Skip to main content

Advertisement

SpringerLink
Log in

Expanding the international conversation with fathers’ mental health: toward an era of inclusion in perinatal research and practice

  • Review Article
  • Published:
Archives of Women's Mental Health Aims and scope Submit manuscript

Abstract

Paternal mental health is beginning to be recognized as an essential part of perinatal health. Historically, fathers were not recognized as being at risk for perinatal mental illnesses or relevant to maternal and infant health outcomes. The purpose of this paper is to provide an overview of paternal perinatal mental health, leading tools to assess paternal depression and anxiety, the impact of paternal mental health on mother and child health, and future directions for the field. An international team of paternal perinatal mental health experts summarized the key findings of the field. Fathers have an elevated risk of depression and anxiety disorders during the perinatal period that is associated with maternal depression and can impact their ability to support mothers. Paternal mental health is uniquely associated with child mental health and developmental outcomes starting from infancy and continuing through the child lifespan. Tailored screening approaches for paternal mental health are essential to support fathers early in the perinatal period, which would offset health risks for the family. Recommendations on paternal mental health are provided on four key areas to support father perinatal mental health: (1) intervention research, (2) clinical training, (3) national policy, and (4) the inclusion of fathers in the focus of the International Marcé Society for Perinatal Mental Health.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Antony MM, Bieling PJ, Cox BJ, Enns MW, Swinson RP (1998) Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample. Psychol Assess 10(2):176

    Article  Google Scholar 

  • Bailey BA (2010) Partner violence during pregnancy: prevalence, effects, screening, and management. Int J Womens Health 2:183

    Article  PubMed  PubMed Central  Google Scholar 

  • Black MC (2011) Intimate partner violence and adverse health consequences: implications for clinicians. Am J Lifestyle Med 5(5):428–439

    Article  Google Scholar 

  • Blair-West GW, Mellsop GW (2001) Major depression: does a gender-based down-rating of suicide risk challenge its diagnostic validity? Aust N Z J Psychiatry 35(3):322–328. https://doi.org/10.1046/j.1440-1614.2001.00895.x

    Article  CAS  PubMed  Google Scholar 

  • Brown A, Davies R (2014) Fathers’ experiences of supporting breastfeeding: challenges for breastfeeding promotion and education. Matern Child Nutr 10(4):510–526

    Article  PubMed  PubMed Central  Google Scholar 

  • Brownhill S, Wilhelm K, Barclay L, Schmied V (2005) ‘Big Build’: hidden depression in men. Aust N Z J Psychiatry 39(10):921–931. https://doi.org/10.1080/j.1440-1614.2005.01665.x

    Article  PubMed  Google Scholar 

  • Cameron EE, Sedov ID, Tomfohr-Madsen LM (2016) Prevalence of paternal depression in pregnancy and the postpartum: an updated meta-analysis. J Affect Disord 206:189–203

    Article  PubMed  Google Scholar 

  • Cameron EE, Giesbrecht GF, Tomfohr-Madsen LM (2021) Psychometric properties of the Pregnancy-Related Anxiety Scale for use with fathers during pregnancy. Psychol Men Masculinities 22(1):26

    Article  Google Scholar 

  • Cheng ER, Rifas-Shiman SL, Perkins ME, Rich-Edwards JW, Gillman MW, Wright R, Taveras EM (2016) The influence of antenatal partner support on pregnancy outcomes. J Womens Health 25(7):672–679

    Article  Google Scholar 

  • Cochran SV, Rabinowitz FE (2003) Gender-sensitive recommendations for assessment and treatment of depression in men. Prof Psychol Res Pract 34(2):132–140. https://doi.org/10.1037/0735-7028.34.2.132

    Article  Google Scholar 

  • Connell AM, Goodman SH (2002) The association between psychopathology in fathers versus mothers and children’s internalizing and externalizing behavior problems: a meta-analysis. Psychol Bull 128(5):746–773. https://doi.org/10.1037/0033-2909.128.5.746

    Article  PubMed  Google Scholar 

  • Cook F, Giallo R, Petrovic Z, Coe A, Seymour M, Cann W, Hiscock H (2017) Depression and anger in fathers of unsettled infants: a community cohort study. J Paediatr Child Health 53(2):131–135

    Article  PubMed  Google Scholar 

  • Cox J, & Holden J (2003) Perinatal mental health: a guide to the Edinburgh Postnatal Depression Scale (EPDS): Royal College of Psychiatrists

