Perinatal depression is not a condition that affects an individual in isolation, but rather it has consequences for the whole family system. When one parent suffers with depression the likelihood of the other parent also becoming symptomatic is increased substantially.
In fact, we know that some 10 percent of fathers become depressed between the first trimester of their partner’s pregnancy and one year following the birth of their baby. Statistics demonstrate that the lowest point for fathers is between 3 and 6 months after the birth of their baby, when rates of depression can rise to as high as 26 per cent of new dads.
This close association between maternal and paternal depression prompts us to consider clinical attention to both. However, fathers are often not as accessible as mothers. In our health system the pregnant woman is considered most often to be ‘the patient’. It’s the woman who needs to visit the doctor or hospital throughout the pregnancy, who is admitted to hospital to deliver, who is discharged home and for whom the follow up appointments are booked. During these processes, for the most part, the father is invited to attend, but he is not the patient.
The features of depression can be grouped into 4 broad categories, feelings, physiological response, thinking, and behaviours.
FEELINGS
- Anger
- Low self worth
- Worthlessness
- Anxiety
- Hopelessness
- Loneliness
- Apathy
- Guilt
- Sadness
- Bitternes
PHYSICAL
- Abdominal pain
- Fatigue
- Insomnia
- Nausea
- Impotence
- Headache
- Constipation
- Sexual disinterest
- Dizziness
- Sleep disturbanc
THINKING
- Ambivalence
- Pessimistic
- Self destructive thoughts
- Effects concentration
- Blaming
- Uncertainty
- Indecisiveness
- Self blam
BEHAVIOUR
- Aggressive
- Intolerant
- Drug and alcohol use
- Irritable
- Lack of spontaneity
- Inability to complete work
- Agitated
- Tearfulness
- Restricted activity
- Withdrawn
- Excessive work
Assessing for Depression
In the past 2 weeks:
- Have you had a depressed or low mood most of the day, nearly everyday?
- Have you experienced reduced interest or pleasure in activities for most days?
- Have there been any significant changes in appetite including weight loss or weight gain?
- Have you experienced insomnia or excessive sleeping nearly every day?
- Have you experienced fatigue or loss of energy for most days?
- Have you felt agitated or more irritable nearly every day?
- Have you experienced strong feelings of worthlessness, hopelessness, or guilt?
- Have you found it more difficult to think, concentrate, or make decisions on most days?
- Have you experienced significant distress in attending to usually occupational or social tasks on most days?
If you answered yes to more than 4 of the 9 questions above, it is recommended that you discuss these with your general practitioner.
LOOKING AFTER DAD
In the first weeks and months after the birth of a new baby, life can be very different for both the mother and father. For some fathers they will take time from work while for others this may not be possible. Some men will be the primary care giver during this time especially if the mother is unwell after the birth.
It is recognised that some important ways for men to protect themselves from depression is talk about how they are coping, to take time to nurture themselves, and to become actively involved in caring for their new baby.
Some Suggestions
- Have you thought of taking paternity leave?
- Take some time out for yourself - do something that you enjoy. Find time to relax.
- Allow your partner to relax.
- Become actively involved in your baby's care. Discuss with your partner what you feel you need and clarify what role you would like to take.
- Talk to your partner about how you are feeling.
- Value your own health and wellbeing and your role as a father.
- Find someone you feel comfortable talking with to share your feelings and concerns.
- Find out resources for families in your area, including meeting and talking with other fathers.
- Be patient, accept that your partner's feelings are genuine, and try not to take any criticisms or negative feelings personally.
- Encourage your partner to talk about her feelings, asking how you can help, and encourage her to seek professional advice if the depression or anxiety continues.
- Nurture your relationship with your baby, whist at the same time providing your partner with a much needed break.
- Plan time together as a couple - your relationship is the most important one for your baby.
- Seek help if you are feeling distressed, depressed, or having difficulty coping.
Men's stressful home experiences are more likely than a woman's to spill over into their work, and affect it negatively.
The big stress for men are:
- `role overload' (feeling that their responsibilities in one area are making them less effective in another),
- arguments with their partners and arguments with their children.
One of the reasons parental leave may be `good for business' is that it may make men more adept at coping with home-stresses and at preventing `stress contagion'.
Paternal perinatal depression can be difficult to assess. New fathers may seem more angry and anxious than sad- and yet depression may be present. Adjusting to a pregnancy or newborn impacts new fathers as well as new mothers, and the emotional health of the father should also be considered and treated during this important time, for the wellbeing of the whole family.
The truth is depression, anxiety and mood disorders in men often go unrecognised and are therefore left untreated. They are just as common and just as real as physical problems such as diabetes and heart disease -they can also be just as crippling. Early identification and treatment of mental health disorders in fathers is paramount to avoid long-term consequences for not only the man, but his partner and children.
