Postpartum emotional support: a qualitative study of women's and men's anticipated needs and preferred sources

Promoting men-inclusive maternity services: exploring the expectations, experiences and needs of men as fathers

AIM

This study aimed to explore the 'real time' expectations, experiences and needs of men who attend maternity services to inform the development of strategies to enhance men's inclusion.

METHODS

A qualitative descriptive design was adopted for the study. Semi-structured face-to-face or telephone interviews were conducted with 48 men attending the Royal Brisbane and Women's Hospital before and after their partner gave birth. Data were coded and analysed thematically.

RESULTS

Most respondents identified their role as a support person rather than a direct beneficiary of maternity services. They expressed the view that if their partner and baby's needs were met, their needs were met. Factors that contributed to a positive experience included the responsiveness of staff and meeting information needs. Factors promoting feelings of inclusion were being directly addressed by staff, having the opportunity to ask questions, and performing practical tasks associated with the birth.

CONCLUSION

Adopting an inclusive communication style promotes men's feelings of inclusion in maternity services. However, the participants' tendency to conflate their needs with those of their partner suggests the ongoing salience of traditional gender role beliefs, which view childbirth primarily as the domain of women.

Barriers and opportunities for health service access among fathers: A review of empirical evidence

ISSUE ADDRESSED

Engagement with health supports benefits the whole family, yet few health services report successful engagement of fathers. Our aim was to describe available evidence on barriers and opportunities relevant to health system access for fathers.

METHODS

Scoping reviews were conducted seeking empirical evidence from (1) Australian studies and (2) international literature reviews.

RESULTS

A total of 52 Australian studies and 44 international reviews were included. The most commonly reported barriers were at the health service level, related to an exclusionary health service focus on mothers. These included both 'surface' factors (e.g., appointment times limited to traditional employment hours) and 'deep' factors, in which health service policies perpetuate traditional gender norms of mothers as 'caregivers' and fathers as 'supporters' or 'providers'. Such barriers were reported consistently, including but not limited to fathers from First Nations or culturally diverse backgrounds, those at risk of poor mental health, experiencing perinatal loss or other adverse pregnancy and birth events, and caring for children with illness, neurodevelopmental or behavioural problems. Opportunities for father engagement include offering father-specific resources and support, facilitating health professionals' confidence and training in working with fathers, and 'gateway consultations', including engaging fathers via appointments for mothers or infants. Ideally, top-down policies should support fathers as infant caregivers in a family-based approach.

CONCLUSIONS

Although barriers and opportunities exist at individual and cultural levels, health services hold the key to improved engagement of fathers. SO WHAT?: Evidence-based, innovative strategies, informed by fathers' needs and healthy masculinities, are needed to engage fathers in health services.

Health literacy among fathers and fathers-to-be: a multi-country, cross-sectional survey

During pregnancy and early fatherhood, men are at higher risk of poor health, exacerbated by low engagement by healthcare services. Yet the transition to fatherhood presents an opportunity for men to improve their health and health behaviours. Health literacy refers to individuals' competence in accessing and applying health information. Poor health literacy is associated with poor health and low help-seeking. The aim of this study was to identify health literacy strengths, needs and profiles among fathers. Men who were expecting a baby ('antenatal') or had become fathers in the past 18 months ('postnatal') were recruited through an international, online paid survey platform. The survey included the nine-scale Health Literacy Questionnaire (HLQ). Of 889 survey respondents (n = 416, 46.5% antenatal; n = 473, 53.5% postnatal), 274 (31.0%) were residing in the USA and 239 (27.0%) in the UK. Relatively higher scores were reported for HLQ scales relating to having sufficient information and finding and understanding this information, as well as social support for health. Relatively lower scores were obtained for scales relating to actively managing one's own health and navigating the health care system. Three scale scores were significantly lower among nulliparous than multiparous men. Seven health literacy profiles were identified. In conclusion, while fathers have some health literacy strengths, they also experience some barriers, particularly first-time fathers. Awareness of diverse health literacy profiles among fathers may assist in developing strategies to strengthen health services' capacity to meet fathers' needs and reduce risks to their health at this critical juncture in families' lives.

Effect of family-centered interventions for perinatal depression: an overview of systematic reviews

Objective

This study aimed to evaluate and conclude the quality of critically systematic reviews (SRs) of the efficacy of family-centered interventions on perinatal depression.

Methods

SRs of the efficacy of family-centered interventions on perinatal depression were systematically searched in nine databases. The retrieval period was from the inception of the database to December 31, 2022. In addition, two reviewers conducted an independent evaluation of the quality of reporting, bias risk, methodologies, and evidence using ROBIS (an instrument for evaluating the bias risk of SRs), Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), AMSTAR 2 (an assessment tool for SRs), and grading of recommendations, assessment, development and evaluations (GRADE).

Results

A total of eight papers satisfied the inclusion criteria. In particular, AMSTAR 2 rated five SRs as extremely low quality and three SRs as low quality. ROBIS graded four out of eight SRs as "low risk." Regarding PRISMA, four of the eight SRs were rated over 50%. Based on the GRADE tool, two out of six SRs rated maternal depressive symptoms as "moderate;" one out of five SRs rated paternal depressive symptoms as "moderate;" one out of six SRs estimated family functioning as "moderate," and the other evidence was rated as "very low" or "low." Of the eight SRs, six (75%) reported that maternal depressive symptoms were significantly reduced, and two SRs (25%) were not reported.

Conclusion

Family-centered interventions may improve maternal depressive symptoms and family function, but not paternal depressive symptoms. However, the quality of methodologies, evidence, reporting, and bias of risk in the included SRs of family-centered interventions for perinatal depression was not satisfactory. The above-mentioned demerits may negatively affect SRs and then cause inconsistent outcomes. Therefore, SRs with a low risk of bias, high-quality evidence, standard reporting, and strict methodology are necessary to provide evidence of the efficacy of family-centered interventions for perinatal depression.

A Longitudinal Dyadic Study of Six Leisure Activities in Swedish Couples During the Transition to Parenthood

Parents are not only caregivers to their children; they also have leisure routines that can impact their own well-being. However, little is known about how leisure activities change within the context of a couple during the transition to parenthood. This study uses latent growth curve models and data from the Swedish Pregnancy Panel to examine how often 918 first-time, heterosexual couples participated in six leisure activities from around pregnancy week 19 to one year postpartum. Compared to fathers, mothers less frequently exercised and listened to news, and more frequently read newspapers, spent time for themselves, and spent time with friends. Over time, mothers increased their frequency of praying to God and decreased spending time for themselves and with friends. Fathers decreased frequency of exercise. Within couples, there was a positive correlation between mothers' and fathers' frequency of engaging in leisure activities, although most changes over time were not associated. Our finding that two individuals within a couple may change their leisure activities independently of each other during the transition to parenthood can help healthcare professionals and researchers prepare expectant couples for upcoming changes (or lack thereof) and promote parent well-being. Our findings also highlight the possibility that in contexts with more state support for families, parenthood may not exacerbate gender gaps in leisure.