  • Daniels E, Arden-Close E, Mayers A (2020) Be quiet and man up: a qualitative questionnaire study into fathers who witnessed their partner’s birth trauma. BMC Pregnancy Childbirth 20:1–12

    Article  Google Scholar 

  • Darwin Z, Domoney J, Iles J, Bristow F, McLeish J, & Sethna V (2021) Involving and supporting partners and other family members in specialist perinatal mental health services. Good practice guide

  • Davis RN, Davis MM, Freed GL, Clark SJ (2011) Fathers’ depression related to positive and negative parenting behaviors with 1-year-old children. Pediatrics 127(4):612–618

    Article  PubMed  PubMed Central  Google Scholar 

  • Deave T, Johnson D (2008) The transition to parenthood: what does it mean for fathers? J Adv Nurs 63(6):626–633

    Article  PubMed  Google Scholar 

  • Dennis CL, Ross L (2006) Women’s perceptions of partner support and conflict in the development of postpartum depressive symptoms. J Adv Nurs 56(6):588–599

    Article  PubMed  Google Scholar 

  • Don BP, Mickelson KD (2012) Paternal postpartum depression: the role of maternal postpartum depression, spousal support, and relationship satisfaction. Couple Family Psychol Res Pract 1(4):323

    Article  Google Scholar 

  • Duvander A-Z, Lappegard T, & Johansson M (2020) Impact of a reform towards shared parental leave on continued fertility in norway and sweden. Popul Res Policy Rev 1–25

  • Eaton WW, Anthony JC, Gallo J, Cai G, Tien A, Romanoski A, ... Chen L-S (1997) Natural history of Diagnostic Interview Schedule/DSM-IV major depression: The Baltimore epidemiologic catchment area follow-up. Arch General Psychiatry 54(11):993-999

  • Figueiredo B, Conde A (2011) Anxiety and depression in women and men from early pregnancy to 3-months postpartum. Arch Womens Mental Health 14(3):247–255

    Article  Google Scholar 

  • Figueiredo B, Canário C, Tendais I, Pinto TM, Kenny DA, Field T (2018) Couples’ relationship affects mothers’ and fathers’ anxiety and depression trajectories over the transition to parenthood. J Affect Disord 238:204–212

    Article  PubMed  Google Scholar 

  • Fisher SD (2016) Paternal mental health: why is it relevant? Am J Lifestyle Med. https://doi.org/10.1177/1559827616629895

  • Fisher SD, Kopelman R, O’Hara MW (2012) Partner report of paternal depression using the Edinburgh Postnatal Depression Scale-Partner. Arch Womens Mental Health 15:283–288. https://doi.org/10.1007/s00737-012-0282-2

    Article  Google Scholar 

  • Fisher SD, Brock RL, O’Hara MW, Kopelman R, Stuart S (2015a) Longitudinal contribution of maternal and paternal depression to toddler behaviors: interparental conflict and later depression as mediators. Couple Family Psychol Res Pract 4(2):61

    Article  Google Scholar 

  • Fisher SD, Brock RL, O’Hara MW, Kopelman R, Stuart S (2015b) Longitudinal contribution of maternal and paternal depression to toddler behaviors: interparental conflict and later depression as mediators. Couple Family Psychol Res Pract 4(2):61

    Article  Google Scholar 

  • Fletcher RJ, Feeman E, Garfield C, Vimpani G (2011) The effects of early paternal depression on children’s development. Med J Aust 195(11–12):685–689

    Article  PubMed  Google Scholar 

  • Fletcher RJ, Maharaj ONN, Fletcher Watson CH, May C, Skeates N, Gruenert S (2013) Fathers with mental illness: implications for clinicians and health services. Med J Aust 199(3):S34–S36

    PubMed  Google Scholar 

  • Fletcher R, Kay-Lambkin F, May C, Oldmeadow C, Attia J, Leigh L (2017) Supporting men through their transition to fatherhood with messages delivered to their smartphones: a feasibility study of SMS4dads. BMC Public Health 17(1):1–10

    Article  Google Scholar 

  • Galbally M, Lewis AJ (2017) Depression and parenting: the need for improved intervention models. Curr Opin Psychol 15:61–65

    Article  PubMed  Google Scholar 

  • Garfield CF, Duncan G, Rutsohn J, McDade TW, Adam EK, Coley RL, & Chase-Lansdale PL (2014) A longitudinal study of paternal mental health during transition to fatherhood as young adults. Pediatrics. https://doi.org/10.1542/peds.2013-3262

