Main Article Content
The perinatal period, which covers the time when a man’s partner becomes pregnant through to the first year after birth can be a time of great excitement, happiness, and joy. However, it can also be a time of great disruption and change. Despite the positive and protective long-term effect that fatherhood has on men’s health, a significant proportion of fathers’ experience depressive symptoms during the perinatal period. This paper aims to review studies that assessed symptoms of depression in fathers during the perinatal period and to describe the prevalence estimates, identify the risk factors and impact of depression, and establish if there are interventions that effectively reduce depression among fathers. A systematic search of relevant electronic databases including Medline, CINAHL, Cochrane Library, PsycARTICLES, PsycINFO, and Psychology and Behavioural Sciences Collection were searched using keywords related to paternal perinatal depression. Prevalence estimates of paternal perinatal depression varied widely between studies, ranging from 1 to 46%. Several sociodemographic variables that contribute to depression in fathers in the perinatal period were reported and these include paternal age, lower education levels, parity, an unplanned pregnancy, and maternal depression. Paternal perinatal depression is associated with morbidity within the father’s family, including depression in his partner, maladjustment to parenthood and future psychological problems in his children. In conclusion, evidence from this review adds further support for the need to review how we plan, provide and resource our health services, to recognize the influence that pregnancy, birth, and fatherhood in the perinatal period can have on men’s mental health.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright of articles published in all DPG titles is retained by the author(s). The author(s) grants DPG the rights to publish the article and identify itself as the original publisher. The author grants DPG exclusive commercial rights to the article. The author grants any party the rights to use the article freely for non-commercial purposes provided that the original work is properly cited.
2. Richardson N, Building momentum, gaining traction: Ireland’s national men’s health policy – 5 years on. New Male Studies 2013;2:93–103.
3. Department of Health. Health in Ireland Key Trends 2018. Available at: https://health.gov.ie/wp-content/uploads/2018/12/Key-Health-Trends-2018.pdf.
4. Garfield CF, Isacco A, Bartlo WD, et al. Men’s health and fatherhood in the urban Midwestern United States. Int J Men’s Health 2010;9:161–74.
5. Mokdad AH, Marks JS, Stroup DF, et al. Actual causes of death in the United States. J Am Med Assoc 2004;291:1238–45.
6. Pattyn E, Verhaeghe M, Bracke P, The gender gap in mental health service use. Soc Psychiatry Psychiatr Epidemiol 2015;50:1089–95.
7. Parent MC, Gobble TD, Rochlen A, Social media behavior, toxic masculinity, and depression. Psychol Men Masculin 2019;20:277–87.
8. Darwin Z, Galdas P, Hinchli? S, et al. Fathers' views and experiences of their own mental health during pregnancy and the ?rst postnatal year: a qualitative interview study of men participating in the UK born and bred in Yorkshire (BaBY) cohort. Available at: https://bmcpregnancychildbirth.biomedcentral.com/track/pdf/10.1186/s12884-017-1229-4.
9. Philpott LF, Leahy-Warren P, FitzGerald S, et al. Stress in fathers in the perinatal period: A systematic review. Midwifery 2017;55:113–27.
10. Giallo R, D'Esposito F, Cooklin A, et al. Psychosocial risk factors associated with fathers’ mental health in the postnatal period: results from a population-based study. Soc Psych and Psych Epi 2013;48:563–73.
11. Shorey S, Dennis CL, Bridge S, et al. First-time fathers’ postnatal experiences and support needs: a descriptive qualitative study. J Adv Nurs 2017;73:2987–996. doi: 10.1111/jan.13349.
12. Schulz A, Fatherhood and Psychological Distress: Paternal Depression, Anxiety, and Stress in the Perinatal Period. 2016. Available at: https://dro.deakin.edu.au/eserv/DU:30084235/schulz-fatherhoodand-2016A.pdf.
13. Haller H, Cramer H, Lauche R, et al. The prevalence and burden of subthreshold generalized anxiety disorder: A systematic review. BMC Psych 2014;14:128–40.
