A white man with cropped yellow hair has one palm on his head in despair or exhaustion whilst holding a screaming baby in the other arm. The baby is wearing a pink babygrow with white spots. Her eyes are closed and she has her head tipped back as she screams. The man is wearing a black t-shirt with a white skull on the front. A red snake is wrapped through the skull and has protruded from the eye socket.
Mental Health,  Paternal Mental Health

Why Does Paternal Mental Health Matter?

June 15, 2019 / 37 Comments

Regardless of how excited a man might be, or how wanted a child is, the transition to fatherhood can be a huge challenge, with poor sleep, increased demand, and an intense sense of responsibility for both their child and their partner.  Paternal mental health is frequently overlooked, but is crucial to the wellbeing and development of a child. 

Let’s imagine a new father.

* Please note: I am aware that this article is unfortunately heteronormative in that it focuses exclusively on “paternal” mental health.  This is because much of the research relates to men as the partners of new mothers.  Parents of all genders can and do suffer mental health problems and need and deserve support and understanding. *

This is Jackson and his first child, Aurelia.

Jackson has known since his own father left suddenly when he was seven that he would one day be a real super-dad who would never let his children down.  Throughout the pregnancy Jackson read everything he could to ensure he knew how to respond to any little problem that might arise.  As a primary school teacher he was confident he would love having kids and his head was full of daydreams about the things he would teach his little daughter.

A white man with cropped yellow hair looks sad and worried as he holds a sleeping baby against his chest. He is slouched on a mocha sofa with a pink muslin over his shoulder. He is wearing a red t'shirt and the baby is wearing a pastel yellow babygrow.

When Heather went into labour they had a whole plan.  She was going to have a water birth and she didn’t want any pain relief.  They had chosen music and been to all the classes and were feeling confident this would be a beautiful, if painful, experience.  Jackson had been so excited to see his daughter enter the world, but when things suddenly started to go wrong he found himself waiting helplessly in the waiting room as both Heather and Aurelia fought for their lives.  Preparing himself to jump up every time someone came through the double doors at the hospital, Jackson felt the most scared he’d ever been.  And the most alone.

A white woman with red and black curly hair is sitting on a mocha sofa with her knees pulled up to her chest, looking unhappy. She is wearing a black long-sleeved top and blue jeans. In the background, a white man with yellow cropped hair and a cerise t'shirt and blue jeans is cradling a baby who is wearing only a nappy. He looks concerned or unhappy.

With Heather and Aurelia both safely at home, Jackson feels like he should be able to move on and start enjoying fatherhood, but somehow that hasn’t happened.  Heather is struggling with the physical recovery from the birth, and is feeling depressed and unable to cope.  Like many new dads, Jackson feels like it is his responsibility to protect and provide for his family, and with the image of “super-dad” in his head, he is trying to balance the demands of his job with the needs of his family. 

He has suddenly found himself with no time for his hobbies, or sleep, or even meals, but what choice does he have when Heather is struggling?

Jackson is feeling stressed and irritable, helpless, and frustrated.  He is ashamed of his inability to do everything, and worse, the anger he feels when Aurelia won’t stop crying when all he needs is a moment to pee.  He has waited so long to be a father; how can this be what it’s like?

 

Paternal Postnatal Depression

Like many dads, Jackson is experiencing postnatal depression (PND).  Research suggests that in the first year after a birth 1.2-25.5% of dads experience depression; a statistic which rises to 24-50% for those with partners with PND (Goodman, 2003) or those for whom the birth was traumatic.  Similarly, 18% of fathers suffer from anxiety in the postpartum period (Leach et al, 2016) and yet health professionals frequently overlook paternal mental health (Palsson et al, 2017).  For Jackson, the triggers for his depression are related to Aurelia’s difficult birth and the consequences of this for Heather, and therefore himself.  Heather’s low mood and anxiety and the increased demand on him has left him feeling responsible for everything and unable to meet his own expectations.  The couple have no family nearby, and Jackson feels too ashamed to tell his friends how stressed he is, so he, like many men in his situation, is lacking emotional support (Meighan, Davis, Thomas, & Droppleman, 1999).

A white man with cropped yellow hair has one palm on his head in despair or exhaustion whilst holding a screaming baby in the other arm. The baby is wearing a pink babygrow with white spots. Her eyes are closed and she has her head tipped back as she screams. The man is wearing a black t-shirt with a white skull on the front. A red snake is wrapped through the skull and has protruded from the eye socket.

Jackson isn’t aware that he is feeling depressed, just that he is incredibly stressed and tired, and that he seems to be unusually short-tempered (Madsen, Blazina, & Shen-Miller, 2011).  He has lost all interest in sex (not that he has enough energy for that anyway!), and feels hopeless, helpless, and detached.  Sometimes, on his way home from school, he stops at the corner shop and downs a few cans of lager.  He knows it’s wrong when he’ll be looking after Aurelia, but he doesn’t know how else to dim the constant self-criticism which tells him he’s a deadbeat dad, much like his own.  Like many men with postnatal depression, he is engaging in “escape activities” or avoidance (Veskrna, 2010) as he doubts the legitimacy of his struggles and prioritises Heather’s experiences (Darwin et al, 2017).