  • Garfield CF, Fisher SD, Barretto D, Rutsohn J, Isacco A (2019) Development and validation of a father involvement in health measure. Psychol Men Masculinities 20(1):148

    Article  Google Scholar 

  • Gelenberg AJ (2010) The prevalence and impact of depression. J Clin Psychiatry 71(3):e06. https://doi.org/10.4088/jcp.8001tx17c

    Article  PubMed  Google Scholar 

  • Gillis A, Roskam I (2019) Daily exhaustion and support in parenting: impact on the quality of the parent–child relationship. J Child Fam Stud 28(7):2007–2016

    Article  Google Scholar 

  • Goldstein Z, Rosen B, Howlett A, Anderson M, Herman D (2020) Interventions for paternal perinatal depression: a systematic review. J Affect Disord 265:505–510

    Article  PubMed  Google Scholar 

  • Goodman JH (2004) Paternal postpartum depression, its relationship to maternal postpartum depression, and implications for family health. J Adv Nurs 45(1):26–35

    Article  PubMed  Google Scholar 

  • Hanington L, Heron J, Stein A, Ramchandani P (2012) Parental depression and child outcomes–is marital conflict the missing link? Child 38(4):520–529

    Article  CAS  PubMed Central  Google Scholar 

  • Hossain Z, Field T, Gonzalez J, Malphurs J, Valle CD, Pickens J (1994) Infants of “depressed” mothers interact better with their nondepressed fathers. Infant Ment Health J 15(4):348–357

    Article  Google Scholar 

  • Kiviruusu O, Pietikäinen JT, Kylliäinen A, Pölkki P, Saarenpää-Heikkilä O, Marttunen M et al (2020) Trajectories of mothers’ and fathers’ depressive symptoms from pregnancy to 24 months postpartum. J Affect Disord 260:629–637

  • Kroenke K, Spitzer RL, & Williams JB (2003) The Patient Health Questionnaire-2: validity of a two-item depression screener. Med Care 1284–1292

  • Lamb ME, Pleck JH, Charnov EL, & Levine JA (1985) Paternal behavior in humans. Am Zool 25(3):883–894. Retrieved from http://www.jstor.org.ezproxy.bu.edu/stable/3883043

  • Leach LS, Poyser C, Cooklin AR, Giallo R (2016) Prevalence and course of anxiety disorders (and symptom levels) in men across the perinatal period: a systematic review. J Affect Disord 190:675–686

    Article  PubMed  Google Scholar 

  • Liber JM, van Widenfelt BM, Goedhart AW, Utens EM, van der Leeden AJ, Markus MT, Treffers PD (2008) Parenting and parental anxiety and depression as predictors of treatment outcome for childhood anxiety disorders: Has the role of fathers been underestimated? J Clin Child Adolesc Psychol 37(4):747–758

    Article  PubMed  Google Scholar 

  • Lovejoy MC, Graczyk PA, O’Hare E, Neuman G (2000) Maternal depression and parenting behavior: a meta-analytic review. Clin Psychol Rev 20(5):561–592

    Article  CAS  PubMed  Google Scholar 

  • Löwe B, Decker O, Müller S, Brähler E, Schellberg D, Herzog W, & Herzberg PY (2008) Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population. Med Care 266–274

  • Magovcevic M, Addis ME (2008) The Masculine Depression Scale: development and psychometric evaluation. Psychoneuroendocrinology 9:117–132. https://doi.org/10.1037/1524-9220.9.3.117

    Article  Google Scholar 

  • Martens P, Kirk RS, Reed-Ashcraft K (2004) National Family Preservation Network. Director 888:498–9047

    Google Scholar 

  • Martínez-Borba V, Suso-Ribera C, Osma J (2018) The use of information and communication technologies in perinatal depression screening: a systematic review. Cyberpsychol Behav Soc Netw 21(12):741–752

    Article  PubMed  Google Scholar 

  • Matthey S, Barnett B, Ungerer J, Waters B (2000) Paternal and maternal depressed mood during the transition to parenthood. J Affect Disord 60(2):75–85

    Article  CAS  PubMed  Google Scholar 

  • Mayers A, Hambidge S, Bryant O, Arden-Close E (2020) Supporting women who develop poor postnatal mental health: what support do fathers receive to support their partner and their own mental health? BMC Pregnancy Childbirth 20(1):359. https://doi.org/10.1186/s12884-020-03043-2