14. Koh YW, Lee AM, Chan CY, et al. Survey on examining prevalence of paternal anxiety and its risk factors in perinatal period in Hong Kong: A longitudinal study. BMC Pub Health 2015;15(1):1131. Doi: 10.1186/s12889-015-2436-4.
15. Green BN, Johnson CD, Adams A, Writing narrative literature reviews for peer-reviewed journals: secrets of the trade. J Chiropractic Med 2006;5(3):101–17.
16. Paulson JF, Bazemore SD, Prenatal and postpartum depression in fathers and its association with maternal depression: A meta-analysis. JAMA 2010;303:1961–69. doi:10.1001/jama.2010.605.
17. Cameron EE, Sedov ID, Tomfohr-Madsen LM, Prevalence of paternal depression in pregnancy and the postpartum: an updated meta-analysis. J Affect Dis 2016;206:189–203. doi: 10.1016/j.jad.2016.07.044.
18. Philpott LF, Paternal postnatal depression: an overview for primary healthcare professionals. Prim Health Care 2016;26:23–27. doi: 10.7748/phc.2016.e1120.
19. Leach LS, Poyser C, Cooklin AR, et al. Prevalence and course of anxiety disorders (and symptom levels) in men across the perinatal period: a systematic review. J Affect Dis 2016;190:675–86.
20. Health Service Executive. Specialist Perinatal Mental Health Model of Care. 2018. Available at: https://www.hse.ie/eng/services/list/4/mental-health-services/specialist-perinatal-mental-health/specialist-perinatal-mental-health-services-model-of-care-2017.pdf.
21. American Psychiatric Association. The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. Washington: American Psychiatric Association; 2013.
22. Martin LA, Neighbors HW, Griffith DM, The experience of symptoms of depression in men vs women: Analysis of the national comorbidity survey replication. JAMA Psych 2013;70:1100–106.
23. World Health Organisation. Depression and Other Common Mental Disorders: Global Health Estimates. 2017. Available at: https://apps.who.int/iris/bitstream/handle/10665/254610/WHO-MSD-MER-2017.2-eng.pdf;sequence=1.
24. Dudley M, Roy K, Kelk N, et al. Psychological correlates of depression in fathers and mothers in the first postnatal year. J Reprod Infant Psychol 2001;19:187–202.
25. Philpott LF, Corcoran P. Paternal postnatal depression in Ireland: Prevalence and associated factors. Mid 2018;56:121–27. http://dx.doi.org/10.1016/j.midw.2017.10.009
26. Goodman JH, Paternal postpartum depression, its relationship to maternal postpartum depression, and implications for family health. J Adv Nurs 2004;45:26–35. doi: 10.1046/j.1365-2648.2003.02857.x
27. Higgins JPT, Thomas J, Chandler J, et al. (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.0 (updated July 2019). Cochrane, 2019. Available from: www.training.cochrane.org/handbook.
28. National Institute of Mental Health. Major depression among adults. 2015. Available at: https://www.nimh.nih.gov/health/statistics/major-depression.shtml.
29. Veskrna L, Peripartum depression—Does it occur in fathers and does it matter? J Men’s Health 2010;7:420–30. https://doi.org/10.1016/j.jomh.2010.10.004.
30. Cox JL, Holden JM, Sagovsky R, Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression Scale. The Brit J Psych 1987;150:782–86. doi:10.1192/bjp.150.6.782.
31. Beck AT, Ward CH, Mendelson M, et al. An inventory for measuring depression. Arch Gen Psych 1961;4:561–71.
32. Goldberg DP, Blackwell B, Psychiatric illness in general practice: A detailed study using a new method of case identification. BMJ 1970;1:439–43.
33. Radloff LS, The CES-D scale: A self report depression scale for research in the general population. App Psych Meas 1977;1:385–401.
34. Zigmond AS, Snaith RP, The Hospital Anxiety and Depression Scale. Acta Psych Scand Acta 1983;67:361–70.
35. Zierau F, Bille A, Rutz W, et al. The Gotland Male Depression Scale: A validity study in patients with alcohol use disorder. Nordic J Psychiatr 2002;56:265–71. doi:10.1080/08039480260242750.
