clinical distinction between postpartum depression and the so-called “baby blues” that many new parents deal with. The blues manifest as sadness, tiredness and worry, and typically only last a few days. Postpartum depression persists for much longer, and includes symptoms such as uncontrollable crying, anger, withdrawal, and feeling numb or disconnected to your baby. Like moms, dads with PPD often feel incompetent as parents and have negative thoughts about their infant children. This emotional state can have significant negative impacts on the entire family.
“When untreated, parents’ resentment of their babies can grow into loathing for the child,” says Brandon Eddy, a marriage and family therapist and an assistant professor at the University of Nevada, Las Vegas. “Parents not suffering from depression will bond more quickly and effectively with their babies, whereas partners with it will not.”
Eddy’s research about fathers and PPD has revealed some consistent themes. “Fathers need more education about what to expect after the birth of a child,” he says. “Many don’t know that PPD in dads is even a thing; and neither fathers, nor mothers, are familiar with the signs to look for.”
Compared to women, men might also have a different way of expressing how they’re feeling, which is important for both their partners and mental health professionals to recognize, says San Diego psychologist Daniel Singley, director of The Center for Men’s Excellence. Men’s depression typically manifests as irritability, anger and avoidance, and might even cause physical symptoms such as headaches and stomach problems, Singley says. Men might seek out dopamine rushes from sources such as video games, masturbation, substance misuse and risky sex.
Joshua Maze, 33, is a father, pharmacy technician and specialized coordinator at Postpartum International, a hotline for anyone seeking support postpartum. Many dads who call think it’s unusual to feel resentment toward their babies, or shame, anger or sadness about fatherhood, says Maze.
“So many dads think they’re the only ones thinking these things,” Maze says. “I try to lift dads up and reassure them. They often call because they’re not getting validation elsewhere.”
There are also fewer opportunities for dads to be diagnosed. Expectant moms see doctors regularly. But men, who are less likely to have primary care doctors to begin with, may not get medical care in the time leading up to childbirth. Even men who accompany their partners to prenatal visits might not feel included in the experience. When Eddy’s wife was pregnant with their third child, her ob-gyn barely acknowledged his presence. He’s heard similar stories from fathers he’s counseled.
“It was like I was a weird bystander,” he says. “If we’re making fathers feel like they’re not a part of the pregnancy, that’s a bad message.”
Research on postpartum depression in men barely existed until recently, and studies are still on same-sex couples are still sparse. But mental health experts suspect similar issues arise in new parents regardless of their sexual orientation or gender identity. Take Jennifer, a yoga instructor and mother of a 6-year-old in Saint Petersburg, Florida. She no longer felt like the most important person in her wife’s life when their son was born. At first, she found it hard to bond with him.
“It wasn’t easy and took a long time to adjust to my new role,” says Jennifer. “The birth mom often seems to step naturally up, like it’s a promotion, whereas I felt I’d been demoted.”
Dr. Craig Garfield, a professor, and his colleagues at Northwestern sought to solve some of these problems through some new research. Luckily, they didn’t need to design a research project from scratch. Northwestern already had a national parenting program in place, called Mothers and Babies, serving 500,000 new moms. The program trained and dispatched volunteers to help moms manage stress and build childcare skills after giving birth. Garfield and his team recruited interested fathers from families already participating in the Mothers and Babies program, and created an added support system tailored specifically to these dads.
“We heard a lot from home visitors that moms wanted something for dads. But there was nothing tailored for [them],” Garfield says.
Past research programs for new fathers have mainly focused on dads helping moms transition to parenthood, Garfield notes. In developing Fathers and Babies, he and his co-authors grappled with how much to focus on dads individually, rather than as supporting players. Merely acknowledging fathers’ importance, they found, seemed to make a difference.
“Respecting dads as individuals and not just as providers of sperm can go a long way,” Garfield says. “It allows dads, many for the first time, to think about their own health. It also became clear how grateful they were just to be included. They wanted to know what they’re supposed to be doing as fathers.”
In the study, volunteers met with 30 different couples who’d recently had babies. On average, the fathers were 27 years old, and more than half of the couples were unmarried. Non-biological fathers, as well as those who didn’t live in the home, were included in the program, too.
Over the next several months, the volunteers checked in with these dads about the state of their mental health, via in-person conversations, phone calls and text messages. They asked them to reflect on any harmful thoughts, assigned them workbook exercises to deal with these thoughts, and recommended low-cost family-bonding activities to help them reduce stress. Although the study was conducted pre-pandemic, Garfield says its lessons can still be applied today.
“The pandemic emphasizes how important it is now and in the future to have flexible ways to reach parents — from in person, to video conferencing, to text,” he says. “So much can be done by embracing these technologies and adding them to existing in-person efforts.”
Volunteers conducted surveys of both moms and the dads three and six months after the babies were born. Dads’ response to the home visitors was generally positive, Garfield says. Fathers’ stress levels dropped significantly. Those who were experiencing feelings of hopelessness noticed a drop in their depression symptoms. Dads experiencing overwhelming anxiety began to feel some relief. Importantly, all of the parents who participated in the program said they felt they had the tools they needed to take care of their babies, and now understood how to manage their stress and ask for help when they needed it.
Going forward, Garfield says he and his team will continue to refine the program to better fit the needs of dads so that it can serve as an example for other programs.
Figuring out the best ways to reach new dads struggling with their mental health is “the million dollar question,” for which there are no clear answers, yet, Eddy says. But a collective, societal shift in how we view fathers would help a lot.
“Part of it will require a shift making it acceptable to talk about this,” Eddy says. “Every father I talk to about PPD mentions the shame [associated with it], gender role expectations, and not being able to share what they’re thinking. We can be more inclusive just by asking, ‘How’s dad doing?’ in addition to asking about mom.”