Getting help as a depressed dad: A lived experience narrative of paternal postnatal depression, with considerations for healthcare practice

WHAT IS KNOWN ABOUT THE SUBJECT?: A significant proportion of fathers report experiencing depression after their baby is born Fathers are not offered regular support for their psychological well-being in the transition to parenthood despite an acknowledged need for such support WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: Lived experience provides new insight into how one father experienced postnatal depression, including the role of his partner in help-seeking It explains the delayed presentation in help-seeking as resulting from healthcare practitioner language and attitudes, and gendered expectations around mental health and help-seeking in the context of fatherhood WHAT ARE THE IMPLICATIONS FOR MENTAL HEALTH NURSING?: Mental health nurses should be aware that postnatal depression can affect fathers as well as mothers, and that it is necessary to support fathers in safe spaces and with appropriate language Planning care for depression in men should consider the recent birth of a child in order to provide effective care Clearer guidance is needed for supporting new fathers with postnatal depression ABSTRACT: Introduction Fathers are not universally supported with their perinatal mental health, but evidence shows that they suffer at a similar level to mothers. Aim This paper examines the journey of one father through his PND experience, his help seeking, and encounters in healthcare, in order to highlight the needs of a depressed father. Method The method is a father's lived experience narrative which has been written alongside a health visitor who highlights the relevance of the condition to healthcare practice. Results & Discussion The needs of fathers are unmet. They require support which considers their gender role expectations. Partners are key to their help seeking. Implications for practice The language and sensitivity used by nurses is key to encouraging fathers to share their depression and reduce stigma around the condition.

Dads in Distress: symptoms of depression and traumatic stress in fathers following poor fetal, neonatal, and maternal outcomes

BACKGROUND

This study aims to explore the prevalence of symptoms of depression and traumatic stress in fathers in the setting of poor fetal, neonatal, and maternal outcomes.

METHODS

A prospective mixed-methods study was conducted at an outer metropolitan public teaching hospital in Brisbane, Australia, with quantitative results presented here. Subjects included 28 fathers whose male partners had experienced pregnancy or childbirth complicated by a significant congenital abnormality or aneuploidy, termination of pregnancy, fetal death in-utero, stillbirth, admission to the neonatal intensive care unit or special care nursery or significant maternal morbidity, such as a postpartum haemorrhage or an emergency postpartum hysterectomy. These experiences were classified into two groups: anticipatory (time to prepare) and sudden (no warning). The fathers were screened using the Edinburgh Postnatal Depression Scale (EPDS) and the Impact of Events Scale-Revised (IES-R) to assess subjective distress at 2-3 weeks (timepoint 1) and 3-4 months (timepoint 2) after the event.

RESULTS

Data for both the EPDS and IES-R scales was available for 26 fathers (92.9%) at timepoint 1 and for 15 fathers (53.6%) at timepoint 2. High overall EPDS scores (≥10) were noted in 16/27 (59.3%) fathers at timepoint 1 and 6/15 fathers (40.0%) at timepoint 2. High overall IES-R scores ≥33 were noted in 12/26 (46.2%) fathers at timepoint 1 and 4/15 fathers (26.7%) at timepoint 2. A higher percentage of fathers who experienced anticipatory events had EPDS and IES-R score above these cut-offs at timepoint 1 (8/13 or 61.5%) compared to those experiencing sudden events (8/14 or 57.1%), however, percentages were similar between groups at time point 2 (2/7 or 28.6%% and 4/8 or 50.0%, respectively). More fathers who experienced anticipatory events had IES-R scores ≥33 at timepoint 1 (7/13 or 53.8%) compared to those experiencing sudden events (5/14 or 38.0%).

CONCLUSION

Our study indicates high rates of distress in fathers exposed to poor fetal, neonatal, and maternal outcomes, which can persist for months after the event. Increased support for fathers in this setting may be required to prevent poor mental health. Further research on the long-term effects of these adverse events is warranted.

Relationships between parent-infant bonding, dyadic adjustment and quality of life, in an intra-partner sample

The transition to parenthood represents a moment of change and adaptation in which the dyadic marital relationship becomes a triadic relationship. Facilitating a positive transition requires a thorough understanding of the explanatory model of the relationship between parental-infant bonding, dyadic adjustment and quality of life (QoL) from an integrative perspective of the family unit. The aim of this work was to analyse the relationships between parent-infant bonding, dyadic adjustment and QoL from an intra-partner perspective, 6-12 months after the birth of a child. A cross-sectional observational study was performed in a convenience sample of 222 couples 6-12 months postpartum, enrolled from October 2013 to March 2016. The mean age of the mothers was 34.07 years (SD = 3.67), and for the fathers, it was 35.75 years (SD = 4.02). Mothers perceived better QoL and greater mother-infant bonding compared to fathers. The perception of an adequate dyadic adjustment, together with positive parent-infant bonding, had positively influenced the individual QoL of both members of the couple 6-12 months after birth. From an intra-partner perspective, the positive transition was influenced by the relationship between parent-infant bonding, dyadic adjustment and QoL. Positive parent-infant bonding in mothers and fathers, as well as promotion of the quality of the relationships between couples, can help promote a better QoL. Positive health results can be achieved in terms of individual and family well-being by designing healthcare interventions that encourage the presence and participation of the family unit.

Is participation in antenatal classes associated with fathers' mental health? A quasi-experimental and prospective study

BACKGROUND

In comparison to those conducted with women, studies about the transition of men to parenthood are limited in numbers, especially in developing countries. Moreover, in Turkey, along with gender roles and sociocultural changes, the roles of fathers are also changing. This change highlights the need to understand early parenthood for fathers.

METHODS

A quasi-experimental, non-randomized prospective study with a pre- and post-training model was conducted in a hospital in Istanbul, Turkey. Men in the antenatal education group (EG = 55) and their pregnant wives participated in 6 weeks of training during pregnancy (24th-28th weeks gestation). Men in the care-as-usual group (CG = 55) attended routine check-ups and follow-ups with their wives. GHQ-28 (General Health Questionnaire-28) was administered three times in total at study enrolment, immediately following the 6-week intervention period, and at the 6th postpartum week.

RESULTS

There was no significant difference between the groups' GHQ-28 scores before and after the training. In the 6th week of postpartum follow-up, the GHQ-28 scores were significantly higher for the fathers who participated in the educational intervention.

CONCLUSIONS

Antenatal education classes were found to be associated with the mental health of fathers. Further research evaluating family-centered parenting support programs is warranted to better understand how to support fathers in the transition to parenthood, particularly in countries in which fathers' roles in pregnancy and early parenthood are changing.

Interventions for Perinatal Depression and Anxiety in Fathers: A Mini-Review

Background and Objectives

Up to 10% of fathers experience perinatal depression, often accompanied by anxiety, with a detrimental impact on the emotional and behavioural development of infants. Yet, few evidence-based interventions specifically for paternal perinatal depression or anxiety exist, and few depressed or anxious fathers engage with support. This mini-review aims to build on the evidence base set by other recent systematic reviews by synthesising more recently available studies on interventions for paternal perinatal depression and anxiety. Secondarily, we also aimed to identify useful information on key implementation strategies, if any, that increase the engagement of men.

Methods

We drew upon three major previous systematic reviews and performed an updated search of PubMed/Medline; Psycinfo; Cochrane Database; Embase and Cinahl. The search was limited to trials, feasibility studies or pilot studies of interventions published between 2015 and 2020 that reported on fathers' perinatal mental health. We included psychological, educational, psychosocial, paternal, couple-focused, or group therapies, delivered face-to-face, via telephone and/or online that reported on either paternal depression, anxiety or both.

Results

Eleven studies satisfied search criteria (5 of which were not included in previous reviews). The majority were randomised controlled trials. Most interventions incorporated counselling, therapy or psychoeducation and took an indirect approach to perinatal mental health through antenatal or postnatal education and were couple-focused. No studies reported a presence of diagnosed depression or anxiety at baseline, although five studies reported a positive effect on sub-threshold symptoms.