36. Lovibond SH, Lovibond PF, Manual for the Depression Anxiety & Stress Scales, 2nd edition. Sydney: Psychology Foundation; 1995.
37. Matthey S, Agostini F, Using the Edinburgh Postnatal Depression Scale for women and men-some cautionary thoughts. Arch Wom Men Health 2017;20:345–54. https://doi.org/10.1007/s00737-016-0710-9.
38. Call JB, Shafer K, Gendered manifestations of depression and help seeking among men. Am J Men’s Health 2015;12:41–55. doi:10.1177/1557988315623993.
39. Azorin JM, Belzeaux R, Fakra E, et al. Gender differences in a cohort of major depressive patients: further evidence for the male depression syndrome hypothesis. J Aff Dis 2014;167:85–92. http://dx.doi.org/10.1016/j.jad.2014.05.058
40. Psouni E, Agebjorn J, Linder H, Symptoms of depression in Swedish fathers in the postnatal period and development of a screening tool. Scand J Psych 2017;58:485–96.
41. O’Brien AP, McNeil KA, Fletcher R, et al. New fathers’ perinatal depression and anxiety—treatment options: an integrative review. Am J Men's Health 2016;11:863–76. https://doi.org/10.1177/1557988316669047.
42. Massoudi P, Depression and distress in Swedish fathers in the postnatal period.2013. Available at: https://gupea.ub.gu.se/bitstream/2077/32509/1/gupea_2077_32509_1.pdf.
43. Thorpe K, Dragonas T, Golding J, The effects of psychosocial factors on the mother's emotional well-being during early parenthood: a cross-cultural study of Britain and Greece. J Rep Inf Psych 1991;10:205–17.
44. Matthey S, Barnett B, Kavanagh DJ, et al. Validation of the Edinburgh Postnatal Depression Scale for men, and comparison of item endorsement with their partners. J Affect Dis 2001;64:175–84. doi: 10.1016/s0165- 0327(00)00236-6.
45. Loscalzo Y, Giannini M, Contena B, et al. The Edinburgh Postnatal Depression Scale for fathers: A contribution to the validation for an Italian sample. Gen Hosp Psychiatr 2015;37:251–56. doi: 10.1016/j.genhosppsych.2015.02.002.
46. Edmondson OJ, Psychogiou L, Vlachos H, et al. Depression in fathers in the postnatal period: assessment of the Edinburgh Postnatal Depression Scale as a screening measure. J Affect Dis 2010;125:365–68. doi: 10.1016/j.jad.2010.01.069.
47. Lai BPY, Tang AKL, Lee DTS, et al. Detecting postnatal depression in Chinese men: A comparison of three instruments. Psych Res 2010;180:80–85. doi: 10.1016/j.psychres.2009.07.015.
48. Habib C, Paternal perinatal depression: An overview and suggestions towards an intervention model. J Fam Stud 2012;18:4–16. doi:10.5172/jfs.2012.18.1.4.
49. Bielawska-Batorowicz E, Kossakowska-Petrycka K, Depressive mood in men after the birth of their offspring in relation to a partner’s depression, social support, fathers’ personality and prenatal expectations. J Rep Inf Psych 2006;24:21–29. doi: 10.1080/02646830500475179.
50. Glasser S, Lerner-Geva L, Focus on fathers: paternal depression in the perinatal period Perspectives in Public Health. 2018. Available at: https://doi.org/10.1177/1757913918790597.
51. Wee KY, Skouteris H, Pier C, et al. Correlates of ante- and postnatal depression in fathers: A systematic review. J Affect Dis 2011;130:358–77. doi: 10.1016/j.jad.2010.06.019.
52. Gao L, Chan SW, Mao Q, Depression, perceived stress, and social support among first-time Chinese mothers and fathers in the postpartum period. Res Nurs Health 2009;32:50–58.
