Introduction

‘Typically, at this appointment, women all over the country are asked to fill out the Edinburgh Depression Scale (EPDS) to find out if they're experiencing “signs of symptoms associated with depression.” After reading the questions, I started uncomfortably laughing a bit because as she was answering them, I began to feel like someone should be asking me the same questions.’¹ - says a father who suffers from postnatal depression. And he is not alone.

When people hear ‘postnatal depression’, the majority of them imagine a mother who is constantly feeling sad and ignoring her parenting duties after giving birth.² However, this image can be misleading because people assigned female at birth (AFAB) are not the only ones who can suffer from this psychiatric condition. Postnatal depression also affects fathers, who need to face multiple challenges after the arrival of a baby, adapt to the role of parenthood, and find balance among personal, emotional, relational, and work-related needs.^3,4 Although these new duties can be a source of growth and development, they can lead to stress - and in extreme cases - anxiety and depression. Based on statistics, in the first year of a newborn's life, 8-25% of fathers can experience paternal postnatal depression (PPD).⁵

‘I found myself huddled in my home office, secretly and somewhat reluctantly shedding a tear in the dark.’¹

What is paternal postnatal depression? What are the symptoms?

Paternal postnatal depression (PPD) is when the father experiences consistent low mood and other symptoms after the birth of a child.

It can have similar symptoms to its maternal type, such as:

• Sadness
• Feeling hopeless
• Loss of energy
• Lack of interest in hobbies
• Difficulty concentrating 

But certain differences characterise PPD. Fathers with postnatal depression can become irritable, hostile, and have anger attacks.^2,6

These feelings can lead to marital conflict and, in some cases, to partner violence.² Similar to maternal postnatal depression, fathers can also have thoughts about hurting their babies - or hurting themselves.¹

Fathers experiencing PPD can start to withdraw or avoid social situations, work parties or family gatherings, and escape to activities such as overwork, sports, sex or gambling.⁴ This denial and avoidance can lead to substance use, such as alcohol or drugs. Fathers with PPD can also become indecisive, cynical, emotionally rigid and self-critical. 

Besides the behavioural changes, somatic symptoms can also occur, such as:²

• indigestion
• changes in appetite
• weight loss or gain
• diarrhoea or constipation
• headaches
• toothaches
• nausea
• insomnia

Causes and risk factors of paternal postnatal depression

Although the causes and risk factors of paternal postnatal depression are less established than those of its maternal type, studies have identified certain biological and environmental reasons for it.

Biological factors

Researchers have not yet clarified all biological risk factors in PPD, but there are a few known factors that can increase the chance of developing this disease.^3,7

During pregnancy and after childbirth, hormonal changes occur not only in people AFAB, but also in their partners, too. These fluctuations, including changes in testosterone levels, are proven to have roles in maternal postnatal depression. 

For example, the testosterone level in fathers decreases in the last few months of their partner’s pregnancy, and its level remains low for several months after birth. It is suggested that the reduced amount of testosterone prevents aggression, helps focus on parenting duties, and establishes a stronger bond to the newborn. Studies show that fathers who have a decreased level of testosterone have more sympathy towards their child and an urge to respond to a baby’s crying. It is also found that people assigned male at birth (AMAB) with depression symptoms have a lower level of testosterone, which can be a reason for PPD.⁷ Other hormones and their dysregulations also could be responsible for depression in fathers. Oestrogen, cortisol, vasopressin, and prolactin are all assumed to have a role in the father-baby bonding, parenting behaviour, and sensitivity towards their newborn. Thus, abnormal regulation of these hormones’ levels might pose a risk for PPD.⁷

Besides hormonal changes, a history of mental illness shows a strong relation to PPD.⁸ Fathers who live with obsessive-compulsive disorder or anxiety have a higher chance of falling into depression. Another biological factor includes a disrupted circadian rhythm. As a newborn’s sleeping pattern is very different from an adult’s, many parents suffer from sleep deprivation. This irregular circadian rhythm can cause frustration, mood changes and can contribute to the development of PPD.⁷

Environmental factors

A comprehensive study identified multiple environmental factors that can contribute to PPD:⁸

