Postpartum Depression… in Dads! – PediaCast 493
- Dr David Levine visits the PediaCast studio as we consider postpartum depression… in dads! Depression and anxiety are common among new fathers but these conditions are often overlooked, which can impact the entire family in negative ways. We explore symptoms, diagnosis and management. We hope you can join us!
- Depression and Anxiety in Fathers after the Birth of a Baby
- Dr David Levine
Pediatrician, Atlantic Medical Group
Director of Professional Outreach
Postpartum Support International
- Postpartum Support International
- Help for Dads – Postpartum Support International
- Postpartum Depression Screening Tool
- Tips for Dads on Taking Care of Themselves and Their Partners
- Postpartum Men Website
- The Postpartum Husband: Practical Solutions for Living with PPD (Amazon | B&N)
- Boot Camp for New Dads (Online Workshop)
- The Good Men Project
- Center for Men’s Excellence – Advice for New Dads
- Postpartum Depression Hotline: 1-800-944-4773
- National Suicide Prevention Lifeline: 1-800-273-TALK (8255)
- National Hopeline Network: 1-800-442-HOPE (4673)
Announcer 1: This is PediaCast.
Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike.
Dr. Mike Patrick: Hello, everyone and welcome once again to PediaCast. It is a pediatric podcast for moms and dads. This is Dr. Mike, coming to you from Nationwide Children's Hospital. We're in Columbus, Ohio.
It's Episode 493 for June 16th, 2021. We're calling this one "Postpartum Depression… in Dads!". I want to welcome all of you to the program.
So, we have two important dates coming up and they are particularly important if you are a father or if you have a father. This Sunday, June 20th is Father's Day and next Monday, June 21st, is International Father's Mental Health Day. And so, this seemed like a good week to turn the spotlight on fathers and consider a topic that impacts their mental health.
Now, the other part of this episode's title is post-partum depression. And when you hear these words, the next thing that probably comes to your mind is moms because we often hear about mothers suffering from post-partum depression. But did you know that fathers also suffer from post-partum depression and anxiety. In fact, one of out of every four fathers, so 25%, suffer some degree of depression or anxiety during the first year of their baby's life.
And it doesn't matter if that baby is a first child or an additional brother or sister in the home. Ten percent of fathers suffer significant postpartum depression and 18% have anxiety following the birth of the baby. Mood disorders, including depression and anxiety are common in dads after a baby is born. But we do not hear about it. And many of these dads suffer without knowing what is really going on and without support or treatment.
And it turns out that postpartum depression and anxiety in fathers has significant consequences on the entire family because when dads are impacted by mental health conditions, it spills over into relationship problems with their spouse or partner and with their children. It raises family stress levels. It can lead to household conflict and discord, which has the potential to lead to even bigger problems like domestic abuse, child abuse, and divorce.
So, it's really important that we recognize postpartum depression and anxiety, not only in mothers, that's also very important, but also in dads. And it's equally important to get these fathers connected to the help and support they need.
So that's our topic today, postpartum depression and its impact on fathers. So please do share this episode with the dads in your life so we can raise awareness and help families heal and thrive.
To help us with the topic today, we have another terrific guest joining us. Dr. David Levine. He is a pediatrician with the Atlantic Medical Group and director of Professional Outreach for Postpartum Support International.
Before we get to him, let's cover a few quick housekeeping items. Don't forget, you can find PediaCast wherever podcasts are found. We are in the Apple and Google Podcast apps, iHeartRadio, Spotify, SoundCloud, Amazon Music and most other podcast apps for iOS and Android. If you like what you hear, please remember to subscribe to our show so you don't miss an episode.
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So, let's take a quick break. We'll get Dr. David Levine connected to the studio. And then, we will be back to talk more about fathers and postpartum depression. It's coming up right after this.
Dr. Mike Patrick: Dr. David Levine is a pediatrician with Atlantic Medical Group in Scotch Plains, New Jersey and director of Professional Outreach for Postpartum Support International, which is a non-profit organization that seeks to increase awareness about the emotional changes that women and men experience during pregnancy and after the birth of a baby.
That's what he's here to talk about today, postpartum depression and the impact it has on fathers. So, let's give a warm PediaCast welcome to Dr. David Levine. Thank you so much for stopping by.
Dr. David Levine: Thank you so much for having me.
Dr. Mike Patrick: Yeah, really appreciate you taking the time to connect with us.
This Sunday, June 28th is Father's Day. And next Monday, June 21st, is International Father's Mental Health Day. So, we together thought that this would be a great topic to talk about on PediaCast.
And I know the this is something that's really near and dear to your heart because you have some personal experience with postpartum depression. Tell us a little bit about your experience and your journey there.
