Paternal perinatal mental health: evidence review

6. Support needs and current sources of support for men in the perinatal period

Fathers can experience distress, anxiety and uncertainty during the transition to parenthood, the negative implications of which can impact upon their partners and children. For example, fathers’ perinatal mental health problems can create strain on the couple’s relationship, and can significantly impact children’s emotional, social, and cognitive development and well-being (Buist et al., 2003; Connell & Goodman, 2002; Giallo et al., 2013; Ramchandani et al., 2005; Ramchandani et al., 2008). Therefore, it is important to understand what men’s mental health support needs are during the perinatal period and where they most commonly seek support. While there is relatively little research available on fathers’ help-seeking behaviour and attitudes during the transition to fatherhood, what research exists points to fathers accessing support from both formal services and informal sources (Venning et al., 2021) .

Existing research shows that some men prefer not to seek help with mental health concerns during the perinatal period and instead seek to cope on their own (Baldwin et al., 2019; Leahy-Warren et al., 2022). When men do seek mental health support during the perinatal period, they tend to rely on their partners, family, friends, wider social networks (e.g. colleagues) and community-based support over formal support from healthcare services.

The following sections explore men’s support needs and some of the sources that men draw on for mental health support during the perinatal period. These sources include their partners, family and friends, and healthcare services.

6.1. Men’s support needs

A scoping review by Leahy-Warren et al. (2022) of literature relating to fathers’ perceptions and experiences of support during the perinatal period identified several key messages. These included how there are few studies that have explored what constitutes ‘support’ for fathers, that the types of support fathers seek and access might be different to the kinds of support sought by mothers, and how previous research has tended to focus on the challenges and barriers fathers face to accessing mental health support in the perinatal period. The review concluded that men required and should be able to access support from multiple sources, that includes recognition and support from partners, family, peers, employers, policy makers and health services.

While there is still a limited understanding of support needs for fathers during the perinatal period, a systematic review of qualitative studies by Shorey & Chan (2021) reported that fathers thought that support could enhance their mental health, using opportunities provided through antenatal classes, small group discussions led by experienced fathers, healthcare professional support, and promotion of mental health information. Other reviews have also highlighted the need for father-inclusive models of support for men so that they feel acknowledged and adequately supported during the transition to fatherhood (Baldwin, 2019).

6.2. Support from partners

Research has highlighted that most fathers regard their partners as an important source of support during the perinatal period, compared to friends, other family members and healthcare professionals (Forsyth et al., 2011; Chalmers et al., 1996), and the most effective support for fathers is likely to come from their partner (Wee et al., 2013). However, relying solely or exclusively on their partners, may put men at risk of not seeking or being unsupported by other sources of support.

An in-depth qualitative study by Davenport and Swami (2023), based on the lived experience of one father with postnatal depression and the support he received from his partner, offers some granular insight into how men can devalue their own needs during the perinatal period and the role that partners can play in supporting fathers to seek and access help. In the study, the participant described his emotional experiences of fatherhood, which included suicidal thoughts, frequent bouts of anxiety, debilitating sadness, and anger at himself and others. The participant contextualised his own feelings and needs as ‘unimportant’ when compared to those of his partner and son. This partly stemmed from his needs being somewhat trivialised by healthcare professionals, but also from shame associated with admitting he needed help. Despite encouragement from his partner to seek help, this only occurred when his partner made his GP appointment and accompanied him to it, and then spoke with him afterwards to ensure that his feelings had been accurately articulated to the GP. The participant described the actions taken by his partner as an act that saved his life.

A reason for partners being such an important source of support for fathers could be that, as both parents increase their focus on the needs of their new child, men are often less proactive about seeking out social support from sources other than their partners because of increased demands managing a new baby (Patulny, 2011). Being more reliant on partners for support than other sources, however, presents risks for the mental health of fathers during the perinatal period. For example, research shows that during the perinatal period, couples are likely to spend less time together and fathers are less likely to receive support from their partners (Darwin et al., 2017). Several sources also highlight fathers wanting to support their partners (Baldwin et al., 2019), and the feelings of guilt that can arise when feeling unable to do so (such as when returning to work) (Darwin et al., 2017), which can result in fathers minimising or delegitimising their own struggles. Fathers may attempt to hide their symptoms from their partner to avoid worrying them or may feel uncomfortable about relying on their partner for support while they are coping with pregnancy and new parenting themselves (Ghaleiha et al., 2022).

6.3. Support from family and friends

The wider families of fathers beyond their partners, including parents and siblings, can also be sources of mental health support during the perinatal period, giving them a sense of security or stress relief (Persson et al, 2012). For example, qualitative research has highlighted the role of extended family, including mothers and mothers-in-law, who can provide support, having been parents themselves (Marrs et al., 2014).

