Postpartum depression affects (also) the couple
Postpartum depression in mothers is only now beginning to be recognized and acknowledged by healthcare services and in our society. But if I say that partners can also experience postpartum depression , someone might think, "Where are we going with this?" Well, I'll explain, step by step, where I'm going with this.
In the social imagination of the late 20th and early 21st centuries, everything surrounding pregnancy and postpartum has often been imbued with an aura or fantasy of happiness . That is, no one thought or wanted to think that the birth of a child could be accompanied by problems, discomfort, unhappiness, or even illness. In my opinion, the media and periodicals about pregnancy and parenting have played a significant role in this perception. Babies were born clean and rosy-cheeked, mothers appeared young, slim, smiling, and rested (and even made up and with their hair perfectly styled) after giving birth, and the professionals who attended them were all young, slim, and wore clean, impeccably ironed medical coats. The partners who accompanied them also appeared rested, young, attentive, and solicitous at the mother's every whim. In the postpartum period, the mothers featured in these magazines feel empowered and are primarily concerned with their baby's healthy growth and the timely achievement of developmental milestones, which they see as natural laws that every baby must follow. And breastfeeding is almost a moral obligation.
But what happens when the reality of our labor and postpartum experience bears no resemblance whatsoever to this image? Childbirth can be a difficult time for many mothers and partners, and the postpartum period a complex adjustment . Sometimes, mothers may experience complications such as blood loss (anemia), high blood pressure (preeclampsia), or infections, among others. Sometimes, breastfeeding is not possible (or not desired). Sometimes, babies require hospitalization for more or less serious problems, with the resulting stress for both parents. In fact, postpartum depression affects between 15 and 20% of all mothers, with varying degrees of severity.
Everything you need to know about postpartum depression
A recent international review by Dr. David Fisher and colleagues (2021) from Northwestern University in the United States has once again highlighted the need to pay attention to the mental health of couples . Although they have obviously not experienced all the physical and biological (hormonal) stress that pregnancy and childbirth entail for mothers, the pregnancy and postpartum period can also be a time of change and challenges for couples, even a time of suffering and mental distress.
The mental health of couples after childbirth
Partner support for mothers throughout pregnancy, childbirth, and the postpartum period is fundamental (Brown & Davies, 2014). We know that this support should not be merely instrumental, or financial, but fundamentally emotional. Shared responsibility in the care of the newborn is essential for a harmonious and respectful process that transcends the outdated tasks and roles "assigned" by a traditional, patriarchal, and sexist view of the role of both parents in this process. Social advances, such as maternity (and paternity) leave, have allowed us to have this much-needed adjustment period for both parents, with all these new roles developing. However, these paid leaves, so common in many Western countries, are not universally available, and their duration remains suboptimal.
Although they do not experience all the physical and biological stress of mothers, the pregnancy and postpartum period can also be a time of change and mental suffering for couples.
Several recent studies show that the prevalence (frequency) of postpartum depression in couples is not minimal. In a recent meta-analysis of 47 studies, with a total of 20,728 subjects included from different countries and cultures, the prevalence of depression during pregnancy in couples was 9.76%, while the prevalence of postpartum depression was 8.75% during the full year after delivery (Rao et al., 2020).
Therefore, we can consider the prevalence of depressive symptoms in partners, although clearly lower than in mothers, to be relevant. But the question we can ask ourselves is: Why hasn't it been detected until now? In my opinion, this lack of interest has much to do with the general lack of interest among political leaders (with honorable exceptions) in the mental health problems of the population. There is a lack of resources not only for postpartum depression in mothers, but also, in general, for all common mental health problems affecting both women and men.
Maternal mental health: warning signs
Promoting well-being, healthy lifestyle habits, diet, and exercise among expectant mothers and their partners could be the key to a pregnancy freer from mental health problems. In this regard, we must remember that, although postpartum depression is a clear risk in every pregnancy, we can take preventative measures simply by engaging in moderate exercise (such as walking), quitting smoking, following a balanced Mediterranean diet, and maintaining adequate sleep habits. This applies to both mothers and their partners.
Characteristics and consequences of postpartum depression in the couple
Returning to perinatal mental disorders in couples, their clinical characteristics are more heterogeneous and show less defined symptoms compared to maternal perinatal disorders. The course of the illness is quite long: more than half of the fathers or partners with depression during pregnancy continue to be symptomatic six months postpartum (Zelkowitz & Milet, 2001).
Mood changes and anxiety are consistently present in postpartum depression in couples, but they are often underestimated, unrecognized, or not properly addressed (if suspected). Furthermore, more behavioral symptoms appear (Bruno et al., 2020).
Among the main differences (or similarities) between paternal and maternal depression, we find the following (Bruno et al., 2020):
| Common symptoms with maternal depression |
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| Differential symptoms with maternal depression |
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In addition, paternal depressions tend to have a longer duration and slower remission or recovery compared to maternal depressions (Escribe-Aguir et al., 2008; van den Berg et al., 2009).
Failure to detect depression in a partner can lead to inadequate treatment and a spiral of distress and neglect.
The consequences of chronic or untreated depression can be significant. Aside from the suffering it can cause for the individual and their family, there is a decline in functioning and a reduced quality of life (Field, 2018). It can also affect infant development, increase the risk of emotional and behavioral problems in children, and lead to greater subsequent psychiatric morbidity in offspring (Weitzman et al., 2011; Gutierrez-Galve et al., 2019; Ramchandani et al., 2008; Ramchandani et al., 2005). Furthermore, it can lead to marital conflict and difficulties with children (Ramchandani et al., 2011; Kouros et al., 2014).
Perinatal period and mental health: this is something that is being discussed
So, if it's so serious and has so many consequences, why is it so under-detected? There are several possible explanations. On the one hand, healthcare professionals are still not very aware of and have little information about this health problem . On the other hand, our society has a "cultural" bias, and in the case of fathers (and men in general), they tend to pay less attention (awareness) to their feelings and emotions, and therefore seek less help when they need it.
In any case, this lack of detection leads to them not receiving adequate treatment or even entering a spiral of discomfort and neglect, sometimes for long periods.
In addition to postpartum depression, couples are also exposed to other health problems during the perinatal period, just as mothers are. In the case of perinatal loss , for example, they often face concealment or denial of their feelings of grief (Obst et al., 2020).
In conclusion, and based on the meta-analysis by Rao et al. (2020), prenatal and postpartum depression in couples is a relatively common problem. Therefore, as with maternal depression, it is also necessary to implement regular screening strategies, effective prevention, and appropriate treatment in this population.
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