Wednesday, May 19, 2010

'Baby Blues' Can K.O. Fathers – Not Just Moms

For a significant number of fathers, the birth of a baby is followed by a plunge into depression, according to new research that challenges the medical dogma that the "baby blues" or postpartum depression solely afflicts new moms.

A study appearing in today’s Journal of the American Medical Association found that large numbers of men DO suffer from post-natal depression and their feelings can be just as debilitating as women’s.

Maternal prenatal and postpartum depression is a well accepted phenomena, but the prevalence, risk factors and effects of depression among new fathers is not well understood, and has received little attention from researchers and clinicians, according to background information in the article.

James F. Paulson, of the Eastern Virginia Medical School, Norfolk, Va., and co-author Sharnail D. Bazemore, M.S., of the Eastern Virginia Medical School, conducted a study that documented depression in fathers between the first trimester and the first postpartum year, and identified 43 studies involving 28,004 participants for inclusion in the analysis.

In a paper published in the May 19 issue of the JAMA the researchers report:

– About 10 percent of fathers experience depression between the first trimester of their wives pregnancies and the first year after the birth, compared to only about 4.8 percent of men in the general population.
– Men were most likely to become depressed in the first three to six months after the baby's birth, when the rate was 25.6 percent.
– U.S, men are more likely than those in other countries to experience depression. The rate is 14.1 percent in the United States, compared to 8.2 percent internationally.

Estimates of how many women suffer from the condition range from 10 to 20 per cent, although it is feared that the true figure could be even higher because many women suffer in silence.

Typical symptoms include feelings of helplessness or extreme anxiety about their child. Women also often describe feelings of guilt that they do not love their child enough.

But the condition is highly variable and can range from mild depression to thoughts of suicide.

While clinicians and researchers talk a lot about the very serious effects depression can have on women and their families while they're carrying a baby and in the postpartum period, there's little understanding on the impact of fathers who struggle with depression, the report explains.

Even less is understood about why fathers struggle with depression after the birth of a child. Researchers think the reasons are similar to why mothers get depressed – financial stress and sleep deprivation among others. It is believed that while men do not undergo the physical changes of pregnancy and labor, the upheaval caused by a new baby or by feelings of apprehension towards fatherhood can contribute to the development of depression.

But there may be other issues particular to dads, just as mothers have their own concerns, including hormonal changes.

It has long been believed that depression in new mothers is due to hormonal changes, says study co-author Paulson, who is a clinical psychologist and associate professor of pediatrics.

"If you put 100 per cent of your chips on that bet, then really, there's nothing left that you would expect with dads. If moms are getting depressed because of hormone changes, why would dads get depressed? They don't go through the same hormone changes – they don't have to be pregnant, they don't have to deliver the baby. That bias has had a lot do with what people think," Paulson says.

"The fact of the matter is that the evidence of hormone theories and pre- and post-natal depression is pretty inconsistent, and it's not as strong as the evidence on psychosocial factors – things like changes in the relationship, financial stress, social support and social stress, which are reasonable things to expect to affect fathers."

Other studies have found that men's hormones do also change, both late in a partner's pregnancy and during the first three months after the child's birth. Those hormonal changes include decreases in testosterone and increases in levels of estrogen, says Will Courtenay, a California psychotherapist and founder of a website and online forum for men experiencing postpartum depression.

Scientific theory is that the change in men’s hormone levels is evolutionary, to make them more nurturing to their off-spring.

Studies have shown that post-natal depression in new mothers can affect their child’s development.

Babies are less likely to bond as closely, and more likely to be withdrawn or demanding, if their mother has the condition.

Recent studies have also found that post-natal depression in new fathers can have long-term psychological consequences for their children.

The babies of depressed men were twice as likely to suffer from behavioral problems, including hyperactivity, as they grew older as those whose fathers are not depressed.

Until now, research into postpartum depression in men has been scattered and inconsistent. For their analysis, the Virginia researchers pulled every article they could find that reasonably documented the phenomenon. They included studies that looked at depression in dads between the first trimester of pregnancy, through to the first year after the baby was delivered.

Across all time points, the overall rate of depression was 10.4 per cent – twice the rate of depression among men in the general population. "This isn't something that's just a fluke. This is a significant problem," Paulson says.

In terms of timing, fathers experienced the highest rates of depression – 25.6 per cent – when their babies were three to six months old, according to the study.

That needs to be interpreted cautiously, because it's based on only three studies. But sleep deprivation is one of the major causes of postpartum depression, in both women and men, and sleep deprivation is cumulative.

By the time babies are three months old, "the bloke's gone back to work, he's probably disrupted, he's probably not getting a lot of sleep, he's probably got competing priorities, things are shifting," says John Oliffe, an associate professor in the school of nursing at the University of British Columbia.

"Just disrupting that – for want of a better term – 'type A' fellow, it can be enough to push someone into a different space, and get them feeling down."

Oliffe suspects the true rate in men is likely higher than 10 per cent. "There are a lot of guys who don't get diagnosed with depression, who don't necessarily participate in studies, or necessarily arrive at clinical practice to suggest that they might be feeling blue," he says.

The findings indicate a "significant public health concern" that a lot of doctors may be overlooking, researchers said. Further, depression can affect the entire family and the fact that fathers were likely to be depressed when mothers were, points to the need for screening both moms and dads for the blues, the study states.

The authors write:

The observation that expecting and new fathers disproportionately experience depression suggests that more efforts should be made to improve screening and referral, particularly in light of the mounting evidence that early paternal depression may have substantial emotional, behavioral, and developmental effects on children. The correlation between paternal and maternal depression also suggests a screening rubric—depression in one parent should prompt clinical attention to the other. Likewise, prevention and intervention efforts for depression in parents might be focused on the couple and family rather than the individual.

— The Curator

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