Male post-natal depression – the facts

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By George Maxwell

Updated on 01/07/2015

This first article is a very general overview of the phenomenon of depression in new dads (DND), male post-natal depression, male PND or Male post-partum depression. My aims here are to simply present some preliminary information about depression in general and then detail some of the academic evidence which support the fact that it exists as a phenomenon. Having experienced it myself, and having provided Cognitive Behavioural Therapy (CBT) for others who have, I am of the belief that we have a genuine social health issue which requires appropriate identification and treatment. As detailed later in the article, post-natal depression in men has substantial negative consequences for the individual and his spouse, the child and for society in general, and yet there are still so many barriers to getting help. Hopefully, this article and the CBT self-help information on the rest of this site can help us to change this.

Why would becoming a dad lead to depression?

Few people are prepared for the impact that becoming a parent involves. Whereas life may have been previously manageable, predictable to some degree, the seemingly random cries of an infant introduce a dose of uncertainty and confusion to the mix which may have not been there before. Whilst previously in a crisis you would call upon your well developed male problem solving abilities to address it, now finding that you have exhausted all feeding, changing and burping solutions and still your little one is crying can quickly lead you to doubt your ability to cope. But you want to help, you’re a modern man and you want to share the duties. You’ll help with the night feeds, just so your partner can get some rest, even if it means you’re going to be tired for work the next day. And this works…for a while. Eventually through tiredness, you make a mistake at work and your boss gives you a reprimand which makes you feel both angry and sad. “I’m doing my best” you think, “but if I lose my job then how will I provide for my family?”

Rather than talk to your partner about your work problems, you decide to not add any stress to the nesting at home and you choose to keep this to yourself. You believe its probably better for your new family if you just sort this stuff out independently. And you do. But you find yourself thinking about your poor performance at work whilst you are at home, and whilst in work you’re thinking about how challenging things can be at home. A process of rumination has begun. Whilst all of this is going on, you’re still doing the night feeds, trying to take as much pressure off your partner as you can and trying to be the best dad you can. You notice that your partner doesn’t always seem as grateful as she could be for the efforts you are making. You understand that sex is off the cards but a little acknowledgement would be nice. Thoughts start to run through your head, “she doesn’t think I’m doing enough”, “I’m not a good enough dad.” You start to notice that you’re not enjoying this role as much as you thought you would. You feel tears well up in your eyes everytime you hear the baby cry, you resent your wife’s lack of response and apparent reliance upon you, and you really can’t be bothered with work anymore – but go you must. And so it goes…

Depression in New Dads.

I’m deciding to use the phrase “depression in new dads” or it’s abbreviation “DND” when talking about the subject because, as will be looked at elsewhere on the site, there are some researchers and commentators who argue against the existence of “Male post-natal depression.” Some of the objections are tied up in the medical profession’s ultra-dependency upon the “bio-medical model”, a denial or ignorance of the emerging body of male PND evidence or an anti-male worldview which goes something like “he’s depressed? he didn’t have to carry a baby around for 9 months!” Each of these objections needs to be looked at in depth, and as such go beyond the scope of this preliminary article, but as far as I’m concerned, anything which inhibits depressed males from accessing support at such a fundamental stage in their, and their new family’s life, needs to be scrutinised and challenged.

A bit about depression

Depression is a big deal and whether we like to talk about it or not, there are a hell of a lot of people who experience it. The World Health Organisation (WHO) estimates that as many as 350 million people worldwide are affected by the condition, and in a survey of 17 countries found that 1 in 20 people will experience depression each year. It can lead to a severe negative impact upon life functioning, and in the worst of cases suicide. In England and Wales in the UK, death by suicide is the biggest killer of males between the ages of 20 to 49. Sadly though, we’re more likely to see public campaigns about cancers, obesity and road safety than we are to see campaigns about male suicide. There is a culture of non-acknowledgement and “stiff upper lip” which, in my opinion, is shameful.

The recently published DSM 5, the diagnostics and statistics manual published by the American Psychiatric Association, suggests that a diagnosis of major depressive episode should be given if the following criteria are met:

 

DSM V depression

Why do we get depression?

