Postpartum depression is a condition diagnosed in mothers—birth mothers, specifically—coming home from the hospital after giving birth and feeling that something is off. That the joy they thought they should be feeling is nowhere to be found.
While hormonal changes associated with birth can play a role, according to the Mayo Clinic, hormones are just one ingredient in a stew of risk factors that also includes sleep deprivation, lifestyle, and environment. All of these other factors can affect any new parent. And they do.
Research shows “postpartum” or early parenthood depression occurring in all kinds of parents—biological, nonbiological, adoptive, gay, or straight.
A new longitudinal study out of Northwestern University examined more than 10,000 men over 23 years, tracking their depressive symptoms throughout their lives, for both fathers and non-fathers, fathers who lived with their children and fathers who didn’t. The data for nonresident fathers was not statistically significant, perhaps due to a small sample size, but the researchers found that for resident fathers, depressive symptoms increased by 68 percent during their child’s first five years of life. And as the study notes, “for children, the 0 to 5 years are key developmental years when attachment, security, and the ability to safely explore…are of paramount importance.”
“Dads have doubled the amount of time they spend in childcare from 1965 to 2011,” says Dr. Craig Garfield, lead author on the study and associate professor in pediatrics hospital-based medicine and medical social sciences at Northwestern. “If we know that dads who are depressed are more likely to use physical punishment and less likely to read to their kids, this has an effect on the child as well…Dads are key players. They have contributions to make, and they can be positive or negative contributions.”
Postpartum depression may be more likely to go undiagnosed in men, though, as men are traditionally less likely to ask for help than women, and are more willing to report problems like irritability and fatigue than feelings of sadness or worthlessness.
“I’m not sure that the male/female part has as much to do with it as we all thought,” says Karen Kleiman, founder and director of the Postpartum Stress Center and author of This Wasn’t What I Expected: Overcoming Postpartum Depression. “It’s just hard to have a baby. It’s hard to have a baby and continue to work, at work and at your relationships.”
Intellectually, most of us know this. That having a baby changes everything is stale, cliché—if true—advice. But there’s a difference between knowing and doing, and even parents who are prepared and eager to have a child can easily find themselves overwhelmed during the transition. Whether that will translate into depression for a particular person is impossible to predict, but stems from an elusive combination of genetics, psychology, and the support available to the parent.
One thing that seems to play into all this is the dissonance between a person’s expectations of parenthood and the reality.
“It’s like holding your breath for a really long time,” Kleiman says. “Then all of a sudden we get what we think we want and think, ‘I finally have what I want, why do I feel so bad? And now on top of that I feel guilty for feeling so bad.’”
Unmet expectations play a particularly key role in the development of depression in adoptive patients, according to Dr. Karen Foli, an assistant professor at the Purdue University School of Nursing and author of The Post-Adoption Blues. “The adoptive process is a pretty rigorous investigation,” she says. “The adoptive parent is kind of selling themselves as being worthy of a license to parent. After the placement of the child, no parent can uphold that.”
No parent can be that kind of super-parent all the time, just as no child can be the perfect child parents may build up in their heads while waiting to adopt. Many adopted children may come to their new homes with challenging behaviors, depending on their pasts. Adoptive mothers Foli studied were more likely to experience depressive symptoms if they reported having expectations of themselves, the child, or family and friends. Foli says the rate of depression is similar in adoptive mothers and birth mothers—around 7 to 8 percent. (The Centers for Disease Control and Prevention put the rate at 8 to 19 percent for birth mothers, and about 4 percent for fathers).
“Examine some of those expectations,” Foli advises. “Are they realistic? Have you set yourself up to be something that’s not attainable as a parent?”
In the realm of nonbiological parents, nonbiological lesbian mothers are often in a unique situation where their partners give birth to the baby and they can be left to struggle for their role in the family, both legally in places where parental rights for gay couples are hard to come by, and socially, when they don’t have pregnancy as a visual cue that they, too, are becoming mothers.
Studies that have been done on this so far have been qualitative, not quantitative, but the anecdotal evidence suggests that these mothers experience depression, too.
Dr. Michele McKelvey wrote her dissertation at the University of Connecticut on this concept of “the other mother,” and interviewed 10 nonbiological lesbian mothers about their experiences. McKelvey told me about one woman who felt that she went through postpartum depression more than her wife who had given birth, and how their strong relationship got her through it. Another woman had a worse experience, in which she felt that she had to stay in an unhealthy relationship with her partner, because the place where she lived didn’t offer her any parental rights as the non-birth mother. So if she left, she might not get to see her child.
“She was a legal stranger to her daughter,” McKelvey says. “Those were the words she used… [The women I talked to told me they were] fighting for every piece of motherhood.”
Some women reported feeling invisible as mothers, something that could contribute to depressive symptoms. “There’s so much recognition of mothers in our society,” McKelvey says. “When a woman becomes pregnant, you have a baby shower for her.”
When you don’t get that kind of recognition, it can feel like your experience is less validated, even though in getting a child, you’re going through the same transition, the same joy and uncertainty that any parent does. Foli notes that things can fall similarly flat sometimes for adoptive parents. “There are casseroles sent, and there’s a little bit more celebration sometimes for the birth of a child,” she says.
Whatever depression’s causes, when it hits a parent in the wake of a new child, it can take a toll on the whole family. There is a risk for negative outcomes for the child if the depression goes untreated, although Kleiman says that “most women who are experiencing depression continue to take good care of their children, maybe at their own expense.”
Postpartum depression is also associated with marital dissatisfaction, though it’s hard to know which comes first.
“The truth is just sort of obvious,” Kleiman says. “When depression descends, resources are depleted, partners become weary. Even the most loving partners become tired of taking care of each other when they’re not getting a lot back.” She says that even so, among couples she’s worked with, the other partner “generally rises to the occasion and does what needs to be done.”
As with all mental illnesses, the important thing is to talk about it and seek treatment. That can be hard, though, especially because, as Kleiman notes, while mental illness is stigmatized, when you combine it with parenthood, the taboo gets worse. “We don’t like talking about moms and dads who don’t feel like being moms and dads,” she says.