The secret struggle of new fathers

One of the most vivid memories I have from the early days after my first child’s birth is of walking into the bedroom to see my husband sitting on the bed, rocking our newborn son to and fro while singing nursery rhymes. At first glance, it was the perfect picture of new fatherhood; but on second glance, the baby was crying hysterically, and both of them had hot, wet tears streaming down their cheeks.

It’s not something we ever talk about, but new fatherhood can be just as challenging as new motherhood. Men, too, have to go through that head-spinning identity switch from man to father. There’s heightened pressure on men to provide financially, as well as emotionally, and there’s little room for a new father who is struggling to ask for support – after all, he’s not the one who’s just been through childbirth.

While mothers understandably tend to hog the headlines when it comes to postpartum depression, there’s a growing awareness of how it can affect dads too. A recent poll by the Priory clinic found that 39% of men experience ‘some anxieties’ after having children; one in ten men say they have ‘negative thoughts’; while one in 15 said they believed they were suffering from Paternal Postnatal Depression (PPND).

“New fathers can become overwhelmed by their additional responsibilities and the fundamental change in family dynamics, which often includes managing on a reduced family income, but their own emotional support is regarded as secondary,” says Maartje Suijskens, a psychologist at the Priory Wellbeing Centre in Dubai. “Yet, as with women, men can also be vulnerable to depression during this new, sleep-deprived chapter in their lives.”

Exacerbated by COVID-19

The situation for new dads has been made even harder with the pandemic, says Dr Rasha Bassim, Specialist Psychiatrist and Medical Director, Priory Wellbeing Centre, Dubai. “Due to the Covid-related restrictions, we are now seeing more and more cases of post-natal depression in both men and women as these restrictions have significantly impacted opportunities for personal interaction. The sense of isolation, loneliness, anxiety and uncertainty will have been much greater as a direct result, leaving many – both mums and dads – feeling completely overwhelmed. For dads, the need to adapt to parenthood at this time can feel even more challenging, particularly for those who are the main breadwinners and trying to hold down their jobs while the global economy is currently in such turmoil. Financial pressures will just add to stress and anxiety levels.”

This is particularly evident in the Gulf region, adds Dr Bassim. “In countries like the UAE, where many people are working away from their families and supportive networks. This increases their sense of loneliness and isolation because their key support persons might be stuck back in the home country, unable to visit or help in taking care of a new-born. Of course, they can still provide emotional support through digital communications, but this is not the most effective way to transmit the warmth of human emotions.”

How birth can affect men

Becoming a father can be one of the most significant and profoundly life-changing events for any man, says psychiatrist Dr Yaseen Aslam from The Psychiatry and Therapy Centre Dubai. “Often we’re told about the positive aspects, but fatherhood can be a very daunting proposition. It’s often a difficult period of transition and adjustment for many men. They’re required to be more organised, to plan more effectively, and to balance the demands of a new baby with all their other growing commitments.”

It’s not merely an increased financial responsibility, says Dr Aslam: “Fatherhood also requires men to be more flexible in order to support their partners, particularly on an emotional level. Often fathers-to-be describe feeling ill-prepared and apprehensive about the daunting task which lies ahead.”

First-time fathers can experience feelings of rejection and abandonment with the birth of a new baby, as their partner focuses much of her attention – and time – on the new baby. “Many couples don’t take the time to listen to each other and explore each other’s feelings during this difficult adjustment period, and this can lead to a whole host of issues, with some fathers acting out due to frustration and anger, driven by feelings of rejection and being pushed out,” says Dr Aslam.

And the pressure on expat fathers can be just as significant if not higher than that on dads who are living in their home country, says The Priory’s Suijskens. “The increase in pressure comes from simply being an expat, which is living in a location that is geographically distant from your family, friends and well-known support systems. This increases the pressure on the spouse to be the sole provider, not only financially, but also emotionally. Providing this support can be overwhelming and increase the risk of developing Paternal Post Natal Depression (PPND).”

How PPND is different from maternal postnatal depression

For any mother who has ever experienced the depths of postnatal depression, the idea that men are now staking a claim to postnatal depression too might seem a bit rich, considering that they don’t go through the hormonal haywire of pregnancy or birth.

But although it may not be at the same level, new fathers also go through hormonal changes, The Priory’s Suijskens points out: “Research from the University of Michigan (2015) shows that just as new mothers experience hormonal changes, new fathers’ hormones shift too.

“Their testosterone levels go down and their estrogen levels go up. Their increased levels of estrogen make them feel more emotional than usual and low levels of testosterone are associated with depression in men.”

