Investigating the rarely talked-about condition.
In 2004, after the difficult birth of his son and his wife’s subsequent battle with postnatal depression, Mark Williams found himself having mental health issues of his own. “The fact that my wife had postnatal depression, the worry that I wasn’t going to be a good enough father, waking up with nightmares about the birth. I just didn’t get the feeling of love for the baby,” he told The Guardian last year. Later, he would realise that he had postnatal depression too, and set up the UK charity Fathers Reaching Out to help other men like himself. “A dad with postnatal depression comes across as a bad dad,” he said. “He doesn’t want to change a nappy and be involved.”
While the stigma around postnatal depression in women is slowly being broken down, we rarely speak about how the time before and after a birth can affect a new father’s mental health. According to recent research, paternal postnatal depression (PPND) affects up to 10% of new fathers worldwide. So why isn’t this acknowledged more widely?
“In the time of birth and infancy, the focus in healthcare has always been, rightly, on the mother and child. The father hasn’t been particularly included,” explains Lloyd Philpott, a lecturer in University College Cork’s School of Nursing and Midwifery. He has been researching PPND for several years, and in 2015 conducted a study on 100 new Irish dads, using the scale normally employed to screen new mothers. He found that 12% of the men scored high enough on the scale to be diagnosed with the condition.
Having said that, you have to put it in social context – fatherhood has changed over the last 20 years, and fathers are now more involved in domestic work and childcare. The role of the mother is also changing, with more gender balance in the home and the workplace.
We know that men have traditionally been less open about their mental health issues, and slower to seek help than women can be. There’s also the misconception that postnatal depression is caused by hormonal changes in women, though recent research has shown that there are many factors at play, from the social to the psychological. Both men and women can share the same risks of PND, including relationship worries, financial concerns, a difficult pregnancy or birth, a newborn that is sick or not sleeping, or simply stress from the life-changing event that is having a baby.
One of the biggest risks occurs when their partner is suffering from postnatal depression themselves. “If a man’s partner is suffering from depression, there’s a huge risk to him, and vice versa. The reality is the greatest support to any man or woman at this time is their own partner,” Lloyd says. “That’s why there are still a lot of issues with men not speaking up – they don’t want to worry their partner, they feel that their partner is more important and they need to be strong.”
Signs of postnatal depression in women can include feelings of sadness, anxiety, and loneliness, as well as difficulty bonding with their newborn. While men can share similar symptoms, they tend to manifest differently – men are more likely to express their stress, anxiety or depression through emotional rigidity, anger, working excessively, or abuse of alcohol.
It can be difficult for a partner to know what to look for, and given the fact that paternal postnatal depression is rarely acknowledged, they may not know what to look at all. New fathers aren’t screened for the condition like new mothers are, and it’s still not known exactly when they should be screened to best identify those at risk. But if you suspect that your partner might be suffering from PPND, getting them to visit their GP to talk about it would be the best option.
While Lloyd is ultimately working to raise awareness of the condition, he’s careful to state that feelings of stress during this time are absolutely normal. “While the perinatal period for many fathers can be a very exciting time of joy and newness and transition, it can also be very stressful. There can be financial concerns, as well as stress around work commitments and how their relationship with their partner may change after the birth,” he clarifies. “It all depends on how the person copes with it at that particular time.”
So how can we better support new fathers? The Paternity Leave and Benefit Act of 2016 was a good start, but in Lloyd’s opinion, it needs to go further.
If you look at Scandinavian countries that are way more progressive in terms of gender equality, the fathers get more paternity leave, which gives greater freedom to the mothers. This is a time when the father supports the mother, and a time of huge bonding between the father and the infant.
Since 2016, new fathers in Ireland have been entitled to two weeks of paternity leave, where before it was entirely at the discretion of the employer. However, employers are not obliged to pay men on paternity leave – you can apply for Paternity Benefit (€245 a week) from the Government, but understandably the idea of going two weeks without pay is not appealing to everyone.
“I don’t want to knock the fact that paternity leave has been introduced, but the uptake hasn’t been as good as we would want it to be, with people having mortgages and other children to take care of,” explains Lloyd. “The evidence suggests that paternity leave is something that will improve the whole family health at that particular time, but for me it needs to be taken a step further.”
For now, we can work to raise awareness of the condition, both among the general public and healthcare professionals. We can encourage new fathers to talk about how they’re feeling, as we have tried to encourage men to be more open about their mental health in general. In the UK, Mark Williams’ Fathers Reaching Out now provides support groups and counsellors for men struggling after the birth of their children. Lloyd thinks something similar could work well here in Ireland.
“A lot of the time, fathers go in with their eyes closed, and the whole time period can be a huge shock to the system. We need to increase awareness of postnatal depression in men, decrease stigma in speaking out, and put supports in place, such as paternity leave and support groups for new fathers.
We’re starting to see maternity hospitals set up specific teams for maternal mental health, which is fantastic, but they don’t mention the potential for fathers to have issues during this time. While things are progressing, they’re progressing slowly, but there is an awareness now of paternal postnatal depression that there wasn’t 10 or 15 years ago.”