Fathers Suffer, Too: The Reality of Perinatal Mental Health

I would bet all the money in the world that he had postpartum anxiety, and nobody told him that he was at risk for developing it. Nobody ever expressed to him that fathers get it, too. Nobody ever even did a screening on him.

This quote comes from a woman who courageously shared her postpartum journey as part of our ongoing study on perinatal mood and anxiety disorders (PMADs), conducted in collaboration with our nonprofit research organization, Nested, and our research team at New York University. With the consent of all caregivers quoted in this piece, we bring you their powerful narratives. A striking theme emerging from her interview, echoed by many others, is the significant impact of PMADs on fathers.

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What are PMADs?

PMADs are a group of mental health conditions that can affect individuals during pregnancy and the first year postpartum.

One of the biggest misconceptions around perinatal mental health is that struggles only show up as depression or anxiety. The conversation is shifting toward PMADs to include a wider scope of possible symptoms, from intrusive, repetitive thoughts about the baby to compulsive behaviors, to hypervigilance about the baby’s safety, to flashbacks or nightmares of a traumatic event related to childbirth.

Focusing on PMADs rather than just on postpartum depression or anxiety recognizes that symptoms can show up in different ways for different people. The word “perinatal” instead of “postpartum” also underscores how the timing of symptoms may not be limited to after the arrival of a baby.

How prevalent are PMADs among fathers?

While PMADs have traditionally been associated with birthing parents, research increasingly reveals that fathers and nonbirthing parents are also vulnerable to these disorders. The prevalence of PMADs among fathers and nonbirthing parents has historically been underestimated and understudied. However, recent research has shed light on the significant impact of these disorders on this population. With approximately 10 percent of fathers experiencing postpartum depression and up to 18 percent of fathers developing anxiety disorders postpartum, it’s crucial to recognize and address PMADs in fathers and nonbirthing parents. Very little is known about other PMADs among fathers beyond anxiety and depression—a gap that we are pushing to address.

Our research is digging even deeper. Among fathers who experience PMADs, almost none are formally diagnosed, according to our preliminary findings. Getting support with a diagnosis is hard enough. Without it, dads are left with nowhere to turn.

Why isn’t anyone telling expecting parents what’s coming?

Despite knowing just how prevalent PMADs can be, one of our interview participants noted “and even with all of the research that I had done, about postpartum depression and anxiety, we were not educated or prepared to deal with it [for my husband].”

Another mom echoed her frustration:

Is it frustrating it was never diagnosed for him? Yes. But not a single medical professional warned him that it could happen to him, too. Nobody talked to him like he was involved in the process because the baby wasn't coming out of his body. Nobody told him that there are chemical changes that happen in dad's brains when they become fathers. Nobody told him there are physiological changes that happen to him. Nobody talked about what his health would do or how it would change once I gave birth. And that's wild to me because we have proof.

It's an asteroid coming to Earth, and you call the people in the building that the asteroid is going to hit. "Hey, guys, just so you know, the asteroid is going to hit you," but you don't bother to call any of the neighbors.

Speaking more about prenatal care, another woman said,

I think one of the things missing in the beginning is how...Everything talks about the baby and less about you and your partner. And so there's no... that I noticed, real like, "What do you both need after? What is your care?"

It’s crucial to recognize and support nonbirthing parents’ mental health, too. The entire family dynamic is impacted when any single member is struggling. As one mother in our study, who experienced difficulty in her relationship postpartum, said,

that would have made such a big difference for us… having it be public knowledge that dads can be impacted by postpartum depression and anxiety, too. I know toxic masculinity, the former, has run its course and people roll their eyes at it now, but I think that's definitely a part of it as well.

She described her husband's feelings of isolation and anxiety and difficulty relating to their infant.

