Maternal postpartum depression (PPD) is a widely studied and discussed phenomenon, whereas much less is known about the concept of paternal PPD. Nonetheless, recent studies have indicated that depression in new fathers is a significant public health concern.
A 2010 meta-analysis in JAMA (2010; 303:1961-9) calculated the overall rate of paternal depression in the prenatal and postpartum period to be 10.4%, with the U.S. rate higher at 14%. Considering that the estimated rate of depression in the general population for men in this age group is lower at 4.8% (JAMA 2003; 289:3095-105), this period poses a substantially increased risk for developing depression in men, just as it does in women. Even though men are at risk for up to a year after their child is born, data suggest that the rate of depression peaks between the 3- and 6-month postpartum period.
Why the marked increase in depression? The causes are likely multifactorial, including personal or family predisposition to depression, shifting family dynamics, adjustment to parenthood, lack of sleep, and even hormonal changes. While it may be self-evident that hormonal changes occur in pregnant, peripartum, and lactating women, changes also happen (but are far less studied) in men. For example, studies have found that men experience a significant decrease in testosterone levels while their wives are pregnant (Am J Hum Biol 2015; 27:317-25), and this effect could extend to the postnatal period (Evol Hum Behav 2000; 21:79-95).
Changes in the levels of other hormones, including estrogen, vasopressin, and prolactin, have also been noted. While these changes likely reflect adaptive shifts to fatherhood by facilitating the father’s focus toward caregiving and nurturing, these fluctuations also likely increase men’s susceptibility to depression during this period.
Postpartum depression in men could have a more insidious onset than it does in women. Even though men experience traditional symptoms of depression like sad mood, decreased interest level, decreased energy and concentration, sleep problems, guilt, and even suicidal thoughts, they may be reluctant to endorse these in conversations with their health care team or in self-report questionnaires. Rather, men may present with less obvious symptoms like avoidance, withdrawal from social activities, cynicism, anger outbursts, irritability, and self-criticism (Psychiatry [Edgmont] 2007; 4:35-47). They may also mask their emotional pain by overworking, over-exercising, or changing their sexual behavior (Professional Psychology: Research and Practice 2003; 34:132-40).
In fact, a study suggests that men are more likely to endorse anger attacks and aggressiveness, lower stress threshold, burnout, affective rigidity, self-criticism, and alcohol and drug abuse (JAMA Psychiatry 2013; 70:1100-6). Relying only on the disclosure of traditional symptoms of depression could lead to a missed diagnosis of depression.