    Article  PubMed  PubMed Central  Google Scholar 

  • McBride BA, Mills G (1993) A comparison of mother and father involvement with their preschool age children. Early Childhood Res Q 8(4):457–477

    Article  Google Scholar 

  • Morrell CJ, Ricketts T, Tudor K, Williams C, Curran J, Barkham M (2011) Training health visitors in cognitive behavioural and person-centred approaches for depression in postnatal women as part of a cluster randomised trial and economic evaluation in primary care: the PoNDER trial. Primary Health Care Res Dev 12(1):11–20

    Article  Google Scholar 

  • Mumford EA, Liu W, Joseph H (2018) Postpartum domestic violence in homes with young children: the role of maternal and paternal drinking. Violence Women 24(2):144–162

    Article  Google Scholar 

  • Nandi A, Jahagirdar D, Dimitris MC, Labrecque JA, Strumpf EC, Kaufman JS, ... Earle A (2018) The impact of parental and medical leave policies on socioeconomic and health outcomes in OECD countries: a systematic review of the empirical literature. Milbank Q 96(3):434-471

  • O’Hara MW, Swain AM (1996) Rates and risk of postpartum depression-a meta-analysis. Int Rev Psychiatry 8:37–54. https://doi.org/10.3109/09540269609037816

    Article  Google Scholar 

  • Paulson JF, Bazemore SD (2010) Prenatal and postpartum depression in fathers and its association with maternal depression: a meta-analysis. J Am Med Assoc 303:1961–1969. https://doi.org/10.1001/jama.2010.605

    Article  CAS  Google Scholar 

  • Paulson JF, Keefe HA, Leiferman JA (2009) Early parental depression and child language development. J Child Psychol Psychiatry 50(3):254–262

    Article  PubMed  Google Scholar 

  • Philpott LF, Leahy-Warren P, FitzGerald S, Savage E (2017) Stress in fathers in the perinatal period: a systematic review. Midwifery 55:113–127

    Article  PubMed  Google Scholar 

  • Philpott LF, Savage E, FitzGerald S, Leahy-Warren P (2019) Anxiety in fathers in the perinatal period: a systematic review. Midwifery 76:54–101

    Article  PubMed  Google Scholar 

  • Pinheiro R, Magalhães P, Horta B, Pinheiro K, Da Silva R, Pinto R (2006) Is paternal postpartum depression associated with maternal postpartum depression? Population-based study in Brazil. Acta Psychiatr Scand 113(3):230–232

    Article  CAS  PubMed  Google Scholar 

  • Pinto TM, Samorinha C, Tendais I, Nunes-Costa R, Figueiredo B (2017) Paternal adjustment and paternal attitudes questionnaire: antenatal and postnatal Portuguese versions. Assessment 24(6):820–830

    Article  PubMed  Google Scholar 

  • Psouni E, Eichbichler A (2020) Feelings of restriction and incompetence in parenting mediate the link between attachment anxiety and paternal postnatal depression. Psychol Men Masculinities 21(3):416

    Article  Google Scholar 

  • Ramchandani P, Psychogiou L (2009) Paternal psychiatric disorders and children’s psychosocial development. Lancet 374(9690):646–653

    Article  PubMed  Google Scholar 

  • Ramchandani P, Stein A, Evans J, O’Connor TG (2005) Paternal depression in the postnatal period and child development: a prospective population study. Lancet 365:2201–2205. https://doi.org/10.1016/S0140-6736(05)66778-5

    Article  PubMed  Google Scholar 

  • Ramchandani PG, Stein A, O’Connor TG, Heron J, Murray L, Evans J (2008) Depression in men in the postnatal period and later child psychopathology: a population cohort study. J Am Acad Child Adolesc Psychiatry 47(4):390–398

    Article  PubMed  PubMed Central  Google Scholar 

  • Rao W-W, Zhu X-M, Zong Q-Q, Zhang Q, Hall BJ, Ungvari GS, Xiang Y-T (2020) Prevalence of prenatal and postpartum depression in fathers: a comprehensive meta-analysis of observational surveys. J Affect Disord 263:491–499

    Article  PubMed  Google Scholar 

  • Rapee RM (2000) Group treatment of children with anxiety disorders: outcome and predictors of treatment response. Aust J Psychol 52(3):125–129. https://doi.org/10.1080/00049530008255379

    Article  Google Scholar 

  • Sanders MR (2012) Development, evaluation, and multinational dissemination of the Triple P-Positive Parenting Program. Annu Rev Clin Psychol 8:345–379

