March 20, 2015

Recent research shows that a new baby can have an effect on the psychological health of fathers

First Published; Independent.ie, 20-March-2015

Eileen was struggling with severe mood swings, and was prone to outbursts of anger and frustration – which were directed at Brian. "Everything seemed to be taken out on me. She was ordering me to do this and do that. There seemed to be nothing I could do to make her happy."

And then, baby Donal got croup. "There was no sleep. None of us were getting any sleep."

But Eileen wasn't the only one who was struggling mentally. Looking after the baby and the household chores, getting by on very little sleep, and having to watch his wife suffer in a way he couldn't help with, took its toll on Brian."It was because I wanted to fix things, and I couldn't fix them," he says. "And I couldn't understand why I couldn't fix them. I wanted to have a happy family. But Eileen wasn't right – and I couldn't fix it.

"I felt a bit lost. I felt a bit… I suppose 'sad' is the word."

Brian was also struggling with some very difficult feelings about his son. "I just thought that when your child comes along, you bond straight away. But that didn't happen. I was blaming the baby for what Eileen was going through. How crazy is that, blaming this little person, with two hands and two feet, for the trouble I was seeing my wife go through?"

Fortunately, Eileen's postnatal depression was picked up quite quickly. But Brian didn't know there was a name for what he was feeling.

In the first study of its kind in Ireland, 100 men, who had recently become fathers, were asked to complete a questionnaire to assess them for the symptoms normally associated with postnatal depression in women. The questionnaire, devised by public health nurse Lloyd Philpott and Dr Paul Corcoran, both of University College Cork, was designed to determine the prevalence of paternal postnatal depression (PPND), a form of postpartum depression, unique to men.

Though the men in the study were chosen at random, and none of them had been diagnosed with the condition prior to the study, 12pc of the men scored high enough on the scale to be diagnosed with PPND. The study aimed to establish the prevalence of the condition and the factors that contribute to its development. However, Philpot and Corcoran hoped it would also raise awareness of the existence of PPND. Because, although virtually unheard of until quite recently, it is a condition that can have some very serious consequences – for both father and child.

Starting in 1994, and for the next two decades, the Longitudinal Study of Adolescent Health monitored the physical and mental health of 20,745 young Americans as they progressed from adolescence to adulthood. The study involved assessing the participants for the symptoms of depression at various points over 20 years. As 3,425 of the men became fathers during this time, it gave Dr Garfield and his colleagues at Northwester University an opportunity to study the mental health of an individual before and after becoming a father.

They found that 10pc of the men had developed depression when they became fathers, and the depression continued beyond the first 12 months of fatherhood. In fact, during the first five years of fatherhood, the dads' symptoms, as measured on a depressive symptoms scale, continued to increase by an average of 68pc.

This was a significant finding. The first five years of a child's life are extremely important. It's a time when the child should be bonding with its parents – both parents.

Research has found that fathers play a major role in the healthy development of a child. But other research has found that depressed fathers can be detrimental to that development. They have poorer parenting skills and are less likely to engage with their child. A depressed father can also affect the relationship between mother and baby – especially if the mother also has postnatal depression.

Forming a bond with its parents is fundamental to a child's long-term prospects. Psychologists call this bond "secure attachment". It develops from birth and is built on the quality of the interactions between the parent and baby, such as holding the baby lovingly and responding to its needs. These interactions support the baby's social and emotional development and help cognitive development.

Without this bond, children are more likely to begin their school lives with poor language skills and behavioural problems, and can be at increased risk of developing psychiatric disorders in later life. Disturbingly, a US longitudinal study of 14,000 children found that 40pc did not have a secure attachment with their parents.

"When helpless infants learn early that their cries will be responded to, they also learn that their needs will be met, and they are likely to form a secure attachment to their parents," said Susan Campbell, one of the psychologists behind the US study. "However, when the caregivers are overwhelmed because of their own difficulties, infants are more likely to learn that the world is not a safe place – leading them to become needy, frustrated, withdrawn or disorganised."

Read more:  Early detection and treatment make for better outcomes with PPND. But there are several reasons why this may be difficult with the condition: men are still reluctant to talk about difficult emotions, and depressed dads may not know they have depression, like Brian.

He says: "It didn't occur to me to seek help. I thought it was the norm. I'd never read an article or seen anything on television in relation to fathers suffering from postnatal depression."

Some researchers suggest that men's symptoms of depression may vary from the "classic" symptoms of depression, making recognition of the condition much more difficult. Men's depressive symptoms may include violence, obsessing about performance at work, and impulsive and reckless behaviour – including extramarital sex. "Everybody reacts differently," says Lloyd Philpott. "Some depressed men will go into themselves; other depressed men will come out of themselves. Some men's depression will manifest itself through anger, alcohol abuse, escapist behaviour, and excess work. And other men may fail to express emotions."

The good news is that there are tools available to screen men for PPND: the Edinburgh Postnatal Depression Scale, developed to screen women for postnatal depression, has been found to be equally effective at detecting the condition in men. However, what's not known is when these tools should be used to have the best chance of identifying those at risk.

Lloyd Philpott explains: "With women, there's a time to screen; and with men, there's a time to screen. But we're not sure when to screen men, because we don't have longitudinal studies to look at to see when men are at more risk… What needs to be done is to look at fathers over a long period of time, and see what the outcomes are for them, their partners and their children."

The treatment of PPND is
also still in its infancy. While there is any number of therapy and medication options available for depression, there are few designed specifically for depressed fathers.

However, there's some evidence that helping fathers with PPND may require some lateral thinking.

"I think men talk best when they're side-by-side, rather than face-to-face," says Mark Williams, who founded Fathers Reaching Out, a Cardiff-based charity for fathers with PPND. "I've started a number of projects that involved doing things together, not just sitting in a room talking about feelings."

Mark was brought to the brink of suicide by his own experience of PPND. But he kept it hidden. "I kept smiling. I was keeping up appearances," he says. But a chance encounter with someone who'd had the same experience gave Mark the opportunity to say out loud how he was feeling, and he began to feel better. Fathers Reaching Out was formed soon after this experience.

Fathers Reaching Out set up support groups, provided counsellors, and had professionals talk to the fathers about cognitive behavioural therapy (CBT) and mindfulness. But Mark found that, by taking a slightly different approach, they got men talking.

"A lot of guys don't want to go to a venue associated with mental health. So, I did a pilot at Cardiff City Football Club. I'd do a talk and then we'd take a walk around the ground. What I found was, people would come up to me and talk about their depression. Then we'd have a game of football afterwards. As we were walking and playing, we were opening up. We'd also meet for coffee, then go for walks. And we'd open up more when we were walking side-by-side."

Unfortunately, Brian didn't get any treatment. He managed his symptoms by walking and getting sleep when his father-in-law came to hold the fort. It was improvements in Eileen's condition that prompted his own recovery. "There was a huge improvement in her. And she had stopped breastfeeding; so I was able to feed Donal, and I started to bond with him. It took about six months, but he's the jewel of my eye."

The UCC study offered a glimpse into a condition that may affect 12pc of new dads. Because of the potential long-term effects of PPND, and because we don't know as much as we should, it can all seem very grim. But there are ways to beat it.

"The outcomes for mother and baby are much better when you have a father who's happy and well," says Philpott. "By looking after the father, you're looking after the mother and the baby too. As a community, that's what we need to get our head around."

"I fully appreciate that the focus is on the mother and child, and that child birth can be traumatic," says Brian. "But sometimes, daddy needs looked after too."

*Names have been changed

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