Postnatal depression (PND) continues to be seen as a predominately female condition, with one in five mothers experiencing some level of anxiety, depression, or other mental health issue in the first year post-partum. But fathers are also at risk, and may experience a level of mental health distress with feelings of overwhelm and irritability. This is often compounded by the fact that screening tools are specific to the mother, with struggling fathers rarely identified.
Postnatal depression in fathers is vastly underestimated, with a low evaluation determining that 10 per cent of fathers experience mental health distress. The figure is likely to be higher. A father’s risk factor increases by up to five times if their partner also experiences postnatal depression.
Navigating this time of new parenthood for couples is difficult enough as it is, without additional postnatal challenges.
Fiona Reidy, a psychodynamic psychotherapist with Evidence-Based Therapy Centre in Galway, works with couples where one or both have been diagnosed with PND often, but not always, linked to birth trauma experiences.
“Paternal postnatal depression (PPND) is not discussed enough,” says Reidy. “Understandably, stretched healthcare systems are focused on delivering the best care to mother and baby, which often unintentionally neglects the non-birthing partner or father in the process. There are no routine screenings for fathers and often signs of PPND can be missed by experienced professionals due to a lack of awareness and education on the symptoms.”
Reidy notes that we also “unfortunately still live in a culture and society where men’s feelings and emotions are often suppressed and some people can struggle to have the language to express what they are dealing with, such as the expectations on them as a father. This can be compounded by social norms of dad returning to work quickly as if everything goes back to ‘normal’ after two weeks.”
Take into consideration also that there are “limited spaces” for fathers to discuss the challenges they are experiencing and where “dads and couples can come together to feel safe in discussing feelings of shame, guilt, and fear when they are expected to be ‘happy’.”
Reidy explains that when she works with new parents, together they consider the impact of the pregnancy, birth and parenting journey of both parents to uncover the stresses, fears, worries, and overwhelm they are experiencing.
“This helps us to think about not just what is happening for them as parents, but about any history of trauma or emotional difficulty linked to pregnancy, birth, parenting and family more broadly,” she says.
“For example, histories that include absent parents, miscarriages or other losses, mental health conditions in pregnancy, fertility challenges and the parent’s own past experiences, especially from childhood, may unconsciously affect their responses to the baby.”
This approach works differently to what is considered general mental health support services which potentially focuses on symptoms and individual outcomes as everyone’s experience and requirements are different. While one person may respond well to talk therapy, others may require support from the general practitioner or health visitor in terms of medication.
The approach of Reidy and her team at EBTC recognises that couples or individual parents, regardless of gender, can be affected by post-partum depression due to a mix of biological, sociological, and psychological factors.
“Biological factors, particularly in the mother, are more widely understood,” says Reidy. These include lack of sleep, drastic hormonal changes or genetic and family history. “But these could also impact a father, especially where pre-existing conditions such as withdrawal, anxiety or panic attacks are present.”
Additionally, Reidy recognises that sociological factors can affect a new parent’s support system. In situations where there is no family close by, where there are increased financial or housing pressures, work related stress or the many other stressors that can occur throughout life, new parenthood becomes even more complicated.
“Psychologically, there are many factors that can influence PND as a result of a birth trauma, including the non-birthing partner’s pre-existing mental health and personality,” says Reidy. “For example, anxiety or perfectionism, low self-esteem, difficulty processing emotions, trauma history themselves or in their family.”
A lot of couples focus on the pregnancy and birth and don’t have the time or space to prepare emotionally for the impact becoming parents will have on them
— Fiona Reidy
Reidy explains that unprocessed feelings and experiences from their own birth and generational trauma about having children or becoming parents can be present and resurface, without the new parents even knowing it. The connection between the couple is also an important factor that can disrupt the dynamic of new parents, especially if the father witnesses a birth trauma which resulted in a threat to life.
“For example, a mother under anaesthetic can be a physically and emotionally traumatic experience that needs to be processed after the birth,” says Reidy. “This is often difficult on the father as the demands of a newborn baby, and the care that may be needed for the birthing partner, such as physical recovery post-surgery, take priority. Other day-to-day challenges such as feeling unprepared for the demands of parenthood, responding to the needs of the baby while having their own needs neglected, feeling left out of the bond between baby and mother, changes to the relationship between them and their partner before or after the baby is born can all become overwhelming.”
While the culture and social norms, along with limited paternal research, focus on maternal and infant care, couples can remain focused on each other and speak openly about their individual expectations. PND presents with persistent changes to mood, including irritability, anger, sadness, and low mood. A partner may have difficulty bonding with their baby, experience a loss of interest or a sense of presence, thoughts of self-harm, other intrusive thoughts particularly linked to the baby, a loss of usual cognitive functioning, and changes to eating and sleeping patterns. Being aware that these changes might occur can help to recognise the need for support early.
“There are overlaps and differences for moms and dads,” says Reidy. “Some of the things to watch out for with dads are detachment from the family, becoming emotionally withdrawn, unusually frustrated/irritable, increased arguments or conflict between the couple or others. It can also present as increased risk-taking such as substance abuse.”
Reidy advises couples to share their experiences and expectations before their baby is born in an “honest space for sharing their fears and challenges.” In this way, couples may learn about what their partner expects to be challenging when the baby arrives.
“A lot of couples focus on the pregnancy and birth,” says Reidy, “and don’t have the time or space to prepare emotionally for the impact becoming parents will have on them. Thinking about their needs as a couple and the change to this once baby arrives can also be important.”
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For example, Reidy notes that changes to libido or interest in sex, and feelings of being left out, are all common experiences.
Parenting is a major transition in a couple’s life. Support is available, but having a “safety plan”, as Reidy suggests, will help couples when things get difficult. This could be a plan for when a partner needs physical or emotional support. Reidy also suggests that it is worth being aware of the possibility of PND and how they may support each other.
“Get help sooner rather than later,” says Reidy. “Don’t wait it out for arguments to escalate and hope that it will resolve itself.”