In addition to family, friends can also provide practical and emotional support to fathers (Ghaleiha et al., 2022; Darwin et al., 2017). Multiple studies have observed that fathers would like to be able to share their experiences with peers in an informal manner to help them learn from each other’s experiences, and so that they can support each other as they are going through the same phase in life (Ross et al., 2012; Rominov et al., 2018; Persson et al., 2012; Shorey & Ang, 2019; Carlson et al., 2014; Nash, 2018; Hrybanova et al., 2019).

Fathers in a qualitative study from Australia (Rominov, et al., 2018), which explored men’s experiences of seeking support for their mental health and parenting in the perinatal period, expressed a preference for informal support sources, such as friends, family, work colleagues, and online information. Relating to support among friends, there was an inclination towards seeking support from those who were also fathers (Rominov, et al., 2018; Ross et al., 2012). Support from friends who were also fathers was seen as valuable on account of men feeling more comfortable opening up to them (Letourneau et al., 2011), providing reassurance (Rominov et al., 2018) and connecting with someone they could look to model their behaviour on (Harringon et al, 2010).

Contrastingly, research about the experience of new fathers found that they lacked support from some of their peers who were not fathers, including work colleagues, due to a lack of understanding about the challenges associated with their new role as fathers, and that some men had started to drift apart from their friends (Finnbogadottir et al., 2003). The lack of peer support available to first time fathers specifically was reported on in a systematic review by Baldwin et al. (2018). This finding was linked to research noting the positive impact that social support can have for fathers as a protective factor against depression and distress (Castle et al., 2008) and how poor social support is associated with symptoms of PPD (Da Costa et al., 2015). The absence of social support has been shown to have a negative impact on fathers’ mental health; fathers with effective social networks are less likely to experience parenting and marital conflicts (Nomaguchi & Milkie, 2020).

6.4. Support from healthcare services

There is evidence that healthcare services, including perinatal health professionals, have been found to overlook the mental health needs of men during the transition to parenthood (Darwin et al., 2017; Daniels et al., 2020; Mayers et al., 2020). However, this is not an exclusive finding. Research has found instances where some fathers have had positive experiences (Persson et al., 2012; Poh et al., 2014; Premberg et al., 2011; Salzmann-Erikson & Eriksson, 2013), from a wide range of support sources including midwives and nurses (Eriksson & Salzmann-Erikson, 2013; Persson et al., 2012; Poh, et al, 2014; Rominov et al., 2018; Shorey et al., 2017), lactation consultants (Majee, et al, 2017; Shorey et al., 2017), breastfeeding clinics (Persson et al., 2012), and GPs (Letourneau et al., 2012).

Studies show that the provision of effective support from healthcare services can reduce distress for fathers and their partners during and after pregnancy. They can also be an important source of knowledge about mental health for fathers (Ghaleiha et al., 2022; Hambidge et al., 2021). Men may also use father and baby groups as a source of mental health support during the perinatal period, although studies have shown that men can feel uncomfortable in these groups and when accessing other services, such as birth classes (Darwin et al., 2017). In some cases, when men feel less comfortable asking for support, studies show that health information helplines can be as important (Ghaleiha et al., 2022).

GPs have been shown to be fathers’ preferred healthcare professionals to approach for support with perinatal mental health issues (Baldwin et al., 2019). However, fathers will often only contact their GP if their symptoms are unmanageable (Darwin et al., 2017). Evidence suggests that fathers only seek help with their mental health needs after they experience severe symptoms or with encouragement from family members, because of the barriers they experience when accessing mental health support (Pedersen et al., 2021).

There is also evidence which shows how healthcare professionals have relatively limited experiences of working with first time fathers. Qualitative research with health visitors highlighted concerns relating to a lack of training and confidence in working with fathers (Whitelock, 2016). The predominantly female workforce within perinatal healthcare services has been highlighted as a potential challenge to building the trust and confidence required to address fathers’ mental health needs (Whitelock, 2016; Darwin et al., 2021).

Research shows that older fathers may be more likely to engage with perinatal mental health services. For example, in one study trialling a text message service that supported men as they transitioned to fatherhood, older fathers (25 and above) were much more likely to engage in the service than younger fathers (Fletcher et al., 2017).

Approaches to improving how healthcare services could meet the mental health needs of fathers during the perinatal period include offering regular mental health screenings for men, father-focused birth groups, and maternity services that provide men with counselling and information regarding the perinatal period (Fisher et al., 2021; Fletcher et al., 2015). Screening may be particularly impactful, with research showing that men perceive it as beneficial in helping normalise their experiences, reducing the stigma attached to seeking support for their mental health, and could help some recognise they have PPD (Schuppan et al., 2019).