Free Treating Paternal Postpartum Depression: Interdisciplinary Views, Interventions & Effectiveness Thesis Sample
One of the greatest obstacles that the field of paternal postpartum depression must overcome is a basic lack of recognition of the condition. Many practitioners and society as a whole, see the issue of postpartum depression as a purely feminine issue. This means that the nearly 11% of all men who suffer from symptoms of postpartum depression have serious emotional and mental health needs that are not being addressed. Two disciplines that desperately need to recognize paternal postpartum depression as a condition, and increase support for new fathers are the health community, especially with regard to medical health, and economists.
The American medical community often views postpartum depression as a condition effecting new mothers, who are struggling to adjust to life after the birth of their baby, due to physical and chemical changes happening in their body, and new social pressures in their life. The impact that the birth has on their partners in largely ignored (Buist, Morse, & Durkin, 2003). As a result, no one single official set of diagnostic criteria for paternal postpartum depression exists (Buist, Morse, & Durkin, 2003).
Though research has demonstrated that the emerging symptoms for paternal PPD are fundamentally different than those for mothers, including increased aggression and withdraw, paternal cases of post-partum depression are still primarily assessed using measures developed for measuring maternal PPD (Gray & Anderson, 2010). Similarly, the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSMIV), only maternal PPD is defined (Gray & Anderson, 2010)
Generally, studies of the effectiveness of these tools, when measuring a father’s need for care, demonstrate that the cut-off score to best identify fathers who were depressed differs from cut-off scores for mothers leading to an underestimations of the significance of paternal PPD (Kim & Swain, 2007). This demonstrates that the medical community needs to focus on the development of measures that specifically look at paternal postpartum depression and create a better means of determining cut off scores, and depressive symptomology so that men who need help are consistently diagnosed, and treated for their condition, is key.
Similarly, Economists need to view paternal PPD as a global health crisis that effects a father’s ability to provide for his family, and to positively impact the national economy (Coast, Leone, Hirose & Jones, 2012). Currently, it is understood that PPD is a public health problem with substantial impacts on maternal health, and family financial welfare, but the ways in which it effect paternal health and family emotional and financial stability, is both under-acknowledged and under researched (Coast, Leone, Hirose & Jones, 2012). This is especially true of cases of paternal postpartum depression which occur in countries that have a lowered income base.
The majority of evidence relating to postnatal depression is from high income countries (HICs) while very little information regarding PPD comes from low to low middle income countries (LLMIC) (Coast, Leone, Hirose & Jones, 2012). More specifically, perinatal mental health problems have been studied in more than 90% of HICs in the world, but comparatively, similar studies have taken place in just 10% of low and middle income countries (WHO, 2008a).
More specifically, a longitudinal community-based study found evidence of a bivariate relationship between income and duration of PPD, in layman’s terms, this means that the poorer the individual, the longer the episode of postpartum depression was likely to last (Coast, Leone, Hirose & Jones, 2012). Additionally, those with low income, or lower socio-economic status, and a lack of education are all significantly more at risk for the development at Postpartum Depression (Coast, Leone, Hirose & Jones, 2012). When you compare this to the fact that there are no intervention studies that focus on poverty reduction within active postpartum depression patient populations as a way to alleviate depression symptoms (Coast, Leone, Hirose & Jones, 2012), and the fact that LLMIC are least studied with regard to postpartum depression emergence and treatment, what this really means is that the social groups who are most impacted by postpartum depression, and most at risk of devastation related to PPD, and prolonged postpartum depression related sickness, are being most ignored by both the economic and medical disciplines.
The reality is that for those living in these already high-pressure conditions, the arrival of a new family member may increase economic pressure on the father, thus compromising his psychological well-being (Misri, Kostaras, Fox, & Kostaras, 2000). This means that they need more, not less, support than those in HICs or upperly mobile socio-economic families.
There are a number of social interventions which can be put in place to support fathers during the post natal period, and lower the impact of socio-economic pressures for a new family, while increasing the father’s sense of paternal satisfactions, greatly lowering both the medical risk of PPD, and decreasing the impact of PPD on the local economy.
For example, parental leave laws can support new fathers in two complementary ways: by offering job-protected leave and by offering financial support during that leave (Gornick, Schmitt, and Ray, 2008). More specifically, job protection allows parents to take time to care for their child while ensuring they will be able to return to the same job after the immediate postnatal period (Gornick, Schmitt, and Ray, 2008).
Several countries have already taken steps to ensure paternal jobs are protected. For example, in Sweden, parents have a right to 15 months of paid parental leave that can be shared between mothers and fathers (Gornick, Schmitt, and Ray, 2008). Similarly, in the Netherlands, workers with two years of job tenure with the same employer have the right to a change in working hours after the birth of a child (Gornick, Schmitt, and Ray, 2008).
