ORIGINAL ARTICLE

O privire asupra factorilor implicaţi în apariţia tulburării depresive paterne post-partum

 A glimpse of factors involved in the occurrence of paternal postpartum depression disorder

First published: 18 aprilie 2021

Editorial Group: MEDICHUB MEDIA

DOI: 10.26416/Psih.65.2.2021.4993

Abstract

Depression is a mood disorder that occurs more frequently in women. It causes incessantly feelings of discouragement, sadness, social reticence and withdrawal, along with loss of interest. The pregnancy and postpartum period is associated with many couple adjustments and poses risks for depression for both mother and father. Paternal postpartum depression (PPD) is defined when paternal depression disorder occurs within the first twelve months in the postpartum period. Herein we present a glimpse of risk factors for the occurrence of PPD and their potential explanation. New demands and responsibilities in the postpartum period often cause significant changes in a father’s life. Because paternal emotional development contributes to the child development and because mental health and wellness are essential for protecting the family, it remains important to carefully determine if the fathers’ emotional expression is beyond a normal response to this new period of life.

Keywords
paternal, postpartum, depression

Rezumat

Depresia este o tulburare a dispoziţiei care apare mai frecvent la femei. Depresia provoacă neîncetat sentimente de descurajare, tristeţe, reticenţă socială şi retragere şi pierderea interesului. Sarcina şi perioada de post-partum sunt asociate cu multe ajustări ale cuplului şi prezintă riscuri de depresie atât pentru mamă, cât şi pentru tată. Depresia post-partum paternă (DPP) este definită atunci când tulburarea de depresie paternă apare în primele douăsprezece luni din perioada post-partum. În cadrul acestui articol, prezentăm factorii de risc pentru apariţia DPP şi posibila explicaţie a acestora. Noile cerinţe şi responsabilităţi în perioada de post-partum determină adesea schimbări semnificative în viaţa unui tată. Deoarece dezvoltarea emoţională paternă contribuie la dezvoltarea copilului şi pentru că sănătatea mintală şi bunăstarea sunt esenţiale pentru protejarea familiei, rămâne important să se determine cu atenţie dacă expresia emoţională a taţilor depăşeşte un răspuns normal la această nouă perioadă a vieţii.

Cuvinte cheie

Depression is a mood disorder that causes incessantly feelings of discouragement, sadness, social reticence and withdrawal, along with loss of interest. Major depressive disorder is a chronic disease, a heterogenic syndrome with a reported prevalence of 3.2% in men and 5.3% in women(1).

Paternal postpartum depression (PPD) is defined when paternal depression disorder occurs within the first twelve months in the postpartum period(2,3). PPD cannot differentiate between the nine symptoms considered in the DSM criteria: if the father expresses a depressive mood, a drop of enjoyment, or he expresses excessive guilt and worthlessness or he is incapable to think or to concentrate, or he has obsessive thinking of death or suicidal ideation(4).

Many etiopathogenic factors are contributing to understanding the increasing prevalence nowadays. It was stipulated that depression is a disease of modernity, of the society’s urbanization, industrialization, artificial intelligence, secularization, consumerism and westernization(5)

At first pregnancy, the mother’s age increased to 29 years old in Romania and at 30 years old worldwide(6), but also the paternal’s age at first pregnancy. Many couples have their first baby after their 40s.

The transition to parenthood can lead to psychological distress in both mothers and fathers, with short- and long-term effects for the family and infants(7,8)

Although ignored in men’s case, postpartum depression is always directed towards the mother. Depression can be explained by genetic predisposition, insufficient familial and social support(9), or by thyroids dysfunction(10). Maternal depression manifestations may be explained by the fact that women experience more specific forms of depression-related illness, including premenstrual dysphoric disorder, postmenopausal depression and anxiety and postpartum depression. These are associated with physiological changes in ovarian hormones and could contribute to the increased prevalence in women(11).

In the last decades, it has been shown that fathers experience significant psychological changes during pregnancy and in the postpartum period(12). Although approximated, the reported incidence of PPD is stated from 4% to 25% of new fathers(3,12) and from 4.1% to 16% during the the prenatal period(13). Many studies have shown the importance of an optimal mental health in fathers for optimal child development and healthy marital relationships(14).

