Assessing the Mental Health of Fathers, Other Co-parents, and Partners in the Perinatal Period: Mixed Methods Evidence Synthesis

Abstract

Introduction: Five to 10 percentage of fathers experience perinatal depression and 5–15% experience perinatal anxiety, with rates increasing when mothers are also experiencing perinatal mental health disorders. Perinatal mental illness in either parent contributes to adverse child and family outcomes. While there are increasing calls to assess the mental health of both parents, universal services (e.g., maternity) and specialist perinatal mental health services usually focus on the mother (i.e., the gestational parent). The aim of this review was to identify and synthesize evidence on the performance of mental health screening tools and the acceptability of mental health assessment, specifically in relation to fathers, other co-parents and partners in the perinatal period.Methods: A systematic search was conducted using electronic databases (MEDLINE, PsycINFO, Maternity, and Infant Care Database and CINAHL). Articles were eligible if they included expectant or new partners, regardless of the partner's gender or relationship status. Accuracy was determined by comparison of screening tool with diagnostic interview. Acceptability was predominantly assessed through parents' and health professionals' perspectives. Narrative synthesis was applied to all elements of the review, with thematic analysis applied to the acceptability studies.Results: Seven accuracy studies and 20 acceptability studies were included. The review identified that existing evidence focuses on resident fathers and assessing depression in universal settings. All accuracy studies assessed the Edinburgh Postnatal Depression Scale but with highly varied results. Evidence on acceptability in practice is limited to postnatal settings. Amongst both fathers and health professionals, views on assessment are mixed. Identified challenges were categorized at the individual-, practitioner- and service-level. These include: gendered perspectives on mental health; the potential to compromise support offered to mothers; practitioners' knowledge, skills, and confidence; service culture and remit; time pressures; opportunity for contact; and the need for tools, training, supervision and onward referral routes.Conclusion: There is a paucity of published evidence on assessing the mental health of fathers, co-mothers, step-parents and other partners in the perinatal period. Whilst practitioners need to be responsive to mental health needs, further research is needed with stakeholders in a range of practice settings, with attention to ethical and practical considerations, to inform the implementation of evidence-based assessment.

Examining the Effectiveness of the Fathers and Babies Intervention: A Pilot Study

“…Results on the pilot study's acceptability and feasibility are presented in Hamil et al (under review), with this manuscript describing paternal and maternal mental health outcomes associated with the FAB pilot study. Consistent with previous research, we found that mothers exhibited greater anxiety and depressive symptomatology than fathers (Wee et al, 2011;Darwin et al, 2021). We found statistically significant decreases in perceived stress among both fathers and mothers with corresponding moderate effect sizes.…”

Impact of psychological distress and psychophysical wellbeing on posttraumatic symptoms in parents of preterm infants after NICU discharge

“…This result is in line with an emerging evidence concerning paternal perinatal depression as a public health concern to take care of [ 21 ]. In particular, a number of studies is suggesting to develop specific tools in order to detect perinatal depression symptoms in fathers [ 22 ]. A systematic review of qualitative studies shows that paternal depressive symptoms during NICU admission may be explained by their oscillating self-representation and the fear to harm their own infant [ 23 ].…”

Father’s Perspectives on Family Relationships and Mental Health Treatment Participation in the Context of Maternal Postpartum Depression

“…In spite of fathers voicing an array of strong emotions during the research interview, many also noted that they had trouble expressing their feelings, or felt they needed to prioritize their partners’ needs. Prior research has similarly found that postpartum fathers may question the legitimacy of their feelings and needs, particularly when they have a depressed partner ( Darwin et al, 2021 ). Our sample was diverse in terms of race and ethnicity and socio-economic background; though not directly examined in the current study, it is possible that cultural norms and beliefs could impact father’s views regarding expression of emotions.…”

“…The past decade has seen a steady increase in studies focused on postpartum fathers and partners ( Darwin et al, 2021 ). Although most clinical, policy, and research attention remains focused on maternal mental health, there is growing recognition that many fathers and other non-birthing parents and partners face significant challenges during the perinatal period, with up to 10% suffering clinical symptoms of depression or anxiety in the months after a new baby is born ( Paulson and Bazemore, 2010 ; Cameron et al, 2016 ; Leach et al, 2016 ).…”