Dr. David Levine: So much like probably a lot of people who are listening to this, I knew about postpartum depression in moms. I've been a pediatrician for 16 years and 8 of those years, I spent without kids. So, during that time, in the state of New Jersey, it's actually a law that we have to screen parents, screen mothers I should say, for postpartum depression but does not specify as to what that means. You could just ask is someone's doing okay, and they say yes, and you move on.
And that's basically what I did for about eight years. I asked people how they were doing. Never bothered to ask dad how he was doing, just asked mom and I went about my business.
Then, my wife gave birth to our first child about seven and a half years ago. And within the first two to three weeks, I started to feel very strange. I took two weeks off to be at home with him. And I started to be very… I realized in hindsight I was getting very anxious. I did not realize it at that time.
I did what most men do, I didn't tell anybody. I just sat there, and I try to be the good soldier. I want to be the rock for my wife. She had gone through everything. She went to the postpartum blues. I was there for her. I felt fine.
We're Jewish, so my son had his bris. We cried at the bris. And then my wife start to feel better. The feeding got easier. Everything started to gong fine. And that's when I started to hit a wall. And over the course of about five or six weeks, things just got worse and worse.
And at some point, I Googled postpartum depression in dads. I didn't find a lot back then, but I did find a couple of things that it was something. But I was like, you know what, I'll be okay. I minimized it. I did what a lot of people do, but especially men do in situations like this.
I went to work. People didn't really assume anything was wrong. But I wasn't sleeping. I was trying very hard to be a 50-50 parent, even though my wife was on maternity and I was working full time. I wanted to make sure that I was helping out at night. My son was formula-fed so we would try to take turns at night. I ended up getting probably four or five hours a night of sleep if I was lucky.
And then, eventually, it just became insurmountable for me. I was getting increasingly angry at my son. I would curse him, and I would tell my wife that our life was over because of him. And if this is how bad he was at two weeks or at two months, imagine how terrible he'll be at two years. And my wife just thought, "Oh, he'll be okay. He just is going through this and he'll be all right." Never really suspecting that deep down, I was actually starting to have very, very negative thoughts, visions of violence towards my son.
And then one day, my wife and I were supposed to go out on a weekend. Our parents were going to come and watch my son. And I was driving to work from Jersey City. It was raining and I'm in the car. And I called my wife on the car just to say, "I just want to make sure that we're still on for this weekend because…" I must have said something really terrible that morning. And I thought I heard her say no, and I just broke down crying.
I don't mean crying. I was weeping openly in the car. And she was like, “What's the matter? What's the matter?" I'm like, "It's over, I knew it." And she said, "No, no, I didn't say no. I said yes." And then she's like, "What's the matter?" And I just keep crying and crying. I'm amazed I got to work that day because I was just crying the whole time.
And she said to me, "You need to get help." And I said to her, "We need a baby nurse." So, she got to work getting a baby nurse to help us get some sleep. And I got to work.
And I spoke to a friend of mine who is a PDR doctor in Philly. And he had two daughters at the time. And he said to me, he's like, "Look, the first couple of weeks of both of my kids, I wasn't that great. It just kind of clicked for her. And it didn't seem that natural to me. It took a while." And he's like, "I know, I don't feel the weight that you felt to this degree, but I know what you're going through."
And luckily, I worked for a group at that time that had behavioral health. And I was able to find somebody who specialize in postpartum depression. But as I found, subsequently, nobody had ever worked with a dad before. They work with mom but never dads.
But I made the appointment and I showed up. And I started the cognitive behavioral therapy for about two months. And it was necessary because my grand plan with my son was that my wife was going to take three months of maternity and I was going to take a month of paternity leave, which you are allowed to take in New Jersey.
And I was like, 'Oh I want to be there. I'm going to be there. Just give me a nudge." And as we got closer and closer that day, I was becoming really nervous that one of us was not going to get through that week, that month together. I was genuinely petrified that I would snap during that time.
And luckily, the therapy kicked in. But also, my son turned out to be a fourth trimester baby, where the first three months, he was just a nightmare. He cried and screamed. And he gained weight and he hit his milestones, but he seems miserable. At least he seemed miserable to me.
I really don't know what the reality was because I saw whatever I was seeing. By the time I was supposed to be home with him, he was like, "Oh yeah, hey, dad." And he would cry when he was tired or hungry or he pooped and not all the other times. And it was almost like, I used to tell people, he knew he was put up or shut up time. Like if he did not snap out of this, this was not going to go well.
But he did and we had a great three and a half weeks together. And he started to daycare and I started back at work again, I was not a new man, but I was a much better father at that point. I continued therapy for a little while afterwards.
The first year of his life was not great. On our second anniversary dinner, me, and my wife, she cried most of that dinner because she just couldn't understand what happened during this past year. Because I didn't tell her.