In Romania, depression is underreported. This is mainly due to the fact the mental illness is not timely diagnosed and treated. Many people do not want to admit they have problems and wait longer for mental and psychological healthcare.

PPD is briefly described in the literature, not being classified as a part of a syndrome.

Sometimes, humour is used in the interpretation of the problematic relationship.

The general population has a little understanding on PPD. Daily life stressful and emotional events perceptions and adaptation alterations can affect people’s mental health.

Much of the study of parenting has focused on how parents care for their babies and children and on the development of attachment behaviours(15). Also, it has been analyzed how adults become parents, how women become mothers and men become fathers; how parents (mother and father) develop normative psychological adjustment and reorganization that takes place when an adult is either pregnant or anticipating the birth of their child.

The most common psychiatric disorders that occur with postpartum depression are anxiety and obsessive-compulsive disorders.  Some studies have reported that 95% of mothers and 80% of fathers have recurring thoughts about the possibility of harming their children up to the age of 8 months old. Forty-five percent of fathers reported a concern that their babies could suffocate, about 25% had a concern about feeding their babies, and 3% of men reported a concern about losing babies. These findings suggest that a psychiatric disorder makes fathers more vulnerable to other psychiatric disorders(16).

The transition from woman to mother and from man to father is often reported as a stressful experience. The father’s anxiety and depression can also be translated into violent behaviour towards his partner. Thus, 15% of women reported violence from their partner and 69% said that violence was manifested for the first time during pregnancy or postpartum. Paternal postpartum depression is also considered a risk factor for child abuse and infanticide(12).

A meta-analysis of 28,004 participants has reported pooled prevalence rates of postpartum depression in men of 8% from birth to three months, 26% from three to six months, and 9% from six to twelve months(17).

Recently, it has been reported that 10% of men get depressed during the first trimester of pregnancy of the partner, up to six months after the child’s birth. The percentage increased to 26% between three and six months after the arrival of the baby. In the United States of America, one in four fathers become depressed after giving birth to their own child(18).

Herein we present the risk factors for the occurrence of PPD. Fathers don’t access medical services that ­mothers do. They don’t tend to see their doctor, obstetrician, general practitioner, paediatrician, maternal or child nurse or midwife, where problems are often raised in women. This glimpse of facts may be helpful for doctors who are dealing with fathers expressing abnormal emotions during pregnancy and postnatally, beyond the adaptation of this new period of life.   

Men’s psychological distress during gravidity and after birth has been related to poor relationship satisfaction, financial burden, poor job quality, and maternal psychological distress(19).

Expecting and having an infant are new and unique experiences which may be related to increased distress at this time, such as extreme responsibility, time spent, extreme fatigue, poor partner, witnessing, birth trauma, infant health and feelings of inadequacy as a parent(19,20). In a large study from 3,219 fathers, 10% of them have reported elevated symptoms of psychological distress(19).

The risk factors for PPD are the following(14-21)

  • Negative changes in the relationship.

  • Lower socioeconomic status (financial problems).

  • Mother’s postpartum depression.

  • Personal or family history of depression.

  • Unwanted pregnancy.

  • Sleep deprivation or chronic lack of sleep.

  • Chronic illness or prematurity affecting the child development.

  • Difficulty in dealing with your child.

  • Lack of a male model.

  • Lack of financial, social and psychological help from family or friends.

  • He feels excluded and jealous about the mother-child connection.

  • Lack of attention from the partner.

  • Self-efficacy(25)

Similar to the hormonal adaptation of women to pregnancy and postpartum, there are hormonal changes for paternal adaptation. Increases in estrogen, cortisol, vasopressin and prolactin levels, simultaneously with decreases in testosterone levels are responsible for stronger parent-infant attachment and might be associated with more engaged paternal parenting(26-28).

