Eleven participants received a medical diagnosis for their mental health condition, while the remaining eighteen self-diagnosed. Participants’ mental health problems included depression, anxiety, post-traumatic stress disorder, obsessive compulsive disorder, bipolar and borderline personality disorder. Five participants reported experiencing mental health problems prior to their partners pregnancy, eight participants during the pregnancy and sixteen participants for the first time during the postnatal period. There were also differences regarding duration of symptoms experienced and personal recovery from these symptoms. Some participants’ symptoms declined immediately after the birth of their child whilst for others symptoms continued for up to a year or more.
Participants demonstrated varying levels of insight into their own mental health. They reported that their mental health was negatively influenced by changes in their relationship with partners, adjustments in lifestyle choices and the home environment or routine and coping with pregnancy symptoms and complications and the arrival of a new baby. Those who had experienced poor mental health prior to their partner’s pregnancy reported greater awareness of mental health symptoms, whereas participants with no prior experience of mental health problems required information regarding the signs of mental health problems.
Thematic analysis identified three key themes: “Factors Influencing Fathers’ Mental Health” (Sub-themes: “Unmet Expectations”, “Lack of Support”, “Significance of Mothers During the Perinatal Period” “Stability of Relationship with Partner”); “Consequences of Poor Mental Health in Fathers’” (Sub-themes: “Changes in Behaviour and Personality”, “Ambivalent Emotions and Feelings”); and, “Solutions to Improve Fathers’ Mental Health (Sub-themes: “External Factors”, “Personal Factors”).
Factors Influencing Fathers’ Mental Health
Unmet Expectations. The realities of pregnancy and the postpartum period differed significantly from participants’ expectations. One participant described fatherhood as: “not just changing nappies and night feeds” (P2). The gap between expectation and reality caused him to believe he was failing as a father and a husband: “I went from being able to try and be super-dad for my first son, to not feeling like I could do anything for either of the boys” (P2). Another expected fatherhood to be a positive time but found that coping with a new baby left him wondering “whether we would ever have a happy time” (P5). Participants said they would advise future fathers on the realistic expectations of becoming a father and encourage men to research what parenthood entails as: “it’s harder than you could possibly imagine” (P8).
Lack of Support for Fathers’ Mental Health. Fifteen participants claimed they were not offered any support from health care professionals “explicitly for mental health” (P4) during the perinatal period. They expressed the view that healthcare professionals were unconcerned about fathers’ mental health, and support is only offered once “you try to harm yourself or you have a breakdown” (P1). For example, one participant who witnessed his partner’s complicated birth of their premature son: “wasn’t offered any help or support” (P9) to cope with the traumatic event. Lack of support left participants feeling uncertain and lacking confidence in their role as a father: “(I) didn’t know how things would turn out” (P6).
Difficulties being Male in a Female Environment. Many participants experienced difficulties being male in a female focused environment which affected their sense of masculinity, leading them to question their role as a man. One participant claimed he “felt like a failure, no true man” (P11). One father asked “what sort of man gets depressed after they’ve had a baby?” and described feeling “lots of shame” as a result of his mental health problems (P3). Nine participants described the lack of support they received in comparison to support their partners received: “my wife had plenty [of support]” (P8), “[their] focus is on mothers” (P6). One participant reported being envious of the support his partner received:
“Everyone seemed to be there for her … the midwives in the hospital
barely speak to the father. One [midwife] offered me a coffee,
but that was literally it. Fathers are pretty much ignored throughout the process” (P8).
One participant reported receiving information on how to support his partner, but no information about how to seek support for himself: “looking back the institutions, family and myself, focussed on how I would support my wife and the emphasis was on me staying strong” (P5). During their engagement with these services (i.e. antenatal classes, birth of the baby), participants were unclear regarding their role, and felt there was an expectation from healthcare professionals that they should support their partner.
