Tuesday, November 16, 2010

Emily Anthes - Dads Get Blue, Too: The problem of postpartum depression in fathers

Ramchandani also showed that kids whose fathers suffered from depression when they were 8 weeks old were 66 percent more likely to suffer from a diagnosable psychiatric disorder at age 7.
That's huge - and that is more than enough reason to be alert to depression in new fathers. I think it's good that this is posted in the XX blog for Slate, a women's blog. New mothers can held their husbands identify depression they may write off as lack of sleep.

Dads Get Blue, Too: The problem of postpartum depression in fathers

Illustration by Robert Neubecker. Click image to expand.

Last week, the American Academy of Pediatrics officially recommended that pediatricians begin screening their infant patients' mothers for signs of postpartum depression. It's a compelling and simple idea—tired and stressed moms may not take the time to see their own doctors, but you can bet that they won't miss a single appointment with the pediatrician. Now the AAP should go one more step and recommend that the babies' doctors look out for depression in new dads, too.

In the last few years, studies have revealed that it's not just women whose moods can plummet after they become parents. In a 2006 study, James Paulson, a psychologist at Eastern Virginia Medical School, assessed the parents of 5,089 infants and found that 14 percent of the mothers had signs of moderate to severe depression. And so did 10 percent of the fathers. Compare that with the 3 percent to 5 percent of men in the general population who are depressed (as well as the 8 percent or 9 percent of women).

Though the percentages vary, other studies have backed up the idea that for men, as well as women, parenthood can cause a bump in the rates of mood disorders. Depression in new fathers has spawned Web sites and support groups, articles by dads struggling with their new roles, and even a storyline in ABC's Desperate Housewives this fall.

Still, PPD for dads remains understudied, under-recognized, and controversial. Even among scientists who research the baby blues in new fathers, there's debate about whether "postpartum depression" is the right term. One researcher told me that when talking about men, he prefers "depression during the postnatal period." Whatever you call it, distress after a baby is born is much easier to explain among moms. Pregnancy and childbirth, of course, are hugely taxing and exhausting for women. And, of course, these processes can wreak havoc with a woman's hormones and, thereby, her psychological wellbeing.

Over the last decade, however, researchers have discovered that, lo and behold, parenthood prompts hormonal changes in men, too. (More on that here .) Although the hormonal roller coaster is less pronounced in dads, it could certainly contribute to lousy mood.

What's more, researchers are starting to explore the idea that the psychological lows that follow the arrival of a baby may sometimes result merely from the challenges of bringing her home. "The exposure to stress, the change in life, the change in role—men in the home with a new baby experience a lot of the same kinds of stresses that women experience," Paulson says. "So from that perspective, seeing that men, postpartum, get depressed more often is really no surprise." (Support for the idea that stress can cause the baby blues comes from studies that show, for instance, that new parents who lack social support, have marital troubles, or are struggling financially—among other factors—have a higher incidence of depression.)

One of the reasons that postpartum depression has garnered so much attention is because it can have serious consequences for children. The AAP's new report lists the many ways in which kids of depressed moms may be worse-off: They are more likely to have developmental delays, social and emotional difficulties, cognitive and language problems, and more.

The emerging work on fathers shows that depression in dads can have similar ripple effects. In his 2006 study, Paulson found that melancholy fathers were less likely to play with or read, sing, or tell stories to their babies. A follow-up study, published in 2009, shows that these behavioral changes can have long-term effects on child development. Sad dads read to their kids less frequently, and the less reading aloud that fathers did, the worse their 2-year-olds scored on vocabulary tests.

Other research, conducted by University of Oxford psychiatrist Paul Ramchandani, turned up evidence that children whose fathers were depressed during their early infancy were more likely to suffer from behavioral problems at age 3-and-a-half. In 2008, Ramchandani also showed that kids whose fathers suffered from depression when they were 8 weeks old were 66 percent more likely to suffer from a diagnosable psychiatric disorder at age 7.

Of course, children of depressed fathers are more likely to have some genetic risk for developing their own mood disorders. But there could easily be environmental mechanisms at work as well. "Depression affects how fathers interact with their children," Ramchandani says. "They may be more irritable, they may be more withdrawn. That might affect children's understanding of emotions and how they learn to regulate their own emotions." Mood problems may also influence fathers' ability to work, affect the strength of their marital relationships, and more—any of which could put their kids at risk.

The accumulated evidence is clear: Depression in new dads—whatever the name, whatever the mechanism—is a real problem. And we need to be more proactive about catching it. It's not necessarily an easy task. As the AAP recommendations demonstrate, doctors involved in pregnancy and childbirth are trained, for obvious reasons, to focus on the health of mother and child. In Britain, however, physicians are starting to consider the missing family member: the father. In a pilot program launched at a hospital in Essex, England, the nurses and midwives in the maternity ward screen new dads, as well as moms, for signs of mood problems, both during pregnancy and after childbirth. Experienced dads have also been trained to run a fathers-only telephone helpline. It's a simple intervention and a good place to start.

The AAP's paper could have provided the impetus for doctors and hospitals in the United States to start taking similar action. Instead, it continued the not-so-grand tradition of ignoring dads.

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