Prevent and screen for depression in new fathers.

Takeaways:

• Paternal postpartum depression effects one in ten fathers.
• Paternal postpartum depression can affect fathers, the likelihood of the mother developing postpartum depression, and the ability for both mother and father to bond with the infant.
• Prevention and treatment for paternal postpartum depression begins with nurses.

A pregnant woman is coping well with her labor—just as she dreamed she would—when suddenly her water breaks and with the fluid comes an umbilical cord prolapse. What was a happy day quickly turns into the controlled chaos a labor nurse knows well but a soon-to-be mother never imagined. The woman is whisked to the operating room (OR), where her baby is delivered and taken to the neonatal intensive care unit (NICU). After the delivery, the new mother experiences significant bleeding in the postanesthesia care unit (PACU) and is rushed back to the OR, where more nurses and physicians rush to stabilize her. After 4 eventful days in the hospital, mother and baby are discharged and the family goes home.

Most nurses involved in prenatal, antenatal, labor and delivery, and postpartum care who hear this story will appropriately think about the mother and how this situation will complicate her postpartum period and increase her risk for postpartum depression and anxiety. But what most won’t consider is the new father, who was left in the labor room with little understanding of what was happening to his wife and unborn child in the OR, who watched his baby taken to the NICU, and who was left in the PACU after his wife was taken back to the OR. In other words, pregnancy, birth, and postpartum care don’t affect only mother and baby.

Paternal postpartum depression

Postpartum depression is finally getting the attention it deserves in the media, hospitals, and healthcare in general, but fathers generally aren’t mentioned. Paternal postpartum depression affects men all over the world, but it’s rarely discussed, and few—including fathers who are at risk and nurses who care for families—are educated about it. Studies show that about one in 10 fathers develop paternal postpartum depression; according to the Centers for Disease Control and Prevention (CDC), about one in nine mothers will experience postpartum depression symptoms.

Paternal postpartum depression typically begins in the first 12 months after a baby’s birth, with the highest number of cases beginning between 3 and 6 months after birth—later than when postpartum depression generally develops in women. A study by Paulson and colleagues comparing women’s and men’s depression symptoms prenatally and at 1, 3, and 6 months postpartum found that of those who were depressed prenatally, symptoms began to decline at 1 month postpartum, but men’s symptoms then increased at 3 and 6 months while women’s declined; 86% of these men remained depressed at 6 months postpartum, and 79% of these were depressed at each stage of evaluation.

Signs, symptoms, and risk factors

Signs and symptoms of paternal postpartum depression are similar to maternal postpartum depression, but men may experience additional symptoms, such as aggressiveness, substance misuse, risk-taking behavior, partner violence, and infidelity. (See Know the signs and symptoms.) Paternal postpartum depression also can affect both parents’ ability to bond with a new baby. A study by Kerstis and colleagues of how fathers’ depressive symptoms affect bonding showed that fathers with depressive symptoms 6 weeks postpartum have impaired bonding with their baby at 6 months. This same study found that a father’s depression symptoms can decrease a mother’s bonding ability.

Many of the risk factors for maternal and paternal postpartum depression are similar; however, some differences exist. One risk factor more commonly seen with fathers is witnessing a life-threatening obstetric event or poor outcome during delivery. (See What are the risks?) One of the more significant risk factors for paternal postpartum depression is a partner’s postpartum depression. A father’s postpartum depression also can affect the mother. A woman with postpartum depression whose partner also has postpartum depression is 4.2 times more likely to show a worsening of her symptoms over time; however, a woman whose partner doesn’t have paternal postpartum depression shows symptom improvement.

Treatment, prevention, and nursing implications

Preventing and treating paternal postpartum depression should begin before the baby is born and continue in the hospital and after the baby is delivered.

Prenatal care

Begin paternal postpartum depression prevention during prenatal care. Obtain a health history of the mother and father, including mental health. Education should include information about physical changes the mother can expect during pregnancy, physical and hormonal changes that the father may experience, how the new parenting role will change the couple’s life, and maternal and paternal postpartum depression.

Start education about paternal postpartum depression early to help remove any stigma around the condition. Simple steps, such as having posters on paternal postpartum depression hanging in clinical areas, can be helpful. Fathers also can be referred to father-centered education groups, where they can learn about pregnancy, birth, and parenthood. Fathers should be encouraged to talk with other new or soon-to-be fathers about what they’re experiencing and what they can expect.

Assess the father’s confidence in taking on his new role and encourage him to practice childcare skills (such as diapering and bathing) before the baby comes and to participate in care as much as possible after birth. Also provide lifestyle education about sleep health, nutrition, physical activity, self-image, and postpartum sexual activity  to help prevent paternal postpartum depression.

