In a recent Freedom of Information request, BBC Scotland asked 14 Scottish health boards if they regularly screened or monitored the mental health of men before and after the birth of a child. Though some boards mentioned signposting to a GP, with others asking about new father’s mental health once, none of the 14 routinely asked men about their mental health in the antenatal and postnatal period, nor had a way to formally monitor the mental health of new fathers.

What does this say about how we treat the mental health of men in and out of the context of becoming a parent?

Post-natal depression (PND), is thought to occur during the first year after giving birth; perinatal depression can happen any time during the period of becoming pregnant to around one year after giving birth.

For a long time, there has been the misconception that PND is specifically caused by the change in hormones that women and people with cervixes experience during the postnatal period. However, experts have now come to understand it as being far more complex and nuanced than this, with a widely understood cause being already existing or previous instances of mental-ill health.

PND is a serious mental health condition, with symptoms such as: losing touch with reality, feelings of guilt and worthlessness, feeling hostility or indifference to your partner and/or new child, losing interest or pleasure in things that usually bring you joy and feeling empty or numb.

In 2018, The Guardian reported on the need for more research and public health efforts dedicated to PND in men. In the article, they spoke to Ross Hunt, a man who experienced severe PND after the birth of his daughter. Despite having been diagnosed with depression previous to having a child, Hunt didn’t assume that what he was experiencing at the time was PND, stating that he only understood paternal PND as “something that might be triggered by a postnatally depressed partner”, but his partner wasn’t postnatally depressed.

The article also references a 2016 study, that found 8% of men in the meta-analysis experienced PND. However, shortly after the publication of this study, researchers in Sweden found that the screening tool currently widely used to diagnose PND, is not applicable and less reliable when applied to men, because it was initially developed for women.

More recently, a Canadian study that included almost 2,500 fathers has given a clearer picture than ever before, on just how common experiences of both PND and anxiety are in men, around the time their children are born.

This Canadian study, conducted by the University of Toronto, found that a staggering one in four fathers experienced both depression and anxiety for the first year after their child was born.

Despite the growing evidence over the last five years, dated cultural expectations around how men and fathers should ‘be’ after their child is born still persist. This notion that men should primarily be a resilient rock for their partner not only impacts men and their mental health in the aftermath of a birth, but also puts undue pressure on the person who has just undergone one of the most physically and psychologically taxing periods of their life.

Shifting perspectives

The question of how we shift our treatment and perception of postnatal and perinatal mental health, and who should receive attention and care for it, requires some careful balancing. The solution is not to ‘take away’ resources from people who can give birth, but to give men and fathers some much needed, and specifically tailored support too.

To elucidate this difficult balance and the topic as a whole we spoke to, Viren Swami, a Professor of Social Psychology at Anglia Ruskin University, who has a particular interest in PND in men.

What has your experience been when researching the topic of PND and how much do men have an understanding of what it is?

“Although I'd done some work on "mental health literacy" - basically how non-scientists make sense of mental ill-health - I hadn't thought much about postnatal depression until I experienced myself. My colleagues and I have since examined what the public in the UK and other European nations understand about postnatal depression. Our findings broadly show that, while postnatal depression in mothers is near universally recognised, the same isn't true of postnatal depression in fathers.”

“When presented with examples of mothers and fathers experiencing the same depressive symptoms, for instance, the public are able to correctly identify the mother as experiencing postnatal depression, but are more likely to believe that the father is just "stressed", "tired", or "lacks sleep". I've argued there is a "gender binary" in how postnatal depression is understood: in simple terms, most people think it only affects mums, while dads are immune.”

What needs to change in how we discuss the perinatal period and how it can impact men/dads?

“Put simply, we need to recognise that fathers can experience postnatal depression - in fact, up to 1 in 10 new dads will experience postnatal depression. And that can have a hugely detrimental effect not just on dads themselves…But also on their partners (e.g., increased risk of experiencing postnatal depression themselves) and their children (cognitive delays and developmental problems).”

Professor Swami also mentioned that “postnatal depression in men is much more likely to be triggered by social and economic changes”.

What do you think could be done to improve how new dads talk about and relate to their mental health?

“I’m not sure the best response is to place the burden on individuals. What we need instead is to facilitate societal change in the ways we communicate and construct masculinities; we need to help men gain the tools and skills to avoid constructing mental illness as a frailty or weakness, and help-seeking as something to be avoided.”

“But honestly, the best change we could make is to ensure that all parents ̶ not just mothers ̶ are screened for symptoms of mental ill-health during the antenatal period.”

Could a more ‘co-parenting’ approach to the prenatal and postnatal period that doesn’t exclude men be part of this solution?

“I prefer to talk about helping the family unit holistically. Historically, fathers have been excluded from these conversations, precisely it’s been assumed they will be the “rock” of the family, that they are immune to psychological distress during the antenatal period. We need to recognise that fathers are not immune, just as no one is, and we need to ensure that every member of the family unit is well looked after.”

“Emphasising the mental health of fathers doesn’t mean taking away resources to support mothers; it means prioritising the well-being of every member of the family unit, so that every member is able to thrive.”

There is a clear and dire need for more mental health literacy, as Viren Swami but it, for both men and women around how PND can affect men too , as well as a wider cultural discussion on how we might shift perceptions of men’s mental health around the perinatal and postnatal period.

To explore this more we will soon be publishing an interview with a very generous individual, who spoke to us about his experiences of PND as a first-time dad.