Discussion

There was some evidence that these approaches may be useful in the initial engagement of fathers with perinatal supports and improve depression and anxiety scores. No studies targeted the explicit treatment of clinically depressed or anxious men, and this remains the most substantial gap in the peer-reviewed evidence base. Our results highlight the need to deliver perinatal interventions specifically designed for men and evaluate them in populations with clinical levels of depressive and anxious symptomatology.

Social support needs of first-time parents in the early-postpartum period: A qualitative study

Background

The early postpartum period is a critical time for first-time parents as they adapt to their new role. Perceived lack of social support is a risk factor for developing mental health problems. Insufficient or inappropriate professional support for both parents has been reported by many studies. Social support that appropriately meets parents' needs is an important protective factor for parents' wellbeing; however, little is known about the social support needs of both first-time parents.

Aims and objectives

To describe both first-time parents' formal social support needs in the early postpartum period.

Method

Individual semi-structured interviews were conducted with first-time parents recruited on the postpartum ward of a Swiss university hospital. Thematic analysis was used to identify themes and sub-themes.

Results

Fifteen mothers and eleven fathers were interviewed. Twelve themes were identified. Mothers' themes were "experiencing postpartum changes," "creation of a family unit," "self-esteem," "emotional needs," "difficulty in communicating their needs," and "the postpartum stay." Fathers' themes were "to be included in care procedures on the postpartum ward," "to be reassured," "to anticipate their postpartum stay" and "to consider their need as non-priority." Parental shared needs were: "to care for their newborn," and "returning home."

Conclusion

Mothers' and fathers' needs differed. Mothers needed more emotional support than fathers and fathers considered themselves as the main support for their partner. Fathers wanted to be integrated in the care of their newborn.

A mixed-methods feasibility study of an intervention to improve men's mental health and wellbeing during their transition to fatherhood

BACKGROUND

Many health visiting services in England use the Promotional Guide system with mothers and fathers, an intervention to support their transition to parenthood, but there is little known about its use and effectiveness, especially with fathers. The aim of this study was to test the feasibility and acceptability of the Promotional Guide system with first-time fathers and pilot potential outcome measures to assess their mental health and wellbeing.

METHODS

A mixed methods prospective observational cohort study. Expectant first-time fathers were recruited from four London (UK) local authority boroughs. Data were collected through online pre and post intervention questionnaires, and semi-structured telephone interviews. Quantitative data were analysed using descriptive statistics and qualitative data were analysed using framework analysis.

RESULTS

Eighty-six fathers were interested in participating; 7 did not meet inclusion criteria and 79 were invited to complete the baseline questionnaire. Questionnaires completed by 45 men at both timepoints were included in the final analysis. Mean and standard deviations were calculated for all outcomes, showing a slight deterioration in the scores across all measures in the postnatal period compared to the antenatal. Ten of these men were also interviewed. Six major categories were identified: 1) Experience of health visitor contact, 2) Experience of Promotional Guides, 3) Experience of perinatal health services, 4) Experience of fatherhood, 5) Fathers' mental health and wellbeing, and 6) Experience of the research process. While antenatal and postnatal outcomes were collected from 45 first-time fathers, none had received the intervention in its entirety. This study identified major gaps in the implementation of the Promotional Guide system with fathers.

CONCLUSION

This study assessed recruitment of first-time fathers, time to complete recruitment, and retention rates and identified outcome measures that could be used in a future definitive study. While it wasn't possible to examine the potential changes following the use of the Promotional Guide system, the study reported on the changes in the fathers' 'states' in the antenatal and postnatal period. It provided a narrative on whether first-time fathers found it acceptable to be asked about their mental health and wellbeing, highlighted their specific needs during their transition to fatherhood, and how they wanted to be supported. It also identified barriers to implementation of the Promotional Guide system by health visitors, which need to be addressed prior to any future research into this intervention. These findings have a number of implications for researchers, health professionals, health service managers, commissioners, policy makers and parents.

The development of the postpartum mobile support application and the effect of the application on mothers' anxiety and depression symptoms

OBJECTIVE

The study aimed to develop the postpartum mobile support application to support postpartum mothers and to examine the effects of the use of mobile app on mothers' anxiety level and depression symptoms.

RESEARCH DESIGN/SETTING

It is a parallel group pretest-posttest randomized controlled study carried out between July 2017 and February 2020. The mothers (62 in the experiment and 62 in the control group) who gave birth in full-term at a university hospital in Konya province in Turkey and who had healthy newborns constituted the study group. Data were collected using the Information Form, the STAI State and Continuity Anxiety Scale, and the Edinburgh Postpartum Depression Scale. Mixed pattern variance analysis (mixed anova), t test in dependent groups, t test and chi square analysis in independent groups were used to analyze the data.

FINDINGS

Most of the mothers who used the application fed their baby only with breast milk and felt more sufficient about breastfeeding. The depression symptoms of mothers using the postpartum mobile support application was lower than that of the mothers in the control group; however, it was found that the application was not adequate alone to decrease anxiety levels and depression symptoms (p > 0.05).

CONCLUSIONS

The postpartum mobile support application is an important and useful source in accessing reliable information; however, it was found to be insufficient to lower anxiety levels and prevent depression symptoms at the end of the six-week postpartum period.

Fathers' involvement in perinatal healthcare in Australia: experiences and reflections of Ethiopian-Australian men and women

Background

Family-centred maternity care models include the expectation that fathers prepare for and attend the birth. In Australia over 20% of the population is from a culturally and linguistically diverse background. Public policies espouse culturally competent healthcare. Little is known about the experiences of perinatal health care of men from culturally and linguistically diverse (CALD) communities living in high income countries. The aim was to understand the experiences, attitudes and beliefs about father’s inclusion in perinatal healthcare, from the growing, and recently settled community of Ethiopian families living in Australia.

Methods

A qualitative study using semi-structured individual interviews with Ethiopian-Australian men and women who had experienced Australian maternity care and were sampled for diversity of time since migration, and parity. Interviews were in English, audio-recorded, transcribed and then analysed thematically.

Results

Participants were seven women and six men all born in Ethiopia, including two couples. Key themes included: the loss of extended family through migration, new roles for both parents and the need to establish ‘family-like’ relationships with friendship groups in Australia. There was a willingness to involve male partners in the Ethiopian community in Australia, although it was recognised as a cultural change. Experiences of male partner involvement were mixed among healthcare types, with men attending Maternal and Child Health (MCH) appointments less frequently than antenatal (ANC) appointments.

Conclusions

Results suggests men may be missing out on the education provided during antenatal appointments and may benefit from an alternative. There were not universally high levels of cultural competency among healthcare professionals, with further training still required. Commitment to paid employment remains a barrier to men’s involvement, suggesting that flexible working conditions and increased paternity leave would support their involvement. Alternatively services could utilise flexible delivery methods such as phone and zoom to include fathers.

A Review of the Involvement of Partners and Family Members in Psychosocial Interventions for Supporting Women at Risk of or Experiencing Perinatal Depression and Anxiety

A maternal experience of perinatal mental health conditions can have serious short- and long-term consequences for child development and family relationships. Women with perinatal depression and/or anxiety are primarily supported by their partner/spouse and family. The aim of this review was to synthesise data from studies that have examined the inclusion of partners or family members in psychosocial interventions for women at risk of or experiencing perinatal depression and/or anxiety. A systematic search of five databases was conducted to identify literature published between 2010 and 2020. Nine empirical studies met the eligibility criteria and were independently assessed by two authors using the National Heart, Lung and Blood Institute Quality Assessment Tools and data were extracted and narratively synthesised guided by TIDieR (Template for Intervention Description and Replication) checklist. Eligible studies detailed diverse interventions facilitated by a variety of programme facilitators, with no central model of intervention or study outcome measures evident across the studies. All studies except one reported a significant change in maternal depression and anxiety scores. The interventions had limited evaluation of the woman’s, partner’s or family member’s experiences of involvement in the intervention. Further research is required to firmly establish the effectiveness of co-designed interventions to support the sustainable integration of such interventions into routine perinatal mental health services.

