Postpartum Depression refers to episodes of major depressive disorder that occurs immediately after the birth of one's child. Typically, mothers are known to develop postpartum depression frequently, but the truth is that fathers also are capable of developing PPD. Maternal depression is a well-known and studied mental disorder; however, paternal depression is excluded when dealing with infant and child growth and development. It is essential to bring awareness to paternal postpartum depression, a disorder that health care providers fail to address. There has been an increased prevalence of fathers experiencing postpartum depression symptoms. Approximately 4-13% of new fathers suffer from postpartum depression, and there is little to no support documented. (Charandabi et al., 2017). Postpartum depression is a psychological disorder that can be thoroughly screened and communicated to mothers, but poorly educated and unscreened by clinicians in fathers.
Few studies have examined postpartum depression among fathers. Narayanan and Nærde (2016) assert that postpartum depression is typically regarded as a maternal concept; thus, most research of after-birth complications center on women. However, men can and often do experience postpartum depression as well. Postpartum depression is a significant concern in the US, affecting many families. Postpartum paternal depression is often excluded when examining the growth and development effects on the child ( Narayanan & Nærde, 2016) . Many providers are not aware of postpartum paternal depression, and it is often not identified or addressed.
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Risk Factors for Paternal PPD
Several factors may heighten the risk of men developing postpartum depression in men. These may include a previous history of depression, poverty, marital conflicts, and unplanned pregnancies and deliveries. Studies also show that disrupted circadian rhythm and sleep deprivation, which positively correlate with depressive symptoms in mothers, may heighten the risk of PPD development in men. Research by Kamalifard et al. (2018) shows that a father may experience hormonal changes during a pregnancy period, and these may last for several months after the birth of the child. Some of these hormonal changes are also significant risk factors for fathers developing PPD ( Kamalifard et al., 2018) . Studies have identified various causal factors for paternal and maternal postpartum depression.
For the mother, the following are the primary causal factors for maternal depression: marital problems, and personal history of depression, poor quality of life, maternal antenatal depression, low social support, and even little marital relationship satisfaction ( Kamalifard et al., 2018) . Infant-related problems such as sleeping problems are connected to both maternal and paternal level of depression. The father’s postpartum depression mostly originates from neuroticism and substance abuse.
The previous history of severe depression of the father, together with high prenatal symptom rates for depression, intensifies their rates of depression. Also, lower levels of satisfaction in their relationships contribute to the paternal depression. Also, men with wives who might be experiencing elevated depressive symptoms are at a higher risk of getting postpartum depression. According to Biebel and Alikhan (2016) , there were more postpartum depression symptoms among the fathers whose partners were shown to be depressed.
The majority of low-income new fathers have further been shown to be highly vulnerable to postpartum depression as a result of the interacting factors. Among the low-income African Americans, 56 percent of all these fathers were confirmed to have significant signs for postpartum depression, which indicated cause for greater clinical concerns ( Chhabra et al., 2020) . Some of the primary sources of their depression included problems with drugs, criminal conviction history, and permanent housing challenges. Arguably, higher levels of social support were primarily related to higher depressive symptomatology for low-income fathers as a result of the assumed cost of reciprocity, which ultimately prevents them from making use of the available social support ( Chhabra et al., 2020) . In addition to this, the more tenuous the relationship of the father is to the mother of their child, the more probable it is that these fathers will experience postpartum depression.
Effects of Paternal PPD on the Children
Recent studies have established that the fathers' postpartum depression can negatively impact on their children in infancy through 4 years of age. Based on research by Sweeney and MacBeth (2016) , there was a severe postpartum depression in fathers related to higher rates of behavioral and emotional issues among their infants, especially the male children aged 3.5 years. In addition to this, the most severe consequences were experienced when these dads were reported to be profoundly post-natally and prenatally depressed ( Sweeney & MacBeth, 2016) .
Postpartum depression of the father risks the relationship's quality between the new father and mother. A higher-quality relationship between couples has been intimately connected to decreased child fussiness level. Research has also shown that parental and marital depression is linked with a higher adjustment challenge among kids ( Sweeney & MacBeth, 2016) .
In their study, Koch et al. (2019) established that dads diagnosed with elevated postpartum depression tend to be less engaged with the infants. Stress affects the father's level of attachment with the infants. On the other hand, poor father-child attachment is associated with problems in children's peer relationships. While the father's psychological well-being is positively linked to the parent’s sensitivity, the father’s postpartum depression arguably seems to limit their capability to parents these children much efficiently ( Koch et al., 2019) .