I did not tell her any of these things. She knew I was getting help but I didn't go into any details with her. And then it was about a year and a half later, I was asked to speak about my experiences on the Old Charlie Rose Show. And in order to do that, I knew I had to tell my wife.
And so, I told her more than she knew before. And because my wife is who she is, she cried because she just wished that I had told her because she wanted to be there to help. And I was so worried that by telling her, she would reject me. Because I wasn't the man that she thought I was supposed to be. I wasn't this ideal that I apparently had in my head of who I would be as a father.
Afterwards and learning more about this illness, and then becoming a part of Postpartum Support International, I started to realize that if men are lucky, they will see one doctor when their child is born. That's us. That's the pediatrician.
Most men do not have an internal medicine doctor. They generally do not go to the doctor unless they really have to. They have to be forced by their wives to do so. The OB is not going to see them.
Nobody is asking how dad is doing. And that is a major mistake that we make because if dad is suffering and does not get help, there's a version of my story where I'm not sitting here talking to you and something terrible has happened, whether it's to my child or to me or to my family or to my marriage. I'm lucky and I realized that I'm lucky.
But it's sad that I had to be a pediatrician with a little bit of introspection and knowledge of what this could be and had access to care. Whereas the majority of American males do not have most of those things, so they do not get help.
And the ramifications, it's like if we don't do anything about it now, it's going to come back to us because the kids are going to have problems and we're not going to know why.
Dr. Mike Patrick: Wow, such a powerful story. And something that we really need to increase awareness about because as it turns out, postpartum depression in dads is just as common as it is in moms, but is not recognized nearly as often and dads don't get the help that they need.
The first thing that I want to point out with this is we call it postpartum depression, but there's really a whole range of mood disorders that are encompassing that, right? It's not just depression. So, if you think, am I depressed? I'm not depressed. I'm feeling anxious or I'm feeling angry or combative. I mean, there's really a lot of emotions that can happen with this, right?
Dr. David Levine: Yeah, they're technically called perinatal mood and anxiety disorders of which postpartum depression and anxiety are the two main ones. And in many cases, it's the anxiety that triggers the depression, but some people can get just one or the other.
Dr. Mike Patrick: And why does this happen? Why do we see mood disorders both in men and women surrounding pregnancy and the birth of a baby?
Dr. David Levine: So, it's not very well understood. A lot of misconceptions about postpartum depression, especially in fathers because the feeling is, and let's face it because of the Brooke Shields and the Chrissy Teigens of the world, a lot of women are aware of this. And the stigma is definitely, as there's a stigma with all mental illness, it's a little bit lower in women because they can point to these celebrities of famous women who've come out and said "I've suffered and I want to make sure that you know that you can suffer as well."
But now, the conception is, well, you get this because you're pregnant. And it's because of the hormones and the weight changes and all the different things that go along with that. And although that there is probably some truth to that, it's misguided in that it forgets that actually, the non-birth parent. And now, I am talking about dads specifically, but what I am talking about is applicable to any non-birth parent. Even adoptive parents can go through a postpartum anxiety or depression.
Men, or fathers I should say, they do have some of the same hormonal changes, differences in oxytocin and progesterone and testosterone levels that we believe are necessary to help with bonding with the infant. Many men or non-birth parents do gain weight along with their spouses, maybe not obviously to the same degree but there are definitely changes.
And then, there's all the things that happen afterwards. There is sleep deprivation. There is our modern societies, insistence that this be about the parents and the child and not about the family.
I don't know how you were when you were born. But when I was born, I was in Long Island and my mother, her family was around. Everybody lived very close by and so the grandparent were close, and the cousins were close. And so, if my parents needed help, they had help.
Nowadays, a lot of children move away from their parents. And then, when they have children, they don't have that tight-knit group around them. They might have some friends, but friends are not family. And family will be there.
And back generations ago, that's what would happen. People would move in together or you live with your parents. And that was because they knew that when a baby comes into your life, it is a major stress.
Unfortunately, here, we’ve been told that, no, it's not a stress. You can be a great parent and you can work, and you can have all this fun. And therefore, if the problem lies anywhere, it lies in you. And then comes all the shame with it.
So that it is not unique to the birth parent. That is possible for both parents. So, they undergo a lot of the same changes and then it's just nature nurture. There's genetically something and then there's an environmental. And statistically, it's 1 in 10, as you said for dads, and 1 in 5 to 7 for moms. But we think that they're probably more equal than we think. And it's not everybody in those situations. It's just something in some people that it triggers.
Dr. Mike Patrick: So really, there's lots of different reasons for this happening. And we have to recognize that having a baby is a big life change. And any big life change does come with mourning our previous life, the increase in responsibilities, tighter finances. We may even have conflicts with our partner over parenting styles. As you mentioned, lack of sleep is really a big compounding factor in all of these feelings.
