Paternal perinatal mental health: evidence review

Key Findings

There is a relative lack of attention in research, policy and service provision around the mental health implications of the transition to parenthood for fathers. There is an increasing acknowledgement of the mental health needs of fathers during this time. Evidence shows that there may be an elevated risk of depression and anxiety amongst fathers in the perinatal period, which impacts fathers’ wellbeing, as well as their relationships with their partners and children. Paternal mental health is associated with child mental health and developmental outcomes starting from infancy and continuing through the lifespan.

Paternal mental health challenges in the perinatal period are related to psychological, physiological, and social factors which can influence how fathers respond to becoming parents. These factors include:

• Stress related to pregnancy and childbirth
• Lifestyle changes due to increased responsibilities, financial concerns, lack of sleep, reduced social life, and lack of confidence in a new role as a father
• Hormonal changes which have been linked to fathering stress, paternal depressive symptoms and intimate partner aggression following the birth of a child
• Emotional changes, including feelings of inadequacy
• Societal gender constructs, which can lead to men feeling increased pressure as “providers” for their families, less able to ask for help and conflict between more traditional versus contemporary expectations of fatherhood
• Changing relationships with partners

Experiences of paternal perinatal mental health vary across the population and some groups may have specific needs. Currently, there is limited and unclear evidence about the impact of equalities characteristics on paternal perinatal mental health, particularly around the representation of minority ethnic groups in the available UK literature. Fathers from low income groups may be at higher risk of depression and anxiety during the perinatal period, thought to be related to financial stress and poorer job security. Evidence also shows that prior experiences of mental ill health and difficult and traumatic life experiences can negatively influence the mental health of fathers during the perinatal period. Separated and divorced fathers may be more likely to experience perinatal depression.

The review identified some of the potential support needs for fathers during the perinatal period, and highlighted some of the key existing sources of support:

• There is a current lack of research into what constitutes ‘support’ for fathers, but we know that the types of support men seek and access may be different to those sought by mothers, and that many men prefer not to seek support.
• Support for men’s mental health needs are required from multiple sources including partners, family, peers, employers, policy makers and health services.
• Options such as antenatal classes, small group discussions with experienced fathers, healthcare professional support and promotion of mental health information have been discussed as ways to develop father-inclusive models of support.
• Research has highlighted that partners are an important source of support to fathers, but that this can cause challenges as they risk being unsupported by other sources and may attempt to hide their feelings from their partners to avoid overburdening them during the perinatal period.
• Family and friends can provide practical and emotional support to fathers, and many men prefer informal support. However, a lack of peer support, particularly for first time fathers, can have a negative impact on mental health.
• There were mixed findings about experiences of healthcare services, including perinatal health professionals, in providing mental health support to men during the perinatal period. While there were positive experiences, studies show that healthcare professionals sometimes overlook the mental health needs of fathers. Research with healthcare professionals highlights a lack of training and confidence working with fathers.
• GPs are a preferred route for fathers accessing mental health services, but many will often only contact their GP once their symptoms become severe or unmanageable.

The review highlighted several key barriers to men accessing mental health support during the perinatal period, these include:

• Lack of perinatal mental health services specifically tailored to the needs of men, including:
  • A lack of evidence relating to the effectiveness of different interventions and treatments for men during the perinatal period.
  • Current perinatal mental health services overlooking the mental health needs of men, with low levels of practical accessibility (for instance, in the availability of appointments outside of working hours) and lack of awareness and training amongst workforce.
• Lack of awareness or acknowledgement of mental health needs amongst men during the perinatal period
  • Men often have poorer mental health literacy than women, and there is a lower general awareness of paternal perinatal mental health in the general public, compared to awareness of maternal perinatal mental health.
  • Fathers have been found to be more likely to conceal or not disclose their mental health concerns, which may be due to a reluctance to seek help amid concerns this could detract from the needs of the partners or children.
• Gender-based stigma and gender roles
  • Stereotypes of masculinity and normative expectations around fathers’ mental health can be a barrier in seeking support, which can be due to stigmatising views relating to mental health.