    Article  PubMed  Google Scholar 

  • Saxbe DE, Schetter CD, Simon CD, Adam EK, Shalowitz MU (2017) High paternal testosterone may protect against postpartum depressive symptoms in fathers, but confer risk to mothers and children. Horm Behav 95:103–112

    Article  CAS  PubMed  Google Scholar 

  • Sethna V, Murray L, Netsi E, Psychogiou L, Ramchandani PG (2015) Paternal depression in the postnatal period and early father–infant interactions. Parenting 15(1):1–8

    Article  PubMed  Google Scholar 

  • Sethna V, Murray L, Edmondson O, Iles J, Ramchandani PG (2018) Depression and playfulness in fathers and young infants: a matched design comparison study. J Affect Disord 229:364–370

    Article  PubMed  PubMed Central  Google Scholar 

  • Sidebottom AC, Harrison PA, Godecker A, Kim H (2012) Validation of the Patient Health Questionnaire (PHQ)-9 for prenatal depression screening. Arch Womens Mental Health 15(5):367–374

    Article  Google Scholar 

  • Singley DB, Edwards LM (2015) Men’s perinatal mental health in the transition to fatherhood. Prof Psychol Res Pract 46(5):309

  • Singley DB, Cole BP, Hammer JH, Molloy S, Rowell A, Isacco A (2018) Development and psychometric evaluation of the Paternal Involvement With Infants Scale. Psychol Men Masculinity 19(2):167

    Article  Google Scholar 

  • Sockol LE, Allred KM (2018) Correlates of symptoms of depression and anxiety among expectant and new fathers. Psychol Men Masculinity 19(3):362

    Article  Google Scholar 

  • Stapleton LRT, Schetter CD, Westling E, Rini C, Glynn LM, Hobel CJ, Sandman CA (2012) Perceived partner support in pregnancy predicts lower maternal and infant distress. J Fam Psychol 26(3):453

    Article  PubMed  Google Scholar 

  • Tambelli R, Trentini C, Trovato A, Volpi B (2019) Role of psychosocial risk factors in predicting maternal and paternal depressive symptomatology during pregnancy. Infant Ment Health J 40(4):541–556

    Article  PubMed  Google Scholar 

  • Vakrat A, Apter-Levy Y, Feldman R (2018) Sensitive fathering buffers the effects of chronic maternal depression on child psychopathology. Child Psychiatry Hum Dev 49(5):779–785

    Article  PubMed  Google Scholar 

  • Volling BL, & Belsky J (1991) Multiple determinants of father involvement during infancy in dual-earner and single-earner families. J Marriage Family 461–474

  • Zierau F, Bille A, Rutz W, Bech P (2002) The Gotland Male Depression Scale: a validity study in patients with alcohol use disorder. Nord J Psychiatry 56(4):265–271

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA

    Sheehan D. Fisher

  2. Psychiatry Department, Corporació Sanitària Parc Taulí - CIBERSAM - I3PT - Universitat Autònoma de Barcelona (Sabadell, Barcelona), Barcelona, Spain

    Jesus Cobo

  3. School of Psychology, University of Minho, Braga, Portugal

    Barbara Figueiredo

  4. College of Heath, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, 2308, Australia

    Richard Fletcher

  5. Department of Pediatrics, Ann& Robert H. Lurie Children’s Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Craig F. Garfield

  6. Perinatal MH Training CIC, Carmarthen, Wales, UK

    Jane Hanley

  7. Swansea University, Swansea, Wales, UK

    Jane Hanley

  8. PEDAL Research Centre, Faculty of Education, University of Cambridge, Cambridge, UK

    Paul Ramchandani

  9. The Center for Men’s Excellence, San Diego, CA, USA

    Daniel B. Singley

Authors
  1. Sheehan D. Fisher
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jesus Cobo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Barbara Figueiredo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Richard Fletcher
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Craig F. Garfield
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jane Hanley
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Paul Ramchandani
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Daniel B. Singley
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sheehan D. Fisher.

Ethics declarations

Research involving human participants and/or animals

Not applicable.

Informed consent

Not applicable.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fisher, S.D., Cobo, J., Figueiredo, B. et al. Expanding the international conversation with fathers’ mental health: toward an era of inclusion in perinatal research and practice. Arch Womens Ment Health 24, 841–848 (2021). https://doi.org/10.1007/s00737-021-01171-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00737-021-01171-y

Keywords

Search

Navigation