And then, of course, not feeling up to the task, can I really do this and how is this going to go? And what's the end result going to look like? So, it's complicated and I think that the biggest thing today is just raising awareness that this exist. And if you find yourself in this position, really, the best thing you can do is, as you did, really seek help, and try to recognize it as much as you can.
And so, I would say to the audience out there, if you know someone who is pregnant, they're expecting, talk about this. Say, "Hey, you know, depression is a real thing, or anxiety and these feelings." And you may be doing someone's family that you're friends with or related t, a really big service by warning them about this. So, when it does happen, they're not caught unexpected.
So, you mentioned some of the symptoms that you had. What are the symptoms of paternal postpartum depression and how do those differ from men versus women?
Dr. David Levine: So, most of our conceptions of mental health, sadly, have a feminine slant to that. Hysteria is from hyster, which is the Greek for uterus. So, a lot of the things that we assume we're going to see is what we would see in a woman. So, you have a postpartum depression and anxiety in a mother would look like tearfulness, fears that something's going to happen.
Women typically have more tight-knit social groups, so they are much more likely to express how they're feeling to friends or family. They will express to the pediatricians the worries, that, "There's something wrong with the baby," "Are you sure about this?" "Maybe more phone calls." There are a lot more tip-offs that there could be something.
But if you look for those same symptoms in a man, you will miss them because men are much more closed off in general about our feelings. We tend to minimize issues. So, you're not going to see the father coming in with dozens and dozens of questions, calling every day, or sending you messages to the patient portal every day.
But you will see though, or if you ask the mother, you will find out is dad's working later, spending more time with his friends, more time in the man cave if they have one in their house. They're enjoying a little bit more of the things that they used to enjoy, like if they like to have a beer while they're watching the game, either having a six-pack.
They're more irritable and angrier. Whereas, people don't usually associate that with an anxious or depressed father. There's a theory of the male masked depression. And irritability and anger is actually one of the signs.
Whereas a woman will not typically show signs of anger, they will be more tearful. So, if you're applying the same criteria that you're looking for in women into men, you will miss this. You have to ask those questions specifically.
And as you rightfully pointed out, you need to educate, and you need to validate in order for anybody to get help. You have to, whether you're doing a prenatal or you're talking to a parent group, it's not bad to acknowledge that these are things that can happen.
Also, women typically will experience their symptoms in the first three months. Men are more likely to experience in the second, months three through six. Although it has to be said that that's when they present with them more. They're probably experiencing it at the same time, but they hide it. So, it doesn't come out.
Like I should have probably been diagnosed much earlier than I was but nobody, and this is not the fault of my child's pediatrician, they did not ask me. They did not hand me anything. They didn't acknowledge that this was a thing, so if they weren't asking, I wouldn't tell.
Dr. Mike Patrick: And a lot of fathers don't go to the pediatrician necessarily. It may just be mom coming in by herself. And so, sometimes, you have to tease out if this is happening through mom because you don't have access to dad.
Dr. David Levine: Yeah, and COVID made that even harder, where we were limiting the number, we only have one parent come in. So, most of the time, that was mom. Dad was on the phone or on Facetime, it is very difficult to ask these questions via a screen. You really need to have them there.
Where I practice, there's a higher chance that you're going to see the dad for the first couple of visits. So, there is that opportunity. But you're right, usually after two months, you're not really seeing dad much during these physicals, so you have to plant those seeds early. And then you have to start remembering to ask mom too when you are screening her for postpartum depression, asking "How is dad doing?" and being specific about it.
Dr. Mike Patrick: Are there any risk factors that increase the likelihood of this happening, something that we can point to and say, "Hey, this is more of a risk. Maybe I really need to screen this family with more intention than another?"
Dr. David Levine: Yes. If there's a history of anxiety or depression, that can obviously increase the risks. But it is not guaranteed. So, if you have a father who has had a history of depression, that doesn't mean they're going to have postpartum depression. And the opposite is true as well. I had never had depression. I had some anxiousness, but I'm divorced, so a lot of that came out during my divorce.
I'm married with kids now, but this is prior to that. That there was some anxiousness there, but that would never had prepared me for this. I don't think anybody would have thought that that was something. Because many people have had anxiety and depression. They will not suffer from this problem. Even if it's one in ten like they say, it's still nine out of ten fathers are not going to have this.
A lower socioeconomic status, higher stresses, younger age of birth, teenagers, early 20s are certainly in a different position than if they were in their early 20s, 30s, more established financially. Anything that's going to increase the stress, are there other children? Are you living with large numbers of people who are also having their own troubles?
