Why diagnose and treat?
Why is it important to diagnose and treat men with postpartum depression? There are significant consequences to paternal depression in the postpartum period. It not only negatively impacts the father’s sense of well-being, but it also interferes with his care of and bonding with his child. In addition, it puts significant stress on the family unit. Unsurprisingly, paternal PPD has also been associated with increased risk of emotional and behavioral problems in children and later psychopathology.
A large family study of U.S. children and their families found that paternal PPD was linked to decreased paternal engagement in positive enrichment activities such as reading (Pediatrics 2006; 118:659-68). Ramchandi and colleagues found that fathers who were depressed both prenatally and during the postpartum period were more likely to have children with emotional and conduct disorders, hyperactivity, and social problems at both 3.5 and 7 years of age (J Am Acad Child Adolesc Psychiatry 2008; 47:390-8). Interestingly, this effect was more pronounced in boys.
How can we engage men in seeking help and getting support for their needs as fathers? Multiple points of contact with an expecting or new father may allow for implementation of screening, prevention, education, and referral/treatment measures. For example, if a father-to-be is encountered in a primary care setting or a specialty clinic, he could be assessed for risk factors (table 1), screened using a depression questionnaire (table 2), and engaged in a conversation about potential symptomatology of depression (table 3).
Since one of the most striking predictors of depression in new fathers is maternal PPD in their partners, new fathers whose wives screen positive for PPD should also be screened for depression. Fathers could also be screened in clinics where they bring their newborn for checkup or treatment.