Nursery World - Health - Taking the strain

The mental health of new fathers is rarely assessed as part of ante- or postnatal care. With dads’ depression on the rise, this needs to change, finds Meredith Jones Russell

Around one in four women experiences mental health problems in pregnancy and during the 24 months after giving birth, with lack of access to mental health care during this perinatal period estimated to cost the NHS and social care £1.2 billion per year.

Meanwhile, 40 per cent of fathers report having concerns about their mental health during the perinatal period. Research is limited, but up to one in ten fathers were believed to be suffering from depression in a 2010 study. Fathers with mental health problems during the perinatal period are up to 47 times more likely to be classed as a suicide risk than at any other time.

The NHS Long Term Plan in 2019 committed to offering fathers mental health assessments, but only when their partners had a history of anxiety, depression or more severe disorders.

WHAT ARE THE SYMPTOMS?

According to the National Childbirth Trust, postnatal depression in fathers can show itself in ways including:

fear, confusion, helplessness and uncertainty about the future
withdrawal from family life, work and social situations
indecisiveness
frustration, irritability, cynicism and anger
marital conflict
partner violence
negative parenting behaviours
alcohol and drug use
insomnia
physical symptoms such as indigestion, changes in appetite and weight, diarrhoea, constipation, headaches, toothaches and nausea.

Sharin Baldwin, clinical research fellow at the University of Warwick and leader of the New Dad Study (NEST), says, ‘A lot of the signs of depression in men would be similar to what you see in women, such as low mood or feeling unmotivated. With men you tend also to see anger, withdrawn behaviour, or getting involved in activities viewed as an escape, such as drinking or working more, almost as coping mechanisms.’

WHAT ARE THE CAUSES?

Ms Baldwin explains that the causes of paternal perinatal depression can overlap significantly with the causes of maternal mental health problems. ‘A lot of cases come from the huge lifestyle change of becoming a parent,’ she says. ‘It is also caused by lack of sleep. One father in my study talked about the “non-stopness” of parenting, especially in the early weeks and months after birth. Of course, it is like that for mothers as well, but fathers feel it too.’

Men whose partners experience difficulties within the perinatal period are up to 50 times more likely to develop postnatal depression.

Ms Baldwin adds, ‘Some men worry a lot about their partner, but they don’t want to burden them so won’t talk about any difficulties they may be experiencing. For some men it is financial worry as well, concern about providing for their family or worries about being a good father.’

Mark Williams, founder of Fathers Reaching Out, a campaign group for fathers’ mental health, adds that childbirth can act as a trigger for paternal depression.

‘A big factor is birth trauma, with fathers experiencing symptoms of PTSD from witnessing childbirth,’ he explains. ‘Thinking your partner or child is going to die in front of you and not knowing what is going on can be the worst experience in the world and can certainly overlap into the postnatal period.’

While many causes are likely to be environmental, the 2007 ‘Sad Dads’ research paper in journal Psychiatry suggested that changes in hormones may also affect fathers’ mental health after birth, with shifts in levels of testosterone, oestrogen, cortisol, vasopressin and prolactin during the postpartum period found to be potential risk factors.

During the pandemic, prospective fathers in many areas have missed out on attending scans and routine appointments as a result of Covid-19 measures, while many classes, group sessions and support from Children’s Centres have reduced or ceased.

Mr Williams believes this has led to fathers-to-be feeling powerless and excluded.

‘I think we are seeing a big rise in paternal antenatal mental health problems since Covid, with dads left on their own, outside the room or in car parks during appointments,’ he explains.

WHAT ARE THE EFFECTS?

Paternal mental health struggles can put strain on all familial relationships, partners and children. Ms Baldwin says, ‘If either parent is depressed, we know that can have a huge effect on a child’s behavioural and cognitive development and school readiness. And if you have a family where both parents are depressed, the impact on the child will be even greater.’

Furthermore, she points out, happy, healthy fathers have a unique contribution to make to their child’s progress. ‘Fathers and mothers often play with children quite differently, and children get different things from each, both of which are equally important,’ she says. ‘When fathers know about the important role they play in child development, they are more likely to engage in those activities.’

Mr Williams agrees that if a dad is suffering from anxiety or depression, he is less likely to play or sing. ‘At the moment especially, dads are at home more, and if they are depressed, that can have a huge impact on a child growing up,’ he adds.

In wider terms, a 2014 report found that maternal perinatal depression, anxiety and psychosis carry a total long-term cost to society of about £8.1 billion for each one-year cohort of UK births. Almost three-quarters (72 per cent) of these costs relate to adverse impacts on the child. There are no such figures for paternal mental health.

Ms Baldwin explains, ‘From a cost point of view, this all has a huge effect on society. If a father is depressed, and that affects the partner and the child, all the services that then need to get involved in supporting the family can end up costing enormous amounts.’

WHAT CAN BE DONE?

Mr Williams has produced a report with 25 recommendations to help improve responses to paternal mental health problems (see Further information). They include:

The introduction of mental health screening of all partners during the perinatal period.
More support for paternal mental health during the perinatal period to ensure fathers are able to provide support for the mother’s mental health, as well as protecting against any negative impact on the child.
Increased availability of father-focused resources to help prepare men for parenthood.
More dads-only support groups, enabling dads-to-be and new dads to share their concerns.

Fathers Reaching Out is also calling for the World Health Organization and NICE clinical guidelines to recognise paternal perinatal depression, and for an All-Party Parliamentary Group on paternal deaths.

Advice for practitioners

Sharin Baldwin, clinical research fellow at the University of Warwick, suggests a variety of approaches to support new fathers:

Think about fathers in preparation for any sessions run for families. Include pictures of fathers on posters.
Actively welcome fathers, especially when they are the only male.
Provide tips for fathers on how they can be involved in their child’s life, particularly in the early weeks. Suggest songs and lullabies they could sing.
Ask how fathers are and invite them to share their feelings.
Involve fathers in all discussions, from breastfeeding to accident prevention. If they know how they can provide or access support, they can in turn help to support their partner and child.

FURTHER INFORMATION