Any predisposing mental health condition can increase the risk of this, but you have to just remember that that is not the gold standard. A lot of this will be sporadic. Or more importantly, they will be in fathers who subsequently will say that I've had issues during my life but never saw treatment for it. Which makes this that much harder because there's so little good data on men's mental health, because it's hard to get men to talk about this type of things.
That's why, like you said, the stated rate is one in ten, but if you really dig through the data and you ask the right questions, you'll find that it's probably equal to moms.
Dr. Mike Patrick: Some of the research that I had looked at as I was preparing for this said that there was the feeling that about 25% of fathers are affected at some point during the first year after a baby is born. Ten percent with postpartum depression compared to 15% for women, but 18% developed an anxiety disorder including generalized anxiety, obsessive compulsive disorder, post-traumatic stress disorder.
And so again, even though if you just surveyed folks, you may just come up with 10%, but it's probably much higher than that when you really dig deep.
And then, of course, mom having postpartum depression, that's a big stressor for dad. So, is it more likely that dads could develop postpartum mood disorders? Not because, but if mom has issues, it's a little more likely maybe but fathers will, too. And I guess it's probably interrelated. If fathers are more angry and not as communicative, is it more likely than the mom is also going to suffer from perinatal mood disorders? So, it's really connected with each other, right?
Dr. David Levine: Very much so. And again, this is why it's not unique to mothers, but it can be any non-birth parent. When it comes to fathers, it's 50%. So, if mom is suffering from postpartum depression or anxiety, there's a 50% chance that the father will as well. And that's like you said, it's being in that environment, dealing with the mentally ill spouse, trying to deal with the child as well during this very stressful time, it's just inevitable that some of these other parents are going to break down as well.
So even more importantly, when you have a mother who says to you, "Yes, I'm talking to a therapist and I'm on some medicine for my depression that I developed in the last couple of weeks since the baby is born," you really have to say how is your partner doing? How is the other partner doing? Because that's your biggest risk factor. And if you're not aware of it, and if they're not aware of it, they're going to miss the signs, and then it's just going to compound.
Dr. Mike Patrick: And this is something that is particularly important to address, not just for mom and dad as individuals, but this really impacts the future of the family, or it can.
So, give us a little information on that. How does postpartum mood disorders impact the entire family down the road?
Dr. David Levine: So, there are a lot of different ways to look at it. So directly, there was JAMA Psychiatry article back in December 2018 that found that there was an increase in depression in teenage daughters if the father was depressed postpartum. As a father with postpartum depression has an increased chance of depression after the postpartum period, you can look at the impact of the depressed fathers on children.
Meaning, you can be an undiagnosed postpartum depressed or anxious dad who then goes on to develop a major depressive disorder, which many of these men do have and many fathers end up having. And you may be able to trace it all the while back to the postpartum period.
So depressed fathers, their children are twice are likely to develop a psychiatric disorder by the age of seven. It's not clear if this is nature or nurture. And since postpartum depression can increase the chances of divorce, you can also look at the literature on ACEs, so adverse childhood events.
And in theory, a depressed father can check off eight of the ten boxes for ACEs. And scores that are greater than four significantly impact the overall health as many of your listeners know in terms of job prospects, income, and lifespan. Just because you look at divorce, substance use, emotional and physical neglect, and abuse, these are all possibilities in a parent but especially a father who is depressed.
And to give you an idea, when I had my depression, which again was really just those first few months before my child was really conscious of anything, I checked at least three boxes. And had I not gotten help, if you had added the potential for more neglect into there and even the potential for divorce, potentially before my child is even out of diapers, I have set that child potentially up for failure in the future.
And he still has money and he still has food and shelter. But because of my or the parents' mental health, 10, 20, 30, 40 years down the road, society is now dealing with this broken person. And it started in a postpartum period where, "Look, we're in pediatrics, we're all about prevention. This is our opportunity to prevent this from happening."
Dr. Mike Patrick: Yeah, absolutely. I mean you can see that trail as you move forward in undiagnosed and untreated mood disorders, anxiety, depression that then end up resulting in marital conflict and substance abuse and domestic abuse, and even child abuse. And just bad outcomes that could have been prevented.
And I guess that's why this is such an important topic for the pediatric audience, because we do have a chance to intervene and prevent that sequence of events right at the very beginning by hopefully getting dads the help they need when they need it.
So, we do have a lot of pediatric providers who listen to this podcast. Why is this an important consideration for us and how can we practically make a difference?
Dr. David Levine: So, it's a partial consideration for because, one, we don't just take care of the child. We take care of the family and the impact that one has on the other. As I stated before, we are often the only doctors who will see the father. And remember, in those first year, we see that child so often, especially the first six months when most of these symptoms will arise that we have the opportunity to intervene or to get them help.
