Why protecting fathers' mental health is so important

By Michael Merschel, American Heart Association News

aldomurillo/E+ via Getty Images
(aldomurillo/E+ via Getty Images)

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In Hollywood, the image of the overwhelmed dad is played for laughs, with consequences rarely more serious than an awkward diaper change or a frustrated cry of, "D'oh!"

But in real life, experts say the stresses of parenthood can pose challenges to the mental health of fathers, with implications not only for their physical health but for their children's well-being, too.

The exact challenges would be unique to each father, said Dr. Kate Gawlik, a nurse practitioner and an associate clinical professor at the Ohio State College of Nursing in Columbus. But overall, "the mental health and behaviors of the child are very intertwined with those of the parent," said Gawlik, who also is co-director of her school's undergraduate program in health and wellness.

The importance of a father's mental health hasn't always been emphasized by researchers or society in general, said Dr. Sheehan Fisher, an associate professor in psychiatry and behavioral sciences at the Northwestern University Feinberg School of Medicine in Chicago. "Historically, we viewed it that as long as the mom is well, that's what impacts the kid. But we know that the father has a direct impact on the child's mental health, medical and developmental outcomes."

Challenges can begin as soon as fatherhood does. "It's well-established that fathers are at an increased risk for depression and anxiety symptoms during the perinatal period," just before and just after a child is born, Fisher said.

About 10% of new fathers experience postpartum depression, Fisher said, with the highest risk being three to six months after a child is born. That's less than half the rate among women. It also might be an underestimate, he said, because traditional measures might not fully measure depression in fathers.

"Men tend to mask their depression through substances like alcohol or illicit substances, or they engage in aggressive behaviors," such as verbal or physical aggression, or even hypersexuality, Fisher said.

The effects on children seem to start early, too. In a review of research on fathers and mental health that was published in the American Journal of Lifestyle Medicine in 2016, Fisher wrote that fathers' depression has been linked to negative behaviors in their offspring from infancy through early childhood. Later in a child's life, paternal depression has been shown to affect the likelihood of a child developing depression or anxiety in adolescence and into early adulthood.

Fatherhood also brings stress. As any parent knows, raising children can be simultaneously one of the most rewarding and challenging experiences a person can go through, said Gawlik, a mother of four. "There's just so much involved," she said. "You're literally responsible for other humans that you can't control."

In unpublished findings from an online survey of 722 parents of children younger than 18 for a recent report on parenting that Gawlik co-wrote, 44% of the men reported feeling burnout, which the report defined as "chronic stress and exhaustion that overwhelm a parent's ability to cope and function." Burnout, the report said, can leave parents feeling detached from their children and physically, mentally and emotionally exhausted.

"Another thing that our research uncovered is that a lot of parents are lonely," Gawlik said. In her survey, 79% of parents and 75% of fathers said they would welcome more interaction with adults outside of work. "And when parents feel lonely and isolated, their burnout also goes up."

Mothers face their own physical and mental challenges. Maternal depression can harm children in many ways. And in Gawlik's survey, 55% of mothers reported feeling burned out – a level even higher than for men.

All that has implications for heart health: Stress , depression and loneliness have been associated with cardiovascular problems.

Fathers who are not depressed can be a buffer for children when mothers experience problems, research has shown. But Fisher, a single father of a 5-year-old daughter, said that society usually is better at recognizing the needs of new moms than those of dads.

The American Academy of Pediatrics, for example, encourages screening all parents for signs of depression. The recommendations call for testing mothers during well-infant visits several times in the first six months – but fathers only once.

Meanwhile, many modern fathers are working without a blueprint as they retain traditional duties and learn to be nurturing in ways that earlier generations didn't model, Fisher said. "They're not always sure of what is their role, and how can they do it, because they don't have examples."

While much of the research has been done on biological fathers, he said, most of the findings don't seem to be limited to being a biological parent.

"We need to expand perinatal research to understand the experiences of sexual- and gender-minority parents and diverse family structures," Fisher said. "We suspect that some of the experiences of fathers would apply to non-birthing parents in general, although they have many unique experiences that need to be understood."

Fisher suggested several ways to support fathers – some on a broad scale, some individual.

On the societal level, he said that fathers in the U.S. typically don't get access to parental leave during the crucial days after a child arrives, and when they do, they take less time off than moms. Both pale in comparison with other industrialized countries.

"It really puts them at a disadvantage at a very critical period in their lives," Fisher said.

On the personal level, he said, fathers need to be aware of the potential for mental health problems and be willing to say they need help. Men often don't seek treatment for their medical needs, he said, and depression can make asking even harder.

Men should be honest with themselves if they feel depressed, down or anxious, while also "taking the feedback from other people that people might notice you seem different than normal. You might notice you're having an extra nightcap every night, or you might notice a little more irritability."

A professional can help, Fisher said. "Getting assessed lets you know what is recommended and what are your options to support yourself," he said, and it doesn't always mean medication or therapy.

Gawlik agrees the culture needs to be more supportive of the challenges of modern fatherhood. "I really do feel like this is an area whereas a society, as communities, we're really dropping the ball."

Sometimes, a parent can identify problems and reach out to others for relief, she said. For example, if a parent is stressed because they feel like all they're doing is hauling their kids to extracurricular activities, forming a carpool might help.

Speaking with other parents at those activities can help in many other ways, especially for dads, she said.

If a child has a specific issue, such as ADHD, "it would be really great to build a connection with other parents that have children with ADHD, because they're going through what you're going through," she said. Those other parents can provide empathy and possibly suggest strategies that worked for them.

Real-life connections can help with another common stressor: the idea that everyone else has parenting figured out. "Setting yourself up to try to be perfect all the time is an unrealistic expectation," Gawlik said. "So we really need to think about readjusting what our expectations are for not only ourselves, but also for our children."

She's done that herself – learning to celebrate the way toys are constantly strewn about her once-tidy home because it shows that children are playing and being creative there.

Her work suggests that a child's mental health improves when parents spend time playing with them and worsens as the number of extracurricular activities rises. Since a child's mental health issues are a big contributor to the parent's own stress levels, that means that a parent who focuses on the core relationship with their child might see benefits all around.

Solutions, like problems, would vary from person to person, Gawlik said, but it's important to act early. "It's all prevention," she said. "Once you get into a burnout cycle, it's harder to get to get out of it."

Fisher also emphasized the need for fathers to develop a supportive community even if they're feeling well. Self-care – including regular health checkups and finding time to relax – are important "to ensure that they are taking care of their overall well-being, which impacts the whole family."

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