A trial of a new cognitive behavioral therapy program may provide a step toward greater support for new fathers experiencing postpartum depression, which is underrecognized in men.

While postpartum depression is common in women — affecting around 25% of new mothers — it also affects 10% of new fathers. The emotional and psychological toll on men can be just as profound. 

A new parental training intervention highlighting childhood developmental milestones and play-based parenting has shown promise for men with the condition. The results of the 18-month trial have now been published in the journal JAMA Psychiatry.

Among 357 new fathers split into two trial groups, those who undertook the "Learning Through Play Plus Dads" program showed a reduction in depressive symptoms. Children also benefitted.

"Children of fathers [who] received the intervention showed better social and emotional development compared to children of fathers [who] received [no] treatment," said study leader Ishrat Husain from the University of Toronto, Canada.

Postpartum depression in men is hard to spot, new dads called for help

Rates of depression and postpartum depression are higher in lower middle-income countries, where access to evidence-based mental health assessment and treatment can be limited. 

Husain's latest study emerged from work with mothers managing postpartum depression in Pakistan.

"During our group's work with mothers experiencing postpartum depression in Pakistan, we were approached by their partners to develop similar interventions for them," said Husain.

Husain's treatment for postpartum depression is one of many being trialed around the world. 

Broadly, they find that similar support interventions are moderately effective at treating this depression in both men and women, especially when coupled with antidepressants.

Experts say the main problem is that postpartum depression in men is an underrecognized issue, so people often don't realize effective treatments are available.

There is also little research into sociocultural factors associated with postpartum depression, and whether policy-level changes such as parental leave for fathers help the psychology of families.

How is postpartum depression different for men than women?

While mothers with postpartum depression often display sadness and anxiety, men may experience symptoms that are less easily recognized as depression. Common signs include:

• Irritability or anger: Dads may become short-tempered or prone to frustration.
• Withdrawal: They might isolate themselves from their families or avoid bonding with their baby.
• Risky behaviors: Some engage in substance use, gambling, or other impulsive actions as a coping mechanism.
• Work-related changes: Excessive working or a sudden drop in productivity can be signs of avoidance or feelings of inadequacy.
• Physical symptoms: Fatigue, headaches, or changes in appetite can accompany emotional struggles.

Postpartum depression in a parent has been shown to impair a child's cognitive performance, behavior disturbance, and insecurity of attachment. 

These problems can persist into late childhood and adolescence, furthering the importance of finding effective treatments for postpartum depression. 

What causes postpartum depression?

Scientists don't have a definitive answer on what causes postpartum depression. 

Husain explained postpartum depression for men and women is due to a combination of factors. These include biological factors like genetic vulnerability to depression, factors like low self-esteem, and social factors like the financial strain and social isolation that many new parents experience. 

For women, pregnancy rewires parts of their brains. Women also experience shifts in hormonal levels in the transition to pregnancy and after childbirth. These hormonal shifts can disrupt mood regulation, especially in people more susceptible to hormonal fluctuations.

Naturally, these changes do not occur in the same way for men. But studies show that men do experience hormonal shifts when they become dads.

"Studies in men with postpartum depression have shown changes in brain structure and function in fathers compared to men without children, as well as decreased testosterone levels in expectant fathers," said Husain.

Researchers are working to understand how these systems interact and why some people develop postpartum while others do not. The hope is that they can develop new ways to better detect and treat postpartum depression for both moms and dads alike.

Edited by: Matthew Ward Agius

Source:

Husain MI, Kiran T, Sattar R, et al. A Group Parenting Intervention for Male Postpartum Depression: A Cluster Randomized Clinical Trial. JAMA Psychiatry. Published online October 02, 2024.doi:10.1001/jamapsychiatry.2024.2752