And I remember when we first started to hear about this and we're supposed to start screening in New Jersey, I speak for us, where a lot of us were like, "What are we supposed to do? I don't take care of the father. I don't take care of mom. What if she says she's having trouble, what am I supposed to do? I can't prescribe. Who takes care of these parents? I have no idea."
And that's another one of the reasons why I thank you for giving me the opportunity to speak to your audience today because after hearing this, now you can say, "Well, I know of somebody. It's not that I've never heard of this before. I know of somebody and now, I know what to do."
I am on the Postpartum Support. There are many other groups that do it, but Postpartum Support International has a website, www. postpartum. net. And we have a hotline, 1-800-944-4773. That is a 24-hour warm line for any parent to call and get help. So, they can call and say I'm having trouble. They have a live person who's going to be able to talk to them.
We have chapters in almost every state. And we have people in almost every state who have taken certification exams through us that know or specializing in postpartum depression. And if they know how to deal with the mom, they can figure out how to deal with the dad. The newer version of our certification has a specific section on fathers. And they can help link parents to providers in their state and hopefully locally who can help them.
And for doctors, that same phone number, one of the options, I believe it's option number 4, can get you in touch with a perinatal psychiatrist. It is not expected that a pediatrician is going to treat these parents. But it is important to know, what am I supposed to do? Do they need to go to the emergency room? We don't want them going to the emergency room and having a child taken away, which is not good.
We don't want them locked up in a psych institution when they need to be with their child. But since most of us, in all of our medical training, we don't get a lot of training in mental health. We certainly don't get a lot of training in the parents’ mental health. So knowing that these options exist and that there are organizations, more than just mine that are out there to help doctors and therefore help their patients, takes away the, "Well, I'm not going to ask because I don't know what to do." Well, you do know what to do and there are things that you can do to help.
And a lot of times, you don't even need to do that much. Sometimes, as I said, just that validation. Like I had one dad once and I mention this to every new parent. And I can count on one hand the number of dads who have ever actually spoken to me honestly about it. But I had one dad who said, "She's nursing. I'm not doing that stuff and I'm feeling this way. And I haven't earned the right to feel this way. And so that makes me feel ashamed." And then I feel ashamed that I feel this way.
And that put it beautifully, because that's how a lot of fathers feel, and a lot of non-birth parents feel. I'm not the one doing all the hard work. I didn't have the baby. I'm not the one who's there with the baby all day long. I've gone back to work or whatnot." As if you have to earn the right to feel.
And that's a terrible feeling, to have to feel like, "No, no, I'm not worthy of this." So just knowing that that's okay takes their stress levels down. And I'm not going to say it cures them, but it opens up the doorway to being more open with their spouse or with their family about this. And then, maybe saying, "You know what, maybe my mother should come this weekend." Or, "We should have someone come to help us."
And by doing that, they start to get better, because this doesn't require medicine. Probably, some people do need behavioral therapy for it. But also, with COVID, much more of this is available virtually, so you don't even have to necessarily be right there in the office. You hopefully have somebody in your state where they can do it in some other if they've waived whatever the regulations are, you could talk to somebody out the state and they can help you.
Dr. Mike Patrick: Absolutely. You had mentioned before you had personal experience with this and really started digging and learning about it. You may just say, "Hey, how are you doing?" But there is a better way to…
Dr. David Levine: Yeah, much better.
Dr. Mike Patrick: Describe that to us. How do we go about getting at if this is really happening or not in the family?
Dr. David Levine: So again, I'm a primary care doctor. So I'm fully aware of the time crunch when you're trying to see families and you're trying to do all the stuff that Bright Futures expects that you're somehow going to be able to do in a 30-minute visit or what-not. But you can train your staff to hand an Edinburgh Depression Screen to not just one parent, but to both parents that are there.
Have them fill it out and then, the medical assistant, while they're weighing and measuring the baby, can grab those forms, bring them out to you, score them. If your EHR has the scoring, they could enter it in. If not, they can just show it to you. You know what the cutoffs are, you know what to look for. And before you get into the room, you could have already screened both parents.
Now, the screening for moms is 10 and up is a fail. Or if you say anything other than normal on question number 10, these are validated screens. They are valid for fathers but there are some anecdotal evidence that you can't use 10 as a cutoff, but you probably have to lower it because again, fathers tend to minimize our symptoms so you might need to look at a cutoff of 7 to really start to probe a little deeper into what they're experiencing.
But the Edinburgh is perfect. There's the GAD 7. You could do a PHQ. There's a lot of different screen tools, but the Edinburgh is the main one. I don't know if anybody is working on a father version where the questions might be slightly different to really get at more of the symptoms that fathers use, that fathers experience. But it's the best that we have. And you're hopefully already giving it to the mother, so it doesn't take much to just hand it to the other parent.
Dr. Mike Patrick: And if the father is not there, you could ask the mother to answer the questions, her best guess of what dad would be feeling, to try to get an idea what the dad is thinking.
