For a man, admitting depression is a “double disgrace”

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– There were days when I wished you were gone. I couldn’t hear you cry. I couldn’t watch her feed you – this is how one of the fathers recalls the first weeks after the birth of his son. Zuzanna Opolska talks to a psychiatrist professor Dominika Dudek about postpartum depression in men.

As part of our campaign “We choose the truth”, we recall selected texts from TvoiLokona that influenced the reality around us. In the coming months, more articles from the series will be presented on the TvoiLokony home page.

1. The scale of postpartum depression in fathers in Poland is not known, but a meta-analysis of studies from various countries (Prenatal and Postpartum Depression in Fathers and Its Association With Maternal Depression) indicates that this problem affects 10-20% worldwide. men
2. A woman has a social consent to weakness, emotionality and tears. On the other hand, “a real man never cries”. When educating, we reward boys for bravado, assertiveness and competition. For a man, admitting depression is a “double disgrace” – says prof. Dominika Dudek
3. The image of a depressive episode in men may be different from a typical depression presented by women. A man collapses inside himself, moves away from loved ones, withdraws or defends himself from his own emotions, hurts others and escapes self-destructive behavior
4. You can find more interviews on the TvoiLokony home page

Zuzanna Opolska / Medonet: Professor, the new standards of perinatal care will include depression tests for mothers, and what about fathers? Apparently more than 10 percent. of them struggle with postpartum depression …

Prof. Dominika Dudek: It is difficult to talk about specific numbers – this phenomenon has not been sufficiently studied and we still do not have strong data allowing to determine its frequency or specificity. However, I think that we should look at the problem of male postpartum depression a little wider.

We will read in any textbook on psychiatry that depression is twice as common in women as in men, but that it is a distorted picture for several reasons. Firstly, the symptoms of depression in men are different, and secondly, men are much less likely to seek help. Finally, women pay more attention to depressive states and recall a greater number of symptoms retrospectively.

It is “not appropriate” for a man to be depressed?

A woman has a social consent to weakness, emotionality and tears. On the other hand, “a real man never cries.” Stereotypes of masculinity and femininity are deeply entrenched in most cultures. In the process of upbringing, we reward boys for bravado, assertiveness and competition. For a man, admitting depression is a “double disgrace”. On the one hand, it is a stigma of mental illness, on the other hand, it is a stigma of female emotionality. The shame of suffering from depression often has tragic consequences. There is talk of a gender paradox – women are about three times more likely than men to attempt suicide, while men are three times more likely than women to commit suicide. If he decides to take his own life, he chooses effective methods – rope, firearms. She usually takes medication or cuts her veins.

What might be the causes of postnatal depression?

As with other affective disorders, there is no single, simple relationship that determines the appearance of postnatal depression. In the case of mothers, we can talk about biological reasons, i.e. changes in the hormonal economy, but also about psychological and social reasons such as: adaptation to the maternal role, role conflict, relationship with a partner, lack of a job.

What about fathers?

In men, the main role is played by psychological and social factors. When a baby arrives, family life changes 180 degrees. A man, like a woman, has to face the parental role. If he has been the “navel of the world” until now and is suddenly dethroned, he may feel withdrawn and lonely. Additionally, there is a fear of responsibility – the child is forever and is always responsible for the family.

How is HER and HIS postnatal depression different?

We cannot talk about one phenomenon, i.e. postpartum depression in isolation from typical depression. Depression in men often takes on the mask of attacks of aggression, hostility and irritability. Conflicts with the environment intensify, sexual dysfunctions occur, which additionally lower self-esteem, and problems with fulfilling professional duties increase.

A depressive man collapses in himself, moves away from his relatives, withdraws or, by defending himself against his own emotions, hurts others, runs away into self-destructive behavior, including the worst – suicidal. Often there is alexithymia, that is, the inability to understand, express and name emotions.

And the lack of a sense of connection with the child? The thought that we would be better off without him?

It also happens. The baby appears as an intruder who has destroyed the current calm and well-organized life, or as a competitor who takes his beloved woman. Such thinking often appears in emotionally immature men, such as Peter Pan, in whom problems from previous stages of development have not been resolved.

Is it true that if the mother struggles with postnatal depression, the likelihood that the father will also be affected increases?

Based on clinical experience, I can say yes. Depression is a disease that affects the entire family. A healthy partner may develop symptoms of anxiety, depressed mood, sleep disturbances, and a depressive, pessimistic way of thinking. Although the research conducted so far on its effects on married couples shows that women are more often “infected” with depression.

Why is this happening?

A woman tries to find herself in the role of a person supporting a depressed patient and becomes infected with his style of thinking, a sense of inadequacy or hopelessness. On the other hand, the man more often chooses avoidance behaviors – he escapes from problems with work or drugs. However, when a young child shows up in the home, escape strategies do not work and the likelihood that the young father will be overwhelmed by the new situation increases.

Is the risk of postnatal depression highest with the first baby?

It is not fully known – some studies have confirmed it, others have denied it. When it comes to adapting to a new life role, adaptive abilities must be most activated with the first child.

What is the risk of being sick alone?

There are many negative consequences of untreated depression. Let us not forget that this is the “greatest killer” among mental disorders. It is estimated that about 15% of people with recurrent affective disorders people commit suicide, and as I mentioned, the risk of suicide is greater in men than in women. In addition, depression is associated with suffering, falling out of social and professional roles, an increase in self-destructive behaviors, and an economic burden not only on the family, but on the entire system.

When it comes to the perinatal period, we must remember that depression seriously disrupts the relationship with the baby and can adversely affect its development. Infants of depressed mothers do not develop a secure attachment pattern, resulting in poorer stress responses, greater difficulty in regulating behavior, and emotional deficits that are relatively persistent. I don’t know of studies that specifically address fathers’ postpartum depression, but a full and happy family is the optimal environment for a baby.

The Edinburgh Postnatal Depression Scale is used for the initial detection of postpartum depression in mothers, can fathers also use it?

Interesting results in research were brought by the Gotland Male Depression Scale (GMDS – The Gotland Male Depression Scale) created in 1999 by Wolfgang Rutz. The difference between the Gotland scale and the classic self-assessment scales of depression is that, in addition to the typical symptoms of depression, it includes questions related to experiencing irritation, stress, emptiness, fatigue or burnout. As a result, there have been studies showing that the Gotland Scale of Male Depression can detect more cases of postpartum depression in men than the Edinburgh Scale.

After all, I think there is nothing to get too attached to scales. They should be treated as an auxiliary tool, and depression in women and men should be diagnosed on the basis of an interview, clinical examination and observation of the patient.

There is more and more talk about postpartum depression in women, and it is still quiet about men. Can young fathers count on professional help in Poland?

I do not know any centers that would specialize in this and frankly speaking, I do not think there is such a need. There are plenty of centers and places where a man with depression can get professional help. However, what is a problem in Poland is the availability of psychotherapy.

We will wait a few months for an appointment with a psychiatrist under the National Health Fund …

Yes, and many young people who have small children and are on the verge of making a life together cannot afford private therapy. Let us not forget that a man’s crisis related to the birth of a child is also a crisis for the whole family. Apart from his young father, his exhausted and lonely partner may need help.

The text was first published on February 28, 2019.

Also check:

1. Nervous breakdown – causes, symptoms, treatment
2. Peter Pan syndrome – origin, symptoms, relationships
3. Men and women react to stress differently