Transcription:
Gender Inequities That Affect Maternal and Paternal Mental Health

Melanie Cole (Host): Welcome to Better Edge, a Northwestern Medicine Podcast for physicians. I'm Melanie Cole. Joining me today is Dr. Sheehan Fisher. He's an associate professor of psychiatry and behavioral Sciences at Northwestern Medicine, and and he's here to highlight gender inequities that affect paternal and paternal mental. Dr. Fisher, thank you so much for joining us today as we get into this topic. This is really fascinating, by the way. Can you tell us a little bit about the association between maternal and paternal mental health?

Dr Sheehan Fisher: Well, we know that within couples that if one person is dealing with depression and anxiety, it is more likely that the other will also be dealing with similar symptoms. Some of it's because of just, the interactions within the interpersonal relationship and then also some of the other stressors. But we do know there is an association between the two.

Melanie Cole (Host): Well, we certainly do. What an interesting topic of study. So tell us a little bit about the impacts of both maternal and paternal mental health on parenting. That inter parental relationship and infant and child health outcomes, because there are studies on this, yes?

Dr Sheehan Fisher: Yes, like it's an important to at least understand that when you're dealing with perinatal mental health, it isn't just the person who's the one suffering. It has an impact on the family dynamic. So, When parents are feeling, for example, depressed, it can start to diminish their parenting abilities, whether they're not being as engaged or safety precautions, or on the other side, sometimes being a little more irritable in their parenting, which can have a course, an impact on the child. In addition, like their relationship can start to suffer where their relationship between one another for the romantic relationship can start to decline and not have as much, positivity within their relationship because of some of the maladaptive interpersonal skills. And then in addition, the child is exposed to all that. So that can have an impact on the child's health outcomes for both their mental health and their medical health outcomes.

Melanie Cole (Host): So now talk about gender, Dr. Fisher, and the inequities that affect maternal and paternal mental health. Where does gender play a role in this? Because it seems that, probably back in the fifties, women were very overlooked and mental health was probably a lot worse than we realized. And the dads went off to work and it was this little rosy picture, but probably not so much? But nowadays, there's a little bit more of a give and take. We see men being more involved, but tell us about gender and where that fits into these inequities?

Dr Sheehan Fisher: Well, a problem is that even though we've made huge improvements, a lot of the burden still falls on the mom. So we're talking about parents, so that doesn't necessarily mean mother or father only, and so that we need to make it one more inclusive, but also when we're thinking about the gender, we assume their role. We assume many times that we're thinking about a mom, that it's the primary parent or the father, secondary parent, which pigeonholes people many times in a position that they don't want to be in. Therefore, mothers tend to hold most of the burden within the household responsibilities of childcare responsibilities, while still maintaining a full-time job.

So when we're thinking about trying to make adjustments to this, we need to think through ways of getting away from gender, dictating people's roles so that we can create equality within the home. On the other side of fathers, many times feel like the secondary parent where their approach is not as valued or people, make jokes about fathers being incompetent and that discourages father involvement. So we need to do more to improve it, not only for father to take on that personal responsibility for it, but also creating environmental changes that can support that. For example, like parental leave or other policies that would support, father involvement.

Melanie Cole (Host): What a great point you just made and I'm thinking that not everyone thinks about the paternal mental health aspect and that sometimes they are undervalued or appreciated. Dr. Fisher, data has shown that people from racial or ethnic minority groups are less likely to receive preventive healthcare across the board. Various ethnic groups have faced this disproportionate health burden. Can you talk to us a little bit about the unique challenges these communities have, that they faced in terms of maternal healthcare disparities, not to mention any paternal healthcare at all? Tell us where the healthcare industry can be reformed to better serve these patients. What are some of those cultural and social influences on parental wellbeing?

Dr Sheehan Fisher: Well, I think that there is distrust many times within minority communities about going to doctors in general and then also culturally, mental health is not something that is discussed at all around different. Racial ethnic cultures, but also within mass and culture in general. So there's a lot up against fathers from getting access to treatment and to even acknowledge that they might need support. But then in addition to that, there's not many services available. For example, I have my father's, mental health specialty clinic, but there's very few perinatal clinics that focus on the father's unique experiences and how to support them during that time.

And without a home for these fathers to go to, they're much more, less inclined to take steps to address their mental health. So there's a lot of psycho education that needs to be provided and trying to make our services more appropriate to make sure that when fathers even take that risk to come in, they feel like there is, appropriate services for what they need.

Melanie Cole (Host): That's very true. Now, what are some of the ways, and I'd like to turn this on both sides here, the ways that fathers can support maternal mental health and the ways that mothers can support paternal mental health and adding to this picture, the way that the primary care provider or the obstetrician gynecologist or the pediatrician, the way that the healthcare provider and the medical home can support this couple?

