For a significant number of fathers, the birth of a baby is followed by a plunge into depression, according to new research that challenges the medical dogma that the "baby blues" are solely the domain of women.
An analysis of 43 studies, including Canadian research, that together involved 28,000 men, found that 10 per cent of expectant or new fathers experience depression – and as many as one in four new dads experiences depression during the three- to six-month period after their baby is born.
It’s long been believed that depression in new mothers is due to hormonal changes, says study co-author James Paulson, a clinical psychologist and associate professor of pediatrics at Eastern Virginia Medical School, in Norfolk, Va.
"If you put 100 per cent of your chips on that bet, then really, there’s nothing left that you would expect with dads. If moms are getting depressed because of hormone changes, why would dads get depressed? They don’t go through the same hormone changes – they don’t have to be pregnant, they don’t have to deliver the baby. That bias has had a lot do with what people think," Paulson says.
"The fact of the matter is that the evidence of hormone theories and pre- and post-natal depression is pretty inconsistent, and it’s not as strong as the evidence on psychosocial factors – things like changes in the relationship, financial stress, social support and social stress, which are reasonable things to expect to affect fathers."
Until now, research into postpartum depression in men has been scattered and inconsistent. For their analysis, the Virginia researchers pulled every article they could find that reasonably documented the phenomenon. They included studies that looked at depression in dads between the first trimester of pregnancy, through to the first year after the baby was delivered.
Across all time points, the overall rate of depression was 10.4 per cent – twice the rate of depression among men in the general population. "This isn’t something that’s just a fluke. This is a significant problem," Paulson says.
In terms of timing, fathers experienced the highest rates of depression – 25.6 per cent – when their babies were three to six months old, according to the study, published this week in the Journal of the American Medical Association.
That needs to be interpreted cautiously, because it’s based on only three studies. But sleep deprivation is one of the major causes of postpartum depression, in both women and men, and sleep deprivation is cumulative.
By the time babies are three months old, "the bloke’s gone back to work, he’s probably disrupted, he’s probably not getting a lot of sleep, he’s probably got competing priorities, things are shifting," says John Oliffe, an associate professor in the school of nursing at the University of British Columbia.
"Just disrupting that – for want of a better term – ‘type A’ fellow, it can be enough to push someone into a different space, and get them feeling down."
Oliffe suspects the true rate in men is likely higher than 10 per cent. "There are a lot of guys who don’t get diagnosed with depression, who don’t necessarily participate in studies, or necessarily arrive at clinical practice to suggest that they might be feeling blue," he says.
It’s been estimated that 10 to 30 per cent of mothers experience postpartum depression.
Other studies have found that men’s hormones also change, both late in a partner’s pregnancy and during the first three months after the child’s birth. Those hormonal changes include decreases in testosterone and increases in levels of estrogen, says Will Courtenay, a California psychotherapist and founder of a website and online forum for men experiencing postpartum depression. "All of those hormonal changes, along with the neurochemical changes that occur in the brain with sleep deprivation, probably come together and create this perfect storm that peaks around that three- to six-month (postpartum) period."
Oliffe believes paternal depression is more a social construct, that "it’s more about circumstances."
Either way, Paulson says evidence is mounting that depression in fathers can have profound effects on children. Dads who are depressed engage less with their child, he said. They don’t bond as well. They read to their child less often. Studies have found a decrease in child language development by age two; by age 3 1/2, children start experiencing emotional and behavioural problems, and, by age seven, the child is more likely to have a psychiatric disorder.
"Anybody who is doing health education or childbirth preparation classes should include fathers when they talk about postpartum depression," Paulson says.
The team also found that when dad is more depressed, mom is also more depressed, and vice versa. "If one partner experiences depression, it may very well be affecting both parents," Paulson said.
Research suggests men can experience depression differently than women: they’re more likely to become irritable and angry, sometimes violent, and also isolate or withdraw from others, Courtenay says. "They can start working 60 hours a week, or isolate themselves in their garage doing some special project. Or they can drink more – we often times see an increase in both alcohol and drug use, and also an increase in compulsiveness. That can include an extramarital affair, or increased gambling.
"Those are not things we typically think of when we think of depression."
skirkey@canwest.com
Comments