Receiving maternity care during the COVID-19 pandemic: Experiences of women's partners and support persons

Background

In Australia, the provision of maternity care during the COVID-19 pandemic was significantly altered to limit transmission of the virus. Many hospitals limited face-to-face appointments to only the pregnant woman and restricted the number of support people present during labour, birth, and postnatal visits to one person. How these restrictions were experienced by partners and support persons of childbearing women are unknown.

Aim

To explore the experiences of partners and support persons of women receiving maternity care during the COVID-19 pandemic.

Methods

A two-phased qualitative study including an online survey and interviews. Analysis was undertaken using content analysis.

Findings

Partners and support persons experienced a sense of ‘missing out’ from the pregnancy and maternity care experience because of changes in the provision of care during the pandemic. They reported feelings of isolation, psychological distress, and reduced bonding time with babies. Conflicting information and processes within and across maternity services contributed to feelings of uncertainty and a perceived reduction in the quality of care. Partners and support persons were negatively impacted by restrictions on maternity wards, however they also perceived these to be of benefit to women.

Discussion

Many partners and support persons were negatively impacted by restrictions in maternity services during the pandemic; strategies to ensure their active involvement in maternity care are needed.

Conclusion

This study offers insights from the unique perspective of partners and support people of women receiving maternity care during the pandemic. Policies and processes that exclude partners and support persons need to be reconsidered.

Attitudes and Engagement of Pregnant and Postnatal Women With a Web-Based Emotional Health Tool (Mummatters): Cross-sectional Study

BACKGROUND

Mummatters is a web-based health tool that allows women to self-assess the symptoms of depression and the presence of psychosocial risk factors throughout pregnancy and the postnatal period. It aims to increase women's awareness of their own symptoms or risk factors and their knowledge of the available support options, to encourage engagement with these support options (as appropriate), and to facilitate communication about emotional health issues between women and their health care providers.

OBJECTIVE

The aim of this study is to report the uptake of mummatters; the sociodemographic and psychosocial risk profiles of a subsample of users; and the acceptability, credibility, perceived effect, and motivational appeal of the tool. The help-seeking behaviors of the subsample of users and barriers to help seeking were also examined.

METHODS

Mummatters was launched in November 2016. Women who completed the mummatters baseline assessment were invited to complete a web-based follow-up survey 1 month later.

RESULTS

A total of 2817 women downloaded and used mummatters between November 13, 2016, and May 22, 2018, and 140 women participated in the follow-up study. Approximately half of these women (51%; 72/140) were Whooley positive (possible depression), and 43% (60/140) had an elevated psychosocial risk score on the Antenatal Risk Questionnaire. Mummatters was rated favorably by pregnant and postnatal women in terms of its acceptability (94%-99%), credibility (93%-97%), appeal (78%-91%), and potential to affect a range of health behaviors specific to supporting emotional wellness during the perinatal period (78%-93%). Whooley-positive women were more likely to speak with their families than with a health care provider about their emotional health. Normalizing symptoms and stigma were key barriers to seeking help.

CONCLUSIONS

Although mummatters was rated positively by consumers, only 53% (19/36) to 61% (22/36) of women with possible depression reported speaking to their health care providers about their emotional health. There was a trend for more prominent barriers to seeking help among postnatal women than among pregnant women. Future studies that investigate whether social barriers to seeking help are greater once a woman has an infant are warranted. Such barriers potentially place these women at greater risk of remaining untreated, as the demands on them are greater.

How are you sleeping? Starting the conversation with fathers about their mental health in the early parenting years

BACKGROUND

Approximately 1 in 10 fathers of infants experience symptoms of common mental health disorders, prompting calls for paternal postpartum screening. However, numerous obstacles exist to screening implementation. The aim of this study was to provide preliminary evidence for an alternative approach that starts with asking fathers about their sleep.

METHODS

Using self-reported father data at 0 to 36 months postpartum (N=1204) from four Australian cohort studies, we assessed associations between responses to various single-item questions about sleep (good to poor), and scores on validated measures of mental health (depression, anxiety and stress). We conducted regressions, unadjusted and adjusted for father age, child age, household income, education, first or later child, and marital status, to test associations between sleep and each indicator of mental health. We then meta-analyzed effects and assessed interactions between sleep and each of the covariates.

RESULTS

Consistent associations between fathers' subjective poor sleep and depression, anxiety and stress were replicated across the four cohorts despite heterogeneity in the sleep questions. At the meta-analytic level, effects ranged from weak to moderate (0.25 to 0.37) and were robust to all adjustments. Interactions were only detected between family income and poor sleep, such that the association was stronger for high income fathers.

LIMITATIONS

This study does not address the sensitivity or specificity of single-item sleep questions for assessing paternal mental health risk.

CONCLUSIONS

A low-cost, non-stigmatizing single question to postpartum fathers about their sleep may present a gateway opportunity to enquiring about mental health.

Prenatal Anxiety and Depression: Treatment Uptake, Barriers, and Facilitators in Midwifery Care

Background: While many women experience prenatal symptoms of anxiety and/or depression (PSAD), treatment uptake rates are relatively low. Left untreated, symptoms can unfavorably affect maternal and infant health. The first aim of this study was to identify the treatment uptake rate and modalities of treatment received in a community sample of Dutch pregnant women. The second aim was to investigate reasons for not engaging in treatment and to describe facilitators for treatment uptake. The third aim was to determine facilitators and barriers for self-disclosure of feelings to midwives. Materials and Methods: Data were collected from a convenience sample of 1439 Dutch women with low-risk mid-term pregnancies in midwifery care. PSAD was assessed with online questionnaires on symptoms. Reasons, facilitators, and barriers were determined with checklists and open questions. Data were analyzed using conventional content analysis and open code quantification. Results: Only 15% of women with PSAD (scoring above cutoffs; 22% of the full sample) received treatment. Psychotherapy was the most commonly received treatment. The main reason for not engaging in treatment was regarding PSAD as a natural part of pregnancy (71%). The main facilitator to engage in treatment was referral by midwives (16%), and for self-disclosure was the midwife asking about PSAD (59%), whereas not asking formed the main barrier for self-disclosure (23%). Conclusions: Relatively few pregnant women received treatment for PSAD. Midwives play an essential role in identifying and referring women for treatment. Routine screening may be a starting point to offer support and, if needed, referral.

