Paternal perinatal mental health: evidence review

3. Overview of paternal perinatal mental health

Perinatal mental health conditions in men are less understood than perinatal mental health conditions experienced by women (Pedersen et al., 2021). It is recognised that the symptoms experienced often vary between men and women (Mangialavori et al., 2021). This section provides a brief overview of paternal perinatal depression and anxiety, including their prevalence, symptoms, impacts and interaction with maternal perinatal mental health.

3.1. Paternal Perinatal Depression

The prevalence and impacts of postpartum depression amongst mothers is well established within research and healthcare services. It is now increasingly understood that fathers can also experience depression during the perinatal period (Wee et al., 2011). However, the incidence and epidemiology of paternal perinatal depression (PPD) is not fully understood. This is reflected in the varying prevalence rates of PPD documented in research, which fluctuate, for example, from 4% to 25% in first-time fathers (Cameron et al., 2016; Da Costa et al., 2017; Paulson & Bazemore, 2010; Spry et al., 2018). These figures do, however, indicate that new fathers may report depressive symptoms at higher rates than men in the general population (Craig et al., 2014; Gettler & Oka, 2016; Paulson & Bazemore, 2010).

Maternal and paternal perinatal depression are interdependent. Maternal depression is one of the most common predictors of paternal perinatal depression. Mothers whose partners are depressed are more than four times more likely to have worsened depressive symptoms by six months postpartum(Paulson et al., 2016). PPD has also been shown to adversely affect children's social and emotional development, behaviour, and attachment (Field et al., 2004; Fletcher et al., 2011; Giallo et al., 2013; Rominov et al., 2016).

Risk factors for PPD include being a first-time father, having birth concerns, low partnership satisfaction, a history of depression and father’s concerns for their own and their family’s future (Gawlik et al., 2014; Fisher et al., 2012; Ramchandani & Psychogiou, 2009). Common symptoms of PPD include depressed mood, restlessness, irritability, impaired concentration and work performance, social isolation, changes to appetite, reduced libido, and insomnia (Berg & Ahmed, 2016). Men suffering from PPD may also experience higher rates of anger, substance use, low job satisfaction and poor physical health (Epifanio et al., 2015; Speisman et al., 2011). Symptoms of PPD differ from those seen in maternal perinatal depression, with milder depressive symptoms and increased comorbidity with anxiety, hostility or anger attacks, substance use or other high risk behaviours (Mangialavori et al., 2021).

Despite these distinctions, PPD is mostly assessed by measurements developed to identify maternal perinatal depression (Mangialavori et al., 2021). As such, because these symptoms are often not recognised as PPD, they can go unnoticed in men (Pedersen et al., 2021). Fathers may also hide symptoms of PPD from their immediate family, friends, or health professionals, as their disclosure is felt to be taboo (Pedersen et al., 2021). Misconceived notions about the intensity and features of fathers’ symptoms of PPD may prevent fathers with moderate depressive symptoms from seeking support (Felder et al., 2017; Pedersen et al., 2021).

3.2. Paternal Perinatal Anxiety

As with PPD, there is a need for more evidence about paternal perinatal anxiety (PPA) (Fisher et al., 2022). Prevalence estimates for PPA range between 3.4% and 25% antenatally, and 2.4% and 51% postnatally (Philpott et al., 2019). The discrepancies in these figures have been attributed to underreporting and variance between outcome measures (Fisher et al., 2022).

A systematic review of risk factors for PPD and PPA by Chhabra, McDermott and Li (2020), identified several for PPA. These included parenting stress, maternal depression, marital distress, lack of social support, and work-family-conflict. Like depression, fathers are more likely to develop anxiety during the perinatal period if they are a new father and have not taken care of a baby previously.

Experiencing PPA can adversely affect fathers, their partners and their children. Reported adverse outcomes for PPA include poor mental health for both parents, relationship dysfunction, disordered attachments and short- and long-term child development issues (Ayano et al., 2021).