Fathers experiencing postpartum depression have been reported to be less likely to tell stories, read, and even sing songs to their babies compared to fathers who are not depressed. This explains the reasons why a father's postpartum depression has a negative impact than that of the mothers on the child's language development. In most instances, postpartum depressed dads always will utilize a voice with a flatter tone when they are interacting with their four-month-olds, and this is connected to their infants' cognitive delay ( Koch et al., 2019) .
According to Narayanan and Nærde (2016) , paternal postpartum depression is closely related to delay bonding between the father and the children. Late bonding is a collective experience and mostly occurs for various reasons, such as postpartum depression. In most instances, the fathers tend to have less interest and energy care for the child. Father's postpartum depression arguably tends to compromise his ability to control and manage the interaction, through withdrawal or intrusiveness ( Narayanan & Nærde, 2016) . On the one hand, intrusive fathers often display hostile effects, which disrupt the overall activities of the infants. As a result of the postpartum depression, infants often show high anger levels, distancing from their father, and become highly withdrawn and protective as a coping strategy. Sweeney and MacBeth (2016) assert that the majority of the withdrawn fathers have further been shown to be unresponsive and disengaged. Often, they do little or absolutely nothing to support the activities of the infants. In such cases, the children may be unable to cope with the negative state. They may therefore develop symptoms of withdrawal, passivity, and other regulatory behaviors like thumb-sucking.
Paternal PPD Treatment
Paternal postpartum depression is often undiagnosed and understudies, and for this reason, there are no sufficient controlled trials to evaluate the treatment of the disorder in men. However, because the symptoms of paternal PPD constitute major depressive episodes, which present similarly in both men and women, treatment options are the same for both sexes ( Sockol, 2015) . Clinicians often recommend the administration of Selective Serotonin Reuptake Inhibitors (SSRI) like sertraline to manage the depressive symptoms. Furthermore, psychotherapy measures such as Interpersonal Therapy (IT) and Cognitive Behavioral Therapy (CBT) are effective in reducing depression, especially in new mothers ( Sockol, 2015) . CBT demonstrated more efficacy than antidepressants, and therefore, this therapy may be the most preferred alternative to manage PPD symptoms. Other alternative treatments are also recommended to prevent the occurrence of PPD in both men and women or to alleviate the symptoms of PPD in men. These alternatives include acknowledgment and support of feelings, educational programs for both parents, and support from employers ( Biebel & Alikhan, 2016) . People must understand that men too may experience PPD, and therefore they need help and understanding in dealing with the issue. Talking to professionals and other confidants have also been proved effective in managing depressive symptoms resulting from PPD in men.
Conclusion
Much research has not been conducted on the occurrence and management of paternal postpartum depression. However, many men experience this problem after the birth of their child. Unfortunately, most men decide to conceal their depression because of the societal stigma associated with depression in men. This experience is adverse because suppressed emotions often result in more significant problems later on in the future. For example, untreated episodes of PPD in fathers result in extended life problems for both the child and the father. Many resources are available both online and healthcare facilities that can help men dealing with PPD manage their symptoms and establish productive relationships with their families and children.
References
Biebel, K., & Alikhan, S. (2016). Paternal postpartum depression. Journal of Parent and Family Mental Health , 1 (1), 1.
Charandabi, S. M. A., Mirghafourvand, M., & Sanaati, F. (2017). The effect of lifestyle-based education on the fathers' anxiety and depression during pregnancy and postpartum periods: A randomized controlled trial. Community Mental Health Journal , 53 (4), 482-489.
Chhabra, J., McDermott, B., & Li, W. (2020). Risk factors for paternal perinatal depression and anxiety: A systematic review and meta-analysis. Psychology of Men & Masculinities , 13(4), 122-331.
Kamalifard, M., Bayati Payan, S., Panahi, S., Hasanpoor, S., & Babapour Kheiroddin, J. (2018). Paternal postpartum depression and its relationship with maternal postpartum depression. Journal of Holistic Nursing and Midwifery , 28 (2), 115-120.
Koch, S., De Pascalis, L., Vivian, F., Meurer Renner, A., Murray, L., & Arteche, A. (2019). Effects of male postpartum depression on father–infant interaction: The mediating role of face processing. Infant Mental Health Journal , 40 (2), 263-276.
Narayanan, M. K., & Nærde, A. (2016). Associations between maternal and paternal depressive symptoms and early child behavior problems: Testing a mutually adjusted prospective longitudinal model. Journal of Affective Disorders , 196 , 181-189.
Sockol, L. E. (2015). A systematic review of the efficacy of cognitive-behavioral therapy for treating and preventing perinatal depression. Journal of Affective Disorders , 177 , 7-21.
Sweeney, S., & MacBeth, A. (2016). The effects of paternal depression on child and adolescent outcomes: A systematic review. Journal of Affective Disorders , 205 , 44-59.