Profiles of Depressive Symptoms and Anger in Men: Associations With Postpartum Family Functioning

Background: Evidence suggests that men commonly experience depression as feelings of anger; yet, research has not investigated what this means for the manifestation of depressive symptoms in the early years of fatherhood and for key indicators of family functioning. Methods: Using data from a longitudinal cohort study of men at the normative age for entering fatherhood (28-32 years), we conducted latent class analyses to identify patterns of depressive symptoms and 3 sub-types of state anger (feeling; verbal; physical). We then assessed whether class membership was associated with paternity status (n = 535). In a subsample of fathers of infants aged up to 18 months (n = 162), we prospectively assessed associations with paternal-infant bonding, co-parenting, perceived social support, paternal involvement in childcare and alcohol use up to 2 years later. Results: Five classes emerged that differentiated men by anger and depressive symptom severity and by the degree to which men endorsed the feeling of wanting to express anger physically. Compared to the reference class with minimal symptoms, fathers had a higher probability of being in either the mild or most severe symptom classes. Men in symptomatic classes were at higher risk of lower levels of social support, co-parenting problems, and paternal-infant bonds. Class membership was not associated with alcohol use or paternal involvement in childcare. Conclusions: Our results reveal patterns of co-existing symptoms of depression and anger in fathers of infants that will be relevant to men's own need for support, their family safety, partner mental health and child developmental outcomes.

Psychological Distress, Coping and Perceived Social Support Among Partners of Women with Postpartum Onset Severe Mental Illness (SMI) Admitted to a Mother-Baby Unit

BACKGROUND

The presence of a severe mental illness in the mother during the postpartum period may impact the whole family and specifically have an effect on the health of the spouse. The current study aimed to assess psychological distress, coping, and perceived social support of spouses of women with postpartum onset severe mental illness.

METHODOLOGY

A cross-sectional descriptive research design was used, and 30 spouses of the women admitted to the mother-baby unit (MBU) for psychiatric inpatient care were included in the study. The assessments included sociodemographic details, Kessler psychological distress scale (K10), brief coping orientation to problems experienced scale (brief COPE), and Zimets' multidimensional scale of perceived social support.

RESULTS

Around 50% of the spouses experienced severe psychological distress. Nearly 40% of spouses reported poor coping and 56.7% of spouses had moderate social support from family and friends.

CONCLUSION

The findings indicate the need to address distress and coping in spouses of women with postpartum onset SMI.

Health-care practitioners' assessment and observations of birth trauma in mothers and partners

BACKGROUND

Evidence shows that traumatic childbirth can cause ongoing distress, often referred to as birth trauma. This can have an impact on parents and the couple relationship, and consequently identifying and supporting parents with birth trauma is important to practice.

AIM

To investigate the experiences of health-care practitioners from the United Kingdom (UK) in assessment for birth trauma, perceived occurrence of birth trauma and observed impact on parents and the couple relationship.

METHODS

An online survey of UK health-care practitioners working with parents in the first postnatal year.

RESULTS

A sample of 202 practitioners reported identifying birth trauma in 34.4% of mothers and 25.0% of partners. Assessment for birth trauma was only conducted for 50.3% of mothers and 25.9% of partners. The most observed symptoms were re-experiencing among mothers (87.1%) and avoidance among partners (50.9%). Birth trauma was perceived as impacting on the couple relationship for 29.8% of mothers and 26.9% of partners. Written responses provided more detailed observations of the impact of birth trauma.

CONCLUSION

Understanding how birth trauma may present differently in mothers and partners could support effective assessment. Once birth trauma is identified, parents require personalised support to help them cope with the impact.

Supporting women who develop poor postnatal mental health: what support do fathers receive to support their partner and their own mental health?

Background

Research regarding support provided for poor maternal postnatal mental health (such as depression, anxiety disorders, and postpartum psychosis) is relatively common. Fathers appear to play an important role supporting partners but many feel alienated within maternity services. Research focusing on fathers is less common.

Methods

The current qualitative study aimed to investigate fathers’ experience of support provided to fathers, to help support their partner should she experience poor postnatal mental health.

Results

Twenty-five fathers participated in an online questionnaire regarding their experience of their partner’s poor postnatal mental health and the support provided to fathers to help her. Thematic analysis revealed three main themes and seven sub-themes. The themes were: ‘Support received to help support their partner’, ‘Support fathers wanted that was not received’ and ‘Father’s mental health’. The results highlight an overall lack of support for many fathers, despite many wanting support on how to help their partner, information on their own mental health and the services available. Fathers specifically wanted healthcare professionals to sign-post them to someone they can talk to for emotional support, and to be taught coping strategies which would help them to support both their partner and baby.

Conclusions

The findings from this study suggest that health professionals and perinatal mental health services need a better understanding about what resources fathers need to support the mental health of themselves and their partner.

Paternal mental health during the perinatal period: A qualitative systematic review

AIMS

To examine fathers' experiences and needs associated with mental health during the perinatal period.

DESIGN

Qualitative studies were meta-synthesized using the steps outlined by Sandelowski and Barroso.

DATA SOURCES

Six databases (PubMed, Embase, PsycINFO, CINAHL, Scopus and ProQuest) were searched for qualitative studies from each database's inception to 24 June 2019.

REVIEW METHODS

Studies were critically appraised using the Critical Appraisal Skills Program tool. Qualitative data were extracted, meta-summarized, then meta-synthesized.

RESULTS

Fourteen studies were included and four themes were identified: (a) negative feelings and psychological difficulties, (b) role strain and role conflict with multiple sources, (c) coping strategies that buffered negative feelings and psychological difficulties and (d) support needs to enhance mental health.

CONCLUSION

Fathers reported poor mental health and expressed needs to enhance their mental health across the perinatal period. Future studies can focus specifically on paternal mental health. The development of theory-guided, family inclusive, technology-based healthcare services are needed to manage mental health. Healthcare providers can promote positive mental health to prepare fathers, increasing their awareness to manage their mental health and to seek timely help.

IMPACT

Problem-focused coping (i.e. support and problem-solving with partners and childcare involvement) helped fathers to buffer their negative feelings and psychological difficulties. Future studies should focus on paternal mental health rather than on general fathering experiences. Healthcare providers should focus on promoting positive mental health and well-being. Policymakers should create awareness on paternal mental health across the perinatal period.

First-time mothers' perceptions of social support: Recommendations for best practice

Research indicates social support is imperative for postpartum well-being. The types of social support and access to preferred supports are less understood. This article considers first-time mothers' perceptions of the effectiveness of social supports and perceived barriers to accessing support and provides recommendations for best practice. A search of the literature for terms related to postpartum social support was conducted. Major themes were identified and synthesised. A critique and analysis of the literature is presented with recommendations for best practice. Much of the research around postnatal support fails to distinguish the specific type of support, meaning creating support solutions for the postpartum period may not be effectively targeted. Recommendations for individualised support are made.

Assessing the Mental Health of Fathers, Other Co-parents, and Partners in the Perinatal Period: Mixed Methods Evidence Synthesis

Introduction: Five to 10 percentage of fathers experience perinatal depression and 5-15% experience perinatal anxiety, with rates increasing when mothers are also experiencing perinatal mental health disorders. Perinatal mental illness in either parent contributes to adverse child and family outcomes. While there are increasing calls to assess the mental health of both parents, universal services (e.g., maternity) and specialist perinatal mental health services usually focus on the mother (i.e., the gestational parent). The aim of this review was to identify and synthesize evidence on the performance of mental health screening tools and the acceptability of mental health assessment, specifically in relation to fathers, other co-parents and partners in the perinatal period. Methods: A systematic search was conducted using electronic databases (MEDLINE, PsycINFO, Maternity, and Infant Care Database and CINAHL). Articles were eligible if they included expectant or new partners, regardless of the partner's gender or relationship status. Accuracy was determined by comparison of screening tool with diagnostic interview. Acceptability was predominantly assessed through parents' and health professionals' perspectives. Narrative synthesis was applied to all elements of the review, with thematic analysis applied to the acceptability studies. Results: Seven accuracy studies and 20 acceptability studies were included. The review identified that existing evidence focuses on resident fathers and assessing depression in universal settings. All accuracy studies assessed the Edinburgh Postnatal Depression Scale but with highly varied results. Evidence on acceptability in practice is limited to postnatal settings. Amongst both fathers and health professionals, views on assessment are mixed. Identified challenges were categorized at the individual-, practitioner- and service-level. These include: gendered perspectives on mental health; the potential to compromise support offered to mothers; practitioners' knowledge, skills, and confidence; service culture and remit; time pressures; opportunity for contact; and the need for tools, training, supervision and onward referral routes. Conclusion: There is a paucity of published evidence on assessing the mental health of fathers, co-mothers, step-parents and other partners in the perinatal period. Whilst practitioners need to be responsive to mental health needs, further research is needed with stakeholders in a range of practice settings, with attention to ethical and practical considerations, to inform the implementation of evidence-based assessment.

