SAD DADS: Despite the widely held view that moms are the only ones at risk for postpartum depression, a new review of the literature shows one in 10 dads might be at risk for prenatal and/or postpartum depression. Image: ISTOCKPHOTO/ARTISTICCAPTURES
Strange tales of lactating men or male pregnancy pains crop up in the news from time to time, despite the fact that men cannot get pregnant. Does that mean men are also susceptible to bouts with prenatal and postpartum depression?
Previous research has found rates of depression in new dads that range from 1 percent to 25 percent, but a new meta-analysis, published May 19 in JAMA, Journal of the American Medical Association, assessed 43 studies of a total of more than 28,000 fathers and found that an average of 10.4 percent suffered from depression sometime between the first trimester of their partner's pregnancy and the child's first birthday.
Rates of paternal depression were highest three to six months after birth (25.6 percent) and in the U.S. (14.1 percent versus the international rate of 8.2 percent). All of these numbers are considerably higher than the annual rate for adult male depression, which is 4.8 percent (but lower than the rate for maternal prenatal and postpartum depression, which is estimated to be 23.8 percent).
"This suggests that paternal prenatal and postpartum depression represents a significant public health concern," concluded the authors of the new paper.
Many moms get what is known as the baby blues, a passing sadness in the first few days after the birth of their child. But postpartum depression in both mothers and fathers is a condition that lasts longer, and "it may be very problematic for families and child outcomes," says James Paulson of the Department of Pediatrics at Eastern Virginia Medical School, the lead author of the meta-analysis. Extreme examples of parental depression can lead to suicide or to harm or neglect of the baby, but even mild to moderate depression in fathers has been shown to have lasting negative effects on their children for years to come.
Postpartum depression in moms has become a more widely discussed—and diagnosed—issue in recent years, but finding fathers who are going through something similar has proven difficult. Diagnostic questionnaires often focus on questions about sadness and other states that men typically are less likely to acknowledge. Some researchers have advocated to change the vocabulary to include issues such as irritability, emotional withdrawal and detachment, which can also be symptoms of depression in men, Paulson says.
Additionally, "there's a general cultural myth that men don't get depressed," says Will Courtenay, a psychotherapist and researcher in Oakland, Calif. who is completing research on paternal postpartum depression in collaboration with Harvard's Center for Men at McLean Hospital. "Because of that cultural myth, men oftentimes think they shouldn't get depressed, and when they are depressed they try to hide it."
Many new parents endure a host of symptoms often associated with depression (such as fatigue, change in appetite or anxiety), even if they have a clean bill of mental health. As a parent of an infant, "you don’t have time to eat a normal diet, you don't have time to get eight hours of sleep," Paulson notes. So "trying to parse out fatigue" and other normal indicators of depression can be tricky, he says. But for people who have clear cases of clinical depression, there are cues beyond typical parenting troubles, such as persistent detachment, feeling hopeless or worthless, or thoughts of death.
Finally, doctors and pediatricians usually see new fathers less often than they do new mothers, who are most frequently the parent bringing a baby in for appointments during the first year of life. Even though screening for depression in mothers is far from perfect, it is much easier to do given their more regular contact with the health care system, Paulson noted at a May 18 press briefing hosted by JAMA in New York.
As the childbearers, women have been the primary focus for studies of physiological and psychological changes during and after pregnancy. But more recent literature has begun to uncover changes in dads as well. A few studies have found hormonal changes in men about to become fathers and those who have just had a child, Paulson notes, though he is quick to add that none have yet linked these changes specifically to depression. Many of these shifts, however, mirror those occurring during the same period in women's bodies, such as increases in estrogen and prolactin, Courtenay says.
The sleep deprivation that comes along with being a new parent can alter neurochemical balances in the brain, making some people with underlying risk factors more vulnerable to depression. "It's kind of a double whammy," Courtenay says. "All these hormonal changes and neurochemical changes in the brain due to sleep deprivation can wreak havoc on a man."