Part Two of Kathy Morelli's interview with William Courtney, PhD, LCSW, about Paternal Postnatal Depression - Consequences and Support. Part One: Paternal Postnatal Depression - Signs and Causes can be read here.

What are the consequences of men's postpartum depression? How does it affect the children and the family?

Left untreated, we know that postpartum mood disorders often worsen - and they can ruin a man's marriage or his career, and can lead to serious financial problems.

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Probably the biggest problem with men's postpartum depression is not the depression itself, but the fact that too many men try to go it alone - and they don't get treatment. That's the worse thing they can do. Left untreated, we know that postpartum mood disorders often worsen - and they can ruin a man's marriage or his career, and can lead to serious financial problems.

Suicide is the most tragic consequence of depression. In the United States, suicide rates are 4 to 12 times higher for men than women. Three U.S. men kill themselves every hour of every day. And men's depression doesn't just lead to suicide. Men with depression are twice as likely to die from any cause compared to those men who aren't depressed. That's why I call depression "men's silent killer."

Research consistently shows that a father's postpartum depression has a negative and long-term impact on the psychological, social, and behavioral development of his children - especially boys. We see this in children as young as two, all the way through adolescence, and into young adulthood. This remains true, regardless of whether the mother is depressed. If both parents are depressed, the child's development is even more severely disrupted.

The important thing to remember is that all of the negative consequences of men's depression are avoidable. With proper treatment and support, men can fully recover from PPND.

What can a woman do to help her partner get help? Can paternal postnatal depression be treated?

The best way to prevent PPND in men, is to address the potential causes mentioned above before they occur.

So, if a man has a history of depression, he should see a mental health professional before his child is born and anticipate the possibility of depression postpartum.

If he and his partner have a difficult relationship or poor communication, they should see a marriage or couples' counselor before their child is born.

If the father has economic concerns about supporting his family, rather than avoid or put off thinking about this, he should look at his finances and set up a budget ahead of time; this will do a lot to relieve his stress.

Similarly, if he and his partner don't have a lot of social support, they should try to develop and increase their support network before their baby is born.

Here are some other suggestions:

• Attending hospital-sponsored parenting classes, particularly if the father-to-be is anxious about becoming a dad.
• Devising strategies for shared childcare responsibilities. The father, for example, may handle a nighttime feeding by using formula or pumped breast milk.
• Hiring domestic help if it's affordable or asking a family member to baby-sit once a week.
• Understanding that sex lives change with the birth and may not return to normal for a year or more.
• Joining a support group for new fathers or reading about depression on websites such as SadDaddy.com, which includes a screening test for men.

How do societal beliefs about manhood influence men's postpartum mood disorders?

Men were taught as boys to never cry - and often punished when they did. So, it's no surprise that research shows that men are more likely than women to try to hide their depression - which only worsens it. Men are also taught to be tough, self-reliant and never ask for help. This makes it difficult for men to get the support and professional help they need to recover. It also means they have fewer friendships & smaller social networks than women do - which sometimes leaves them without anyone when their partner becomes a full-time mother.

Men with traditional ideas about how men should be are at greater risk of depression - and cope less effectively with it - than less traditional men. What really pains me, is that men often try really hard to adhere to these social conventions about manhood. But the truth is, for a man to admit he's depressed isn't unmanly or admitting defeat; it's admitting there's hope. And, it's taking charge of his life.

Do changing social expectations of fathers contribute to men's postpartum depression?

We're expecting fathers to be more involved in parenting than ever before, but dads are unprepared. While most dads want to be involved, they don't really know what that looks like.

The fact is, most men in the United States had dads who were completely uninvolved in parenting. That leaves new dads uncertain about what to do. That uncertainty can quickly lead to anxiety - and we know that anxiety postpartum often leads to depression.

For many men, being a dad means being the provider - the economic provider. And when they can't do this as well as they think they should, they often feel like they've failed. Their self-worth is based on their net-worth. And if they believe they've failed as the breadwinner, that can quickly lead to anxiety and depression. A recent and very large study found that U.S. fathers who were unemployed were nearly seven times more likely to be depressed.

How do you prepare your childbirth classes for the possibility that it may be the dad who suffers from a postpartum mood disorder? Do you have resources available for those men and families that may face this as part of their post-birth reality? Please share your ideas and thoughts on this topic in our comment section.

About Dr. Courtenay

Dr. Courtenay received his Ph.D. from the University of California at Berkeley and is a Licensed Clinical Social Worker. He has served on the clinical faculty in the Department of Psychiatry at Harvard Medical School and the University of California, San Francisco, Medical School. He is the author of Dying to Be Men (Routledge, 2011). In 2004, he received the "Researcher of The Year" award from the American Psychological Association and the Society for the Psychological Study of Men and Masculinity.

References

Goodman, J. H. (2004). Paternal postpartum depression, its relationship to maternal postpartum depression, and implications for family health. Journal of Advanced Nursing, 45(1), 26-35.

Kim, P. & Swain, J. E. (2007). Sad dads: Paternal postpartum depression. Psychiatry, 4(2), 36-47.

Paulson, J. F. & Bazemore, S. D. (2010). Prenatal and postpartum depression in fathers and its association with maternal depression: A meta-analysis. Journal of the American Medical Association, 303(19), 1961-1969.

Paulson, J.F., Dauber, S. & Leiferman, J.A. (2006). Individual and combined effects of postpartum depression in mothers and fathers on parenting behavior. Pediatrics, 118(2), 659-668.

Paulson, J.F., Keefe, H.A., & Leiferman, J.A. (2009). Early parental depression and child language development. Journal of Child Psychology and Psychiatry. 50(3), 254-262.

Ramchandini, P. G., Stein, A., O'Connor, T. G., Heron, J., Murray, L., & Evans, J. (2008). Depression in men in the postnatal period and later child psychopathology: A population cohort study. Journal of the American Academy of Child & Adolescent Psychiatry, 47(4), 390-398.

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