In late 1970s, Bandura introduced a new concept of self-efficacy theory for the regulation of emotional states. Briefly, people try only to do what they think they can do. Self-efficacy beliefs make people less stressed, able to regulate emotional stress by reducing their own negative thoughts and by interpreting potentially threatening expectations as feasible(29). Men expressing high general self-efficacy beliefs were related to lower levels of depression which is true for the postpartum period(30)
 

Figure 1. Factors involved in paternal postpartum depression
Figure 1. Factors involved in paternal postpartum depression

New demands and responsibilities in the postpartum period often cause major changes in a father’s life (Figure 1). Fathers often have difficulties developing emotional bonds with infants, compared to women who develop an attachment immediately after birth. The father-child relationship develops more slowly in the first months after birth. Fathers can be jealous of babies because they occupy a large part of their partner’s attention(31).

An interesting report on 438 couples found that becoming parent at a young age was associated more with potential risk factors for PPD. Symptom’s trajectories were related to family support, but less to friendship support(32). Why our parents didn’t get depressed when we were born?

In conclusion, it remains important for those who are more prone to depression or to other mental disorders to understand when they are at risk. It is important for the general practitioner to carefully decide if fathers’ emotional expression is beyond a normal response to this new period of life. Parenting remains a state of mind.   

Bibliografie

  1. Whiteford HA, Degenhardt L, Rehm J, Baxter AJ, Ferrari AJ, Erskine HE, Charlson FJ, Norman RE, Flaxman AD, Johns N, Burstein R, Murray CJ, Vos T. Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet. 2013 Nov 9;382(9904):1575-86.
  2. Nazareth I. Should men be screened and treated for postnatal depression? Expert Rev Neurother. 2011 Jan;11(1):1-3.
  3. Goodman JH. Paternal postpartum depression, its relationship to maternal postpartum depression, and implications for family health. J Adv Nurs. 2004 Jan;45(1):26-35.
  4. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th Ed. Text Revision. Washington, DC: American Psychiatric Association, 2000.
  5. Hidaka BH. Depression as a disease of modernity: explanations for increasing prevalence. J Affect Disord. 2012;140(3):205-214. 
  6. Simionescu AA, Stănescu AMA. Missed Down Syndrome Cases after First Trimester False-Negative Screening-Lessons to be Learned. Medicina (Kaunas). 2020 Apr 23;56(4):199.
  7. Cameron E, Sedov I, Tomfohr-Madsen L. Prevalence of paternal depression in pregnancy and the postpartum: an updated meta-analysis. J Affect Disord. 2016;206:189–203.
  8. Canário C, Figueiredo B. Anxiety and depressive symptoms in women and men from early pregnancy to 30 months postpartum. J Reprod Infant Psychol. 2017;35:431–449.
  9. Miller LJ. Postpartum depression. JAMA. 2002 Feb 13;287(6):762-5.
  10. Simionescu AA, Marin E. Postpartum depression and thyroid dysfunction – should pregnant women be screened for thyroid disorders? JMMS. 2019;6(1):17. 
  11. Albert PR. Why is depression more prevalent in women?. J Psychiatry Neurosci. 2015;40(4):219-221. 
  12. Ramchandani P, Stein A, Evans J, et al. Paternal depression in the postnatal period and child development: a prospective population study. Lancet. 2005;365(9478):2201–5.
  13. Leach LS, Poyser C, Cooklin AR, Giallo R. Prevalence and course of anxiety disorders (and symptom levels) in men across the perinatal period: A systematic review. J Affect Disord. 2016 Jan 15;190:675-686.
  14. 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):655-663. 
  15. Bornstein MH. Parenting infants. In: Bornstein M, editor. Handbook of parenting, vol. 1. Mahwah, NJ: Erlbaum; 1995, p. 3–39.
  16. Mayes LC, Swain JE, Leckman JF. Parental attachment systems: Neural circuits, genes, and experiential contributions to parental engagement. Clin Neurosci Res. 2005;4:301–13.
  17. Paulson JF, Bazemore SD. Prenatal and postpartum depression in fathers and its association with maternal depression: a meta-analysis. JAMA. 2010 May 19;303(19):1961-9.
  18. Scarff JR. Postpartum Depression in Men. Innov Clin Neurosci. 2019;16(5-6):11-14.
  19. Giallo R, D’Esposito F, Cooklin A, Mensah F, Lucas N, Wade C, Nicholson JM. Psychosocial risk factors associated with fathers’ mental health in the postnatal period: results from a population-based study. Soc Psychiatry Psychiatr Epidemiol. 2013 Apr;48(4):563-73. 
  20. Bradley R, Slade P, Leviston A. Low rates of PTSD in men attending childbirth: a preliminary study. Br J Clin Psychol. 2008 Sep;47(Pt 3):295-302. 
  21. Berg AR, Ahmed AH. Paternal perinatal depression: Making a case for routine screening. Nurse Pract. 2016 Oct 20; 41(10):1-5.
  22. Fisher SD, Garfield C Opportunities to Detect and Manage Perinatal Depression in Men. Am Fam Physician. 2016 May 15; 93(10):824-5. 
  23. Rosenthal DG, Learned N, Liu YH, Weitzman M. Characteristics of fathers with depressive symptoms. Matern Child Health J. 2013;17(1):119–128. 
  24. Nishimura A, Ohashi K. Risk factors of paternal depression in the early postnatal period in Japan. Nurs Health Sci. 2010 Jun; 12(2):170-6.
  25. Rabani Bavojdan M, Towhidi A, Rahmati A. The relationship between mental health and general self-efficacy beliefs, coping strategies and locus of control in male drug abusers. Addict Health. 2011;3(3–4):111–8.
  26. Kim P, Swain JE.Sad dads: paternal postpartum depression. Psychiatry (Edgmont). 2007 Feb; 4(2):35-47.
  27. Zarrouf FA, Artz S, Griffith J, Sirbu C, Kommor M. Testosterone and depression: systematic review and meta-analysis. J Psychiatr Pract. 2009 Jul;15(4):289-305.
  28.  Berg SJ, Wynne-Edwards KE. Changes in testosterone, cortisol, and estradiol levels in men becoming fathers. Mayo Clin Proc. 2001 Jun;76(6):582-92.
  29. Bandura A. Self-efficacy: the exercise of control, 4th ed. New York, NY: W.H. Freeman; 1997.
  30. Luszczynska A, Scholz U, Schwarzer R. The general self-efficacy scale: multicultural validation studies. J Psychol. 2005;139(5):439–57.
  31. Gallaher KGH, Slyepchenko A, Frey BN, et al. The role of circadian rhythms in postpartum sleep and mood. Sleep Med Clin. 2018;13(3):359–374.
  32. Hughes C, Devine R.T, Foley S, Ribner AD, Mesman J, Blair C. Couples becoming parents: Trajectories for psychological distress and buffering effects of social support. J Affect Disorders. 2020;265:72-380. 