• Lower education, unemployment, and financial struggles: a decrease in income places financial and mental strain on fathers, alongside the high estimated cost of raising a child to adulthood (£200,000 in 2025) and ineffective maternal leave care and social expectations of fathers as “breadwinners”^4,9
• Older age or multiple children⁸
• Maternal postnatal depression experienced by a partner: Fathers may hesitate to share their feelings and struggles with a mother who experiences depression, leading to PPD in the fathers.^10,11 With a newborn, parents may experience an overwhelming period in their relationship, which, when combined with lack of support and marital dissatisfaction, can trigger PPD⁸ 
• Low social support from the family and friends: When the majority of focus is on the mother and the newborn, fathers can feel isolated from the mother-baby bonding, and be jealous of their partner’s intimate relationship with the newborn or jealous towards their child, as a baby requests time and attention from the mother³
• Negative life events: conflict in the family, a serious illness or injury, or loss of a close family member, or any other negative life event, can also cause hopelessness and depression⁸

As previously mentioned, a newborn brings changes in someone’s life and with it stress. The new duties and roles, worrying about the baby’s well-being and health, including accidental harm to them due to lack of experience, are all stressful thoughts.^{3, 8,12} Fathers may also experience problems with bonding with the babies.³ After two weeks of the birth, mothers spend nearly 14 hours with the newborn, while fathers spend only half of the time.¹³ These stress factors also pose a risk for PPD.⁸

Unfortunately, paternal postpartum depression often goes underscreened, underdiagnosed and undertreated even though it has a significant effect on the family.² More research is needed to provide the best support for fathers living with PPD.

Importance of recognition and treatment of PPD

Early diagnosis and treatment of PPD is not only crucial for fathers experiencing it, but also for their partners and children. Delayed recognition can lead to enormous stress in the family, constant conflicts, and marital problems, as demonstrated in the following quotations:

‘By the time I realised I had depression, our family had nearly broken apart.’¹

People living with PPD not only have an effect on their partner’s life, but also on their babies. Newborns are less likely to be breastfed and more likely to be put to bed with a bottle. Fathers also play less with their babies outside or sing a song for them if both parents suffer from depression. These small actions (or inactions) eventually impact the child’s mental health. Children will feel less secure and less attached to their fathers, develop emotional issues, conduct disorders, and hyperactivity.²

Fathers with PPD often face multiple challenges, as their condition is less well-known, not only in society but also among healthcare professionals. Many fathers who try to seek help only find solutions to their partners' or wives’ problems.¹

‘Fathers with PPD often feel helpless, misunderstood, neglected and ignored - sometimes by their own wives - because they feel unable to share their feelings with them out of fear of looking weak or sounding ridiculous.¹

 Many fathers’ situations are defined by the social stigma and traditional male stereotypes, such as ‘need to be a tough guy’, ‘men don’t cry’, and the expectation of being ‘the man of the house’, and considering everyone else's needs first. People AMAB often feel social pressure to cope with their depression in secret:¹

‘I wanted to cry and give up being a father. But I was afraid to acknowledge those thoughts and feelings in myself—it wasn’t becoming of a man and father to feel those things. I pushed them down so deep that I couldn’t feel anything anymore. I pulled away from my family and started to spend more time outside of home, socialising and looking for companionship. It nearly destroyed my family.’¹

Thus, early recognition and treatment are crucial to help fathers living with PPD and their families.

Treatment options

The majority of treatment options available for people with PPD involve therapy and mental or emotional support. Such treatments include:

• Parenting classes or support: Targets the common stress factors and their consequences, such as the feeling of inadequacy, loss of control, frustration, and low self-confidence
• Interpersonal therapies: Can solve problems in a marriage or partnership, provide solutions to poor communication and give social and emotional support
• Cognitive behaviour therapy: Can help to manage the poor mood associated with depression
• Antidepressant treatment: Can provide further help in the management of paternal postnatal depression²

Summary

Paternal postnatal depression (PPD) is a lesser-known depression that affects fathers. Although it has similar symptoms to the maternal types, it shows certain differences, such as irritability and aggression. Its risk factors are not yet entirely understood, but biological factors, such as hormonal changes or environmental factors (like financial struggles or stress), can lead to paternal postnatal depression. This condition affects not only the fathers but also their families. Thus, it is essential to educate people more about this psychiatric disease and propose early recognition and treatment.