There are many different factors which contribute to the onset and development of depression. In addition to this website’s focus, becoming a dad, other factors include bereavement, losing a job, relationship problems, illness, financial difficulties. In essence, and this is something which is covered when we look at behavioural treatments for depression, when we experience successive punishing or non-rewarding life events then we are at risk of becoming depressed. In addition, there are biological factors which may leave some people to be more at risk of depression than others. This is why, in addition to evidence-based psychological treatments, anti-depressant medication is also an effective treatment for depression symptoms.

How common is Depression in New Dads?

Compared to post-natal depression in females, there have been relatively few studies conducted which seriously look at the incidence of male post-natal depression, however there is an emerging body of research which we can call upon to review the problem. A 2010 meta-analysis, conducted by researchers Paulson and Bazemore, looked at 43 studies published between 1980 and 2009 to identify the incidence of male pre-natal and post-natal depression. The meta-analysis included a total of 28004 individual participants and concluded that pre and post-natal depression was present in about 10% of males and was higher in the 3 to 6 month post-birth period. A 2004 publication by Goodman, again a meta-analysis, looked at 20 published studies with the purpose of identifying the incidence of male PND, to identify precipitating factors to the condition and to look at it’s relationship to female PND. Goodman found that the incidence of male post-natal depression symptoms in the first year post-birth ranged from 1.2% to 25.5%. Further, a 2005 prospective population study conducted by Ramachandani et al., found 4% of 8341 males were to be post-natally depressed 8 weeks after the birth of their child.

Whilst there is obvious considerable variance in incidence between these studies, it is clear that there is a measurable, consistent phenomena of DND and yet it typically fails to get recognised and treated in the same way that female post natal depression does. However, if we take into the account the considerable effects upon family, the child and the wider society which DND projects then maybe we can see some justification in tackling the issue.

Consequences of Depression in New Dads

Post-natal Depression (PND) in females is a widely recognised phenomenon which is routinely screened for by medical professionals in the first year of a child’s life, and justifiably so. PND can lead to reduced interaction with the child (and subsequently hindered development), longer term depression symptoms impacting upon the mothers future personal, social and career functioning and increased suicide risk. Whilst working to identify PND in the mother is of course a positive thing, there is an emerging body of literature which suggest that male depression in the post-natal stage can serve as a mediator in the onset and severity of the female’s symptoms (Wilson & Durbin, 2010; Dudley, Roy, Kelk & Bernard, 2001). That is, male post-natal depression is directly associated to the female PND presentation. Therefore, it seems a fair conclusion to make that if the male is offered similar assessment and evidence based treatment for DND as his female partner, then this will be likely to improve PND outcomes for the female.

The fact that males have traditionally not been included in PND research leads to a further negative implication for the PND female. This is that any child developmental difficulties which are seen to emerge as a consequence of parental depression, have been largely attributed to the mother. We are, however, beginning to see that male PND symptoms are also associated with such developmental issues. Paternal depression has been associated with the child having lower intellectual functioning, lower social cognitive ability, impeded social functioning and an increased chance of themselves becoming depressed in later life. Taking this into account, it makes availability of treatment for male PND an absolute social imperative.

The way forward

Given the prevalence and deleterious effects of male PND, it is essential the the doors be opened up for depressed new dads to get the help that they need. To be given the opportunity and encouragement to open up about how they are feeling and to be offered psychological or psychiatric interventions as is appropriate is not only beneficial for the individual himself but a reflection on society as whole. Becoming a parent can be one of the hardest things we ever do, but as well as looking after the mother, we need to make sure the male voice gets heard too.

George Maxwell is an Accredited Cognitive Behavioural Therapist and director of Access CBT UK.
He specialises in the treatment of Male depression in the post-natal period but also has extensive skills in working with PTSD, Anxiety disorders, OCD and Panic. If you would like to arrange individual therapy with him (either face to face or via the modern miracle of Skype!), or would like to receive information and updates relating to New Dad Depression then feel free to contact him at enquiries@accesscbt.co.uk