LAWRENCE — Mental health experts in the past three decades have emphasized the dangers of postpartum depression for mothers, but a University of Kansas researcher says expanding awareness of several more perinatal mental health conditions is important for all new parents, including fathers.
It has become even more critical as "super mom" and "super dad" pressures continue to grow, said Carrie Wendel-Hummell, a doctoral candidate in sociology.
"Both mothers and fathers need to pay attention to their mental health during the perinatal period, and they need to watch for these other types of conditions, not just the depression," she said. "Anxiety, post-traumatic stress disorder, psychosis and bipolar disorder are all shaped by circumstances that surround having a baby."
Wendel-Hummell, who is also a project manager at KU's Center for Research on Aging and Disability Options in the School of Social Welfare, will present her findings as part of the 109th annual American Sociological Association Meeting, Aug. 16-19 in San Francisco. Her presentation will focus on "Nature and Culture: Lay Accounts of Perinatal Mental Health Disorders."
As part of her research, Wendel-Hummell conducted qualitative in-depth interviews with 17 new fathers and 30 new mothers primarily from Kansas and Missouri. The sample covered a range of low-income to middle-class parents. She did not require a diagnosis of a perinatal mood and anxiety disorder, but all participants had experienced prolonged symptoms. Wendel-Hummell said past research that required a diagnosis tended to exclude many parents who are not treated, especially fathers or lower-income mothers, often due to stigma or lack of health coverage.
She said a major focus of her research is to bring together biological and sociological understandings of the problems that new parents face. Medical researchers for years had attributed post-partum depression in new mothers to hormonal changes, despite etiological evidence to the contrary.
"Now we're becoming a little bit more sophisticated about these other disorders, but it hasn't captured that public attention in the same way because we're so focused on post-partum depression. Also it's been framed so much as being a hormonal disorder, but again the evidence there is actually very limited," she said. "Child birth itself is a life change and a life stressor, so actually there's far more evidence for those risk factors than the hormones."
Instead, distressed mothers and fathers in the interviews generally voiced concerns about social problems, including cultural expectations of parenting, relationship stress, family-work balance issues and struggles with poverty.
"We need to recognize those other conditions, but also we need other ways to screen for those conditions because we really only have a screener for depression, and it's primarily obstetricians who are doing it at the six-week post-partum checkup," Wendel-Hummell said. "There should be improved screening, and it should be done throughout that first year."
She recommended expanding the type of screenings of both parents to include at various stages pediatricians and child-care providers, for example, at least as another avenue to be on the lookout for the whole range of potential mental health issues, for both mothers and fathers.
At root of their depression and anxiety, low-income parents in the interviews mentioned ongoing struggles to tend to their infant's basic needs in the face of low wages and job insecurity, plus affordable quality child care, reliable transportation and safe housing. These parents were often unable to afford mental health treatment. Pregnancy-based Medicaid is often cutoff after a postpartum appointment, not allowing coverage of treatment of postpartum depression or other post-pregnancy mental health disorders, Wendel-Hummell said.
"The implications are that they aren't as good of parents or partners or employees that they could be. Mental health conditions by definition means they are impacting your daily functioning. They aren't getting the support that they need," she said.
Middle-class parents who have succeeded in their careers also tend to put too much pressure on themselves aiming to be perfect parents. Mothers try to do everything to balance both work and home life, and fathers do the same, which is a role shift from the previous generation.
They often study up and seek to do everything "by the book," because this strategy has worked for them in their education and careers. However, this pressure can exacerbate mental health conditions if the parents aren't prepared to handle when things don't go as perfectly as planned. Mothers tend to internalize that guilt, she said.
"Motherhood is different. It's full of all of these things you can't predict. There are no clear measures of productivity unless you are counting diapers," Wendel-Hummell said. "They feel very much like failures because it's so different than anything else they've experienced. That's not necessarily failure. That's the way parenting is."
Fathers tend to suffer stress from more often working in places that don't have family-friendly leave policies and the lack of resources to prepare them. Most people also tend to focus on the mother and baby.
"Nobody is asking about the father and how he's doing. So not only is it more difficult for men to express their emotions, nobody is opening up that window for them either," she said
Wendel-Hummell said focusing more on social issues surrounding new parents and mental health would be a major component of helping address the root of the problem. She argues that this includes paid maternity and paternity leave, sick pay and accessible health coverage. Likewise, Wendel-Hummell advocates for a need to adjust cultural expectations of parenting, including reducing pressures to be the perfect parent that can do everything on his or her own and accepting support from family, friends and the community.
"Social policy is key and not getting nearly enough attention. We focus way too much on 'how do we fix this individual?' which is important. It's important that we have options for those individuals and that they can get mental health treatment and that we improve their social supports and their awareness," she said. "But we need to really address the state of social and family policy."