For most men, the transition into fatherhood is met with joy and elation. For others, the euphoria of being a dad quickly fades into emptiness and sadness. One in seven women suffer from postnatal depression, but what’s not commonly known is that the silent illness affects new fathers too.
It started with sleepless nights and relentless fatigue. A common experience for new fathers like Kham Sirimanotham.
But the tiredness soon turned into a loss of appetite, which then gave way to anxiety. Despite becoming a dad for the first time to a baby girl in 2002, Sirimanotham’s enthusiasm for life waned. All he wanted to do was sleep.
"It’s almost like a butterfly feeling in your tummy... like a nervousness, but it doesn’t go away. It doesn’t go away," he said from his western Sydney home.
"I wasn’t happy, I was constantly sad. I just wanted to sleep."
With his wife Cam Dieu suffering from postnatal depression, as well as ongoing work commitments, the 46-year-old Laotian refugee started to crack under the pressure.
"We had no family support... and it just got too much"
"My concern was making sure my wife was ok and the baby was ok and I didn’t look after myself," said Sirimanotham, who works as a public servant.
"But the signs were there: tiredness, lack of sleep, lack of appetite. Also pressure at work. I’d come home and have to help at home as much as I can," he said. "We had no family support. So we had to do it as a couple, by ourselves. And it just got too much."
In 2004, two years after the birth of his firstborn daughter, Sirimanotham finally admitted he needed help. Despite being prescribed antidepressants, his mental state continued to spiral out of control, to the point where he was hopitalised for three weeks.
"I didn’t know that men could get postnatal depression. Back then, I didn’t know anything about it."
Dads at risk
One in seven mothers are diagnosed with PND. But what’s not commonly known is that the silent illness affects new fathers too, with one in 20 men diagnosed with postnatal depression.
But that number could be higher since men don’t tend seek help, said Belinda Horton, CEO of PANDA (Post and Antenatal Depression Association).
“Postnatal depression is a scary, stressful condition that happens for many new parents, men and women after the birth of a baby. Symptoms include irritability, not enjoying life, not enjoying the baby... There’s also a really strong element of anxiety, where there’s agitation and constant worry.
"We know that there are many men and women from all cultures and all walks of life, who aren’t seeking help. It’s a really shameful and stigmatised mental illness," she said. “The numbers could actually be higher.”
"There are definitely pressures on men to adapt and become ‘new age’ dads... And that is very difficult when men haven’t had the experience of good fathering themselves."
A recent longitudinal study in the Social Psychiatry and Psychiatric Epidemiology identified three main risk factors that contributed to PND in fathers.
Analysing data from 2,470 Australian fathers, researchers found that men who were not confident in their parenting role, had relationship woes, and low job satisfaction were at risk of developing PND. Having a partner with a mental illness or who was suffering from PND could also affect their wellbeing.
During the first year of fatherhood, it’s estimated that one in ten men will experience stress, anxiety and depression. For the majority of fathers, psychological distress will decrease by the time the children are seven. But for approximately eight per cent of men, their distress will increase markedly over time.
"The key messages from our findings are that early childhood services and infant services also need to focus on dads and their experiences in becoming fathers," said lead researcher Rebecca Giallo from the Murdoch Children’s Research Institute.
"And thinking more carefully about how we can support fathers experiencing mental health issues."
For starters, ensuring men have a strong support network is critically important, said psychiatrist Dr Philip Boyce, head of the Perinatal Psychiatry Clinical Research Unit at Westmead Hospital in Sydney.
"When men have few friends... they’re going to have much more difficulty adapting to this new role," said Dr Boyce. "For the majority of men it’s a very fulfilling time, they really relish and enjoy the time of being a new father.
"But for some men who may be vulnerable, it may be a difficult time for them."
Cultural shifts: from breadwinners to bath time
Experts say the growing expectation for men to be more involved in the parenting process can also be stressful, especially if they’ve grown up with traditional gender roles at home.
"We actually have, across all cultures, a generation of men who are challenged by the messages they’ve received from their culture, their society and their own parenting where men are the breadwinners and the head of the household," said Ms Horton.
"When couples from all cultures struggle to communicate these expectations with each other, it can be a source of distress between the couple. So the mum expecting the dad to be more involved; the dad feeling the pressure of needing to be out of the home and earning the income."
The pressure of being an involved father is further complicated by the fact that many men didn’t grow up with that experience themselves.
"There are definitely pressures on men to adapt and become much more involved in parenting and become ‘new age’ dads," said Dr Boyce. "And that is very difficult when men haven’t had the experience of good fathering themselves."
For those from non-English speaking backgrounds, this cultural clash can be more pronounced and harder to reconcile, said clinical psychologist Gabriela Salabert.
"There’s a big pressure and strain on men on being a good provider and bringing a good salary home. Plus being a good father that reads at night, bathes the kids," said Ms Salabert, who works with migrant groups at Transcultural Mental Health Centre in Sydney’s west.
"I believe it’s a big pressure everywhere in the community, but particularly some backgrounds and some CALD [culturally and linguistically diverse] communities can find it more difficult."
Breaking the cycle, ending the silence
As the eldest of five boys in his family, Sirimanotham said discussing feelings wasn’t the norm growing up, particularly in the Laotian community, where any talk of mental illness was seen as a weakness.
"If this illness doesn’t appear in a blood test, like cancer, then you don’t have an illness," he said. "The way of thinking is: take a cup of cement and harden up. It will be ok tomorrow. Just get on with it."
But the silence around mental illness ended abruptly when, after years of depression, his mother took her own life. Sirimanotham was just 19.
"I didn’t want other people to know, so I did a lot of covering up."
"Dad was a nervous wreck. And being boys… we didn’t know how to comfort him. We coped. But emotionally, I don’t think we coped that well. Life just went on as if it was just a normal day to me."
It was until Sirimanotham became a dad himself that he realised he was sinking deeper into depression.
"I didn’t want other people to know, so I did a lot of covering up. If someone asks, 'How are you doing?' [I would say] 'I’m great!'
"I think the hardest bit was the acceptance. Being men, we’re so proud. Don’t talk about it," he said. “'He’s a softie. What a girl. What a wuss.'"
Sirimanotham said treating his depression for the sake of his family was the best decision he ever made.
"My wife and I are trying to break the cycle. We are the new generation. We discuss mental health as a family and educate our children about coming out and asking for help," he said. "You know what, that’s the best thing I ever did. I took the step and said, 'I don’t give a damn. I don’t care what other people think.'"
He hopes his story will encourage other fathers to seek help if they find themselves struggling with postnatal depression.
"Hopefully by me sharing my story, will encourage other men, other fathers from a non-English speaking background will come forward and go and get help.
"Never never neglect yourself. You always put yourself as priority number one. Once you recover, once you’re better… then you can help others. Especially your family."
Postnatal Depression Week runs from Sunday 16 November to Saturday 22 November, 2014.
Readers seeking support and information about postnatal depression or suicide prevention can contact:
National Perinatal Depression Helpline 1 300 726 306 | Beyond Blue 1300 22 4636 | Lifeline 13 11 14 | Suicide Call Back Service 1300 659 467 | Mensline 1300 78 99 78 | Men’s Shed 1300 550 009 | Headspace 1800 650 890 | SANE Helpline 1800 18 7263