The term perinatal mental health is generally used to refer to the mental health of women during pregnancy and in the postpartum period (up to 12 months following childbirth). The burden of perinatal mental health is being increasingly recognized, particularly in low- and middle-income countries (LMICs). The prevalence of maternal perinatal depression is estimated to be 7-15% in high-income countries (HICs) and 19-25% in LMICs. Despite this, women are often under-diagnosed and under-treated. Risk factors for perinatal depression include unintended pregnancy, lack of social support, exposure to physical or sexual violence and poverty—factors that disproportionately affect women in the developing world.
Mental health issues faced by fathers around the time of childbirth are a less recognized risk factor for maternal perinatal mental ill health. The estimated prevalence of paternal postpartum depression (PPD) ranges from 1 to 25%. This wide range may be attributed to inconsistent measurement and diagnosis as well as social and cultural factors. Men are less likely than women to seek help for their mental health, as this does not conform to society’s masculine gender norms of self-reliance, emotional silence and inability to display weakness of any kind.
There is a dearth of literature on paternal perinatal mental health, but studies suggest that it can have a large impact on the health and wellbeing of mothers and offspring as well as on fathers themselves. There is a positive correlation between maternal and paternal PPD—maternal PPD is a risk factor for paternal PPD and vice-versa. In view of this, it is perhaps unsurprising that both partners are affected in up to 50% of cases. One study found that male partners of women with postpartum depression expressed feelings related to fear, confusion, frustration, anger, helplessness, uncertainty about the future, disrupted family and financial concerns. In the best of circumstances, mothers usually rely on their partners for emotional support following childbirth. If a mother is suffering from PPD, the need for emotional support increases, and if the partner is also facing depression, their support mechanism may be compromised. In cases where the mother is mentally well but the father is experiencing PPD, the mother’s vulnerability to mental ill-health may be increased.
Parental PPD has been shown to promote marital conflict. Men with depression or anxiety are more likely to be violent towards their partners and are more likely to engage in alcohol and/or drug abuse, which may further perpetuate this cycle. Marital dissatisfaction may not resolve even if mental health improves over time. This has important implications for the general wellbeing of the couple and on the environment in which their offspring develop.
The effects of poor maternal mental health on neonatal and child outcomes are well-documented. These include lower birth weights, increased neonatal intensive care unit admission, earlier cessation of breastfeeding, diminished completion of vaccination program, growth problems and long-term emotional and behavioral effects. Although not as well investigated, studies suggest that poor paternal mental health also influences their offspring’s health outcomes. Research shows increased emotional and behavioral problems in children, such as conduct problems or hyperactivity, and disturbed development of a secure father-child attachment. It is important to consider that in a large number of cases, both parents are experiencing poor mental health and thus the impact on their offspring may be intensified.
Overall, several things are clear:
- Perinatal mental health issues can lead to negative consequences for mothers, fathers and offspring
- Literature on the subject of paternal perinatal mental health is limited and there is inconsistency in methods between existing prevalence studies
- Further research is needed, particularly in LMICs where the burden of paternal perinatal mental health is likely larger when considering the risk factors for perinatal depression described above
- Gender bias related to mental health-seeking behaviour needs to be addressed to help break down barriers for men suffering from poor mental health
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