Thursday 21 June 2018

Mental health of new dads in post-natal period uncertain

Most studies have found a prevalence of depression among men in general to be around 7-8pc. Picture posed
Most studies have found a prevalence of depression among men in general to be around 7-8pc. Picture posed

Patricia Casey

The status of men's mental health in the post-natal period has been of interest for about a decade and has produced some research suggesting that childbirth had an adverse effect on their mental well-being. Depression and anxiety have been the main focus of this research interest.

It is an important topic since any mental health problem in either parent is likely to impact upon the baby. In addition they are likely to have an adverse effect on the other partner. Depressive illness for example causes feelings of sadness, withdrawal from contact with others, disinterest, difficulty with day-to-day functioning, an inability to show and experience pleasant emotions and irritability.

Some people, especially men, exhibit anger as a feature of depression.

Many mental health and pregnancy-related websites mention the negative impact pregnancy and childbirth has on dads and popular magazines frequently run features on this too.

A report based on a number of studies in the Journal of the American Medical Association in 2006 identified a prevalence of 10pc for paternal post-partum depression (PPPD) from the first trimester of pregnancy, climbing to 26pc in the three to six month period following childbirth. These are astonishing figures and have huge public health implications as well as potential consequences for a baby's development.

By way of comparison, most studies have found a prevalence of depression among men in general to be around 7-8pc. The American Medical Association study also found that one of the biggest risk factors for developing PPPD is having a partner who is also suffering with post-partum depression.

The big question is, are these figures accurate? If so then pregnancy and the post-natal period are times of great psychological fragility not just for mothers but also for fathers, that would require significant additional input from mental health professionals. The answer is we don't know for certain. Personally, I have to admit that I am sceptical because I don't see men who attend my clinic with PPPD. I certainly treat very many men for depression and anxiety but not in the context of expectant or recent fatherhood. One study from Denmark reflected this, in finding that for women during the post-natal period there was an increase in psychiatric hospitalisations and out-patient contact but not among new fathers. Perhaps these men are attending their GPs or even worse, suffering in silence, unheard and unseen.

One way to answer this question is to carry out studies in the general population. Some researchers have done that but wide variations in the prevalence of mental health problems have been identified. Still other studies have demonstrated the opposite and found that men have positive responses to fatherhood. Another possibility is that the measures of depression and anxiety used in these studies are simply measuring distress and not tapping into clinically recognisable psychiatric disorders.

Most importantly, no studies, until recently, have measured the pre-pregnancy level of mental health problems in this group of men. Only by doing this basic analysis can we establish the trajectory of depression and anxiety over time, and especially when men later become fathers.

Studies of this type, called cohort studies, are time-consuming. But an Australian project, led by Dr Liana Leach from the Centre for Research on Ageing, and published in the British Journal of Psychiatry in 2015, has now filled that gap. A cohort of over 1,000 men aged between 20-29 years were interviewed over an eleven-year period and at each point their fatherhood status was evaluated. The study found that expectant and new fathers were not at greater risk of mental health problems than men in general. Factors that might have muddied the waters such as employment status, alcohol intake and so on were controlled in the analysis. Most interestingly, the men whose mental health was least robust were those who were never fathers and did not have a partner.

So, single men, without children, yet again, emerge as a group to whom public and mental health professionals should be directing attention. The benefits of fatherhood and marriage for men have been a consistent finding in many studies. Also, the higher risk of suicide in young, single males provides further confirmation of their vulnerability. We need to develop tools to encourage help seeking in this group. Meanwhile we have to acknowledge that the status of PPPD is uncertain. This is not to say that individual men who are vulnerable during transitions in their lives should not be helped.

The question rather is how do we distribute finite resources?

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