Several psychological theories and studies have attempted to explain the development of PMADs in fathers and nonbirthing parents. The stress-vulnerability model, a prominent framework for understanding mental health disorders, suggests that PMADs arise from an interaction between individual vulnerabilities and environmental stressors. Biological factors, such as hormonal changes and sleep deprivation, can contribute to vulnerability to PMADs. Psychological factors, including a history of mental health issues, anxiety, and low self-esteem, can also increase risk. Social factors, such as relationship difficulties, financial strain, and lack of social support, can further exacerbate vulnerability.

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Empirical studies have provided evidence for the stress-vulnerability model in the context of PMADs among fathers and nonbirthing parents. For example, a study published in the Journal of Affective Disorders in 2018 found that fathers with higher levels of stress and lower levels of social support were more likely to experience PMAD.

Attachment theory, another relevant framework, suggests that PMADs in fathers and nonbirthing parents may be influenced by their attachment styles and experiences. Insecure attachment patterns, characterized by anxiety or avoidance in relationships, may increase the risk of developing PMADs.

Cognitive-behavioral theory highlights the role of negative thoughts and beliefs in the development and maintenance of PMADs. Fathers and nonbirthing parents with negative self-perceptions or unrealistic expectations about parenthood may be more susceptible to these disorders.

As we have found in our work, PMADs in fathers and nonbirthing parents can have far-reaching implications for families and society. Untreated PMADs can negatively impact parent-child relationships, leading to difficulties in bonding, emotional regulation, and behavioral development in children. Furthermore, PMADs can strain partner relationships, resulting in decreased intimacy, communication problems, and increased conflict. These challenges can contribute to marital dissatisfaction and, in some cases, relationship breakdown.

One of our participants' experience highlights the impact of a nonbirthing parent’s experience with PMADs on the whole family:

During the day, I travel for work as a consultant. So once I started traveling again, if he [her husband] was the only person home with her [the baby], he couldn't do things for his own self-care unless our babysitter was there to give her direct attention to our baby…he couldn't shower and get ready for work until there was somebody in the house watching the baby. He couldn't put her in the bath and in her pack and play or whatever, knowing that she's safe in that container and she's immobile.

The broader societal implications of PMADs in fathers and nonbirthing parents are also significant. These disorders can lead to decreased work productivity, increased absenteeism, and economic burden. Moreover, untreated PMADs can perpetuate a cycle of mental health challenges in families, potentially affecting future generations.

What can we do about PMADs, specifically among fathers and nonbirthing parents?

Effective interventions may include individual therapy, couples counseling, support groups, and medication. Therapies like cognitive-behavioral therapy (CBT) can help individuals identify and challenge negative thoughts and beliefs, develop coping skills, and improve emotional regulation. Couples counseling can facilitate communication, strengthen relationships, and address parenting challenges collaboratively.

Support groups provide a safe space for fathers and nonbirthing parents to share their experiences, connect with others facing similar challenges, and receive validation and encouragement.

Emerging technologies, from messaging-based therapists to telehealth, also have the potential to make support more widespread and accessible. For new parents who may struggle to even leave the house with a newborn, this flexibility can mean the difference between getting support and being too overwhelmed to even find an in-person support group or therapist.

In some cases, medication may be necessary to manage symptoms of PMADs, particularly when combined with therapy.

“I didn’t even know that dads could get postpartum depression.”

I can’t underscore this enough: PMADs are not exclusive to birthing mothers; they can significantly impact fathers and nonbirthing parents as well. One of the most common reactions our research team has gotten to our study has been, “I didn’t even know that dads could get postpartum depression.” Increasing awareness and understanding the prevalence, underlying psychological theories, and empirical studies surrounding PMADs in this population is crucial for developing effective prevention and intervention strategies.

For families to thrive, every member needs to be supported. By recognizing the unique challenges faced by fathers and nonbirthing parents, promoting awareness, and providing accessible support services, we can mitigate the negative consequences of PMADs and foster healthy families and communities.

You, too, can contribute to a deeper understanding of PMADs and help shape better support systems for families: If you or your partner has experienced PMADs, we invite you to join our research and share your story by taking this quick survey.

To find a therapist, visit the Psychology Today Therapy Directory.