We're going to put links in the show notes over at pediacast.org for this episode, 493, of all the things that you've been mentioning. So, screening tools, Postpartum Support International, the 24-hour hotline that you had mentioned. So, folks, you don't need to memorize all these things, we'll have the resources for you in the show notes over at pediacast.org.
You mentioned treatment. One thing I really love about the Postpartum Support International website is there's a Provider Search there. So you can really look in your area and see which providers, as you mentioned, has been certified or have a particular interest in seeing and treating fathers and mothers too with mental health conditions around the time of pregnancy and after the birth of a child. So, all of that's available over at that website.
What is the long-term outlook for these fathers? So, if they do get the help they need, is this something that is treatable, and we can get this under control? Or are many of them going to have issues, major mood disorders down the road?
Dr. David Levine: Well, as with all diseases, if you treat it, you can get better from it. A lot of fathers, unfortunately, don't get the treatment that they need, and it continues to linger on. But it can get better. Just like with mothers, if a father gets mental help, mental health help, and they are able to talk it through and start to see what their altered thinking is causing and the negative loops that they are going down, they can get better.
And again, I am living proof of this. I thought that everything my son did, and to lesser extent, my daughter was meant something else. And I had to go through the process of writing down my thoughts and asking myself, if I ask 100 people, if this was true, would they say yes? And I had to be honest with myself and say no, I don't think that 100 people would say that I'm the one who's right and they're all wrong.
And I had to retrain my brain to stop seeing everything in such a negative light. In addition to that, I needed to get sleep which, unfortunately, not every parent has access to a baby nurse and can get two weeks of somebody who's there to take care of the baby so you can get some sleep.
There are workarounds. And again, that's why having family nearby is so important, but you have to make do with what you have. But there is no guarantee that if you experience these things, you're going to destroy your children. When I first read about this, and I first looked at the numbers and the damage that I could potentially cause, I was petrified.
My son is going to turn eight in October. My daughter is going to turn four in October. They appear to love me. We just had a nice weekend where my wife was away. And we made it together and we had a good time.
It is not fait accompli. That if you had a hard time in the beginning, that does not mean you're going to have a hard time for the rest of your parenting career. It just means that you're having a difficult patch that we all go through in life. And you can learn from that, you can get better from that.
And more importantly, you can hopefully share that knowledge with your friends. And then your children, when it's their turn, you can now acknowledge to your children, "Hey guys, if you have anything weird that you experienced when your kids are born, don't worry, talk to me. This can happen and we'll help you get through it. Because now, I have a totally different perspective on what this is like."
Dr. Mike Patrick: Absolutely. Another way that I think you as the audience out there can really make a difference is educating your pediatrician or whoever it is that takes care of your kids about this issue. Because as Dr. Levine mentioned, there's just so much pressure on pediatricians to cover so many different things. That this is not one that may stand out, but as a parent who's seeing the pediatrician, you can mention, "Hey, do you screen for postpartum depression? Do you ask about postpartum depression in dads?"
And then, a very simple thing you could do is just point them toward this episode of PediaCast so that they can learn more about it. Because a lot of this really is just raising awareness about the issue. Because once we do that, then it's easier to identify fathers and mothers and families who are having these concerns and get them connected with the help that they need.
Again, as I mentioned, lots of resources in the show notes this week. Postpartum Support International has part of their website called Help for Dads. And there's just a ton of resources on this part of their website. Again, that Provider Finder that I mentioned. There are links to support groups. There's monthly chats. There's Facebook groups. What other resources are available for families who are impacted by postpartum depression?
Dr. David Levine: There are a lot of local… I mean, a lot of it is local, church groups, hospital groups that do postpartum help. For new fathers, there are a lot more websites available to read and to get more information. There's fatherly.com. There's the Good Dad Project. There's Boot Camp for Dads, which is actually a pretty popular thing if it's in your area where it's fun and it's for fathers to be there sometimes with their children to get… Just like moms groups have this, when the baby is born, they go to their local church or synagogue or their town has little meetups where new parents can get to know each other. Well, there are things like that that exists for fathers as well, where you can learn.
The best thing for me was not only was it the behavioral therapy, but it actually turned up to be that I took the paternal time off, the paternal medical paid leave, which is available in all states. The problem is in most states, it's not paid. Or if it is paid, it is very very small. To the point where it may not be even worth it. I did not do it with my second child, partially because I didn't think I want to put myself through it. I was worried a lot about whether I would be able to do it again with the second child and all those things.
But when I did that, I don't mean to say this in a weird way, but I learned how to be a dad because I could not rely on my wife to do things. Not that I was like, "Oh, she'll take care of it." It's more I had to be responsible for all the diaper changes and all the feedings and all these things.