53. De Magistris A, Carta M, Fanos V, Postpartum depression and the male partner. J Ped Neo Indiv Med 2013;2:15–27.
54. Zhang YP, Zhang LL, Wei HH, et al. Postpartum depression and the psychosocial predictors in first-time fathers from north western China. Mid 2016;35:47–52.
55. Matthey S, Barnett B, Howie P, et al. Diagnosing postpartum depression in mothers and fathers: whatever happened to anxiety? J Affect Dis 2003;74:139–47.
56. Kiecolt-Glaser J, Wilson S, Lovesick: how couples’ relationships influence health. Ann Rev Clin Psychol 2017;13:1–23.
57. Schumacher M, Zubaran C, White G, Bringing birth-related paternal depression to the fore. Wom Bir: J Aus Coll Mid 2008;21:65–70. doi: 10.1016/j.wombi.2008.03.008.
58. Reid H, Wieck A, Matrunola A, The experiences of fathers when their partners are admitted with their infants to a psychiatric mother and baby unit. Clin Psych Psych 2017;24:919–31. doi: 10.1002/cpp.2056.
59. Olatunde A, and Lasebikan VO, Factors associated with paternal perinatal depression in fathers of newborns in Nigeria. J Psych Obs Gyn 2017; doi: 10.1080/0167482X.2017.1398726.
60. Kim P, Swain JE, Sad dads: paternal postpartum depression. Psychiatry 2007;4:35–47.
61. Alibekova R, Huang JP, Lee TS, Effects of smoking on perinatal depression and anxiety in mothers and fathers: a prospective cohort study. J Affect Dis 2016;193:18–26.
62. Genesoni L, Tallandini MA, 2009. Men's psychological transition to fatherhood: an analysis of the literature, 1989–2008. Birth 2009;36:305–17.
63. Anderson EA, Kohler JK, Letiecq BL, Predictors of depression among low-Income non-residential fathers. J Fam Iss 2005;26:547–67.
64. McMunn A, Nazroo J, Breeze E, Inequalities in health at older ages: a longitudinal investigation of the onset of illness and survival effects in England. Age Ageing 2009;38:181–187. doi: 10.1093/ageing/afn236.
65. Szabo A, Allen J, Alpass F, et al. Longitudinal trajectories of quality of life and depression by housing tenure status in the New Zealand Health, Work and Retirement study. The J Ger Ser B: Psych Sci Soc Sci 2017;72(6):1–10. doi:10.1093/geronb/gbx028.
66. Barnes M, People Living in Bad Housing – Numbers and Health Impacts. 2013. Available at: http://england.shelter.org.uk/data/assets/pdffile/0010/726166/PeoplelivinginbadhousingPdf.
67. Barnes M, Lyon N, Conolly A, The Living Standards of Children in Bad Housing: evidence from the Families and Children Study. 2006. Available at: http://www.natcen.ac.uk/media/492166/living%20standards%20kids%20in%20bad%20housing%20report.pdf.
68. Quevedo L, da Silva RA, Coelho F, et al. Risk of suicide and mixed episode in men in the postpartum period. J Aff Dis 2011;132(1–2):243–46. doi: 10.1016/j.jad.2011.01.004.
69. Wee KY, Skouteris H, Richardso B, et al. The inter-relationship between depressive, anxiety and stress symptoms in fathers during the antenatal period. J Rep Inf Psych 2015;33:359–73. doi: 10.1080/02646838.2015.104819.
70. Pinto TM, Figueiredo B, Pinheiro LL, et al. Fathers’ parenting self-efficacy during the transition to parenthood. J Rep Inf Psych 2016;34(4):343–55. http://dx.doi.org/10.1080/02646838.2016.1178853.
71. Albert, PR, Vahid-Ansari F, Luckhart C, Serotonin-prefrontal cortical circuitry in anxiety and depression phenotypes: pivotal role of pre- and post-synaptic 5-HT1A receptor expression. Front Behav Neuro 2013;8(199):1–13. doi: 10.3389/fnbeh.2014.00199.
