Sad Dads

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Sad Dads
Paternal Postpartum Depression
by PILYOUNG KIM, MEd, BA; and JAMES E. SWAIN, MD, PhD, FRCPS AUTHOR AFFILIATIONS—Ms. Kim is from the Department of Human Development, Cornell University, Ithaca, New York; and Dr. Swain is from the Child Study Center, Yale University School of Medicine, New Haven, Connecticut ADDRESS CORRESPONDENCE TO— James E. Swain, MD, PhD, FRCPS, Child Study Center, Yale University School of Medicine, 230 South Frontage Road, New Haven, CT 06520-7900; Phone: (203) 785-6973; Fax: (203) 785-7611; E-mail: james.swain@yale.edu KEY WORDS— fathers/psychology, father-child relations, male, depressive disorders/complications, child development, postpartum depression

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BSTRACT—The postpartum period is associated with many adjustments to fathers that pose risks for depression. Estimates of the prevalence of paternal postpartum depression (PPD) in the first two months postpartum vary in the postpartum period from 4 to 25 percent. Paternal PPD has high comorbidity with maternal PPD and might also be associated with other postpartum psychiatric disorders. Studies so far have only used diagnostic criteria for maternal PPD to investigate paternal PPD, so there is an urgent need to study the validity of these scales for men and develop accurate diagnostic tools for paternal PPD. Paternal PPD has negative impacts on family, including increasing emotional and behavioral problems among their children (either directly or through the mother) and increasing conflicts in the marital relationship. Changes in hormones, including testosterone, estrogen, cortisol, vasopressin, and prolactin, during the postpartum period in fathers may be biological risk factors in paternal PPD. Fathers who have ecological risk factors, such as excessive stress from becoming a parent, lack of social supports for parenting, and feeling excluded from mother-infant bonding, may be more likely to develop paternal PPD. Support from their partner, educational programs, policy for paid paternal leave, as well as consideration of psychiatric care may help fathers cope with stressful experiences during the postpartum period.

INTRODUCTION
Postpartum depression (PPD) typically has been perceived as a problem limited to women with newborn babies and has not included men. Indeed, research accumulated over the past 50 years has focused on the biological and environmental features associated with maternal PPD and the increasingly clear deleterious impact on child development.1,2 However, fathers also experience significant changes in life after childbirth, many of which are similar to the experiences mothers. Fathers must also adjust to an array of new and demanding roles and

tasks during the early postpartum period. This critically depends on the level and quality of cooperation between the mother and father. Clearly, the postnatal experience poses many challenges to men’s as well as women’s lives and mental health,3,4 and the timing and details of paternal PPD are just recently beginning to be recognized and studied.5–7 Studies suggest that paternal PPD has significant prevalence and impact on a father’s positive support for both mother and baby during the first postpartum year. Recent media attention on the father’s mental health during the

postnatal year has also increased public awareness of this issue.8,9 Given the growing body of literature on paternal PPD, we have set out to review current understandings and discuss future research directions. This will help us to improve clinical insight, not only for improving fathers’ mental health, but also for helping the family, including their partners and infants, have a better quality of life. The paper will review diagnostic criteria and characteristics of the paternal PPD and its impact on infants’ and partners’ lives. The paper will also posit biological and ecological risk

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factors for the...
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