Mothers' views of health problems in the 12 months after childbirth: A concept mapping study

AIMS

To identify the health problems that women feel require help and subsequent help-seeking behaviour during the 12 months period after childbirth.

BACKGROUND

Many women experience physical and mental health problems after childbirth, but there is a gap in understanding how they perceive their health after childbirth. Studies suggested they are inhibited in expressing their needs and so seek informal rather than professional help for their health problems.

DESIGN

A mixed method concept mapping study.

METHOD

Two groups of Australian women were recruited by an online platform and purposive sampling (N = 81) in 2017-2018, based on an established concept mapping methodology. A first group created 83 brainstorm statements about post-childbirth health problems and help-seeking and a second group sorted and rated the statements based on their perception of the prevalence of the issues and the help-seeking advice they would offer to others. Bradshaw`s Taxonomy of Needs was used to theoretically underpins the explanation of the results of women's felt need after childbirth.

RESULTS

Multidimensional scaling resulted in six clusters of issues which were categorized into three domains: 'health issues and care', 'support' and 'fitness'. Despite being directly asked, about two-thirds of the women did not report experiencing any health problems.

CONCLUSION

Our findings showed women had a broader perception of healthcare needs which included support and fitness. There is a potential gap in services for women who do not have good social support.

IMPACT

Family and friends were a key source of help-seeking. Post-childbirth routine care was focused on infant care and limited to the first 6 weeks after childbirth. The content of current post-childbirth care must be reviewed.

Mental health and wellbeing during the transition to fatherhood: a systematic review of first time fathers' experiences

OBJECTIVE

The aim of this systematic review was to identify and synthesize the best available evidence on first time fathers' experiences and needs in relation to their mental health and wellbeing during their transition to fatherhood.

INTRODUCTION

Men's mental health and wellbeing during their transition to fatherhood is an important public health issue that is currently under-researched from a qualitative perspective and poorly understood.

INCLUSION CRITERIA

Resident first time fathers (biological and non-biological) of healthy babies born with no identified terminal or long-term conditions were included. The phenomena of interest were their experiences and needs in relation to mental health and wellbeing during their transition to fatherhood, from commencement of pregnancy until one year after birth. Studies based on qualitative data, including, but not limited to, designs within phenomenology, grounded theory, ethnography and action research were included.

METHODS

A three-step search strategy was used. The search strategy explored published and unpublished qualitative studies from 1960 to September 2017. All included studies were assessed by two independent reviewers and any disagreements were resolved by consensus or with a third reviewer. The recommended Joanna Briggs Institute (JBI) approach to critical appraisal, study selection, data extraction and data synthesis was used.

RESULTS

Twenty-two studies met the eligibility criteria and were included in the review, which were then assessed to be of moderate to high quality (scores 5-10) based on the JBI Critical Appraisal Checklist for Qualitative Research. The studies were published between 1990 and 2017, and all used qualitative methodologies to accomplish the overall aim of investigating the experiences of expectant or new fathers. Nine studies were from the UK, three from Sweden, three from Australia, two from Canada, two from the USA, one from Japan, one from Taiwan and one from Singapore. The total number of first time fathers included in the studies was 351. One hundred and forty-four findings were extracted from the included studies. Of these, 142 supported findings were aggregated into 23 categories and seven synthesized findings: 1) New fatherhood identity, 2) Competing challenges of new fatherhood, 3) Negative feelings and fears, 4) Stress and coping, 5) Lack of support, 6) What new fathers want, and 7) Positive aspects of fatherhood.

CONCLUSIONS

Based on the synthesized findings, three main factors that affect first time fathers' mental health and wellbeing during their transition to fatherhood were identified: the formation of the fatherhood identity, competing challenges of the new fatherhood role and negative feelings and fears relating to it. The role restrictions and changes in lifestyle often resulted in feelings of stress, for which fathers used denial or escape activities, such as smoking, working longer hours or listening to music, as coping techniques. Fathers wanted more guidance and support around the preparation for fatherhood, and partner relationship changes. Barriers to accessing support included lack of tailored information resources and acknowledgment from health professionals. Better preparation for fatherhood, and support for couple relationships during the transition to parenthood could facilitate better experiences for new fathers, and contribute to better adjustments and mental wellbeing in new fathers.

Courtesy Stigma and Social Support: An Exploration of Fathers' Buffering Strategies and Blocking Rationalizations

This study extends scholarship on stigma management communication and social support by exploring the experiences of fathers of children living with a rare health condition, Sturge-Weber Syndrome. Findings from this interview-based interpretive study reveal that fathers assuaged the negative effects of stigma on their children-and courtesy stigma on themselves-by employing buffering strategies, including reactive and preemptive information sharing, preparatory conversations, and support blocking. Further, fathers offered three rationalizations for their blocking behaviors-reasoning that to accept support would violate social norms, as well as privacy expectations and that accepting support was not worth the effort (social exchange). These findings encourage scholars to continue to upend predominant constructions of masculinity and also call to question prevailing assumptions about the relationship between technology and privacy.

A qualitative exploratory study of UK first-time fathers' experiences, mental health and wellbeing needs during their transition to fatherhood

OBJECTIVES

To develop an understanding of men's experiences of first-time fatherhood, their mental health and wellbeing needs.

DESIGN

A qualitative study using semi-structured interviews. Data were analysed using framework analysis.

SETTING

Two large National Health Service integrated care trusts covering four London (UK) local authority boroughs.

PARTICIPANTS

First-time fathers with children under 12 months of age were included. Maximum variation sampling was used, with 21 fathers recruited. Ten of these men described their ethnic background as Indian, seven as White British, one as Spanish, one as Black African, one as Black Caribbean and one as Pakistani. Participants' ages ranged from 20 to over 60 years; completion of full-time education ranged from high school certificate to doctorate level; and annual income ranged from £15 000 to over £61 000. Non-English speaking fathers, those experiencing bereavement following neonatal death, stillbirth, pregnancy loss, sudden infant death, and fathers with existing severe mental illnesses were excluded.

RESULTS

Nine major categories were identified: 'preparation for fatherhood', 'rollercoaster of feelings', 'new identity', 'challenges and impact', 'changed relationship: we're in a different place', 'coping and support', 'health professionals and services: experience, provision and support', 'barriers to accessing support', and 'men's perceived needs: what fathers want'. Resident (residing with their partner and baby) and non-resident fathers in this study highlighted broadly similar needs, as did fathers for whom English was their first language and those for whom it was not. A key finding of this study relates to men's own perceived needs and how they would like to be supported during the perinatal period, contributing to the current evidence.

