This Is Why Postpartum Depression In Men Is So Underreported

David Levine of Scotch Plains, Connecticut, went into parenting with more knowledge than your typical dad. As a pediatrician, he had been answering the biggest parenting questions on the regular — questions about breastfeeding, sleep training, and baby milestones. So when he became a dad himself, he was confident that he knew what was coming and how to handle it. This was not the case.

From very early on, Levine didn’t feel any connection to his child. He had a deep, unsettling feeling that something was amiss. “I didn’t realize how much a baby cried. And when mine cried all the time, I couldn’t help but think that something was wrong with him,” Levine says.

As the weeks went on, the situation grew worse. Levine started getting angry with his baby. He didn’t think he fed well, and the crying — oh, the crying. For Levine, it never seemed to end. His thoughts grew darker and darker — of hurting his baby and of hurting himself. He was sure the baby would ruin his marriage and his life.

By week seven, Levine had hit rock bottom. Emotionally and mentally exhausted, he sat in his car on the way to work and burst into furious tears. “That’s when my wife told me I needed help,” he says.

Levine’s experience is not uncommon. Paternal postpartum depression impacts 1 in 10 new fathers, who experience a range of symptoms that may differ from Levine’s. Yet postpartum depression in men often goes undiagnosed, and there’s a lack of awareness about it within the medical community. In fact, there are no established criteria a man must meet to have postpartum depression, and there is no universally accepted diagnosis.

The Stigma of Depression in Fatherhood

Levine says that part of his issue was that he had never heard of paternal postpartum depression. He was also embarrassed about the way he was feeling. “I bottled most of my feelings inside, and I didn’t tell anyone,” he says.

Ideas about masculinity are a major reason why new dads don’t talk about their mental health, says therapist Matthew Braman, CEO and founder of Verve Psychotherapy, who specializes in therapy for new fathers. Because of the stigma of both mental health issues and being vulnerable in general, “asking for help may be considered weak,” he says.

Men are sometimes afraid to acknowledge “authentic human emotions” (except for anger), Braman says, even to a therapist. Even if they do acknowledge that they’re depressed, new dads are often afraid to seek mental health treatment because they’ve been taught culturally not to. Research published in 2018 found that many men were unlikely to seek treatment for postpartum depression because they feared stigma.

“There’s a blind spot in the health care system when it comes to looking after a father’s mental health.”

This holds true to Levine’s personal experience. Cultural stereotypes made it difficult for him to tell his wife the way he was feeling, he says. “I couldn’t tell her that I was depressed because I was so ashamed. I feared that if she knew how I felt that she would think less of me or leave me.”

A Blind Spot in Healthcare

When Levine did eventually seek out a counselor, he chose someone who specializes in postpartum depression in women, because he couldn’t find a paternal specialist. He’s not the only new dad who has experienced that roadblock. Finding specialized help can be next to impossible, says Daniel Singley, Ph.D., a psychologist who specializes in postpartum depression in fathers.

And seeking additional help is often necessary because physicians and healthcare professionals hardly ever ask fathers how they’re holding up. This can make them feel like their feelings about fatherhood aren’t relevant. “There’s a blind spot in the health care system when it comes to looking after a father’s mental health,” Singley says.

Issues with diagnosis can also make it difficult for men to get help. The Diagnostic and Statistical Manual of Mental Disorders — the manual used by mental health experts to give diagnoses — requires that postpartum mental health conditions show up within the first four months postpartum. But oftentimes, fathers manifest postpartum depression symptoms after the four-month mark. This means they often can’t get an official diagnosis, Singley says, which makes it harder for the health care community and society to recognize the condition.

Men are a lot more likely to complain about back pain than sadness.

People are also more likely to miss postpartum depression symptoms in men because they can be so different than symptoms in women. Male depressive episodes are often more about anger, irritability, withdrawal, substance abuse, and somatization (when psychological concerns are converted into physical symptoms like tension or pain in the body). Men, says Singley, are a lot more likely to complain about back pain than sadness. And they’re more likely to abuse alcohol or drugs than they are to admit to a mental health disorder. All of this can make it harder to diagnose the condition.

“This lack of awareness is systemic,” Singley says. “Even within the field of mental health, unless your focus is on postpartum, you’ve probably never even heard of paternal postpartum depression.”

It’s also about how we train clinicians, Singley says, and how organizations such as the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists hardly ever mention paternal mental health. There’s not enough research or funding on the subject, even though 10% or more of new fathers have it, he says.

Screening for Postpartum Depression in Men

One of the biggest problems with paternal postpartum depression is that medical professionals don’t screen for it, says Sheehan D. Fisher, Ph.D., a psychiatrist who focuses on postpartum health in men at Northwestern’s Feinberg School of Medicine. “Because it’s not a commonly recognized disorder, men often don’t realize they’re coping with it. And we don’t have screening available, which means we miss out on what they’re going through as well as its true prevalence,” Fisher says.

The more men that seek help, the better an understanding experts may develop of the disorder. Fathers who think they may be struggling with paternal postpartum depression should first talk to their primary care physician or reach out to a mental health professional for care, Fisher says. Many health care providers will give a questionnaire to assess the degree of depression. New dads can also reach out to Postpartum Support International, one of the few organizations that has support groups specifically for fathers.

Postpartum depression isn’t something you can suppress, push down, avoid, or hide, Levine says. His only regret is that he didn’t seek help sooner. If he had, he thinks the feelings would never have gotten as bad as they did, and he wouldn’t have felt such shame for having them in the first place.

In the end, Levine talked to a therapist for months after his breakdown and got a night nurse that helped him and his wife get the sleep that would help stabilize his emotions. But he still didn’t tell his wife what he had truly experienced until a year later. And when he did, she was sad — not that he had had these feelings, but that he didn’t feel like he could confide in her.

“That was my mistake, and this is a mistake that a lot of men make,” Levine says. “We’re worried to tell our partners because we’re ashamed and think they’re going to think less of us. But mostly, they just want to take care of us.”