Thesis On The Struggle For Recognition: Paternal Postpartum Depression In The United States

There is a growing body of research that supports the idea that men are susceptible to depression during the first year after the birth of a new child, just like new mothers. Experts have coined the phrase “Paternal Postpartum Depression” for this phenomenon, and are working to spread awareness of the condition, and to get new fathers the help they need to reengage with their family in a healthy way. Unfortunately, this field of psychiatric care is both under researched and under diagnosed in the United States, where it is understood that Postpartum Depression is caused by changes in the body that occur during pregnancy, or hormone issues, only suffered by women who have gone through gravidity, labor and delivery. It is essential that America raise awareness of Paternal Postpartum Depression, and treat the condition effectively in order to prevent the long term economic and social costs of allowing the condition to continue unchecked.
Maternal depression has long been considered a serious matter of concern for the medical community. It is known to cause serious issues for new families including increased levels of “parental disharmony,” a family with a lower level of functionality, and a long-term depressive impact on the child’s disposition (Ramchandani, P. et al. 2011). Paul Ramchandani (et al) determined that women have only a slightly higher rate of depression after the birth of a child than men, “emphasizing the importance of considering the potential for men, as well as women, to experience depression in the postnatal period. (2011).
Perhaps one of the most important things to determine, both when trying to create a defining diagnostic criteria for the condition, and for creating a treatment plan, is what serves as the root causes of Paternal Postpartum Depression. It has been conclusively discovered that the post-partum period creates a hormone influx in new fathers, just as it does not mothers. Including increased, or shifting, levels of testosterone, estrogen, cortisol, vasopressin, and prolactin (Swain, J., & Kim P., 2007). The same study determined that environmental stressors could impact a father’s response to their new role as a parent, including work related stressors, changes in lifestyle as a result of the birth, excessive stress over parenting or their role as a parent, a lack of social support, and feeling excluded from the mother-infant relationship (Swain, J., & Kim P., 2007). Multiple studies have determined that fathers are more likely to develop paternal postpartum depression if their wife is suffering from maternal postpartum depression, more specifically, Paulson and Basemore determined that the correlation was moderate in size, with a statistical rate of roughly 30% (2010).
According to Swain and Kim’s model for postpartum depression in men, symptoms of paternal postpartum depression are known to include a low level of interaction with the family unit, low mood, increased irritability, and feelings of helplessness or despair. It is also directly tied to the emersion of several comorbidities including anxiety disorders, and obsessive compulsive disorder (2007). Similarly, authors Pamela S. Wiegartz, Ph.D, and Kevin L. Gyoerkoe, PsyD., offer that postpartum depression can strike a father at any time, during the same period that women are most effected, resulting depressed mood; loss of interest in activities; fatigue; changes in sleep; changes in appetite or weight; difficulty concentrating or making decisions; feelings of guilt or worthlessness; and thoughts of death or suicide (2009). Paulson, however, disagrees slightly with these findings, noting that men are most likely to suffer from irritability, detachment and emotional withdraw (2010). Generally, however all these researchers seem to agree that the greater the body of symptoms, or the higher the symptoms severity and the longer it goes unchecked, the more extensive the impact on the family unit.
This is where the subject becomes significant from a micro perspective. It is essential that we understand the ways in which paternal postpartum depression are directly effecting the family unit, and even the individual child. While Swain and Paul have noted a significant number of impacts in their model of paternal postpartum depression, including an increase in child emotional and behavioral difficulties at a later age, a lack of paternal attachment, or a negative effect on bonding between the father and child, and increased conflict or tension in the marital relationship; several other researchers have also contributed to the body of research that shows the effect of paternal stress and depression on child and family development, and their findings offer specific statistical significances (2007).
Ramchandani’s study found that children whose fathers suffered from postnatal depression during the postnatal period were statistically more likely to have “adverse emotional and behavioral outcomes” by age 3.5. His study determined this was equally true when controlling for maternal depression (2005). A second study by Ramchandani determined that when studied longitudinally, children whose paternal parent had suffered depression during the prenatal stage, and during the first month of life “had the highest risk of subsequent psychopathology,” especially if the children were boys (2008).
These outcomes may be directly related to the father’s increased inability to parent effectively while suffering from depression, and correlate with the period of time that the depression goes untreated. More specifically, in a study by Neal Davis, (et al), those fathers suffering from postpartum depression were nearly 30% more likely to spank their child, under 12-months of age, than fathers who were not suffering from depression (2010). They were also significantly less likely to read to their children, with 38% reporting that they took time to read to their young child less than three times per week while suffering from depression, leading to decreased bonding, social interaction, and verbalization (Davis, N. et al, 2010).
There is at current a high level of social injustice for men who are suffering from postpartum depression. Most analysts agree that the number of self-reported, diagnosed and treated cases of paternal postpartum depression are likely significantly lower than the number of actual cases in the United States, because men are less likely than women to report the condition (Hibbert, 2015). This, to a large extent, because of the social stigma and misunderstanding that currently surrounds these men’s very real struggle. In terms of social justice, we have a responsibility to increase the diligence with which we study, and the compassion and understanding with which we treat this very real condition, in order to minimize its negative effects on both the family unit, and the individual.
Noting that it can be especially difficult for men, Dr. Christina Hibbert, a known expert in treating paternal postnatal depression, works to remind dads of the  Postpartum Support International Motto: “You’re not alone, dads. You’re not to blame. And you will be well (2015).” Noting that it is not only mothers who need to get well, but fathers too. She suggests seven steps to over-coming the condition: recognizing the problem, seeking support, working to get a full night’s sleep, taking breaks for time to yourself, seeking active involvement with the baby, reigniting the couple relationship in the marriage after the baby, and seeking professional treatment (2015). Similarly, in the model of paternal postpartum depression, Swain and Kim recommend a combination of prevention and intervention, including seeking professional treatment, working to gain your partners support, increased parenting education and interaction, and extended paid paternal leave.
In the United States, the reality is that neither mothers nor fathers are guaranteed paid leave when having a baby, which can make it difficult for the family to settle into a new routine, bond as a unit, or maintain basic day to day needs. Technically, federal and state legislation, known as FMLA, or the Family Medical Leave Act, guarantee both parents a total of 12 weeks of after a life changing event, like a birth. Unfortunately, while the employer is required to maintain the employee’s position during this time they are not required to pay their wages during that time (Guerin, L, & England, D., 2014). Further, while it is expected that a mother will take between 6 and 12 weeks off to spend exclusively with the baby, and recovering from labor and delivery, the average husband takes no more than a few days. In fact one study, published in the Washington Post, found that only 60% of dads take any time off, and only a staggering 14% take the full 12 weeks they are allowed (McGregor, J., 2014). The reality most are hesitant to be away from work for more than a few days (Linn, A. 2015). This is another area of major social injustice for those who expressly need the time off to avoid paternal postpartum depression.
A survey published by The New York Times found that there are a variety of reasons that a father greatly benefits from taking a more extended paternity leave, many of which are directly related to the studied causes of postpartum depression. Fathers who took the paternity leave were more likely to form a lasting bond with their babies, increased marital satisfaction during the postpartum period for both partners, better parenting practices and more (Miller, C.2014).
There is little doubt that there is a growing cry for men’s rolls as fathers, especially in the 12 month period immediately postpartum, to change. Not only does increased parental involvement and increased paternity leave decrease the risk of maternal postpartum depression, but it also decreases the risk of paternal postpartum depression. But, acknowledging the clear social injustice of the current system, the problems that the issue causes for the family and the risks it poses to society at large, first means recognizing paternal postpartum depression as a clinical condition, and working to understand its intricacies. Children who are parented by fathers suffering from postpartum depression are significantly more likely to demonstrate psychopathology than children whose parents do not suffer from paternal postpartum depression. Marriages where one or both parents are suffering from postpartum depression are more likely to culminate in physical violence or divorce, because of the increased tension, and those personally suffering from depression are more likely to commit suicide, or engage in other self destructive behaviors. It is essential that the medical community recognize that no less than 1 in 10 American fathers are suffering from clinical symptoms of depression directly related to the birth of their child, and that there is a need to treat these men for their depression to offset the damage it can do to their personal psyche, their marital relationships, and their children.

