Postpartum depression (or PPD) is a mental health disorder that occurs during or shortly after a woman gives birth, but can it occur in men? Experts estimate that 10%-14% of mothers experience symptoms of this condition.
Previously, postpartum depression was viewed solely as a disorder that affects new or soon-to-be-new mothers. But new research shows fathers may also be at risk.
What Is Postpartum Depression?
Before we delve too far into the new research about postpartum depression and dads, let’s take a moment to review what, exactly, this condition is and isn’t.
First, it may be a surprise to some people to learn that the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the standard reference book for clinicians in the United States, does not contain an entry for postpartum depression.
Instead, what we commonly refer to as PPD is listed as major depressive disorder with peripartum onset. This specifier means that a person with this condition will develop the following types of symptoms during pregnancy or within four weeks after giving birth:
- Persistent feelings of sadness, emptiness, or hopelessness most of the day for most days
- Lost or diminished interest in most activities, as well as an inability to find joy in these activities
- Significant unintentional weight gain or loss
- Disrupted sleep patterns, which can include either insomnia or hypersomnia
- Observable sense of agitated, restless, or slowed movements
- Continued struggles with low energy and fatigue
- Sense of excessive or inappropriate guilt or worthlessness
- Problems concentrating, focusing, and making decisions
- Recurrent thoughts of death and dying, which may include suicidal ideation
Many people who develop postpartum depression find it extremely difficult to bond with their baby. This can, in turn, exacerbate their feelings of sadness, worthlessness, and guilt.
The DSM-5 also notes that major depressive disorder with peripartum onset can sometimes involve psychotic symptoms. These symptoms, which typically include hallucinations and/or delusions, may include thoughts of killing the child or fears that the child may be possessed.
Is Postpartum Depression Common?
Most experts estimate that PPD affects one in seven to one in 10 new mothers. However, a February 2023 study in the American Journal of Obstetrics and Gynecology reported that the rate of PPD may be much higher than that.
This study, which reviewed health records from Kaiser Permanente Southern California, found the following:
- PPD among women 2010: 9.4%.
- PPD among women 2021: 19.3%
- That’s a relative increase of 105%.
When they categorized the records by the mothers’ race, the researchers found:
- PPD among White women in 2010: 13.5%
- PPD among Black women in 2021: 22%
- PPD among Asian/Pacific Islander women 2010: 3.6%
- PPD among Asian/Pacific Islander women 2021: 13.8%
- That’s the largest relative increase across all demographics, at 280%.
The DSM-5 also contains the following statistics about postpartum depression:
- Postpartum mood disorders with psychotic features occur about once in every 500 to 1,000 births, or 0.1%-0.2% of all births.
- Among women who have had a peripartum episode with psychotic features, the risk of having a similar experience when giving birth again is 30%-50%.
Finally, studies suggest that as many as half of all women with postpartum depression are never diagnosed with this condition.
These statistics indicate that PPD is far from uncommon among women, though cases that involve psychotic symptoms occur far less frequently. But none of these statistics take into account the likelihood that men many also struggle with this condition after their partners have given birth.
Can Men Really Get Postpartum Depression?
As currently defined by the DSM-5, major depressive disorder with peripartum onset can only be diagnosed among individuals who are pregnant or recently gave birth. By definition, this excludes all cisgender men.
So, does that mean that men can’t get postpartum depression? Not quite.
Remember, postpartum depression is not an exact clinical term. This gives us a bit of leeway in terms of who it may or may not apply to.
If you expand the at-risk population from people who have just given birth to the parents of newborn infants – and you then consider the many fears, stresses, and pressures that new parents experience – it’s easier to understand why it makes sense to take a look at depression rates among men whose partners have recently given birth.
This topic garnered some additional attention in September 2023, when the journal BMC Pregnancy and Childbirth published a small study on postpartum depression among men.
Features of this study, conducted by a team from the University of Illinois at Chicago, included the following:
- 24 fathers whose partners or children received care at the UI Health Two-Generation Clinic.
- 2 of the fathers reported previously diagnosis with a mental health condition
- 1 reported use of psychiatric medication
- 5 reported previous engagement with counseling services
- Social workers screened for PPD with the Edinburgh Postnatal Depression Scale (EPDS) at 1 and 15 months after birth
Here are the results:
- 30% met criteria for PPD.
- Previously, experts estimated the prevalence of PPD among fathers at 8%-13%
- Over 31% of mothers at the clinic met criteria for PPD
- Researchers theorize maternal PPD is a risk factor for paternal PPD
Risk Factors for PPD Among Men
The research team noted many fathers feel that they’re “marginalized or excluded” after the birth of their child, which can contribute to elevated stress and a greater likelihood of PPD.
The researchers cited other factors that may contribute to postpartum depression among men, such as:
- Social biases about how fathers interact with newborns
- Lack of paid leave for new fathers
- Scheduling challenges that make it difficult for fathers to attend checkups and other services for their children
- Negative experiences in spaces that are designed to care for new mothers and their children
“A lot of dads are stressed,” the study’s lead author, Dr. Sam Wainwright, said in an Oct. 4 news release about the research. “They’re scared. They’re struggling with balancing work and parental and partner responsibilities.”
These findings align with what Dr. Jonathan Scarff reported in a May 2019 article in the journal Innovations in Clinical Neuroscience:
- Risk factors for postpartum depression among men can include poverty, sleep deprivation, marital discord, maternal depression, and unintended pregnancy.
- Prior studies show some men experience hormonal changes – including decreased testosterone and increased estrogen, cortisol, vasopressin, and prolactin – in the immediate aftermath of their child’s birth.
- Experts theorize hormonal changes help fathers bond with their infants, but may elevate risk for postpartum depression.
- Other studies show men experience high levels of symptoms similar to anxiety disorders and PTSD, but don’t meet diagnostic criteria
- The lack of established criteria for PPD in men, along with a relative dearth of research in this area, may prevent more men from accurate diagnosis and appropriate treatment
“Recognizing and treating paternal PPD can improve quality of life for the father and the family unit and decrease the risk for emotional and behavioral problems in children,” Scarff wrote. “Clinicians are encouraged to screen for depression in fathers, particularly during the first year postpartum, especially if anxiety or risk factors are present.”
Treatment Options for Postpartum Depression in Men
The good news is that postpartum depression is a treatable condition. When men or women with depression after a birth receive effective care, they can learn to manage their symptoms and achieve full recovery.
The following are among the many types of treatment that help men with postpartum depression:
- Cognitive behavioral therapy (CBT)
- Interpersonal psychotherapy (IPT)
- Individual therapy and couples counseling
- Morning light therapy to reset circadian rhythms
- Selective serotonin reuptake inhibitors (SSRIs) and other medications
- Educational sessions to help fathers improve their parenting skills and alleviate related stresses and fears
- Participation in peer support groups for men with PPD
If you or your partner shows symptoms of postpartum depression, don’t ignore them. It’s common to be tired and stressed when you have a newborn at home – but if your symptoms are severe, or last longer than the typical “baby blues,” we encourage you to seek professional support.
Talk to your pediatrician, your family doctor, or another qualified healthcare provider about your symptoms. Completing a thorough assessment and receiving a proper diagnosis can put you on the path toward effective treatment and improved mental health. Don’t let stigma or a lack of awareness prevent you from getting the help you need to be the best father you can be.
Gianna Melendez
Jodie Dahl, CpHT