While in America, often only mothers are assured any kind of leave related to the birth of a child, other countries are doing a much better job in terms of gender equality. Paid paternity leave allows the father to take parental leave without forfeiting the family’s larger source of earnings (Gornick, Schmitt, and Ray, 2008). For example, Greece offers 100 percent wage replacement for a set amount of parental leave (Gornick, Schmitt, and Ray, 2008). This is significant for low income families because guaranteed paid leave gives lower wage parents the financial security necessary to take the leave available to them (Gornick, Schmitt, and Ray, 2008). This is not true in America, where fathers are guaranteed 12 weeks through FMLA, but where there is no guarantee of paid wages if a father elects to take that time.
One macro theory that is being applied to postpartum depression is the behavioral-social learning theory, in the form of cognitive behavior therapy (CBT). The theory is that if we can understand the thoughts and feelings that effect human behavior, we can eliminate greater human struggles. Therefore, in the case of postpartum depression, if we can understand why such a large number of people in certain communities develop PPD, we can actively prevent the condition by breaking the cycle (Gray & Anderson, 2010). This focuses on how to globally reduce the number of people facing a struggle with PPD.
Inversely, some research suggests that we are better served to research PPD on the personal level. This calls for applying micro theories, like social constructionism. Social constructionism, believes that a great deal of human life is demined through social interaction. This means that PPD is best treated through interpersonal therapy, or by helping people who suffer from PPD manage their own environments. Instead of focusing on the cultural, or global thoughts and feelings that lead to PPD, this focuses on the personal beliefs that lead to perinatal depression. Treatment, in this case, lasts for 12 to 16 weeks, and the main goal is not to eliminate all postpartum depression, but to help a single patient minimize their symptomology.
In order to find the best way of treating paternal postpartum depression, it is important to understand which of these basic mindsets is currently showing the most promise. It could be argued that there is evidence to support both the macro and micro position, and that the best long terms strategy for amelioration of the condition in America is by leveraging what can be learned from each position, and combining them to create an all-inclusive treatment program for those suffering from paternal postpartum depression.
One study which supports the use of macro-based treatments in Alexander’s study “CBT-based support groups for postnatal depression.” The study use a sample size of just 30 participants, who were given a quiz in advance so that both those with a positive and a negative “acquiescence bias” were included in the study (Alexander, 2013). The study then used an exploratory design, and feedback questioneers to determine whether or not participants were demonstrating symptoms of depression or loneliness. The study then explored the benefits of offering postnatal depressed mothers group support that was specifically based on cognitive behavior therapies, or on improving self-esteem and dispelling cultural myths that lowered their self-worth (Alexander, 2013). The study concluded that CBT-based therapy is effective in alleviating the symptoms of depression, and in teaching those suffering from PPD coping strategies. Perhaps most interesting, the study recognized that paternal postpartum depression is also a problem, and cited that a similar study of CBT based therapy in men was of future interest (Alexander, 2013). The limitation of the study, however, was its lack of follow-up. Because the treatment lasts only a short amount of time, and follow up was not conducted over the full two year post-partum period, it is difficult to know what the end result is, or whether or not those patients suffered from regression and recurrence.
A second study, by O’ Hara and associates generated a study known as the “Efficacy of interpersonal psychotherapy for postpartum depression” which focused on the micro effects of post-partum depression, and how treating a single woman’s depression, based on her own self-reported symptoms was effective in treating postpartum depression. The study used a sample size of 120 women, all of whom met the DSM-IV criteria for major depression. The women were randomly assigned to 12 weeks of interpersonal therapy, or a “waiting list” which received no treatment for their depression (O’Hara et al., 2000). Subjects completed a self-reporting assessment once every 4 wweeks while in treatment, and only 9 of the 120 women completed the full protocol. Of those women, DSM scores decreased from 19.4 to 8.3 as a result of the treatment, showing a strong positive correlation between IPT testing and PPD recovery. Unfortunately, because the study’s limitation is that so few of the original study sample completed the entire protocol (O’Hara et al., 2000). Similar studies have not yet been considered for male sufferers of post-partum depression.
It is clear that there needs to be a stronger response from both the medical and economist communities with regard to PPD. It is a known detriment to a family’s mental, emotional, physical, and financial health. Unfortunately, until the focus is allowed to shift away from women, and the same macro and mico issues and related treatments are studied with regard to paternal postpartum depression, the trend that forces men to suffer in silence, and allows their depression to go untreated will continue.
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