CONCLUSIONS

This study provides insight into first-time fathers' experiences during their transition to fatherhood, with important implications for healthcare policy makers, service providers and professionals for how perinatal and early years services are planned and provided for both new parents.

Paternal Perinatal Mental Health: At-Risk Fathers’ Perceptions of Help-Seeking and Screening

Given the prevalence of paternal perinatal mental health concerns, researchers have suggested introducing routine screening. However, little is known about the acceptability of perinatal screening measures in male populations. Furthermore, the need for screening is influenced by men’s perinatal help-seeking behaviors. A thematic analysis of interview data from nine men at risk of paternal perinatal depression and/or anxiety investigated both acceptability of screening and help-seeking behaviors. Themes indicate that routine screening is desired, but acceptability is influenced by perceptions of its intention and possible outcomes. Findings also suggest that barriers to men’s perinatal help-seeking are likely to be minimized by increased awareness and normalization. Future research and clinical practice should account for complexities raised by men’s perceptions of health care services.

Enhancing first-time parents' self-efficacy: A systematic review and meta-analysis of universal parent education interventions' efficacy

BACKGROUND

Poor adjustment during early parenthood often leads to low feelings of parental self-efficacy, which influences parents' behaviours towards their infants. The long-term consequences on infant development warrant the need for more attention on the efficacy of universal parent education interventions to empower parents and enhance their self-efficacy.

OBJECTIVES

To synthesise available evidence and explore the efficacy of universal parent education interventions on the parental self-efficacy of first-time parents.

DESIGN

A systematic review and meta-analysis of randomised controlled trials.

DATA SOURCES

A literature search of 10 databases was conducted to identify randomised controlled trials from each database's point of inception to November 2016.

METHODS

Based on the inclusion criteria, 24,062 articles were screened for their titles and abstracts. Two hundred and eighty articles were identified for full-text screening. Risks of bias posed by the selected articles were assessed using Cochrane's Risk of Bias instrument. Meta-analyses were conducted using RevMan 5.3. The overall intervention effect was evaluated using z tests at p < 0.05, while I² and Cochran Q tests were used to measure heterogeneity.

RESULTS

Ten randomised controlled trials were selected; eight trials were combined in meta-analyses and two trials were synthesised narratively. A meta-analysis revealed that universal parent education interventions significantly enhanced parental self-efficacy (p < 0.001) among first-time parents and these effects were also maintained over time (p < 0.001). The extent of improvement in parental self-efficacy was affected by the duration of the interventions.

CONCLUSION

This review provides sufficient evidence to support the use of universal interventions to enhance new parents' self-efficacy. While intervention effects were sustained at the two-month follow-up, further research using randomised controlled trials and longitudinal studies are needed to determine long-term effects. The findings serve as an impetus for hospitals and healthcare professionals to integrate universal interventions in perinatal care to guide first-time parents' transition into parenthood.

Mental health screening of fathers attending early parenting services in Australia

Paternal perinatal depression and anxiety is a common, though under-recognized mental health condition experienced by men during their transition to fatherhood. An opportunity to screen for paternal mental health issues occurs when parents present for assistance with the care of their baby at early parenting services (EPSs). There are 10 EPSs located across Australia that provide specialist, multidisciplinary interventions to support parents experiencing complex parenting difficulties. Using structured telephone interviews, this qualitative study explored the views of 18 professional staff from nine EPSs regarding screening, referral processes and acceptability of screening fathers for mental health issues. A thematic analysis revealed that most EPSs screened fathers for depression. Participants agreed screening was important and that routine approaches to screening would help normalize the process for both men and services. Despite this, no uniform, comprehensive approach to identifying the mental health needs of fathers was found. EPSs provide a unique opportunity to address the mental health needs of fathers. Results from this study point to the need for a national approach to the development of father-specific screening guidelines for EPSs to improve family well-being, in parallel to those informing the Australian National Perinatal Mental Health Initiative for mothers.

A complex postnatal mental health intervention: Australian translational formative evaluation

Reducing the burden of postnatal maternal mental health problems is an international public health priority. We developed What Were We Thinking (WWWT), a psychoeducation programme for primary postnatal health care that addresses known but neglected risks. We then demonstrated evidence of its effects in a before-and-after controlled study in preventing maternal postnatal mental health problems among women without a psychiatric history participating in the intervention compared to usual care (AOR 0.43; 95% CI 0.21, 0.89) when conducted by specialist nurses. Testing its effectiveness when implemented in routine primary care requires changes at practitioner, organizational and health system levels. This paper describes a programme of translational formative evaluation to inform the protocol for a cluster RCT. Following the UK Medical Research Council (MRC) Guidance for evaluating complex interventions, we conducted a translational formative evaluation using mixed methods. Collection and analysis of postnatal health service documents, semi-structured interviews, group discussions and an online survey were used to investigate service provision, consumers' needs and expectations, clinicians' attitudes and clinical practice, and the implications for health service delivery. Participants were expectant parents, health care providers, health service managers and government policy makers. Results documented current clinical practice, staff training needs, necessary service modifications to standardize advice to parents and include fathers, key priorities and drivers of government health policy, and informed a model of costs and expected health and social outcomes. Implementation of WWWT into routine postnatal care requires adjustments to clinical practice. Staff training, modifications to service opening hours and economic implications for the health system also need to be considered. The MRC Guidance for developing and evaluating complex interventions is a useful framework for conceptualizing and reporting translational formative evaluation, which is an essential step in the evidence trajectory. The results of the evaluation will inform the protocol for a cluster RCT of WWWT and associated health economic evaluation.

Postpartum consultations in Australian general practice

Many GPs undertake postpartum care for women and their infants. GP follow-up enables early identification and management of problems, education and support for parenting, and reconnection with general practice following the birth. However, there is little information about GPs' understanding of their role in postpartum care and how it is undertaken. This cross-sectional survey of GPs in Southern Queensland, conducted between February and July 2013, describes the involvement of GPs in postpartum care. GPs were posted a 52-item questionnaire adapted from a previous Victorian GP study and were telephoned 2 weeks later. GPs completed the survey on paper or online. The response rate was 17.4% (163 GPs). Approximately 39% were uncertain whether women were happy with the GP-provided postpartum care. GPs' recommendations for the timing of postpartum reviews were inconsistent within and across birthing sectors and consultations took longer than anticipated. Developing guidelines around the timing and appropriate length of postpartum consultations could assist GPs in providing appropriate care for mothers and infants.

‘Lost and confused’: parent representative groups’ perspectives on child and family health services in Australia

Consumer involvement in health care is widely accepted in policy and service delivery. Australia offers universal health services for families with children aged 0 to 5 years, provided by child and family health nurses and general practitioners. Services include, but are not limited to, monitoring and promoting child health and development, and supporting parents. This paper reports consumer representatives’ perspectives on Australian parents’ needs and experiences of child and family health services, identifying facilitators and barriers to service utilisation. Twenty-six representatives from consumer organisations explored families’ experiences through focus groups. Qualitative data were analysed thematically. Consumer representatives identified several key implications for families using primary health services: feeling ‘lost and confused’ on the parenting journey; seeking continuity and partnership; feeling judged; and deciding to discontinue services. Participants highlighted accessible, timely, non-judgmental and appropriate interactions with healthcare professionals as vital to positive consumer experiences and optimal health and developmental outcomes. Representatives indicated that families value the fundamentals of well-designed health services: trust, accessibility, continuity, knowledge and approachability. However, both consumers and service providers face barriers to effective ongoing engagement in universally provided services.