And again, this is not, well, when he was a dad, he didn't have to do it. Most fathers were raised by fathers who did a lot of things. So, we don't have those role models to turn to, to ask them, "Okay, what would you do in this situation?" But mothers do this, their generations of women have done all this.
It's only recently that men have started to want to be more responsible, want to be a bigger part of their child's lives. And also, they have to be. Women are working. You have more dual incomes. You need to do this.
And being there alone with him was the best thing, because I took him in the car, and I drove to my parent's house. And I did all of these things and it gave me confidence. And men love to feel confident in things. We love to feel to do things really well.
And you know, sometimes, you just need a little bit of help with that. But when you start to really do well as a father, it's such a great feeling. That after I did that, I just felt better. I just felt like I was actually accomplishing something.
And as everybody know, the first two months, your kid doesn't even smile at you. The kid gives you no acknowledgements. So now, when I'm doing these things, and he's three to four months old, and he's starting to acknowledge me, he's starting to smile at me and he's giggling when I'm doing things, now I'm getting that positive reinforcement that I'm doing it right.
And I tell all parents, I tell both parents this all the time, in the beginning, it's going to be tough because you're not going to know if you're doing it right. And then, all of a sudden, you'll start getting some of that attention back. It's a one-way street in the beginning. Nobody told me.
I'm a pediatrician. Nobody told me this. And I didn't even tell parents this. Maybe that was my own naivete. I mean, I was just doing what I remembered what I was taught to do in residency. But I didn't talk to families the way that I do now because I wasn't the parent.
I don't mean to say that you can't be a good or a great doctor, great pediatrician and not have kids. But I do think that it helps to have children because you can relate to a parent in a completely different way. And when it comes to talking about mental health like this, you having that experience, you're no longer talking above them. You're talking directly to them, and I think it has a much bigger impact.
Dr. Mike Patrick: Yeah, it's the difference between book-smarts and street-smarts, right?
Dr. David Levine: Yes. And when you have that kid, now, suddenly, you get a little bit of both.
Dr. Mike Patrick: I mean, until you experience what we call colic during those first few months of many baby's lives, where they just seem to cry all the time. Until you experience that firsthand, it really is hard to empathize with parents that are going through that.
So, lots of great resources. Again, check out the show notes over pediacast.org. We're going to put all of those there, that Postpartum Depression Hotline. I'm also going to put the phone numbers for the National Suicide Prevention Lifeline and the National Hopeline Network. We've talked about those things before. But again, depression, sometimes, you can have thoughts of ending your life because it just seems hopeless, as you're going through and having these feelings.
And so, it's important that you realize that people do care. There are people in your life who love you and would really really miss you. And that you are an important part of your family. And so, please do seek help if you're having those sorts of feelings, really really important.
Dr. David Levine: And also, I would just add to that, like I said, my wife, I was petrified that she was going to judge me. And that's not unique to me, as I've read, a lot of fathers don't say how they feel because they are very worried about how they will be viewed as men. And if you have a loving spouse, whether that's a male or a female, it does not matter, if they love you, they want what's best for you, too. They want everything to succeed. This is not a competition and the best families know this is not a competition.
And getting over that and realizing that you can say these things freely and know that the people that care about you are going to say, "Okay, how can I help you?" They're not going to say things like, "Whatever, well, all losers feel this way." Although, on the Internet, they do say that. But in real life, they don't.
Dr. Mike Patrick: Absolutely. And moms out there, talk to your husbands about this, or your partner. Whoever your partner is, talk to them about this. Maybe the best Father's Day gift that you can give is opening those lines of communication, raising awareness, and helping out when these issues complicate the lives of families.
So, Dr. David Levine, pediatrician with the Atlantic Medical Group and director of Professional Outreach for Postpartum Support International, we really do appreciate you stopping by and sharing these thoughts today.
Dr. David Levine: Thank you. I really appreciate the opportunity.
Dr. Mike Patrick: We are back with just enough time to say thanks once again to all of you for taking time out of your day and making PediaCast a part of it. Really do appreciate that.
Also, thanks to our guests this week, Dr. David Levine, pediatrician with the Atlantic Medical Group and director of Professional Outreach for Postpartum Support International.
So, this Sunday is Father's Day. I do want to wish all of the fathers out there in the crowd a very happy Father's Day. Fathers are important. And you do a lot for your family, for your partner, your spouse and your kids and just wish you very well and that you all have a terrific Father's Day.
Also, next Monday, June 21st is International Father's Mental Health Day. And so, take some time to think about your mental health. And if it's not going so well, it is okay to seek help because it's going to make you a better person and help your family thrive.
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Thanks again for stopping by. And until next time, this is Dr. Mike saying stay safe, stay healthy and stay involved with your kids. So, long, everybody.
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