Fathers’ perinatal mental health: Impacts, interventions and supports

Background. Fathers’ perinatal mental health problems have far reaching implications not only for themselves, but also for their partner, their couple relationship, and their children. The primary objective of this thesis by publication was to generate evidence to inform the development of policy and intervention efforts to promote fathers’ mental health in the perinatal period. The aims of the research were four-fold: first, to determine the extent to which fathers’ experiences of mental health problems impact parenting and their children; second, to undertake a systematic review into interventions targeting fathers’ perinatal mental health; third, to explore fathers’ support needs in the perinatal period; and finally, to investigate midwives’ perceptions and experiences of working with fathers. Method. A multi-method approach was adopted across four studies. The first study used data from a longitudinal study of a nationally representative sample of Australian children and their families (N = 3,741 fathers) and explored mechanisms that link fathers’ postnatal distress to later child outcomes. Second, a systematic review of existing research detailing interventions targeting expectant and new fathers’ mental health was conducted. Third, fathers’ perceived support needs to accessing mental health and parenting support in the perinatal period were explored through qualitative interviews with fathers (N = 20). Finally, midwives’ perceptions and experiences of engaging fathers in the perinatal period were surveyed via a national online survey (N = 106) and qualitative interviews (N = 13). Results. In Study 1 (Chapter 6), results indicated that fathers’ postnatal distress and low parenting self-efficacy (PSE) were associated with higher levels of fathers’ parenting hostility and lower levels of parenting consistency when children were aged 4-5 years. In turn, this was associated with children’s emotional and behavioural difficulties when aged 8-9 years. Additionally, fathers’ levels of parenting warmth when children were aged 4-5 years was associated with fathers’ postnatal PSE and children’s prosocial outcomes when aged 8-9 years. In Study 2 (Chapter 7), the systematic literature review of interventions identified 11 studies, only five of which demonstrated significant intervention effects. The review highlighted the paucity of literature on interventions targeting fathers’ perinatal mental health and identified specific design issues related to outcome measures, timing of content delivery, and the mode of intervention delivery across the studies. Study 3 (Chapter 8) described a wide range of fathers’ experiences related to seeking support and several subthemes were identified within each broad area of inquiry: 1) support accessed; 2) support needs; 3) barriers to support; 4) facilitators of support; and 5) timing of support. Finally, online survey results in Study 4 (Chapter 9) indicated that the midwives considered engaging fathers to be a part of their professional role and that father-specific training is needed to develop their knowledge and skills in this area. Analysis of the interview data led to the identification of factors specific to midwives, the external workplace, and fathers that can impact a midwife’s ability to engage men in their services. Conclusion. Findings from this thesis extend our theoretical understanding of issues related to fathers’ perinatal mental health in three key areas; intergenerational health, the role of fathers’ PSE, and models of men’s help-seeking behaviour. Practical implications include intervention and support strategies to promote fathers’ perinatal mental health, and building capacity in the service system so perinatal health professionals can engage, support, and be more inclusive of fathers. Recommendations for future research focusing on fathers’ perinatal mental health include the exploration of diverse father groups, longitudinal research designs, enhanced intervention design and evaluation, and expanded professional training resources

Perspectives on supporting fathers affected by postnatal depression and a history of violence

Intimate partner violence in the perinatal period is a significant problem that remains underscreened, underdiagnosed and undertreated. The establishment of evidence-based guidelines to enable health visitors to identify couples experiencing violence and offer appropriate support has been hampered by the complex interplay between maternal and paternal mental health problems and violence. This study explored the experiences of UK fathers who voluntarily engaged with services designed to eliminate their ideation to violence. The findings indicate that the tendency to violence is increased by stresses associated with the transition to parenthood. Men felt pressured by concerns for their partner's mental health, changes in the relationship, sleep disturbances and the burden of infant care they assumed when the mother was unable to cope. Health visitors are ideally placed to assess for factors linked to the emergence of violence and put in place interventions to minimise occurrence

Fathers’ worries during pregnancy: A qualitative content analysis of reddit

Qualitative investigations into the emotional needs of expectant fathers have been limited by difficulties with recruitment. This study aimed to unobtrusively obtain insights into fathers' worries during pregnancy by analyzing the content of posts on the Internet forum Reddit. The majority of worries related to infant well-being (50.8%), particularly the potential for perinatal loss (23.0%). Concerns relating to partner well-being and the couple relationship were also common, comprising 17.0% of posts. Several posts related to individual factors, such as apprehension about the father role (16.3%). Finally, situational factors such as work-family conflict accounted for 15.9% of posts. These findings contribute to the growing literature on fathers' experiences of pregnancy and can inform the development of father-inclusive perinatal education