Hospital care

Before discharge, screen the mother and father for postpartum depression and risk factors using the Edinburgh Postnatal Depression Scale (EPDS). Upon discharge, provide information and education about maternal and paternal postpartum depression and resources to seek help if needed. When providing discharge instructions for the mother and baby, include instructions for the father and information about his role in postpartum care at home.

Postpartum care

Postpartum follow-up should include fathers. Screen them using the EDPS, provide printed materials to read at home, and ensure posters about paternal postpartum depression are visible in clinical areas. Fathers can be screened by their primary care provider and in the pediatrician’s office when the mother is screened.

If paternal postpartum depression is suspected, take action to assist the family. Based on the severity of the father’s depression, providers may refer him to mental healthcare professionals for further evaluation and possible psychotherapy or medication (such as a selective serotonin reuptake inhibitor). In cases where the parents’ relationship is significantly strained, providers may make referrals for couples counseling and parenting skills classes.

Care for the whole family

Mothers may experience the physical effects of childbearing, but fathers also are affected by a baby’s birth. In most cases, both parents will be sleep deprived as they face the challenges of becoming new parents and letting go of their previous life and routine. In addition, they’ll be overwhelmed at times by their baby’s needs, and they may feel a loss of control over their own lives. All of these factors can lead to postpartum depression in mothers and fathers.

The stigma associated with paternal postpartum depression can leave fathers overlooked. However, mental health issues don’t discriminate. Paternal postpartum depression is a serious condition that affects fathers and their families every day. As nurses, we need to learn more about this condition and provide the best care to the whole family after a baby’s birth.

Nicole Altenau is the assistant clinical director of labor and delivery at Monmouth Medical Center in Long Branch, New Jersey

References

Bria KR. Exploring the experiences of first time fatherhood and paternal postnatal depression: A grounded theory analysis revealing the importance of the concept of ‘coping.’ Australian Midwifery News. 2018;18(2):20-2.

 Centers for Disease Control and Prevention. Reproductive health: Depression among women. December 5, 2019. cdc.gov/reproductivehealth/depression/index.htm

Charandabi SM, Mirghafourvand M, Sanaati F. The effect of life style based education on the fathers’ anxiety and depression during pregnancy and postpartum periods: A randomized controlled trial. Community Ment Health J. 2017;53(4):482-9.

Edelstein ES, Wardecker BM, Chopik WJ, et al. Prenatal hormones in first‐time expectant parents: Longitudinal changes and within‐couple correlations. Am J Hum Biol. 2014; 27(3):317-25.

Gönülal D, Yalaz M, Altun-Köroglu O,  Kültürsay N. Both parents of neonatal intensive care unit patients are at risk of depression. Turk J Pediatr. 2014;56(2):171-6.

Harrison Y, White M. How postpartum depression can affect new fathers. Urology Times. July 1, 2017. urologytimes.com/modern-medicine-feature-articles/how-postpartum-depression-can-affect-new-fathers

Hinton L, Locock L, Knight M. Partner experiences of “near-miss” events in pregnancy and childbirth in the UK: A qualitative study. PLoS One. 2014;9(4):e91735.

Kamalifard M, Hasanpoor S, Babapour Kheiroddin J, Panahi S, Bayati Payan S. Relationship between fathers’ depression and perceived social support and stress in postpartum period. J Caring Sci. 2014;3(1):57-66.

Kerstis B, Aarts C, Tillman C, et al. Association between parental depressive symptoms and impaired bonding with the infant. Arch Womens Ment Health. 2016;19(1):87-94.

Mickelson KD, Biehle SN. Gender and the transition to parenthood: Introduction to the special issue. Sex Roles. 2017;76(5-6):271-5.

Paulson JF, Bazemore SD, Goodman JH, Leiferman JA. The course and interrelationship of maternal and paternal perinatal depression. Arch Womens Ment Health. 2016;19(4):655-63.

Philpott LF. Paternal postnatal depression: An overview for primary healthcare professionals. Prim Health Care. 2016;26(6):23-7.

Saxbe DE, Schetter CD, Guardino CM, et al. Sleep quality predicts persistence of parental postpartum depressive symptoms and transmission of depressive symptoms from mothers to fathers. Ann Behav Med. 2016;50(6):862-75.

Singley DB. And daddy makes three: Spotlight on men’s peripartum mental health. Int J Childbirth Educ. 2015;30(1):19-24.

Stadtlander L. Paternal postpartum depression. Int J Childbirth Educ. 2015;30(2):11-3.