Have you ever heard of postpartum anxiety in women? How about for men? Postpartum depression is commonly discussed for mothers and fathers, but what about anxiety? Research often subsumes postpartum anxiety with postpartum depression, especially since there is not a separate diagnosis or subtype for postpartum anxiety in The Diagnostic Statistical Manual of Mental Disorders 5 (DSM-5). In the DSM-5, the categorization of postpartum depression is known as peripartum depression, a subtype of Major Depressive Disorder, which mentions that anxiety while pregnant increases the risk of postpartum depression (American Psychiatric Association, 2013). Of note, the DSM-5 does not mention postpartum depression or anxiety in men, specifically the DSM-5 provides prevalence rates for women and the presentation of postpartum depression in women (American Psychiatric Association, 2013).
In the last 50 years, there has been an increase in the amount of time, nearly tripled, that fathers have been spending with their children (Walsh et al., 2020). Men can experience comorbid postpartum depression and postpartum anxiety, as well as each of these mental health issues individually. The prevalence rate for postpartum depression in men is approximately 10%, with the depressive symptoms continuing throughout the first year (Leiferman et al., 2021). According to the meta-analysis conducted by Leiferman et al. (2021), the prevalence rate of postpartum anxiety in men is approximately 10%, which suggests that postpartum anxiety is equally as pervasive and prominent as postpartum depression in men. A prevalence rate of 10% for men with postpartum anxiety is approximately three times higher than the occurrence of anxiety in the world for men, which is 3.6% (World Health Organization, 2017). A major life event, i.e., birth of a child, can cause stress in one’s life to the point of experiencing intense anxiety that is interfering, even for men.
What does postpartum anxiety look like in men? Here are symptoms that can be occurring:
- Excessive worry
- Panic attacks and/or anxiety attacks
- Racing thoughts
- Inability to relax
- Trouble concentrating
The worry that is experienced may be regarding multiple areas of life but may also be specific toward the baby's safety and health. The first days of bringing home a child are worrisome, with so many unknowns about taking care of a newborn. Having a child, especially as a first-time parent, can cause an increase in worry, which may not be to the level of clinically significant. However, one meets criteria for postpartum anxiety when the worry is excessive, prolonged, and uncontrolled, in addition to other symptoms.
Risk factors are important in understanding what may exacerbate a father’s potential in experiencing mental health problems, including anxiety, after the birth of a child. Research has shown that the birth of the first child is highly stressful. Multiple studies found that a father’s anxiety and distress peaks during the pregnancy, rather than postnatally, when it is their first child (Boyce et al., 2007; Chhabra et al., 2020; Condon et al., 2004). The uncertainty of taking care of a child is highly distressing while the mother is pregnant, however, the distress may decline over time, as a father learns to care for the child.
Chhabra et al. (2020) found several risk factors that increase the likelihood of paternal anxiety. The risk factors include maternal distress, marital distress, social support, work family conflict, and parenting stress. When the mother experiences depression, Chhabra et al. (2020) determined through their meta-analysis that the anxiety for the father was three times greater postpartum. Postpartum anxiety was also found to be three times greater when there was evidence of work family conflict in the father's life (Chhabra et al., 2020). According to Vismara et al. (2016), parenting stress is defined as parenting styles and roles, view of the newborn and the difficulty level, and the value of each of the mother and father’s parent-child interaction. The largest risk factor that demonstrated that postpartum anxiety was likely by more than 14-fold was parenting stress (Chhabra et al., 2020). Whether the presentation of anxiety is experienced perinatally or postnatally, the screening and monitoring for mental health issues is essential for fathers.
Screening for Postpartum Anxiety in Men
The Edinburgh Postnatal Depression Scale (EPDS) is a screening tool used by many physicians working with pregnant women. It has been repeatedly validated to assist in the detection and monitoring of depression (Matthey, 2008). The EPDS has also been validated and found to be reliable in detecting depression in men (Matthey et al., 2001). The EPDS-3A, a subscale within the EPDS, has been studied to discover anxiety, with the included items being 3, 4, and 5. According to Walsh et al. (2020), the cutoff score for those items validated to assess anxiety is six for women and four for men. This demonstrates that the EPDS can be used not only for women in uncovering both depression and anxiety, but also can be a helpful instrument in understanding if there is a presentation of mental health issues affecting the father.
The screening of anxiety, in addition to depression, should be conducted prenatally and postnatally. Many obstetricians utilize the EPDS in the care of pregnant mothers, therefore implementing a policy of administering it to the fathers throughout the pregnancy could assist in early detection of anxiety and/or depression. The American Academy of Pediatrics encourages the use of screening for mental health issues by pediatricians, in addition to obstetricians (Walsh et al., 2020). Pediatricians assume the care of the family and begin having the most contact with the parents. Anxiety and other mental health issues can affect the care of a newborn, therefore early intervention and continuous monitoring is important in supporting the family unit.
Cite This Article
Schroeder, K. (2022, February). Dads experience postpartum anxiety too. [Web article]. Retrieved from http://www.societyforpsychotherapy.org/dads-experience-postpartum-anxiety-too
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Boyce, P., Condon, J., Barton, J., & Corkindale, C. (2007). First-time fathers’ study: psychological distress in expectant fathers during pregnancy. Australian & New Zealand Journal of Psychiatry, 41(9), 718-725.
Chhabra, J., McDermott, B., & Li, W. (2020). Risk factors for paternal perinatal depression and anxiety: A systematic review and meta-analysis. Psychology of Men & Masculinities, 21(4), 593-611. doi:http://dx.doi.org/10.1037/men0000259\
Condon, J. T., Boyce, P., & Corkindale, C. J. (2004). The first-time fathers study: A prospective study of the mental health and wellbeing of men during the transition to parenthood. Australian and New Zealand Journal of Psychiatry, 38(1-2), 56-64. doi:http://dx.doi.org/10.1111/j.1440-1614.2004.01298.x
Leiferman, J. A., Farewell, C. V., Jewell, J., Lacy, R., Walls, J., Harnke, B., & Paulson, J. F. (2021). Anxiety among fathers during the prenatal and postpartum period: A meta-analysis. Journal of Psychosomatic Obstetrics and Gynecology, 42(2), 152-161. doi:http://dx.doi.org/10.1080/0167482X.2021.1885025
Matthey, S. (2008). Using the Edinburgh postnatal depression scale to screen for anxiety disorders. Depression and Anxiety, 25(11), 926-931. doi:http://dx.doi.org/10.1002/da.20415
Matthey, S., Barnett, B., Kavanagh, D. J., & Howie, P. (2001). Validation of the Edinburgh Postnatal Depression Scale for men, and comparison of item endorsement with their partners. Journal of Affective Disorders, 64(2–3), 175–184.
Vismara, L., Rollè, L., Agostini, F., Sechi, C., Fenaroli, V., Molgora, S., Neri, E., Prino, L. E., Odorisio, F., Trovato, A., Polizzi, C., Brustia, P., Lucarelli, L., Monti, F., Saita, E., & Tambelli, R. (2016). Perinatal parenting stress, anxiety, and depression outcomes in first-time mothers and fathers: A 3- to 6-months postpartum follow-up study. Frontiers in Psychology, 7, 10. doi:http://dx.doi.org/10.3389/fpsyg.2016.00938
Walsh, T. B., Davis, R. N., Garfield, C. (2020). A call to action: Screening fathers for perinatal depression. Pediatrics, 145(1). doi: 10.1542/peds.2019-1193. PMID: 31879278.
World Health Organization. (2017). Depression and other common mental disorders: Global health estimates(No. WHO/MSD/MER/2017.2). World Health Organization.