Fathers’ Worries During Pregnancy: A Qualitative Content Analysis of Reddit

Qualitative investigations into the emotional needs of expectant fathers have been limited by difficulties with recruitment. This study aimed to unobtrusively obtain insights into fathers' worries during pregnancy by analyzing the content of posts on the Internet forum Reddit. The majority of worries related to infant well-being (50.8%), particularly the potential for perinatal loss (23.0%). Concerns relating to partner well-being and the couple relationship were also common, comprising 17.0% of posts. Several posts related to individual factors, such as apprehension about the father role (16.3%). Finally, situational factors such as work-family conflict accounted for 15.9% of posts. These findings contribute to the growing literature on fathers' experiences of pregnancy and can inform the development of father-inclusive perinatal education

Systematic review of the impact of coparenting interventions on paternal coparenting behaviour

Aims: The aim of this study was to evaluate the efficacy of interventions to support coparenting, how partners relate to and support one another as parents, on paternal outcomes. Background: Despite societal shifts in gender roles leading to fathers’ increasing involvement in parenting and growing recognition of the need for couples‐based parenting interventions, fathers have been underrepresented in parenting research. Design: Systematic review. Data Sources: Medline, Embase, Healthstar, and PsycInfo. Review methods: We followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses to identify peer‐reviewed articles published up to 2016 that evaluated the effectiveness of coparenting interventions for expectant fathers or fathers of children <18 years. Study quality was assessed using Cochrane risk of bias criteria for Effective Practice and Organisation of Care reviews; Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria were used to summarize quality of the evidence. The primary outcome was coparenting behaviour among men. Results: We identified 16 randomized controlled trials that evaluated 14 coparenting interventions. Nine interventions targeted partners in the perinatal period; five targeted parents of children. All but one involved face‐to‐face contact, but this varied in duration and intensity. Of the 12 trials that examined coparenting outcomes, eight reported an effect on at least one measure of paternal coparenting behaviour. The quality of the evidence was at a low level. Conclusion: Success was moderate, supporting the need for future research to explore the use of additional approaches to increase efficacy, including technology‐based interventions, to improve uptake among men

"Getting help for yourself is a way of helping your baby": Fathers' experiences of support for mental health and parenting in the perinatal period

The need for services targeting fathers in the perinatal period is increasingly apparent. To maximize engagement, such interventions need to be father focused, but men’s experiences and needs around support have not been adequately examined. Therefore, the aims of this qualitative study were to explore men’s experiences of seeking support for their mental health and parenting in the perinatal period, and identify their specific support needs during this time. Australian fathers (N = 20) who were expecting or parenting an infant less than 2 years of age participated in individual semistructured face-to-face or telephone interviews. Thematic content analysis was used to analyze the data. Five broad themes were explored: experiences of support, support needs, barriers to support, facilitators to support, and timing of support. Several subthemes were identified within each category, illustrating a diverse range of issues that fathers experience across the perinatal period. The findings have implications for our understanding of fathers’ help-seeking behaviors, their perinatal support needs and for the development of resources, services, and interventions aiming to engage fathers in maternity health services

Midwives' perceptions and experiences of engaging fathers in perinatal services

Background: The active engagement of fathers in maternity care is associated with long-term benefits for the father, their partner, and their child. Midwives are ideally placed to engage fathers, but few studies have explored midwives’ experiences of working with men. Therefore, the aim of this study was to describe midwives’ perceptions and experiences of engaging fathers in perinatal services. Method: A multi-method approach was utilised. Registered midwives (N = 106) providing perinatal services to families in Australia participated in an online survey. Of these, 13 also participated in semi-structured telephone interviews. Descriptive analyses summarised the online survey data. The interview data were coded using semantic thematic analysis. Results: Survey results indicated that midwives unanimously agreed that engaging fathers is part of their role and acknowledged the importance of receiving education to develop knowledge and skills about fathers. Analysis of the telephone interviews led to the identification of a range of strategies, facilitators and barriers to engaging fathers in midwifery services. Some of these were related to characteristics of midwives, factors related specifically to fathers, and several external factors relating to organisational policies. Conclusions: Findings from this study could inform maternity health care policies, as well the development of resources, education and ongoing professional training for midwives to promote father-inclusive practice