Even dads get the blues

Hardest times ... "Things were very clearly not right. But I was in denial for a long time."
Hardest times ... "Things were very clearly not right. But I was in denial for a long time." 

Dr Richard Evans is a dark-haired, solidly built man. He's a criminology lecturer at Victoria's Deakin University, and writes football ditties for ABC radio. 

He's also the father of two daughters. His first, Rose, was born in 2001. He and his wife, Heather, were given some information about postnatal depression (PND) before her birth, but only in passing.

"I remember they said one in 10 mothers or something was affected, but they didn't mention men at all," says Evans. "I thought, 'Well, we won't be in that 10 per cent of losers.' A very arrogant dismissal, as it turned out."

Dr Richard Evans with his wife Heather and their daughters Rose, 12, and Zoe, 9.
Dr Richard Evans with his wife Heather and their daughters Rose, 12, and Zoe, 9. 

Eight months after Rose's birth, Evans knew he wasn't coping. Rose was a terrible sleeper, and Heather was unwell. "I lost weight, I had no joy in life at all," he recalls. "It required a huge effort of will to do anything. I was finding myself on the edge of tears over minor setbacks at work. I had great difficulty with even very minor decisions: you feel like you're facing an execution when really you just have to write a memo for a meeting.

"Also, I was just extremely tired. I was literally falling asleep on my feet, walking home from the train. Oddly enough, it got worse after Rose was sleeping, because the adrenalin that had pushed me on was gone. Things were very clearly not right. But I was in denial for a long time."

New parenthood is supposed to be a time of happiness; it's extremely hard for either mums or dads to admit that their feelings deviate from this ideal.

For Joe Forrest* and his wife Kate*, having a baby was hard, even before Flynn* arrived in April last year. "We had to do IVF; it was a three-year process," he explains. "So that was stressful, and I had a lot of issues already: work, my stepdad having cancer and being close to passing away, and a back injury. Then, when Flynn was born, he spent the first 10 days in hospital because he was crook."

Fatherhood was nothing like he had imagined. "We'd have a sleepless night, I'd make a suggestion and Kate would shoot me down. And every time I came home from work, Flynn would see me and start screaming. He was just being a baby, but it used to really bother me. I'd think, 'Oh my God, he hates me.'"

Things came to a head five months after Flynn's birth. "I wasn't sleeping, I wasn't eating. I'd come home from work and just sit on the couch and leave Kate and Flynn to do their own thing. I wouldn't help or do anything. I just felt kind of empty: I just wanted to get in a boat and paddle out into the middle of a lake where no one could bother me, just sit there and have that peace.

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"Then one day I had a meeting in the city and I remember parking ... and literally just sitting in the carpark for an hour. I couldn't get out of the car. I just physically could not go and speak to anyone."

At least one in 10 women in Australia experience postnatal depression, but because it's been linked so firmly to women, there's been almost no research into the male condition. The largest study of data so far, however, involving some 28,000 participants, suggests that the same number of men as women - about 10 per cent - suffer from it.

The same study found that as many as 26 per cent of men were depressed between three and six months after the birth of their children. Yet the overwhelming majority of these men never seek treatment.

"I couldn't talk to anyone - not even my wife," says Forrest. "It wasn't that I didn't want to; it was that I didn't know how. My group of mates are pretty blokey. If I sort of said, you know, 'I think I've got depression', they'd just look at me and go, 'Come on, just get a beer up you.'"

According to doctors and researchers, this response is almost universal among men. And given that 300,000 babies are born annually in Australia, it suggests that approximately 30,000 men a year are both experiencing clinical illness and remaining entirely untreated.

We have no idea how many men with PND take their own lives. But we know that close to 80 per cent of all suicides in Australia are men. We also know it's the No. 1 killer of men under 44, when the vast majority of men are becoming fathers. 

Paternal PND, like the maternal illness, puts enormous pressure on relationships. Joe Forrest moved out of home a couple of months after the casino incident. "I just wasn't coping with anything. I know it was a huge thing [to leave my wife and new baby]. But at the time I just felt relief. A kind of numbness, but also relief."

Male PND, much more than the maternal version, can also lead to violence, substance abuse, gambling and loss of professional productivity. A national study commissioned by Melbourne-based PND organisation PANDA calculated that PND cost the Australian economy $433.52 million in 2012. And as PANDA CEO Belinda Horton explains, "Well over half that - $250 million - was related to male antenatal and postnatal depression."

A 2011 study found depressed fathers are nearly four times more likely to spank their one-year-old children, and less than half as likely to consistently read to them. And two large studies in the UK and Australia have found that if a father has symptoms of depression in the first year of his child's life, then his child is significantly more likely to experience behavioural difficulties - such as hyperactivity, emotional issues, and peer and conduct problems - as a preschooler.

"These kids are two or three times more likely to have problems," explains Dr Richard Fletcher, one of the authors of the Australian study, and senior lecturer in the health faculty of Newcastle University. "That's a big effect."