References:

Davis, R., Davis, M., Freed, G., & Clark, S. (2010). Fathers' Depression Related to Positive and Negative Parenting Behaviors With 1-Year-Old Children. Pediatrics, 612-618.
Guerin, L., & England, D. (2014, January 1). Providing Pregnancy and Parental Leave | Nolo.com. Retrieved February 17, 2015, from http://www.nolo.com/legal-encyclopedia/providing-pregnancy-parental-leave-29795.html
Hibbert, H. (2015, January 1). Postpartum Depression & Men: The Facts on Paternal Postnatal Depression. Retrieved February 17, 2015, from http://www.drchristinahibbert.com/postpartum-depression-men-the-facts-on-paternal-postnatal-depression/#_ftn4
McGregor, J. (2014, June 9). When dads take paternity leave. The Washington Post.
Miller, C. (2014, November 7). Paternity Leave: The Rewards and the Remaining Stigma. The New York Times.
Paulson, J., & Bazemore, S. (n.d.). Prenatal And Postpartum Depression In Fathers And Its Association With Maternal Depression: A Meta-analysis. JAMA: The Journal of the American Medical Association, 1961-1969.
Ramchandani, P., O’Connor, T., Evans, J., Heron, J., Murray, L., & Stein, A. (2008). The effects of pre- and postnatal depression in fathers: A natural experiment comparing the effects of exposure to depression on offspring.Journal of Child Psychology and Psychiatry,1069-1078.
Ramchandani, P., Psychogiou, L., Vlachos, H., Iles, J., Sethna, V., Netsi, E., & Lodder, A. (2011). Paternal depression: An examination of its links with father, child and family functioning in the postnatal period. Depression and Anxiety, 471-477.
Swain, J., & Kim, P. (2007). Sad Dads: Paternal postpartum depression. Psychiatry,4(2), 35-47.
Wiegartz, P., & Gyoerkoe, K. (2009). The pregnancy & postpartum anxiety workbook practical skills to help you overcome anxiety, worry, panic attacks, obsessions, and compulsions. Oakland, CA: New Harbinger Publications.