Approximately 1 in 10 fathers suffers from postpartum depression, according to several studies on the topic.
While mothers are warned about the possibility of postpartum depression and sometimes screened for it, fathers and non-birthing parents usually aren't. That makes the diagnosis hard to come by and the experience harder to navigate.
“There is a real sense of isolation for men and non-birthing partners,” said Erin O’Connor, director of NYU’s Early Childhood Education Program. “This isn't something that's widely discussed.”
O’Connor is currently analyzing data and interviews with 1,000 parents to better understand their experiences throughout pregnancy and into their first year with a new baby.
She spoke to WNYC’s Alison Stewart on a recent episode of “All of It” about paternal depression. An edited transcript of their conversation is below.
Alison Stewart: What inspired you to study postpartum depression in fathers?
Dr. Erin O'Connor: The real impetus for me was looking originally at non-birthing parents. I am a mother through adoption, as well as through biology, and I myself suffered from what we now call PMADs – perinatal mood and anxiety disorder – with both of my daughters.
It started me thinking about how we don't give enough credence to anybody, but especially those who don't give birth. That made me delve into the literature around non-birthing parents and fathers, and recognize how little there is out there about this. And yet, at the same time, we do know that it does impact fathers and non-birthing parents biologically, psychologically – as it does those who birth the children.
Many people would say they didn't even know that a father could get postpartum depression or perinatal depression. Why is that?
O'Connor: Several reasons. One is there's actually a biological reason. There are changes in the neurobiology of the brain that occur in fathers as well as mothers. There are changes in hormonal levels that occur in fathers as well as mothers, as well as this massive shift in identity that is occurring for both moms and dads.
I want to make it absolutely clear you use the term perinatal instead of postpartum. What's the difference?
O'Connor: “Perinatal” encompasses the period of pregnancy through the first year, as opposed to “postpartum,” which is referring to that year after the baby arrives. That said, there is even a push to consider the perinatal period to maybe being more than just that pregnancy and that first year, but into the second year.
We're seeing more and more people diagnosed with PMADs in the second year following a child's arrival. For now, it's considered pregnancy in that first year of life.
There's a lot of focus placed on moms post-birth for obvious reasons, but you state that 18% of fathers develop some sort of anxiety disorder. What might that look like?
O'Connor: That can look like fear, I think a great example. In our research study, our participants have agreed to let their stories be heard. This one woman was telling a story about how when she would have to travel for work, her husband was terrified to take a shower. He was terrified to put the baby in the pack and play, and go and do anything, because he was convinced that if he was not with the baby, something bad would happen to her. Things like that, things like another story was a woman was saying, you know, they had the bassinet next to their bed. Her husband kept waking up screaming at night, that he felt like he had rolled over the baby and killed the baby, even though the baby wasn't even in the bed with them. I don't want to call them irrational, but these extreme feelings of anxiety around keeping the child safe and really alive.
How does isolation affect fathers?
O'Connor: Well, I think there's such an isolation for both parents. To an extent, in that you don't have the same freedoms that you had before. You can't just leave the house. You have to always consider all these different factors. You often feel isolated from this life that you had before, but then if we look, there are support groups. I think we need to do a lot better, but there are support groups out there for mothers. If you google, there's a fair amount that comes up. It does not come up with fathers.
There was actually a piece — I'm a huge fan of Emily Oster. In her newsletter, a father wrote in, Kevin McGuire, and he was talking about how he is in England, and he did a search in the National Health Service Directory for information on paternal postpartum depression. Literally what came up was, oh, you mean maternal postpartum depression.
I think there is a real sense of isolation for men and non-birthing partners in general because there aren't those groups out there really en masse, and there's not that awareness out there. It feels like, oh, my gosh, there must be something wrong with me, and I don't know where to go to find help because this isn't something that's widely discussed.
Your article in Psychology Today mentioned two factors that play a role: attachment theory and cognitive behavior. First, how does attachment theory factor in?