It’s true that post-natal depression usually looks different for men and women, continues Suijskens. “New fathers often exhibit less sadness, crying, and outward emotional symptoms that are more commonly identified in new mothers. New fathers with PPND may notice a change in their concentration levels and feel less motivated at work. Furthermore, they may exhibit risk-taking behaviours, irritability, anger, verbal outbursts and violent behaviour.”

Studies have shown that new fathers are also more likely to suffer from delayed depression than mothers, commonly three to six months after their baby is born, and often when the mother has recovered from delivery and is going back to work.

Although there is no specific diagnostic coding that separates postpartum depression from regular depression, “the stressor for paternal postnatal depression is specific,” says Suijskens. “The depressed feelings are related to the event of becoming a father and the depressed or angry feelings can be directed towards the child, therefore early assessment and treatment is extremely important.”

The stigma of male mental health  

“In movies, people find out they're pregnant and it's like this big celebratory moment. There's always that overwhelming rush of love that the parent immediately feels when seeing the baby for the first time. But that really wasn't the case for me,” says Joe Marcantonio, a dad of two and writer and director, whose new film about a pregnant woman ‘Kindred’ was released this year. “The first time I saw my son, I was just like, 'What on earth am I supposed to do now?'"

"When we first found out we were having a kid, it's not that I wasn't excited about it," Marcantonio clarifies, in an interview with the LA Times. "But - and it's quite hard to admit - there's a little part of one's brain that does go, 'Ok, my life is going to change beyond all recognition.'”

This complicated tangle of emotions that come with being a parent can indeed be hard to admit – and it’s even harder to admit for men, who traditionally do not share emotions as freely as women.

In The Priory’s poll, two in five men (42%) who experienced depression or anxieties after the birth of their baby did not seek help, saying they were too embarrassed and ‘thought they should be happy’.

Nearly 70% of men said they felt there was still a stigma around postnatal depression, and that society might view those who suffered from it as ‘inadequate’ parents.

Meanwhile nearly half of men and women (47%) said there was not enough support for new fathers experiencing difficulties adjusting to parenthood, and nearly 80% of men and women said fathers were ‘forgotten’ in discussions about PND.

This social expectation that men should just be able to ‘get on with it ‘is certainly no less in the UAE, says Suijskens: “Among many cultures in this region, showing emotion or exhibiting feelings of anxiety or despair is still regarded as a sign of weakness by many men, who feel family needs should come above their own. As a result, they refuse to recognise when they may need help, which can only have negative consequences.”

What can make the situation even more challenging is the fact that in the UAE many health insurance companies do not cover depression or mental health in any form for either women or men, which contributes to the mistaken perception that depression is not a valid illness.

“Most insurance companies either do not cover mental health at all or they will provide partial coverage for selected diagnosis as well as selected treatment,” says Suijskens.

“This negatively impacts not only the ability for people to obtain quality treatment for their diagnosis but also significantly contributes to the negative stigma and misperceptions around mental health.”

Why it’s important to talk about it

According to researchers, paternal postnatal depression (PPND) affects around one in 10 fathers, and its effects on the dad can be as devastating as that suffered by women.

Just as postnatal depression in the mother can impact a baby’s development, research shows that postnatal depression in fathers can do so too.

“Postpartum parental depression is a complex and challenging disorder and its effects can be far-reaching,” says Suijskens. “It can have a serious effect on parent-infant interaction and bonding during the first year of life, and can contribute to a child’s emotional, behavioural, cognitive and interpersonal problems in later life.”

Although motherhood is unique and intrinsically different from fatherhood, it’s equally as important for fathers to form strong bonds with their children, says Dr Aslam from The Psychiatry and Therapy Centre Dubai. “It’s the strength of these bonds that defines the closeness of relationships, and indeed these bonds are the foundation of the parent-child relationship. Healthy attachments are integral to a child’s emotional and psychological well-being.”

Doctors and psychologists should work together to ensure new parents leave the hospital better informed about the emotional impact of having a new baby, and the support that is available, says Suijskens. “Our research suggests that the number of fathers who experience anxiety and depression is greatly underestimated. New fathers might be aware of the fact they are not feeling well, but they will not link it to possible post-natal depression. Hopefully by raising awareness we can encourage this situation to change.”

Maartje Suijskens strongly advocates an open and supportive relationship between partners: “Becoming a parent is a life-changing experience and so will naturally have its challenges. After the baby is born, it’s important both parents communicate with each other, as well as with family and friends, and share any concerns. The worst thing new parents can do is to bottle up their emotions and hope they will go away. You’re more likely to get a clearer perspective and the support you need to feel better if you talk to a professional.”

“Let’s remember dads aren’t always superheroes,” concludes Dr Aslam, “they need some understanding too.”

Signs of male postnatal depression

If you have serious depression you may: