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FATHERS and Postnatal Depression

FATHERS and Postnatal Depression. Dr Ian Harrison Perinatal and Infant Psychiatrist, Karitane October 2010. Fathers: A neglected group in postnatal research. Why? Traditional tendency in research to focus on mothers. Most children in single parent households live with their mother.

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FATHERS and Postnatal Depression

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  1. FATHERS and Postnatal Depression Dr Ian Harrison Perinatal and Infant Psychiatrist, Karitane October 2010

  2. Fathers: A neglected group in postnatal research. • Why? • Traditional tendency in research to focus on mothers. • Most children in single parent households live with their mother. • Mother’s are frequently responsible for caregiving in first few years of life. • More accessible to researchers.

  3. The Perinatal Period • Stressful – physiologically, psychologically, socially. • Some clients are already vulnerable. • Psychological conditions/illnesses: • can be exacerbated • may have an increased risk of onset • some may even be unique to this period (PND)?

  4. Trends • maternal/paternal age means greater chance of prior treatment of a psychological illness. • treatment of depression generally in women/men of childbearing years. • detection of depression via “screening” programs (antenatally and postnatally).

  5. All babies arise out of a “relationship” • Good or bad • Long or short • Happy or abusive • Baby may be the culmination of everything good about a relationship. • Or the embodiment of everything that went wrong, the turning away, the dashing of hopes.

  6. Studies of PND in men • Very few studies conducted

  7. Rates of PND in Men • Typically the figure for PND in women is 13% • The figures for men are: • 10% at 6 weeks and • 5% at 6 months post-natally.

  8. Risk Factors for Men? • Similar, rather than different, to women (Deater-Deckard et al Am. J. Psych.1998) n=7018 • 1. Unemployment • 2. Conflicted, unhappy marital relationship • 3. Reduced social support and interaction from family and friends • 4. Family structure: Traditional 3%, stepfather 6.8%, stepmother 7.3%, single mother 5.1%. • 5. Maternal postnatal depression

  9. Risk Factors for Stepfathers (Deater- Deckard 1998) • 1. Maternal postnatal depression • 2. Less education • 3. More stressful Life Events • 4. Less social support • 5. Smaller social networks • 6. More aggression in their partnerships. • (i.e. same as for women with PND)

  10. Father’s and Mother’s PND is closely correlated • Mother’s PND is the strongest predictor • WHY? • Each partner’s psychological state influences the other? Living with a depressed person has a depressing effect? • Common causal factors outside the family may effect each partner similarly? • Men and women who are more vulnerable to depression are more likely to form relationships with each other?

  11. Matthey, Barnett et al (2000) • n=157 20 wks pregnant, and • 6, 24 and 52 weeks postnatally • Prenatally: Women 12.3% Men 5.3% • 6 weeks: Women 7.7% Men 2.8% • 24 weeks: Women 9.7% Men 3.2% • 52 weeks Women 12.4% Men 4.7% • 36% of high scoring mothers had high scoring partners at 6 weeks • 53% at 52 weeks.

  12. First-Time Fathers Study • Condon, Boyce, Corkindale (ANZJ Psych 2005) n=312 • Highest level of symptoms in pregnancy with small improvement at 3 months. • Lack of change across the postnatal period. • Problems with sexual relationship and increasing deterioration in the relationship, sleep, job satisfaction, recreation and weight gain.

  13. Paternal Depression and Child Development. • Ramchandani et al (Lancet 2005) • N= 12,884 • Assessed at 8 weeks postnatal and 21 months postnatal. • Paternal depression was associated with conduct problems in boys at 3.5 years. • Women >12 EPDS… 10%, Men >12… 4%

  14. “The Big Build” - Men and Depression • Brownhill, Wilhelm et al(2005) • Acting in • “Avoiding it” • “Numbing it” • “Escaping it” • Acting out • “Escaping it” • “Hating Me, Hurting You” • “Stepping over the Line”

  15. “The Big Build” - Men and depression • Avoiding it: (Avoidant Behaviour) • Over involvement with work • Sickness absence • Out with the boys/sport, etc • Numbing it: (Self-Medication) • Cannabis use • Watching TV • Self medication, etc

  16. “The Big Build” - Men and depression • Escaping it: (Escape Behaviour) • Alcohol • Gambling • Sexual affairs/encounters • Binge drinking • Dangerous drugs

  17. “The Big Build” - Men and depression • Hating Me, Hurting You: (Aggression towards self and others) • Negative effect on mental health of partners • Domestic violence • Antisocial Behaviour • Anger and violence towards others e.g. Road rage • Hurt/pain Anger/rage

  18. “The Big Build” - Men and depression • Stepping Over the Line: (Deliberate Self- harm) • Suicidal ideation/attempt • Deliberate Self-harm

  19. Stepping over the Line Hating Me, Hurting You Escaping “it” Numbing “it” Avoiding “it” “The Big Build” - Men and depression Acting Out Self Harm Acting In Aggression, Violence, Crime Risk Taking Drugs/Alcohol Overwork

  20. Effects of PND on Fathers. • No systematic research on this topic • Handbook of Infant Mental Health says: • “No studies have focused on father’s internal experiences during postpartum depression.” • “Feelings of exclusion from the initial bonding process.” • “Inadequacy regarding care-giving and distractibility at the workplace.”

  21. Effects of PND on Fathers. • Gavin (2002) • “Fathers involvement with the infant during the first 2 months after birth was strongly predicted by the quality of the marital relationship and by the father’s relationship with the maternal grandmother.” • “Women are the gatekeepers of the nursery and fathers need acceptance and support from them to become actors in the infant’s care.” • No systematic research on this topic.

  22. Groups for Men whose partners have PND • E. Andrees and B. Hunt (1998) • Mothers are usually the declared patients/clients. What about the Fathers? • He’s: • “Showing little interest or support despite looking forward to having the baby.” • “Managing to sleep through the crying baby or impatient and angry is she can’t ‘stop it’.” • “Working long hours and when at home he is exhausted, irritated and stressed.”

  23. Groups for Men whose partners have PND. • He’s: • “Unwilling or unable to communicate, watches TV and generally withdraws in some way or perhaps more dysfunctionally withdraws by using pot or alcohol.” • “Taking on excessive work or sport commitments.” • “Becoming violent or ‘abandoning’, which is then more difficult to ignore.”

  24. Groups for Men whose partners have PND • Men are difficult to engage in any therapies. • In describing their situation with maternal PND, the men felt they were: (Andrees, Hunt 1999) • Walking on eggshells. • Keeping the peace. • Partners seen as irrational, unreasonable and unpredictable. • “Everything was alright before ‘the birth’.”

  25. Men whose partners have PND • The unconscious is a poor discriminator of • Person • Time • “The Return of the Repressed” • Is the new mother the “old” abandoning mother? • Are they like the “old” father who is now abandoning their infant or toddler to the mother?

  26. Men whose partners have PND • Unfamiliar roles and tasks • Bread-winner • Cook/Cleaner • Father • “The lot!” • Impact on the relationship (“We just seem to snarl at each other when we talk.”) • “I’m on a roller coaster!” • “I just fell into a heap as well!”

  27. “Men Too Live With PND” • “She’s not the same person anymore.” • “Nothing I do makes any difference. Everything is falling apart.” • “I feel shut out. I feel angry and cheated.” • “Was it my fault in some way?”

  28. Men whose partners have PND • What kind of treatment does he want for his wife? • Does he believe in “PND”? • “All women go through this. It’s a natural part of motherhood.” (i.e. minimiser) • “No woman should ever feel like this about herself or her babies!” (maximiser) • Will his wife become a, “pill popper”? Perhaps like his mother?

  29. Men whose partners have PND • Is he horrified? • Will he be excessively encouraging his partner to take antidepressant medication?

  30. What can we do? • Education: handouts, websites with information • Support and Encouragement: • Advice: Especially regarding communication issues. • Make time to talk • Listen and Validate • Take time out together • Know how to ask for help (no mind reading) • Know how to respond with thanks/praise

  31. What can we do? • “Pitfalls to Avoid” (From TIWIE) • Pretending it isn’t happening. • Criticising or judging her. • Blaming her or someone else for the depression. • Smothering her or overreacting. • Becoming overly preoccupied with why she is feeling what she is feeling instead of accepting her feelings.

  32. The End Thank You

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