In Australia, the major screening tool for PND is the Edinburgh Postnatal Depression Scale, a questionnaire that asks respondents to rate how they've been feeling. But it may not be very good at assessing paternal depression. "It may be that dads are saying, 'Well, yeah, I feel like absolute hell, but I wouldn't say I'm sad,'" explains Belinda Horton. "Depression in men seems to involve anger, irritability and frustration," adds Fletcher, "and not so much crying and sadness. So questions that relate to those feelings may be more appropriate."

Dr Matthew Roberts, a perinatal psychiatrist, always asks his female patients' partners to attend a couples' session, then refers "a significant proportion" of these men for further help. But even as an experienced psychiatrist, and a father, Roberts finds paternal PND "very hard to determine using existing measures. Part of the diagnosis of depression involves self-reporting, and talking about your feelings is something that men might not have been raised to do, or taught to do.

"So a bloke may be able to talk about having anxiety, or even having panic attacks. He might be drinking more. He might be throwing himself into his work, or exercise, or something like that. Conversely, he might be withdrawing socially. But all the screening and diagnosis measures are imperfect."

An additional complexity is that, in half of all cases, men suffering from PND also have wives or partners who are suffering from the same disease: maternal PND is the biggest single predictor for paternal PND.

The Evans family was hit by this double-whammy. Richard's wife Heather was diagnosed with PND a few months after Rose's birth; Richard fell ill soon afterwards. "It's this terrible downward spiral," he recalls. "You feel bad, and as a professional middle-class man, your most meaningful friendship is often with your wife. But when it's your wife who's ill, you can't talk to her, so there's no one to share it with, and it's toxic. I didn't want to add pressure, but the time came when I just had to. I can remember very vividly the conversation with Heather where I said, 'Look, I've been saying I'm okay, but I'm not.' "

In the Forrest family, Joe's illness isolated both him and Kate. "It was hard for Kate to understand," he says. "She knew something was up, but she took it personally - as if it was about her. And she was just a tiny piece of the puzzle. But after I moved out, there were plenty of times when I'd see her, and she'd be in tears and I'd just be like, 'Go away'. It sounds so bad, but it wasn't that I was being deliberately cold; it was that I wasn't feeling anything."

In the end, like almost all men suffering from PND, neither Joe Forrest nor Richard Evans was screened; both had to make appointments with their GPs themselves in order for the treatment process to begin. The irony of this - that you must somehow find the energy for self-advocacy in the midst of an intensely energy-sapping illness - is not lost on either man.

"There I was, unable to deal with the ordinary challenges of day-to-day life, and I had to go and find a doctor, and make what felt like this admission of failure," recalls Richard Evans.

Despite all the bad news - or lack of any news at all - about paternal postnatal depression, if men do manage to get treatment, the news is often, finally, good.

Richard Evans took anti-depressant medication, talked to a psychiatrist, and joined his wife's all-female PND support group. Joe Forrest was also prescribed medication, and is still seeing both a psychologist and a psychiatrist once a month. His psychiatrist helps him with PND-related issues, and he and Kate go to the psychologist together. In April this year, he was able to move back in with her and Flynn.

"About five weeks after I left, I suddenly had this moment where it was like my brain switched on again," he recalls. "And I thought 'What the hell am I doing? Why aren't I at home? I'm missing out on all this stuff.'" Their monthly meetings with the psychologist "just help to clear the air, and make sure we're still on track".

All in all, "the great thing is recovery rates are good, for both men and women," says Matthew Roberts. "A baby's arrival can be the catalyst for problems, but that baby is also an enormous motivation for change and recovery."

"Where I am now is probably what I was expecting two days after Flynn was born," concludes Joe Forrest. "I feel fantastic, on top of the world. I love going home. I open the door and Flynn will stand there - 'Dad! Dad! Dad!' - and he'll give me a big hug. And he follows me around. He wants to come in the shower in the morning; I clean my teeth and he wants his toothbrush. I just love him to death."

Richard Evans experienced a similar sense of renewal - so much so that, three years after Rose's birth, he and Heather had another daughter, Zoe. They did so knowing that for both men and women, one round of PND increases the risk of a recurrence with subsequent children. Sure enough, both experienced PND again. "There was a very severe crisis following Zoe's birth," Richard says. "I didn't really deal properly with my illness until then."

Which just goes to show that depression can be extraordinarily tenacious - but so can parental love.

"Even though it was so dreadful, I remember it as the richest and most profound time in my life," concludes Richard Evans. "That sounds perverse, but it really was. Having a baby can be deeply traumatising and a tremendous struggle, and also really wonderful, and there's no contradiction in that.

"People are reluctant to say anything bad about parenthood because it sounds like you're dissing the whole experience. But like anything worthwhile, it's multifaceted."

* Names have been changed 

This is an edited version of an article that appeared in Good Weekend

If you or someone you know may be suffering from PND, call the beyondblue support service on 1300 22 4636, PANDA National Helpline on 1300 726 306 or visit justspeakup.com.au.