72. Zorn JV, Schur RR, Boks, et al. Cortisol stress reactivity across psychiatric disorders: a systematic review and meta-analysis. Psychoneuroendocrinology 77:25–36. https://doi.org/10.1016/j.psyneuen.2016.11. 036.
73. Loutzenhiser L, McAuslan P, Sharpe DP. The trajectory of maternal and paternal fatigue and factors associated with fatigue across the transition to parenthood. Chil Psych 2015;19:15–27. doi: 10.1111/cp.12048.
74. Cooklin AR, Giallo R, Rose N, Parental fatigue and parenting practices during early childhood: an Australian community survey. Child Care Health Dev 2011;38(5):654–64. doi:10.1111/j.1365-2214.2011.01333.x.
75. Targum SD, Fava M, Fatigue as a residual symptom of depression. Innov Clin Neurosci 2011;8(10):40–3.
76. Oladosu T, Paternal Postnatal Depression. 2012. Available at: http://www.google.ie/url?sa=t&rct=j&q=&esrc=s&frm=1&source=web&cd=1&ved=0CB4QFjAA&url=http%3A%2F%2Fwww.rcpsych.ac.uk%2Fdocs%2FPaternal%2520postnatal%2520depression.doc&ei=muLrU7fDL_Db7Aa454HIDg&usg=AFQjCNHUnKl5MTDRoYbD9d5lnAUh7Ti1uA&sig2=6EY-04pXO1Y-gkv4UmG6eA.
77. McCoy SJB, Postpartum depression in men. 2012. Available at: http://cdn.intechopen.com/pdfs/26577/InTech-Postpartum_depression_in_men.pdf.
78. Wilson S, Durbin CE, Effects of paternal depression on fathers’ parenting behaviours: a meta-analytic review. Clin Psych Rev 2010;30(2):167–80. doi: 10.1016/j.cpr.2009.10.007.
79. Ramchandani P, Stein A, O'Connor TG, Heron, et al. Depression in men in the postnatal period and later child psychopathology: A population cohort study. J Am Acad Child Adolesc Psychiatr 2008;47(4):390–98. doi: 10.1097/CHI.0b013e31816429c2.
80. Davis RN, Davis MM, Freed GL, et al. Fathers' depression related to positive and negative parenting behaviours with 1-year-old children. Ped 2011;127(4):612–18. doi: 10.1542/peds.2010-1779.
81. Paulson J, Keefe H, Leiferman J, Early parental depression and child language development. J Child Psychol Psychiatr 2009;50(3):254–62. doi: 10.1111/j.1469-7610.2008.01973.x.
82. van den Berg M, van der Ende J, Crijnen A, et al. Paternal depressive symptoms during pregnancy are related to excessive infant crying. Ped 2009;124(1):96–103. doi: 10.1542/peds.2008-3100.
83. Edoka IP, Petrou S, Ramchandani PG, Healthcare costs of paternal depression in the postnatal period. J Affect Dis 2011;133:356–60. doi: 10.1016/j.jad.2011.04.005.
84. Beyondblue.org.au. Valuing perinatal health: The consequences of not treating perinatal depression and anxiety. 2019. Available from: https://www.beyondblue.org.au/docs/default-source/8.-perinatal-documents/bw0079-report-valuing-perintal-health.pdf?sfvrsn=2.
85. Rominov H, Pilkington PD, Giallo R, et al. A systematic review of interventions targeting paternal mental health in the perinatal period. Infant Ment Health J 2016;37(3):289–301. doi: 10.1002/imhj.21560.
86. Musser AK, Ahmed AH, Foli KJ, et al. Paternal postpartum depression: what health care providers should know. J Pediatr Health Care 2013;27(6):479–85. doi: 10.1016/j.pedhc.2012.10.001.
87. Hung CH, Chung HH, Chang YY, The effect of childbirth class on first-time fathers’ psychological responses. Kaohsiung J Med Sci 1996;12(4):248–55.
