Boy’s blues? What to do about male postnatal depression

Postnatal depression (PND) in women remains an issue not discussed nearly widely enough. Even less discussed is PND in men. Many people don’t even know or think that it exists. However, a study by the Medical Research Council (MRC) in 2010 highlighted how common male PND can be. It claimed that 1 in 5 fathers will have experienced depression by the time their child is 12 years old. 

The research

The MRC’s study (Incidence of maternal and paternal depression in primary care, September 2010) was conducted between 1993 and 2007 and involved almost 87,000 families. It looked at both men and women, identifying those suffering with depression and following them through the first 12 years of their child’s life. The study found that parents are more likely to experience depression in the first year after the baby arrives: no real surprise there given the huge upheaval a new arrival brings. What is most interesting about the research is that it points to PND being more common in men than previously thought, suggesting that there can be more to the ‘boys’ blues’ than simply a temporary difficulty in adapting to a life changing experience.

The findings show that PND is most common amongst mothers, with 14% experiencing depression in the first year.  More unexpected is the 4% of men found to be experiencing depression in the same period. Going beyond that first year, the study found that 25% of mothers and 10% of fathers suffer depression by the time their child is 4 years’ old.  

Postnatal depression – why men?

Why men? Why not? It is widely assumed that PND is connected to hormones and the process of pregnancy and giving birth and therefore affects only women. This is a myth as there are many other contributing factors beyond the influence of hormones. The majority of these factors are common to the experience of mothers and fathers: sleep deprivation, the change in your relationship with your partner, the general stress of looking after a new baby. (Interestingly, if PND is connected to hormones alone then this doesn’t necessarily discount men. Some studies identify the drop in men’s testosterone levels after a baby is born as a trigger for depression. )

For a father, a contributing factor can be the pressure placed upon him to be the ‘hunter gatherer’, providing for his family whilst his partner is at home.  In the same way as a woman returning to work, a man is forced to juggle an endless list of competing priorities. This is made worse by factors such as sleep deprivation and, more often than not, the lack of time and space to adjust to their new life. Two weeks of statutory paternity leave is barely a chance to take a breath.

Studies have indicated that the following factors can influence a man’s chance of experiencing PND:

• Lack of good sleep.
• Changes in hormones.
• Personal history of depression.
• Relationship stress – with a partner, parents or in-laws.
• Excessive stress about becoming a parent or father.
• Non-standard family (such as being unmarried or a stepfather).
• A lack of support from others.
• Economic problems or limited resources.
• A sense of being excluded from the connection between the mother and baby.

The sense of exclusion from the mother/baby bond is a significant one, particularly if the father is working full-time. At no fault of either parent, fathers can feel like backseat drivers in the new family dynamic simply because they do not have the same opportunity as the mother to spend time with the baby. Failure at relatively simple tasks such as changing a nappy can leave men feeling not quite the ‘wonder dad’ they hoped they’d be.

Symptoms of PND in men

Symptoms in men can be different to those identified in women. The following are symptoms that researchers claim are specific to the male experience of depression:

• Increased anger and conflict with others.
• Increased use of alcohol or other drugs; misuse of prescription drugs.
• Frustration or irritability.
• Violent behaviour.
• Losing weight without trying.
• Isolation from family and friends.
• Impulsiveness and taking risks.
• Increases in complaints about physical problems.
• Ongoing physical symptoms, like headaches, digestion problems or pain.
• Problems with concentration and motivation.
• Loss of interest in work, hobbies and sex.
• Working constantly.
• Increased concerns about productivity and functioning at work.
• Fatigue.
• Experiencing conflict between how you think you should be as a man and how you actually are.
• Thoughts of suicide.

A father suffering from PND won’t necessarily experience all of these symptoms. One alone may be enough to identify that there is an underlying problem.

Clinical disorder or identity crisis?

“What a load of rubbish LOL. I agree there is more pressure on men to provide when they have a family so more stressful maybe but PND? You’re having a laugh.”

Quote from an online forum

Sceptics say that research such as that of the Medical Research Council serves to manufacture yet another social disease. They believe that by defining male PND as a condition, it is medicalising what is essentially an identity crisis. At a time of enormous change, not all men will cope with their situation, whether it is the loss of freedom or sense of responsibility that a baby brings. But is that a clinical disorder? Some say no: it is a normal reaction to life’s upheavals. PND in women is acknowledged as a clinical disorder and a serious one, no less serious than any other type of depression. So where is the difference? Both men and women are affected by hormones and difficult circumstances. Are men simply expected to ‘man up’ and ‘get over it’?

It is the latter expectation that may make it harder for depression to be identified in men and explain why the male postnatal experience is still coming to light. If it’s not a sweeping stereotype, men are less likely to admit how they feel, particularly (studies show) when it comes to feelings of guilt and sadness. They are also less likely to visit a doctor. Women who have suffered from PND say that it’s talking about it that helps them recognise the problem is there and take the first steps towards getting help. Men don’t necessarily give themselves this opportunity to acknowledge the problem and seek treatment.

Depression following the birth of a child is of course on a sliding scale from a general low mood (or ‘baby blues’) to PND to more severe (and thankfully rare) postnatal psychosis. Whether or not men can get PND in the same way as a woman can is not actually the issue here. What is important is the clear need for there to be greater awareness of how men can suffer emotionally and mentally and for that awareness to bring with it greater support.

Finding support

“Parents need to be told about the risks of depression for both mothers and fathers and they should also be told about the signs which they should be looking out for in their partner.”

Rob Williams, Chief Executive, Fatherhood Institute

If male PND is yet to be widely acknowledged as an issue then it is little wonder that support is still limited. Organisations such as the Fatherhood Institute (a fatherhood think-tank) are pressing for fathers to be screened for depression in the same way that women are by health visitors and GPs.  For example, the Institute has worked with Surrey Parenting Education and Support to create a tool to provide health professionals with interview questions to evaluate whether a father is suffering from PND. Initiatives such as this demonstrate a growing recognition of the need to put a framework in place for supporting men in the same way as women currently are.

Regardless of whether you are a man or a woman, there are practical steps you should take if you are experiencing any level of depression after the birth of your child:

• Don’t be afraid or embarrassed to tell someone how you are feeling, whether that be your partner, friends, a health visitor or GP.
• Don’t expect to be able manage everything in the way you did before. If help is offered, accept it.
• Get as much sleep as you can, even if a short nap is all you can grab.
• Eat well and often to maintain energy levels.
• If you suspect your partner is depressed, talk to them and encourage them to seek help from a GP if necessary.
• Take some time for yourself and your partner.
• Talk to other parents with babies – there’s nothing like support from someone who knows what you’re going through. Problems that feel unique to you are more often than not shared by others.

Familiar advice to the new parent but often not heeded when the demands of a new baby take precedence over all else.

Conclusion

Discussions of PND tend to focus on women and this is reflected in the support services currently available. Regardless of whether postnatal depression in men is a medical condition or a non-medical ‘identity crisis’ there is no argument  that the arrival of a child has a significant impact on men and women and neither should be overlooked. If ongoing discussion serves to improve support services and encourages men to seek help then it is a positive step – if not a leap – forward.