Dr Sheehan Fisher: Well, I think that when it comes to the couple, that they should work on supporting one another, that one just having honest conversations about how they're dealing with stress rather than feeling that they have to pretend. I think both moms and dads feel they have to pretend to be strong In a sense of like the social view of strength and to hide what they're going through. So having open dialogue together about what they're going through, and be able to create communication that is conducive to supporting one another based on one another's needs. So for example, like if the one parent needs more support within the home or needs, for the other take on responsibilities or to take on things outside the home, they need to be discussions about this along with learning about the other's mental health.

Like how do they deal with stress or how they do have a diagnosis? What do they need to support that? I currently have a grant that's focused on this to train fathers on how to support mother mental health because fathers don't have that information. But if they were provided, clinical information that would be directly useful for the mother, then the fathers, you are more likely to take on responsibility to support her health because it's gonna impact her and also the child. When it comes to the healthcare system, though, we do need to try to think more about an inclusive approach to think about both moms and dads need to be supportive.

It depends on what the specialty is for how much directly the father's engaged. For example, for the OB GYN office, the mother is the primary patient and should be the focal point. But giving eye contact with the father if he comes into the session or even just asking if he has questions will allow him to know his role within supporting her through this journey so the mother doesn't feel like she's not going through it alone.

Melanie Cole (Host): That's an excellent point for other providers to include that partner, even though their focus is on the new mother or the mother to be, but to include the partner in all of it so that they know best how to support their partner. Now what about the impact on both parts of the couple and their mental health and their ability even to stay together when there's perinatal loss? What have you learned about that?

Dr Sheehan Fisher: The perinatal loss is quite difficult. Many times when there is a loss. Most of the resources, whether within the medical field and also even within the community, do support the mom during that time. But the problem is once the mom starts to feel better, those resources tend to go away. And even the father, during the time the mom is struggling is there to be supportive of her. But once all the support goes away, the father never got a chance to adjust his own sense of loss. So I think we need to do better in making sure that both parents are supported during that time and to be able to address it because it can create a toll on the mental health of both parents, and that then can have an impact on their relationship.

Their considerations of having future children and of course child health outcomes that they do decide have for the children, because sometimes of anxiety can have an impact on how they engage in their parenting.

Melanie Cole (Host): Dr. Fisher, what an important topic this is, and under discussed I imagine. With the recent demands for social justice in the us, many people feel it's important to be introspective and evaluate and adjust their own behaviors. How would you suggest an academic medical center accomplish something like this? As we think about long term solutions, how do you think the healthcare industry can realize these differences in the healthcare systems relationship and engagement with perinatal mothers and fathers?

Dr Sheehan Fisher: Well, I think that having a holistic view of it is important. I think that we are done pretty well with creating interdisciplinary approaches to treating our patients, and I think we need to continue to further that. I think many times other departments are starting to understand the value of understanding mental health and also including services to address the full needs of their patient because they're so human. Even if they're dealing with medical issues, that they still have their mental health and their overall wellbeing that's incorporated into it, to create the best health outcomes. So I think we do need to think holistically.

And then I think also we need to be more conscious of getting away from heteronormative approaches to dealing with patients because it means that we're not addressing the full population. And therefore, even though we're talking about mother, father, there are other family dynamics that need to be incorporated in our questionnaires and our intake forms to make sure that we are truly getting a picture of that family and supporting them.

Melanie Cole (Host): As we wrap up Dr. Fisher, in the pre and postnatal period, I'd like you to summarize for us some of the ways to improve that perinatal wellbeing. In addition to psychopathology, you're speaking to medical home providers. Please summarize what you would like them to know about working with these couples?

Dr Sheehan Fisher: I think part of the thing that needs to be considered is that we focus a lot on postpartum depression become more popular topic, but those who don't even necessarily get to that level criteria does not mean that they're not dealing with significant stress. Part of the reason of this that they're not fully equipped to go onto this new role. We kind of take a hazing approach where you're a new parent, you need to figure out on your own, and so we should be able to support and offer maybe pamphlets or information that will help the person figure out how do they create a postpartum plan to adjust stress rather than trying to recreate the wheel.

Giving them resources, information that will help support them through that transition to reduce their stress even if they don't meet criteria for a psychiatric diagnosis. And in addition, trying to make sure that they think of this as a teamwork exercise. We, like I said, main times, put it on the mom to figure out, and then the five is just gonna add on. But we need to start to change the cultural views of what is it like to go into this role rather than being primary, secondary, but co-parenting in a way that could actually make less stress for both parents and provide the best environment for the child. So it would be adapted depending on the specialty, but trying to provide more of that information and encouraging that culture will hopefully support families through this transition.

Melanie Cole (Host): Thank you so much, Dr. Fisher. I hope that you'll join us again as you learn more because this is really an important topic. Thank you again for joining us and to refer your patient or for more information, please visit our website at Breakthroughsforphysicians.nm.org/psych to get connected with one of our providers. That concludes this episode of Better Edge, a Northwestern Medicine Podcast for physicians. Please always remember to subscribe, rate, and review this podcast and all the other Northwestern Medicine podcasts. I'm Melanie Cole.