FATHERS and Postnatal Depression

Dr Ian HarrisonPerinatal and Infant Psychiatrist, KaritaneOctober 2010

Fathers: A neglected group in postnatal research.

Why? Traditional tendency in research to

focus on mothers. Most children in single parent

households live with their mother. Mother’s are frequently responsible for

caregiving in first few years of life. More accessible to researchers.

The Perinatal Period

Stressful – physiologically, psychologically, socially.

Some clients are already vulnerable. Psychological conditions/illnesses:

can be exacerbated may have an increased risk of onset some may even be unique to this period (PND)?

Trends maternal/paternal age means greater

chance of prior treatment of a psychological illness.

treatment of depression generally in women/men of childbearing years.

detection of depression via “screening” programs (antenatally and postnatally).

All babies arise out of a “relationship”

Good or bad Long or short Happy or abusive Baby may be the culmination of

everything good about a relationship. Or the embodiment of everything that

went wrong, the turning away, the dashing of hopes.

Studies of PND in men Very few studies conducted

Rates of PND in Men Typically the figure for PND in women is

13% The figures for men are:

10% at 6 weeks and 5% at 6 months post-natally.

Risk Factors for Men? Similar, rather than different, to women

(Deater-Deckard et al Am. J. Psych.1998) n=7018

1. Unemployment 2. Conflicted, unhappy marital relationship 3. Reduced social support and interaction from

family and friends 4. Family structure: Traditional 3%, stepfather

6.8%, stepmother 7.3%, single mother 5.1%. 5. Maternal postnatal depression

Risk Factors for Stepfathers(Deater- Deckard 1998) 1. Maternal postnatal depression 2. Less education 3. More stressful Life Events 4. Less social support 5. Smaller social networks 6. More aggression in their partnerships. (i.e. same as for women with PND)

Father’s and Mother’s PND is closely correlated Mother’s PND is the strongest predictor WHY?

Each partner’s psychological state influences the other? Living with a depressed person has a depressing effect?

Common causal factors outside the family may effect each partner similarly?

Men and women who are more vulnerable to depression are more likely to form relationships with each other?

Matthey, Barnett et al (2000) n=157 20 wks pregnant, and 6, 24 and 52 weeks postnatally Prenatally: Women 12.3% Men 5.3% 6 weeks: Women 7.7% Men 2.8% 24 weeks: Women 9.7% Men 3.2% 52 weeks Women 12.4% Men 4.7% 36% of high scoring mothers had high scoring

partners at 6 weeks 53% at 52 weeks.

First-Time Fathers Study Condon, Boyce, Corkindale (ANZJ Psych 2005)

n=312 Highest level of symptoms in pregnancy with

small improvement at 3 months. Lack of change across the postnatal period. Problems with sexual relationship and

increasing deterioration in the relationship, sleep, job satisfaction, recreation and weight gain.

Paternal Depression and Child Development. Ramchandani et al (Lancet 2005) N= 12,884 Assessed at 8 weeks postnatal and 21

months postnatal. Paternal depression was associated with

conduct problems in boys at 3.5 years. Women >12 EPDS… 10%, Men >12… 4%

“The Big Build” - Men and Depression Brownhill, Wilhelm et al(2005) Acting in

“Avoiding it” “Numbing it” “Escaping it”

Acting out “Escaping it” “Hating Me, Hurting You” “Stepping over the Line”

“The Big Build” - Men and depression

Avoiding it: (Avoidant Behaviour) Over involvement with work Sickness absence Out with the boys/sport, etc

Numbing it: (Self-Medication) Cannabis use Watching TV Self medication, etc

“The Big Build” - Men and depression

Escaping it: (Escape Behaviour) Alcohol Gambling Sexual affairs/encounters Binge drinking Dangerous drugs

“The Big Build” - Men and depression

Hating Me, Hurting You: (Aggression towards self and others) Negative effect on mental health of partners Domestic violence Antisocial Behaviour Anger and violence towards others e.g. Road

rage Hurt/pain Anger/rage

“The Big Build” - Men and depression

Stepping Over the Line: (Deliberate Self- harm) Suicidal ideation/attempt Deliberate Self-harm

“The Big Build” - Men and depression

Avoiding “it”

Numbing “it”

Escaping “it”

Hating Me, Hurting

You

Stepping over the

Line

Acting In

Acting Out

Overwork

Drugs/Alcohol

Risk Taking

Aggression, Violence, Crime

Self Harm

Effects of PND on Fathers. No systematic research on this topic Handbook of Infant Mental Health says:

“No studies have focused on father’s internal experiences during postpartum depression.”

“Feelings of exclusion from the initial bonding process.”

“Inadequacy regarding care-giving and distractibility at the workplace.”

Effects of PND on Fathers. Gavin (2002)

“Fathers involvement with the infant during the first 2 months after birth was strongly predicted by the quality of the marital relationship and by the father’s relationship with the maternal grandmother.”

“Women are the gatekeepers of the nursery and fathers need acceptance and support from them to become actors in the infant’s care.”

No systematic research on this topic.

Groups for Men whose partners have PND E. Andrees and B. Hunt (1998) Mothers are usually the declared

patients/clients. What about the Fathers? He’s:

“Showing little interest or support despite looking forward to having the baby.”

“Managing to sleep through the crying baby or impatient and angry is she can’t ‘stop it’.”

“Working long hours and when at home he is exhausted, irritated and stressed.”

Groups for Men whose partners have PND. He’s:

“Unwilling or unable to communicate, watches TV and generally withdraws in some way or perhaps more dysfunctionally withdraws by using pot or alcohol.”

“Taking on excessive work or sport commitments.”

“Becoming violent or ‘abandoning’, which is then more difficult to ignore.”

Groups for Men whose partners have PND Men are difficult to engage in any therapies. In describing their situation with maternal

PND, the men felt they were: (Andrees, Hunt 1999) Walking on eggshells. Keeping the peace. Partners seen as irrational, unreasonable and

unpredictable. “Everything was alright before ‘the birth’.”

Men whose partners have PND The unconscious is a poor discriminator of

Person Time

“The Return of the Repressed” Is the new mother the “old” abandoning

mother? Are they like the “old” father who is now

abandoning their infant or toddler to the mother?

Men whose partners have PND Unfamiliar roles and tasks

Bread-winner Cook/Cleaner Father “The lot!”

Impact on the relationship (“We just seem to snarl at each other when we talk.”)

“I’m on a roller coaster!” “I just fell into a heap as well!”

“Men Too Live With PND”

“She’s not the same person anymore.” “Nothing I do makes any difference.

Everything is falling apart.” “I feel shut out. I feel angry and cheated.” “Was it my fault in some way?”

Men whose partners have PND What kind of treatment does he want for his

wife? Does he believe in “PND”? “All women go through this. It’s a natural

part of motherhood.” (i.e. minimiser) “No woman should ever feel like this about

herself or her babies!” (maximiser) Will his wife become a, “pill popper”?

Perhaps like his mother?

Men whose partners have PND Is he horrified? Will he be excessively encouraging his

partner to take antidepressant medication?

What can we do? Education: handouts, websites with

information Support and Encouragement: Advice: Especially regarding communication

issues. Make time to talk Listen and Validate Take time out together Know how to ask for help (no mind reading) Know how to respond with thanks/praise

What can we do? “Pitfalls to Avoid” (From TIWIE) Pretending it isn’t happening. Criticising or judging her. Blaming her or someone else for the

depression. Smothering her or overreacting. Becoming overly preoccupied with why she

is feeling what she is feeling instead of accepting her feelings.

The End

Thank You