Men’s Health Month: Exploring Paternal Mental Health

June is Men’s Health Month, and with more attention being directed towards the unique mental health concerns of men, the paternal experience is a growing area for research on men’s wellbeing. Given the ties between maternal mental health and paternal mental health, this topic is worth discussing within the lens of maternal and child health as a general public health concern. It is important to preface that a focus on the mental health of men and fathers does not detract from a focus on women’s and mothers’ mental health. While the assumption might hold that men’s mental health is relatively unaffected across the perinatal period (the period of pregnancy and one year postpartum), the wellbeing of male and female partners during pregnancy and postpartum is deeply interdependent. When outcomes for one group worsens, the other follows. In fact, some research studies indicate that approximately 5–10% of new fathers experience depression, while 5–15% suffer from anxiety during the perinatal period [1]. The rates increase when female partners experience perinatal mental health conditions as well. Even still, these figures may be underestimated, as men who ascribe to certain masculine norms are less likely to report mental health issues, leading to underdiagnosis and undertreatment [2]. The transition to parenthood is a critical period for mental health, and there is a need for more comprehensive research and tailored interventions that address men’s mental health in this context. 

Paternal mental health issues are prevalent, with depression, anxiety, and stress being the most commonly reported conditions. While prevalence for each condition varies, in the US, between 8% and 13% of fathers will be affected by some form of depression during early child-rearing [3]. In settings where housing instability and segregation, exposure to violence, lack of family and social support, known risk factors for postpartum depression and consequences of concentrated poverty, prevalence rates have been found to be as high as 30% [4]. This can vary up to around 50% in families where the mother is also facing perinatal depression. The interrelation of mental well underscores the importance of viewing mental health from an epidemiological perspective, rather than an individualistic one.

Risks and vulnerability

In order to look out for potential vulnerabilities, there are several factors that contribute to men’s risk of developing mental health issues during the perinatal period. Negative feelings about pregnancy, lower self-efficacy, feelings of incompetence, adverse child experiences, younger age, a history of depression, and alcohol abuse are some of the factors that can heighten someone’s vulnerability to stress, anxiety, and depression during this period [5]. As mentioned before, relational aspects cannot be understated due to how maternal depression and anxiety can influence paternal mental health. Marital distress, low social support, whether from family or friends, and lack of co-parenting support are significant contributors to difficulties during this period. Reflecting the integral tie between paternal and child health, as well as paternal and maternal health, health issues with the infant, difficulties caring for the infant, high-risk delivery, or obstetric complications can be additional sources of stress, often traumatic, for new fathers. This is compounded by socioeconomic pressures, which have already been found to be associated with higher risks of mental health problems. On a narrative basis, some fathers  report how the pressure to fill the role of a “provider” during a partner’s pregnancy compounds this. Interestingly, the same role functions as a motivator for help-seeking and involved fatherhood, suggesting that this stereotype is adaptive in some cases [6]

Implications of paternal mental health issues

Paternal mental health issues clearly impact an entire family unit through multiple routes, one being the link with maternal health. Additionally, it can adversely affect child development. A synthesis of systematic reviews and meta-analyses found that paternal mental illness is associated with detrimental effects on various domains of child development, including mental health, social, emotional, language, cognitive, and adaptive behaviour [7]. These differences persisted in school-aged children, according to a study of the association between paternal depression and kindergartener’s social-emotional skills and academic performance [8]. Beyond parenting factors and child health, the potential for hostility and conflict in the home is another long-term implication of untreated paternal depression [1]. This evidence points to a need for stronger support for fathers with depression and their families.

Though studies of psychosocial interventions to target paternal mental health in this critical period are scarce and often limited methodologically, one systematic review of 11 studies finds that father-focused psychosocial interventions are generally more effective than couple-focused ones [9]. This might speak to the need for tailored methods that uniquely reflect the challenges of fatherhood and creating spaces where men feel safe to reflect and share their experiences without judgement or expectation. In particular, it is important for programs to address the evolving needs of fathers, considering factors like age, relationship status, and socioeconomic background.

It is worth noting that, like the psychological challenges facing mothers, paternal mental health issues are preventable drivers of morbidity and mortality. Therefore, implementing routine screening for paternal mental health during the perinatal period can lead to early identification and intervention [10]. While this sort of preventive effort has been difficult to expand in clinical settings, even for mothers, due to the time pressure and appointment structures in the postpartum period, routine screenings for parents in pediatric settings offer a potential route forward. Integrating men’s mental health into structural policies around parental leave and reproductive health systems can not only protect fathers, but entire families’ wellbeing [11]. Continued research and the implementation of targeted interventions are essential, especially longitudinal studies of family health outcomes, given that this is an understudied area. Ultimately, paternal mental health is a critical component of perinatal care that requires greater recognition and intervention.