The Impact on Aurelia

Research shows that paternal mental health problems in the postnatal period are significantly associated with emotional and behavioural problems in children (Kvalevaag et al., 2013), perhaps because depressed fathers show poorer parenting behaviours, e.g. lower engagement with their child, higher levels of stress, and a greater risk of neglect (Garfield et al., 2014).   As the child of a depressed father, Aurelia is at increased risk of psychiatric disorders, behaviour problems, difficulties with peers, poorer reading and language development, and fewer pro-social behaviours as she grows (Garfield et al., 2014).   Her first five years are crucial to her development, and it is important that her parents are able to offer her secure attachment relationships, stability, safety, and responsiveness to her emotional needs.  Aurelia’s situation is particularly problematic, as children with two parents in poor mental health are at higher risk of poor developmental outcomes (Foley et al.¸ 2001), whilst a father with good mental health could otherwise act as an effective buffer against the adverse impact of an unwell mother (Kahn, Brandt, Robert, & Whitaker, 2004). 

Getting Help

Although Jackson isn’t aware he is depressed, he knows something is wrong, and desperate to be able to look after Heather and Aurelia in the way he wants to, he goes to the GP.  Aware of the recent guidance (NHS England, 2018) about offering mental health assessments and treatment to partners of new mothers experiencing depression or anxiety, the GP asks Jackson about his experiences and identifies the problem.  The GP normalises Jackson’s experiences and encourages him to talk to his friends, and to Heather, about how he is feeling.  She checks whether he feels dependent on alcohol at this time and whether he needs any support reducing this, and directs him to a counsellor who can help.

Feeling better in himself, he starts to eat proper meals and to exercise again, and no longer feels the need to drink after work.  With both of her parents on the mend, Aurelia feels secure and confident that her needs will be met, and is on her way to growing up happy and healthy, with good social skills, better resilience to stress, fewer behavioural problems, and the potential to do well at school (http://www.newdadstudy.com/).

A man with cropped yellow hair and fair stubble holds a sleeping baby to his chest with her head resting on his left shoulder. Both are Caucasian. The man is wearing a black t-shirt and a gold wedding ring. The baby is bald and is wearing a pink babygrow with short sleeves.

So why does paternal mental health matter?

1) Because dads matter too! It’s hard work being a new parent and adjusting to the demands of a very helpless and dependent little being whilst trying to manage everyday life.

2) Paternal mental health problems in the postnatal period are correlated with poorer developmental outcomes for infants, particularly behaviour in boys.

3) Well-supported and emotionally healthy fathers can act as an effective buffer to the negative effects of an emotionally unwell mother and are more likely to have children who perform well at school, are emotionally intelligent, have fewer behavioural problems, and are better able to cope with stress.

4) Parents who do not attend to their mental health are more likely to neglect their children, with serious consequences for their development.

5) Paternal mental health is frequently overlooked, but crucial to the well-being of the family as a whole.

Bear in Mind xXx 

REFERENCES

Darwin, Z., Galdas, P., Hinchliff, S., Littlewood, E., McMillan, D., McGowan, L. (2017). Born and bred in Yorkshire (BaBY) team. Fathers’ views and experiences of their own mental health during pregnancy and the first postnatal year: a qualitative interview study of men participating in the UK Born and Bred in Yorkshire (BaBY) cohort. BMC Pregnancy and Childbirth, 17(1).

Foley, D.L., Pickles, A., & Simonoff, E. (2001). Parental concordance and comorbidity for psychiatric disorder and associate risks for current psychiatric symptoms and disorders in a community sample of juvenile twins. J Child Psychol Psychiatry.


Goodman, J.H., (2003). Paternal postpartum depression, its relationship to maternal postpartum depression, and implications for family health. Journal of Advanced Nursing, 45(1).

Kahn, R.S., Brandt, D., & Whitaker, R.C. (2004). Combined effect of mothers’ and fathers’  mental health symptoms on children’s behavioural and emotional well-being. Arch Pediatr Adolesc Med, 158(8).

Kvalevaag, A.L., Ramachandani, P.G., Hove, O., Assmus, J., Eberhard-Gran, M., & Biringer, E. (2013). Paternal mental health and socioemotional and behavioral development in their children. Pediatrics, 131(2).

 

Leach, L.S., Poyser, C., Cooklin, A.R., Giallo, R. (2016). Prevalence and course of anxiety disorders (and symptom levels) in men across the perinatal period: A systematic review. Journal of Affective Disorders, 190.

Madsen, S.A., Blazina, C., Shen-Miller, D.S. (2011). Between autonomy and attachment: psychotherapy for men with postnatal depression. An international psychology of me: theoretical advances, case studies, and clinical innovations. Volumer 7 of the Routledge Series on Counseling and Psychotherapy with boys and men. New York: Routledge, 315-340.  

Meighan, M., Davis, M.W., Thomas, S.P., & Droppleman, P.G. (1999). Living with postpartum depression: the father’s experience. Am J Matern Child Nurs, 24(4).

New Dad Study. (http://www.newdadstudy.com/).

NHS England. (2018). https://www.england.nhs.uk/2018/12/partners-of-new-mums-with-mental-illness-set-to-get-targeted-support-on-the-nhs/

Palsson, P., Persson, E.K., Ekelin, M., & Hallstrom, I.K., (2017). First-time fathers experiences of their prenatal preparation in relation to challenges met in the early parenthood period: Implications for early parenthood preparation. Midwifery, 50.

Veskrna, L. (2010). Peripartum depression: does it occur in fathers and does it matter? J Men’s Health, 7(4).


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