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Paternal Post Natal Depression With Grainne Ryan

Tuesday, 27 January 2009

Today Grainne Ryan is in studio to talk about Paternal Post Natal Depression.

Grainne Ryan:
Presenter of Baby on Board Series 2. Grainne is a public health nurse and midwife and mother of three children. Areas of interest child development, parenting issues, adolescent development and post natal depression and works as a public health nurse in Ennis Co. Clare.

What is "male post-natal depression"?
Remember seeing your baby for the first time? You were probably filled with pride and excitement. That's what you always heard it was like having a child - pure joy. Baby bliss.

Then, reality sets in. Sleepless nights. A screaming infant needing nearly constant care. Fights with your partner. Going to work exhausted.

Then, over time, you've noticed things have gotten worse.
Now, you've lost your sense of humor, and there's not much to look forward to. You've started getting more anxious or panicky. You've had trouble sleeping. And you're miserable a lot of the time.

Or perhaps you've been irritable. You're getting more stressed at work and getting angry with your wife. Maybe you've noticed you're drinking more - or withdrawing from people.

These are all signs of men's depression. You may think you should just "get over it" -and that you must be the only guy who can't. But you're not the only one.

What are the symptoms?
. Tiredness, headaches and pain
. Irritability, anxiety and anger
. Loss of libido
. Changes in appetite
. Feelings of being overwhelmed, out of control and unable to cope
. Engaging in risk taking behaviour
. Feelings of isolation and disconnection from partner, friends or family
. Withdrawal from intimate relationships and from family, friends and community life
. Increased hours of work as a part of the withdrawal from family etc
. Increased use of drugs or alcohol instead of seeking treatment for depression
. Some fathers describe their experience of PND as being trapped, almost like pacing a cage, of feeling extremely alone in their situation and not knowing how to get out of it
. Other fathers experience PND as being overcome with anger and rage. They feel angry at their partners, children or other family members.
. Some are overwhelmed by feelings of hopelessness and helplessness that their lives and sense of self may never return to normal.
. Some fathers feel disappointed by their experience of fatherhood and that they have failed in their role as a father and they have let themselves, their children or partners down. They may feel that fatherhood has not been what they expected and feel let down.

Are men likely to talk about it?
Men by their nature are not likely to talk about their feelings while women tend to talk more freely. Women in general have better network supports in friends, family, midwife, public health nurse.

Have there been any studies on this? What do we know about this clinically?
There have been some studies in UK, Australia and America
They studied the records of over 8,000 fathers and found that two months after the birth, over 300 appeared to be suffering with depression. Symptoms included mood swings, feelings of hopelessness and anxiety.

They then looked at the children of all the fathers, when they had reached the age of three-and-a-half, to see if they had developed any emotional and/or behavioural problems.

They found that children whose fathers had suffered postnatal depression, were at an increased risk of behavioural problems between the ages of three and five. This was irrespective of other factors which may have influenced the results, including whether the mother had been depressed also.

Furthermore young boys in particular seem to more susceptible to 'conduct problems' if their father had postnatal depression, compared to young girls.

The influence of fathers during early childhood has probably been underestimated in the past, the researchers said. However these findings indicate that postnatal depression in fathers has a 'specific and persisting impact' on children's early behavioural and emotional development.
Another study found that 7% of men were suffering from depression after the birth of their child (average for men 3.75 -4%).

What are the causes - is it that the father feels pressure to be the "perfect father"?
Male post natal depression sometimes occurs as a reaction when a man's female partner is suffering from post natal depression. Many men have claimed that coping with their partner's depression leaves them feeling overwhelmed, isolated, and stigmatized.

Another reason for male post natal depression is that many men find it difficult to cope with the birth of a child. The new addition to the family can be stressful, especially if the male has to work during the day and cope with the child at night. This type of male post natal depression is independent from female depression. While female post natal depression is thought to be hormonal, the male condition is considered more physical.

As with all forms of depression there are a range of bio-psycho-social factors that contribute to the development of paternal postnatal depression, some physical, some emotional and some social. Some factors are the same as those that contribute to women experiencing antenatal and postnatal depression and others are related to the man's experience of pregnancy and new fatherhood.

