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Perinatal Mood and Anxiety Disorders (PMADs)

Perinatal Mood and Anxiety Disorders (PMADs) are a group of illnesses that affect approximately one in five women during pregnancy and the postpartum period.

PMADs include:

perinatal depression
perinatal anxiety
perinatal obsessive compulsive disorder
perinatal post-traumatic stress disorder
postpartum psychosis

It is understood that the perinatal period begins three months prior to childbirth and may continue to at least one year post birth.

According to the National Institute of Health, maternal mental health disorders are the number one complication associated with pregnancy and the process of childbirth. According to the Maternal Mental Health Leadership Alliance, Black women are twice as likely as white women to experience a PMAD, but half as likely to receive treatment.

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Maternal Mental Health

Maternal Mental Health Resources

ACS is raising awareness about PMADs, signs and symptoms, its prevalence, and the ways in which pregnant and birthing people throughout the perinatal and post-partum periods can be supported and connected to services.

Pregnant, Postpartum and Parenting People who feel they need mental health support can call the National Maternal Mental Health Hotline which provides 24/7, free, confidential support before, during, and after pregnancy at 833-TLC-MAMA (833-852-6262) or the National Suicide Prevention Lifeline at 988.

Resources for Practitioners and Families

For a list of resources, please see below:

Maternal Mental Health Matters
PMADs Services Covered by Medicaid
NYC DOHMH Dear Colleague Letter
Doula Services - A doula is a professional who offers non-medical support to pregnant individuals and their families before, during, and after childbirth. Their services address the physical, emotional, and practical challenges of childbirth, helping to prevent and reduce the risks associated with PMADs.

Videos

Informational Video on PMADs

The Hidden Pain of Perinatal Mood Anxiety Disorders (PMADs)

Maternal Mental Health - The Intersection of Trauma, Substance Use & Interpersonal Violence

Maternal Mental Health & Perinatal Substance Use Disorder

Maternal Mental Health & Interpersonal Partner Violence IPV during the Perinatal Period

Paternal Mental Health

According to Post Partum Men, Paternal Postnatal Depression (PPND) is a common condition among men after the birth of a child. Up to 1 in 4 new dads have PPND. Depression, anxiety, or other problems with mood can occur anytime during the first year of a child’s life.

Why Paternal Mental Health Matters

Perinatal mood and anxiety disorders (PMADs) are not limited to mothers. 10% of fathers will experience depression and 18% will experience anxiety during pregnancy or the first year following birth — yet only 3.2% will seek mental health services. Depression and anxiety are twice as common in expecting and new fathers compared with global estimates in men. Despite this, fathers are rarely screened or supported within perinatal care systems.

Maternal depression is the single most important risk factor for paternal depression.

50% of fathers whose partner has postpartum depression are at increased risk themselves.

How Paternal Depression & Anxiety Present

Fathers often express depression differently than mothers, which contributes to missed diagnoses. Practitioners should recognize both internalized and externalized symptom patterns:

Externalizing Symptoms

Anger, irritability, and aggression
Risk-taking behaviors and substance use
Withdrawal and social isolation
Staying at work longer / avoidance
Low impulse control
Physical symptoms (headaches, muscle tension)
Excessive gaming

Internalizing Symptoms

Persistent low energy and fatigue
Changes in sleep, weight, and appetite
Feeling burned out, empty, or trapped
Loss of interest in hobbies
Excessive worry and panic attacks
Obsessive or intrusive thoughts

Risk Factors

Practitioners should assess for the following when working with fathers in the perinatal period:

Personal or family history of depression, anxiety, or other mental illness
History of trauma, including physical or sexual abuse, or ACEs
History of substance use disorder (personal or familial)
Financial stress, poverty, or pressure to be the sole provider
Lack of social supports and networks
Partner's depression, traumatic birth, or pregnancy complications
Unwanted/unintended pregnancy, premature birth, or infant in the NICU
Difficulty bonding with the baby or feeling excluded from mother-infant bonding
Relationship conflict, dissatisfaction, or communication difficulties
Absence of paternity leave and poor work-life balance
Unrealistic prenatal expectations vs. actual postpartum experience

Barriers to Care

Many fathers report feeling invisible during pregnancy, birth, and the postpartum period. Practitioners should be aware that the following barriers prevent fathers from seeking help:

Masculine norms and stigma around expressing vulnerability or seeking mental health support
Unawareness that fathers can experience PMADs; not recognizing symptoms in themselves
Clinician bias: fathers are rarely screened for PMADs in routine perinatal care
Limited availability of mental health services tailored to fathers' needs
Financial pressure that makes prioritizing mental health feel unaffordable or selfish

Cultural Considerations

BIPOC fathers may face compounding stressors that elevate their risk and limit access to care. Practitioners should account for race-based stressors in clinical conceptualization, including systemic disparities in healthcare access, income, and community resources. Stereotypes — such as the persistent myth that Black fathers are uninvolved parents, despite data showing they are among the most engaged fathers across racial categories — can create additional barriers. Culturally humble, holistic care is essential to serving BIPOC fathers effectively.

Evidence-Informed Treatment & Interventions

Effective treatment for paternal PMADs typically involves a combination of approaches:

Perinatal psychoeducation: Help fathers understand that PMADs are common, treatable, and not a sign of failure
Therapy or counseling: Individual therapy (CBT, trauma-informed approaches) and couples therapy when indicated
Peer support groups: Dad-specific support groups reduce isolation and normalize help-seeking
Medication: Evaluated by a prescriber when clinically appropriate
Practical support: Sleep, exercise, nutrition, and relief from caregiving duties
Fatherhood engagement programs: Structured programs focused on bonding, co-parenting, and parenting skills

Impact on Children & Families

Untreated paternal depression is not only a father's issue — it has measurable effects on the entire family system, which is directly relevant to child welfare practice:

Increases hostility and conflict in the home
Reduces positive engagement with infants (sensitivity, warmth, playfulness) and can delay secure attachment
Decreases enriching interactions with older children (reading, play, storytelling), impacting social-emotional development
Elevates risk of harsh discipline and Adverse Childhood Experiences (ACEs)

Resources for Practitioners and Families

Local Resources (New York)

National Resources

Videos

Trailer: Fathers and Mental Health - Unspoken Conversations - ACS talks to fathers about their journeys to fatherhood, bringing awareness and attention in our Perinatal Mood Anxiety Disorders (PMADs) training series to the mental health of fathers. These unspoken conversations often interfere with a father's ability to care for the child and family; but with supportive resources fathers can get the help they need, build confidence, and become "life preservers" to their families.

Supportive Programs for Dads - Unspoken Conversations

Supporting the Mental Health and Well Being of Fathers - Unspoken Conversations

Raising Awareness: Fathers and Paternal Mental Health - Unspoken Conversations

Jonathan's Fatherhood Journey - Unspoken Conversations

Joseph’s Fatherhood Journey - Unspoken Conversations