Stability of Relationship with Partner. Nineteen participants said their mental health problems negatively affected their relationship with their partner during the perinatal period. The relationship difficulties developed from the rapid changes parents experienced preparing for and/or welcoming a new baby into their lives including difficulties associated with adapting to a new routine: “The relationship was much more strained after the birth due to the pressures relating to lack of sleep and exhaustion (P16). Participants reported breakdown in communication, increased arguments and spending less time with their partners. One participant reported being signed off work due to his mental health problems which caused problems with establishing a new routine with the baby and impacted his mental health further: “my wife couldn’t establish a routine [with the new baby] which compounded my depression as I felt like I wasn’t just failing with fatherhood, but husbandhood” (P5). Only four participants, who developed support systems with their partners, described their mental health problems as having a positive impact on their relationship: “very supportive … she encouraged me to open up” (P11). All participants agreed the importance of trying to maintain a stable relationship with their partner during the perinatal period for the benefit of their partner and the baby’s wellbeing: ““Rest and spend as much quality time as you can with your partner before the birth. Do all you can to reduce work commitments” (P4).
Consequences Of Poor Mental Health In Fathers
Changes in Behaviour and Personality. Changes in their behaviour and personality created challenges for participants throughout the perinatal period. They reported a lack of control over situations, experiencing feelings of failure, lack of confidence and low self-esteem: I struggled with anxiety and intrusive thoughts. After the birth this got significantly worse to point I couldn't leave my bedroom. It severely impacted the relationship with my partner and missed out on opportunity to bond with baby. (P27). A significant challenge for participants was their perceived ability to be a parent, with many focusing on their limitations rather than their successes: “it [mental health problems] reduced my ability to deal with situations that would have otherwise been manageable.” (P1). The perceived inability to be a “good” parent caused a fragmentation in the relationship and their ability to bond with their child: “It affected my bond with my daughter, which sadly I still feel now. I don’t feel the same feelings towards her as I do to my first child, which makes me sad” (P3). Participants felt their behaviour and personality changes contributed to relationship problems due to expressing new and heightened emotions which were absent prior to pregnancy:
“[Changes in behaviour] … lead to a number of arguments, a feeling of resentment on my part as there seemed to be nothing but worry and anxst [angst] at what I was hoping was going to be a joyous time” (P5).
This consequently impacted their mental health problems further: “I cried for the first time ever. Just burst into tears feeling I wasn’t good enough” (P10).
Ambivalent Emotions and Feelings. An overwhelming feeling of uncertainty was common during the perinatal period. Nineteen participants recalled specific feelings of doubt and stress which triggered or enhanced depressive episodes:
“I struggled with anxiety from intrusive thoughts prior to birth. After birth this got significantly worse to point I couldn't leave my bedroom. Severely impacted relationship with my partner and missed out on opportunity to bond with baby” (P13).
These episodes resulted in three participants experiencing suicidal thoughts: “It was a crisis point where OCD was making me suicidal” (P6).
Solutions To Improve Fathers' Mental Health
External Factors. Participants suggested a variety of potentially helpful support mechanisms for understanding and dealing with their mental health problems. These ranged from health care professionals “asking how dad is” (P7) and “acknowledging that he [dad] was there” (P4), through to “practical, behavioural, situational post-natal classes and workshops” (P2) and “practical help with keeping the home running” (P10). Several participants suggested longer paternity leave could provide men additional time to adjust to the arrival of their baby, and potentially mitigate some factors contributing to their mental health problems.
Personal Factors. One participant advised future fathers to: “avoid macho dads, find other men who are able to express some feeling and that can relate to the load, [the] stress and [the] difficulties that lie ahead” (P1). Participants suggested future fathers should be realistic about coping with the transition into parenthood and the support they can provide their partner and child: “don’t set your parenting bar too high [because] this may negatively affect mental health” (P2). They felt new fathers should be made aware of the potential to experience these types of feelings and that it is acceptable for men to express their emotions and to seek support: “don’t be afraid to ask for help and accept your limitations” (P10).