Factors that effect men which are similar to those effecting women include:
. lack of social and emotional support
. personality characteristics
. stress and changes in relationships (particularly the couple relationship)
. lack of sleep
. loss and grief issues
. difficulty adjusting to the changes associated to the transition to parenthood
. unmet prenatal expectations
. negative or traumatic birth experience - the way in which men experience childbirth

Factors that generally relate to the man's experience:
. the impact of changing social roles for fathers in the family
. norms and attitudes toward fatherhood and masculinity -men are less likely to talk about how they feel and maintaining that they are coping is very important
. change in family dynamics so that some men may feel excluded from the parenting role or from the relationship with their partner. This may result in resentment towards the baby.
. worries about extra responsibilities, financial burdens and managing the stresses of work
. unmet expectations for the resumption of the sexual relationship in the early postnatal period
. pregnancy, particularly early on, appears to be the most stressful period for men in the transition to fatherhood. This may be due to changes to his partner's body, how supported and included he feels, concern about the pending changes to his life and feeling unsure about his role in caring for his partner.
. Some men experience postnatal depression in conjunction with their partner's depression.

Studies have shown that maternal and paternal depression are highly correlated (Ramchandani et al, 2005; Meighan et al, 1999). Men report experiencing their partner's PND as causing disruption in their lives and their relationship with their partners. They experience fear, confusion and a sense of helplessness that they are unable to help their partners overcome their depression

. Partner experiencing PND
. Previous history of depression
. Marital problems
. Low self-esteem
. Feelings of incompetence in parenting role
. First time father
. Infant irritability

Paternal PND would appear to be still unrecognized in psychiatric diagnostic literature

To what extent does the new financial pressure impact on the new father?
Historically men were seen as the providers, today with equal opportunities, both parents working you would think that the financial pressures are shared but I feel dads by there very nature want to provide for their family, are responsible and this added pressure may impact on new fathers feelings.

Is it that the father sometimes feels a sense of exclusion - that the mother is now focussed on the child - the dynamic has changed?
Mums do tend to focus on the child especially if they are breast feeding but dads are very good at winding, dressing bathing etc, so it is important to involve in the care of the new baby. Sometimes it may be easier to "do it yourself" rather than watch dad struggling to bath or change a nappy but with time he will become proficient. Girls often have had the advantage of playing with 'tiny tears' as a child and will have learned some skills. Visitors call and ask about mum and baby and dad may be sidelined. Also dads would say to me that when they return to work they find it quiet difficult to adjust to leaving the baby at home - Do we ever think of that

Some men say they feel lonely when the new baby comes on the scene, and if so, why?
There is a whole change in the relationship, the baby now becomes the centre of attention and depending on Dads personality, if mum was a doer and did everything for dad before the birth, or if dad totally relied on mum for friendship (dependent) he is going to find it a lonely place as mothers by their nature will want to nurture this baby and will spend a good part of the doing this and sleeping for the rest of the time.. This does improve but may will never be as it was before the baby arrived.

Because of the huge physical change that the mother undergoes for nine months prior to the birth, is it that she a bit better prepared for it whereas for many fathers birth comes as a shock
- change is overnight?
The key here is good antenatal education, anticipation of the changes that will happen when new baby comes home
Sleepless nights/days, routine all out of zync, Elation after birth coupled with reality of the responsibility of a new baby - all these are normal reactions but it is generally women who talk about this.

The issue of bonding with the child can be stressful for the father - worrying if they won't bond?
Sometimes dads do worry about bonding, but little hints like skin to skin time with dad, winding time/ settling time all help. Also taking baby out in the stroller while mum is catching up on sleep. Sometimes dads tell me they feel awkward handling such a tiny person but with plenty of practice and encouragement they will become old hat in no time.

As a public health nurse, does your work involve fathers, and if so to what extent?
As a PHN my would involve working with fathers, initially in ante natal classes, dads are very involved in the classes, and would be very interactive asking about pregnancy, labour and taking baby home. When mum and baby go home from hospital I would visit their homes and dad are very hands on now, asking about, heel test, feeding etc. However the work would be mainly around mum and baby. Dads tend to be present for many of the development checks and often it would be dads who ring me up with concerns about mum and baby.