Men's peripartum mental health: Issues and interventions

What clinicians need to know about diagnosing and treating depression in men.

By Daniel B. Singley, PhD

Most psychologists do not receive training about the transition to fatherhood, so this article provides a brief overview of critical aspects of men’s peripartum mental health. Each section below covers one key mental health factor along with some brief recommendations to consider when working with new fathers. 

Mental Health History

The strongest predictor of men developing peripartum psychopathology is his partner’s own experience of peripartum mental health problems (Paulson & Basemore, 2010), and men who develop peripartum depression tend to experience symptoms such as irritability, self-isolation, overworking, substance use and hopelessness rather than crying or intense sadness (Kim & Swain, 2007).  

Recommendations: 

  • Take a thorough mental health history of both parents. 
  • Educate parents regarding how their mental health status impacts the family system as-a-whole.

Masculinity

Men are socialized to be strong, adventurous and successful (David & Brannon, 1976) rather than nurturing caregivers. Both the father and his partner may simultaneously feel the need to have him more involved with his infant while also putting up barriers to him doing so due to deeply-ingrained gender roles (Pleck, 2010).

Recommendations:

  • Have men read chapters 1 and 8 of "The Masculine Self" (2007) and discuss with the parents how they express difficult emotions.
  • Discuss parents’ expectations about new fathers.

The Parental Alliance

Research shows that maternal and paternal postpartum depression are indirectly linked through pathways of impaired spousal support and reduced relationship satisfaction (Don & Mickelson, 2012), suggesting that new fathers need to give and to receive support from their partners.

Recommendations:

  • Assess the satisfaction and supportiveness of the parents’ relationship using a valid instrument.
  • Brief couples counseling regarding assertive communication, productive conflict resolution and effective co-parenting. 

Social Supports

Both parents need to nurture their sources of support to buffer the stresses of new parenthood (Crnic et al., 1983). However, new fathers are often largely focused on the mother and baby even to the exclusion of activities with others which they typically find energizing. 

Recommendations:

  • Explain the need to actively have a “diversified social support portfolio” during times of stress.
  • Encourage new fathers and mothers to seek social support from friends and family.

Efficacy

Parenting self-efficacy is defined as “beliefs or judgments a parent holds of their capabilities to organize and execute a set of tasks related to parenting a child.” (Montigny & Lacharite, 2005 – p. 387). 

Confidence in the ability to perform infant care tasks is directly related to a parent’s satisfaction with a parenting role, so fathers with low self-efficacy are less likely to undertake these tasks (Elek et al., 2003). A mother’s “other-efficacy” regarding the father’s parenting ability can result in “gatekeeping” behavior which deprives fathers of newborns with the much-needed practice and connection they need to feel more confident and bond with the baby.

Recommendations:

  • Assess the extent to which both parents feel confident in caring for their baby along with their sense of each others' competence in doing so.
  • Encourage expectant fathers to practice caregiving activities such as bathing, diapering, swaddling, soothing and feeding an infant prior to the birth. 
  • Give the father the opportunity to be alone with and caring for the baby as soon as possible. In the words of one midwife: “Moms should do the nursing, and dads should do everything else.” 

Father Involvement

Children whose fathers are highly involved with them — even from birth — have been shown to be more emotionally secure, confident in exploring their environment and to have better social —relationships with peers during childhood (Parke, 1996; Yeung, Duncan, & Hill, 2000).

Recommendations:

  • Clarify to both parents that fathers are able to handle every aspect of caring for their infant except nursing.
  • Encourage the father to talk with other new dads about caring for an infant.
  • Give both parents a clear understanding of how the father’s direct involvement with his baby impacts the child’s subsequent social, emotional, intellectual and academic functioning. 

The information presented here regarding psychological considerations in men’s transition to fatherhood is by no means comprehensive, but rather is intended to give mental health practitioners a clear list of social cognitive factors which research and theory have shown to be important when working with men and couples in the peripartum period. 

References

Bandura, A. (1997). Self-efficacy: The exercise of control. Macmillan.

Cowan, C. P., & Cowan, P. A. (2000). When partners become parents: The big life change for couples. Lawrence Erlbaum Associates Publishers.

Crnic, K. A., Greenberg, M. T., Ragozin, A. S., Robinson, N. M., & Basham, R. B. (1983). Effects of stress and social support on mothers and premature and full-term infants. Child development, 209-217.

David, D. S., & Brannon, R. (Eds.). (1976). The forty-nine percent majority: The male sex role. Addison Wesley Publishing Company.

Don, B. P., & Mickelson, K. D. (2012). Paternal postpartum depression: The role of maternal postpartum depression, spousal support, and relationship satisfaction. Couple and Family Psychology: Research and Practice, 1(4), 323.

Elek, S. M., Hudson, D. B., & Bouffard, C. (2003). Marital and parenting satisfaction and infant care self-efficacy during the transition to parenthood: The effect of infant sex. Issues in Comprehensive Pediatric Nursing, 26(1), 45-57.

Froman, R. D., & Owen, S. V. (1990). Mothers' and nurses' perceptions of infant care skills. Research in nursing & health, 13(4), 247-253.

Kilmartin, Christopher T.  (2007) The masculine self. Macmillan Publishing Co.

Kim, P., & Swain, J. E. (2007). Sad dads: Paternal postpartum depression. Psychiatry (Edgmont), 4(2), 35.

Montigny, F., & Lacharité, C. (2005). Perceived parental efficacy: Concept analysis. Journal of Advanced Nursing, 49(4), 387-396.

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

Parke, R. D. (1996). Fatherhood. Harvard University Press.

Pleck, J. H. (2010). Paternal involvement: Revised conceptualization and theoretical linkages with child outcomes. The role of the father in child development. 58-93.

Yeung, W. J., Duncan, G. J., & Hill, M. S. (2000). Putting fathers back in the picture: Parental activities and children's adult outcomes. Marriage & family review, 29(2-3), 97-113.