“There’s only so much emotional space in a room, and if mom is taking up that space … dad is kind of left out of that room.” That’s the way Christine Kowaleski, a psychiatric nurse practitioner and co-chairwoman of the New York chapter of Postpartum Support International, characterizes life for many new dads. While society has made strides in supporting new moms, a surprising number of dads are quietly struggling and the signs aren’t always what you’d expect.
It happens, at least 10% of new dads have postpartum depression, but experts such as Dr. Sam Wainwright suspect that the actual number is higher. Indeed, some research has estimated the prevalence as high as 25%. The twist? Dads usually don’t discuss it. Rather, they may retreat, throw themselves into work, or pursue validation in such a way that is subtle and demoralizing.
The first not-so-obvious indicator: being standoffish. While moms tend to fall in love with their newborns immediately, dads can take a few months to feel it too. They can feel like intruders during this time. A father who wished to remain unnamed said that after being absent at the birth of his twins from an emergency C-section, he felt excluded from the start. “I missed it all,” he said. “I didn’t get to support and say … ‘You’re doing great!’. I didn’t get to cut an umbilical cord. I didn’t get any of the experiences that you see in the movies or TV.” Even after he returned home, he found himself withdrawing, uneasy holding his son, and finally realized something was wrong only after getting frustrated.
This feeling of disconnection is more than simply feeling left out. For Dr. Wainwright, “It starts to become a medical problem when it interferes with your normal functioning, and for a parent that means holding your baby, dressing your baby, feeding your baby, diapering your baby.” Dads may appear subdued with friends, stay away from family gatherings, or put in longer hours at work not because they’re not interested, but because they’re overwhelmed and don’t know where they belong. The second indicator? Looking to find fulfillment elsewhere. Reginald Day, who fathered at the age of 22, explains how his self-doubt and anxiety caused him to flee into video games a realm in which he felt triumphant and masterful. “I believe that’s where the seed was planted in my journey that led to depression,” Day explained. What began as a innocent pastime became an addiction, with diaper money spent on new video games. Other fathers may resort to unhealthy behaviors such as drug and alcohol consumption, overeating, dangerous activities, or working too much. As Dr. Wainwright explains, “New dads may pour themselves into something they can control. That can be anywhere on the spectrum from good for their health in other ways to really destructive.”
And then there’s the third sign: a lack of practicing self-care. All new dads are exhausted, but if a dad can sleep or engage in an activity he loves and still isn’t able to, then that’s a warning sign. The anonymous twin dad sacrificed fishing, an activity he cherished, and felt guilty for even considering spending some time on himself. Day’s wholesome habits working out, eating clean, sleeping were gone, exchanged for sleepless nights and runaway thoughts. “I remember going days with no sleep because I was weighed down by so much,” Day said.
While sleep deprivation is a rite of passage for new parents, chronic insomnia or disinterest in self-care may be an insidious but serious indicator of depression. Dr. Wainwright describes it as follows: “The subtle sign is that you actually have a chance to sleep but you still can’t, maybe because you’re worried about what’s going to happen to the baby.” So why does it matter to families? The effects of paternal depression extend far beyond the father himself. Studies indicate that depressive symptoms among fathers are associated with increased risks of preschoolers’ behavior problems, more physical and mental health problems among children, and worse family relationships (increased risk of preschoolers’ behavior problems). A large study discovered that children of dads with postnatal depression are over twice as likely to have emotional and behavioral issues by age 3.5 (paternal depression has a particular and lasting negative effect).
When both parents are under pressure, the detrimental effects compound, resulting in worse outcomes for children. So, what is being done? The good news is that awareness is increasing. The American Academy of Pediatrics now recommends depression screening for dads in the course of well-child visits, with the use of instruments such as the Edinburgh Postnatal Depression Scale (EPDS), PHQ-9, and others (the EPDS scale is validated for diagnosis of PPD in men).
Pediatricians are joining with OB/GYNs and community mental health providers to provide support to both parents (pediatricians can help alleviate the shame or guilt by reassuring the parent how normal depressive feelings are).
Still, there is stigma. There are many dads who won’t say a word, afraid of being judged or not wishing to intrude when all eyes are on mom and baby. But as Kowaleski puts it, “When should they reach out to get help? The answer is yesterday.” Early intervention is important not only for dads, but for the entire family.
Support mechanisms include increasing from therapy and support groups to self-care techniques and even integrative methods like acupuncture and massage (men suffering from PPPD can be relieved and get their lives back in balance). In certain nations, practices like paid paternity leave are assisting fathers to remain engaged and emotionally close, resulting in improved results for all parties. The message is unmistakable: paternal postpartum depression is not just real, but common and treatable, too. Knowing the not-so-obvious symptoms can be the difference-maker not only for new fathers, but for their partners and kids, as well.