O'Connor: In general, when we talk about parenting and we talk about attachment theory, we think about what we call “internal working models,” these ideas of what parenthood looks like based on sort of how we were parented.
If we have what we call a secure attachment to our primary caregiver in childhood, we're more likely to have that type of attachment with our own children.
I think what's interesting, too, especially when we're thinking about fathers – and I'm not sure this really came out in the piece as much – but a lot of the emphasis has always been placed on sort of this mother-child attachment relationship, and so much research has been conducted on it. There are so many books about it and how to foster it.
We, I think, as a community, have somewhat neglected that father-child attachment relationship, and looking at also role models and how to do this, how to be a father and how to be a very engaged father with a secure relationship with their child.
I think that's something that also, we're just starting to really look at, especially the developmental psychology literature. The role that that father plays and being able to provide more information about that and what it looks like to be a dad who forms a secure relationship with his child.
Where does the cognitive behavior factor in?
O'Connor: A lot of that, I think, is almost a fancy term for your own thoughts and how they get in the way. We've had a lot of messaging that dads’ roles are second in a way, I think. As a society, that's been a lot of what's gone on – like mom does best, mom knows best, mom knows what to do.
You get those messages playing in your head, and if you're not the mom – especially the biological mom – it can play tricks on you. Like, “Oh, wait. Maybe I don't know how to do this?” And of course you do, but that's not necessarily the messaging that's been out there. Some of the cognitive behavioral therapy is thinking about how you change that message for yourself.
For someone experiencing PMADs or postpartum depression, how would that affect the relationship with the child?
O'Connor: That's a good question. Sort of going back to attachment theory, we always say, you know, the two most important factors that within the parent-child relationship in those first three to six months is how sensitive and responsive you're able to be. Sort of figuring out the baby's cues, the hungry cry, the tired cry, those sorts of things, and being able to attend to them in that manner.
As we know, if we're experiencing our own mental health concerns, it's harder to gauge someone else's needs and signals that they're giving off. When you have a newborn baby where it's very hard to know what they need, and then when you yourself are unable to sort of attuned to your own emotions, it's very difficult to be able to be. I'm not saying you can't, but it's much more difficult to be that sensitive and responsive parent that we know is so important for the parent-child attachment relationship.
We have two differing texts. We got one that says, “Thank you for this gender equity discussion,” and then this on Twitter: “It's truly an insult for those of us who go through an almost incomparable embodied experience. We can support fathers and non-birthing parents, and raise awareness without trying to make a competitive battle around postpartum depression.” I'm curious what you think of the two responses.
O'Connor: I think that's a valid point. The idea is that we're all in this together – not that it's one versus the other, right? Acknowledging that perinatal mood and anxiety disorder is more prevalent among birthing mothers. It's an incredibly traumatic experience, but we're also seeing that it is also evident among fathers and non-birthing parent. I think working together to raise awareness across the board is where we're going to move forward and make sure that parental mental health gets the supports that it needs.
What do you wish more people knew about this issue?
O'Connor: I think, (a) that they knew how prevalent it was, and (b) that they also knew more about the symptoms. We talk a lot about postpartum depression, which, of course, is very important to talk about, but there's also postpartum anxiety, there's OCD, there's suicidal ideation. There are a lot of other mental health concerns that go along with PMADs, and I think being aware of those so that people are willing to or able to hopefully find the supports that they need. I think something that's come up a lot in the interviews that we've done is a lot of the women have reported high levels of anxiety, but not necessarily feeling depressed, but just very, very anxious, and not really recognizing that it was PMADs. It was just anxiety. It wasn't depression manifesting itself.
If someone is listening to this, and they're thinking, “This might be me,” what should they do? Where should they go?
O'Connor: In an ideal world, your obstetrician should be able to provide resources for you, as well as pediatricians. Pediatricians can be great sources of support for parents, as well as their children. There is a lot of great information online at the Postpartum Support International.