Articole din ediţiile anterioare

REVIEW | Ediţia 4 67 / 2021

Aspecte ale episoadelor depresive şi impactul depresiei la vârstnici

Ana Maria Alexandra Stănescu, Roxana-Marcela Dobre (Miţoi), Ioana Veronica Grăjdeanu, Mira Florea, Anca A. Simionescu

Sindromul depresiv la vârstnici se poate manifesta prin tristeţe, considerată mai frecventă la adulţii în vârstă, sevraj, apatie şi lipsă de vigoar...

20 noiembrie 2021
PREZENTARE DE CAZ | Ediţia 4 59 / 2019

„Adolescenţa complicată” – între agresivitate şi depresie

Cristian Pușcaș

Cu toate că în multe situaţii dau impresia unui adult mai tânăr, adolescenţii prezintă un tablou clinic al patologiilor psihiatrice diferit de cel ...

15 noiembrie 2019
CASE REPORT | Ediţia 2 16 / 2020

Relaţia dintre trăsăturile de personalitate şi tulburările instinctului alimentar

Adrian-Adam Culici, Vlad Negrilă, Cătălina Giurgi-Oncu, Zsolt Popovici, Cristina Bredicean

Pacienţii cu tulburări de personalitate reprezintă o provocare pentru orice clinician, indiferent de experienţă, mai ales când aceştia prezintă şi ...

25 iunie 2020
OPINII | Ediţia 2 / 2015

Depresia provine de la neanderthalieni?

Dan Pereţianu, Aurelian Nebel, Sorin Şuba, Denis Păduraru

Circa 2-4% din genomul uman conţine gene neanderthaliene. Aceasta sugerează că H. Neanderthaliensis s-a sublimat în H. sapines, şi că nu a dispărut...

18 aprilie 2015