Fathers' Worries During Pregnancy: A Qualitative Content Analysis of Reddit

Qualitative investigations into the emotional needs of expectant fathers have been limited by difficulties with recruitment. This study aimed to unobtrusively obtain insights into fathers' worries during pregnancy by analyzing the content of posts on the Internet forum Reddit. The majority of worries related to infant well-being (50.8%), particularly the potential for perinatal loss (23.0%). Concerns relating to partner well-being and the couple relationship were also common, comprising 17.0% of posts. Several posts related to individual factors, such as apprehension about the father role (16.3%). Finally, situational factors such as work-family conflict accounted for 15.9% of posts. These findings contribute to the growing literature on fathers' experiences of pregnancy and can inform the development of father-inclusive perinatal education.

New Fathers' Perinatal Depression and Anxiety-Treatment Options: An Integrative Review

More than 10% of fathers experience depression and anxiety during the perinatal period, but paternal perinatal depression (PPND) and anxiety have received less attention than maternal perinatal mental health problems. Few mainstream treatment options are available for men with PPND and anxiety. The aim of this literature review was to summarize the current understanding of PPND and the treatment programs specifically designed for fathers with perinatal depression. Eight electronic databases were searched using a predefined strategy, and reference lists were also hand searched. PPND and anxiety were identified to have a negative impact on family relationships, as well as the health of mothers and children. Evidence suggests a lack of support and tailored treatment options for men having trouble adjusting to the transition to fatherhood. Of the limited options available, cognitive behavioral therapy, group work, and blended delivery programs, including e-support approaches appear to be most effective in helping fathers with perinatal depression and anxiety. The review findings have important implications for the understanding of PPND and anxiety. Future research is needed to address the adoption of father-inclusive and father-specific models of care to encourage fathers' help-seeking behavior. Inclusion of male-specific requirements into support and treatment options can improve the ability of services to engage new fathers. Psychotherapeutic intervention could assist to address the cognitive differences and dissonance for men adjusting to the role of father, including male identity and role expectations.

A SYSTEMATIC REVIEW OF INTERVENTIONS TARGETING PATERNAL MENTAL HEALTH IN THE PERINATAL PERIOD

Interventions targeting parents' mental health in the perinatal period are critical due to potential consequences of perinatal mental illness for the parent, the infant, and their family. To date, most programs have targeted mothers. This systematic review explores the current status and evidence for intervention programs aiming to prevent or treat paternal mental illness in the perinatal period. Electronic databases were systematically searched to identify peer-reviewed studies that described an intervention targeting fathers' mental health in the perinatal period. Mental health outcomes included depression, anxiety, and stress as well as more general measures of psychological functioning. Eleven studies were identified. Three of five psychosocial interventions and three massage-technique interventions reported significant effects. None of the couple-based interventions reported significant effects. A number of methodological limitations were identified, including inadequate reporting of study designs, and issues with the timing of interventions. The variability in outcomes measures across the studies made it difficult to evaluate the overall effectiveness of the interventions. Father-focused interventions aimed at preventing perinatal mood problems will be improved if future studies utilize more rigorous research strategies.

Enhancing reciprocal partner support to prevent perinatal depression and anxiety: a Delphi consensus study

BACKGROUND

Systematic reviews have established that partner support protects against perinatal mood problems. It is therefore a key target for interventions designed to prevent maternal and paternal depression and anxiety. Nonetheless, the extant literature is yet to be translated into specific actions that parents can implement. Prevention efforts aiming to facilitate reciprocal partner support within the couple dyad need to provide specific guidance on how partners can support one another to reduce their vulnerability to perinatal depression and anxiety.

METHOD

Two panels of experts in perinatal mental health (21 consumer advocates and 39 professionals) participated in a Delphi consensus study to establish how partners can support one another to reduce their risk of developing depression and anxiety during pregnancy and the postpartum period.

RESULTS

A total of 214 recommendations on how partners can support each other were endorsed by at least 80 % of both panels as important or essential in reducing the risk of perinatal depression and anxiety. The recommendations were grouped under the following categories: becoming a parent, supporting each other through pregnancy and childbirth, communication, conflict, division of labor, practical support, emotional support, emotional closeness, sexual satisfaction, using alcohol and drugs, encouraging self-care, developing acceptance, and help-seeking.

CONCLUSION

This study established consensus between consumers and professionals in order to produce a set of guidelines on how partners can support each other to prevent depression and anxiety during pregnancy and following childbirth. It is hoped that these guidelines will inform the development of perinatal depression and anxiety prevention efforts.

Prevalence and course of anxiety disorders (and symptom levels) in men across the perinatal period: A systematic review

BACKGROUND

Men's experiences of anxiety within the perinatal period can adversely impact themselves, their partner and infant. However, we know little about the prevalence and course of men's anxiety across the perinatal period. The current review is one of the first to systematically review the published literature.

METHODS

Five databases (PubMed, PsycINFO, Cochrane, SCOPUS, and Web of Science) were searched to identify relevant papers published prior to April 2015. The literature search identified articles with data for expectant fathers (prenatal period) and/or fathers of an infant aged between 0 and 1 (postnatal period). The following data were extracted: (a) anxiety disorder prevalence (diagnostic clinical interviews), (b) 'high' anxiety symptom prevalence (above thresholds/cut-points on anxiety symptom scales) and (c) mean anxiety levels (anxiety symptom scales). Initially, 537 unique papers were identified. Subsequently, 43 papers met criteria for inclusion in the review.

RESULTS

Prevalence rates for 'any' anxiety disorder (as defined by either diagnostic clinical interviews or above cut-points on symptom scales) ranged between 4.1% and 16.0% during the prenatal period and 2.4-18.0% during the postnatal period. The data reviewed suggest the course of anxiety across the perinatal period is fairly stable with potential decreases postpartum.

LIMITATIONS

Wide variation in study measurement and methodology makes synthesis of individual findings difficult. Anxiety is highly comorbid with depression, and thus measures of mixed anxiety/depression might better capture the overall burden of mental illness.

CONCLUSIONS

Anxiety disorders are common for men during the perinatal period. Both partners should be included in discussions and interventions focused on obstetric care and parent mental health during the perinatal period.

Modifiable partner factors associated with perinatal depression and anxiety: a systematic review and meta-analysis

BACKGROUND

Perinatal distress is a significant public health problem that adversely impacts the individual and their family. The primary objective of this systematic review and meta-analysis was to identify factors that partners can modify to protect each other from developing perinatal depression and anxiety.

METHOD

In accordance with the PRISMA statement, we reviewed the risk and protective factors associated with perinatal depression and anxiety symptoms that partners can potentially modify without professional assistance (PROSPERO reference CRD42014007524). Participants were new or expectant parents aged 16 years or older. The partner factors were sub-grouped into themes (e.g., instrumental support) based on a content analysis of the scale items and measure descriptions. A series of meta-analyses were conducted to estimate the pooled effect sizes of associations.

RESULTS

We included 120 publications, reporting 245 associations with depression and 44 with anxiety. Partner factors with sound evidence that they protect against both perinatal depression and anxiety are: emotional closeness and global support. Partner factors with a sound evidence base for depression only are communication, conflict, emotional and instrumental support, and relationship satisfaction.

LIMITATIONS

This review is limited by the lack of generalizability to single parents and the inability to systematically review moderators and mediators, or control for baseline symptoms.

CONCLUSION

The findings suggest that future prevention programs targeting perinatal depression and anxiety should aim to enhance relationship satisfaction, communication, and emotional closeness, facilitate instrumental and emotional support, and minimize conflict between partners.