88. Matthey S, Kavanagh DJ, Howie P, et al. Prevention of postnatal distress or depression: An evaluation of an intervention at preparation for parenthood classes. J Affect Dis 2004;79(1–3):113–26. doi: 10.1016/s0165 0327(02)00362-2.
89. Feinberg ME, Kan ML, Establishing family foundations: Intervention effects on coparenting, parent/infant well-being, and parent-child relations. J Fam Psychol 2008;22(2):253–63. doi: 10.1037/0893-3126.96.36.199.
90. Field T, Figueiredo B, Hernandez-Reif M, et al. Massage therapy reduces pain in pregnant women, alleviates ante depression in both parents and improves their relationships. J Bodyw Mov Ther 2008;12(2):146–50. doi: 10.1016/j.jbmt.2007.06.003.
91. Tohotoa J, Maycock B, Hauck YL, et al. Can father inclusive practice reduce paternal postnatal anxiety? A repeated measures cohort study using the hospital anxiety and depression scale. BMC Pregnancy Childbirth 2012;12(75). doi: 10.1186/1471-2393-12-75.
92. Edward KL, Castle D, Mills C, Davis, et al. An integrative review of paternal depression. Am J Mens Health 2015;9:26–34.
93. Wittchen HU, Jacob F, Rehm J, et al. The size and burden of mental disorders and other disorders of the brain in Europe 2010. Eur Neuropsychopharmacol 2011;21:655–79.
94. Philpott LF, Savage E, FitzGerald S, et al. Anxiety in fathers in the perinatal period: A systematic review. 2019. Midwifery. doi: https://doi.org/10.1016/j.midw.2019.05.013.
95. Cohen S, Janicki-Deverts D, Miller GE, Psychological stress and disease. JAMA 2007;298:1685–87.
96. Cohen S, Janicki-Deverts D. Who's stressed? Distributions of psychological stress in the United States in probability samples from 1983, 2006, and 2009. J Appl Soc Psychol 2012;42:1320–34.
97. Yelland J, Sutherland G, Brown SJ, Postpartum anxiety, depression and social health: findings from a population-based survey of Australian women. BMC Public Health 2010;10:771. doi: 10.1186/1471-2458-10-771.
98. Agius A, Xuereb RB, Carrick-Sen D, The co-existence of depression, anxiety and post-traumatic stress symptoms in the perinatal period: a systematic review. Midwifery 2016;36:70–79.
99. Beaupré P, Dryburgh H, Wendt M, Making fathers “count”. Statistics Canada. 2014. Available at: http://www.statcan.gc.ca/pub/11008-x/2010002/article/11165-eng.htm#bx2n1.
100. Redshaw M, Henderson J, Fathers’ engagement in pregnancy and childbirth: evidence from a national survey. BMC Pregnancy Childbirth 2013;13:1–15. https://doi.org/10.1186/1471-2393-13-70.
101. Yogman M, Garfield CF, and the Committee on Psychosocial Aspects of Child and Family Health, American Academy of Pediatrics. Fathers’ roles in the care and development of their children: the role of paediatricians. Pediatrics 2016;138(1);1–15. doi: 10.1542/peds.2016-1128.
102. Longworth HL, Kingdon CK, Fathers in the birth room: what are they expecting and experiencing? A phenomenological study. Midwifery 2011;27:588–94. doi: 10.1016/j.midw.2010.06.013.
103. Widarsson M, Engstrom G, Tyden T. Paddling upstream’: Fathers’ involvement during pregnancy as described by expectant fathers and mothers. J Clin Nurs 2015;24(7–8):1059–068. doi: 10.1111/jocn.12784.
104. Jacobsen PB, Jim HS, Psychosocial interventions for anxiety and depression in adult cancer patients: achievements and challenges. CA Cancer J Clin 2008;58:214–30.
105. Nash M. “It’s just good to get a bit of man-talk out in the open”: men’s experiences of father-only antenatal preparation classes in Tasmania, Australia. 2017. Available at: http://dx.doi.org/10.1037/men0000102.
106. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009;151:264–69.