Socioecological factors associated with fathers' well‐being difficulties in the early parenting period

Maternal distress during the COVID-19 outbreak: A socio-ecological perspective

INTRODUCTION

Mothers faced an increased risk of adverse mental health outcomes during the COVID-19 pandemic compared to other populations. However, there is little data on the factors that placed mothers at increased risk of distress.

AIMS

The present study explored a range of individual, familial, and environmental factors associated with psychological distress in mothers during the COVID-19 pandemic.

METHOD

This repeated cross-sectional study was composed of a convenience sample of mothers who completed an online survey that included a demographic questionnaire, an emotion regulation questionnaire, and the Depression, Anxiety, and Stress scale. The survey was administered during the second and third lockdowns in Israel in 2020-2021.

RESULTS

The study included 575 mothers (M age = 39). The findings of a hierarchical regression indicated that individual-level factors, composed of age and emotion regulation tendencies predicted psychological distress. The family-level factors of household income and number of children in the family also predicted distress. In terms of environmental-level factors, COVID-19-related media consumption and school status (open or closed) were also significant predictors of psychological distress. Importantly, the results showed that the most important predictors of psychological distress in mothers during the COVID-19 outbreak were school closures, household income, and the use of adaptive and maladaptive emotion regulation strategies.

CONCLUSIONS

The findings highlight the intersection of individual, familial, and environmental factors in mothers' mental health during crises.

Working out dads (WOD): a study protocol for a randomised controlled trial of a group-based peer support intervention for men experiencing mental health difficulties in early fatherhood

BACKGROUND

Approximately one in ten men experience mental health difficulties during the early years of fatherhood, and these can have negative impacts on children and families. However, few evidence-based interventions targeting fathers' mental health are available. The aim of the trial is to evaluate the effectiveness and cost-effectiveness of Working Out Dads (WOD) - a facilitated peer support group intervention for fathers of young children, in reducing psychological distress and other mental health symptoms.

METHODS

This trial will employ a parallel-arm randomised controlled trial (RCT) to evaluate the effectiveness and cost effectiveness of WOD peer support group intervention compared to usual care (a 30-min mental health and service focused phone consultation with a health professional). A total of 280 fathers of young children (aged 0-4 years) who are experiencing mental health difficulties and/or are at risk of poor mental health will be recruited. Randomisation and analyses will be at the level of the individual participant. The primary outcome is psychological distress symptoms, measured by the Kessler Psychological Distress Scale (K10) from baseline to 24 weeks post randomisation. A range of secondary outcomes will be assessed including suicidal ideation; mental health disorders, specific symptoms of depression, anxiety, and stress; social support, quality of life, health service use, and health care costs. Data will be collected at baseline, 10- and 24 weeks post-randomisation.

DISCUSSION

This trial will examine the effectiveness of a novel group-based peer support intervention in reducing the psychological distress and other mental health symptoms of fathers compared to usual care. The economic and process evaluation will guide policy decision making along with informing the future implementation of WOD on a larger scale if effectiveness is demonstrated.

TRIAL REGISTRATION

The current trial has been registered with ClinicalTrials.gov (Registration ID - NCT04813042 ). Date of Registration: March 22nd, 2021.

Child Sleep Problems Affect Mothers and Fathers Differently: How Infant and Young Child Sleep Affects Paternal and Maternal Sleep Quality, Emotion Regulation, and Sleep-Related Cognitions

PURPOSE

Problems in infant and young child sleep can represent a serious challenge to parental behavior of mother and father. However, most research about the effect of infant and young child sleep on parenting has focused on mothers. Therefore, the present study aimed to explore the perception and consequences of infant and young child sleep problems of both parents.

PARTICIPANTS AND METHODS

Participants were recruited via random sampling at, eg, kindergartens in North Rhine Westphalia. The sample includes data of heterosexual German-speaking couples with children without any medical or psychopathological problems. For this study, parents were asked to complete the test battery with regard to their youngest child. As sampling was via the kindergarten, the range of child age was 4-68 months. A survey assessed data of parents (N=196, 46% female). The test battery contained the following questionnaires: Children Sleep Habits Questionnaire (CSHQ), Pittsburgh Sleep Quality Index (PSQI), Self-Report Measure for the Assessment of Emotion Regulation Skills (SEK-27), and a German version of the Infant Sleep Vignettes Interpretation Scale (ISVIS). For the outcome variables of parental sleep as well as for parental emotional competence, the statistical tests of ANOVA were used, and for parental sleep-related cognitions with the grouping variables of infant and young child sleep as well as parental gender, a MANOVA was used. According to the analysis of group differences, the age of the child was also included additional to the grouping variable of parental gender and children's sleep.

RESULTS

Mothers and fathers in this sample were equally aware of their children's sleep problems and reported similar sleep quality and emotion regulation themselves (all p > 0.05). Mothers as well as fathers of children with sleep problems had lower parental sleep quality (F(1, 183) = 110.01, p < 0.001) and emotion regulation (F(1, 184) = 143.16, p < 0.001) compared to parents of children without sleep problems. In children under 26 months of age, the child's age seemed to have less negative impact on the father's sleep quality (F(1, 183) = 5.01, p < 0.001) and emotion regulation (F(1, 184) = 0.72, p < 0.05) than on the outcomes of the mother. With regard to sleep-related cognition, there were statistically significant effects of parental gender (F(2, 185) = 44.39, p < 0.001) and interaction effects of parental gender × child sleep problems observed (F(2, 185) = 31.91, p < 0.001).

CONCLUSION

The conclusion from this survey refers to the role of the father. According to the results, an association between paternal emotional competence, sleep quality as well as their sleep-related cognitions and infants and toddlers sleep behavior could be assumed in addition to and independent of the results of mothers. We would highlight the urgent need of inclusion of fathers in infant and developmental sleep research. In the context of sleep intervention, both parents should be provided with ongoing support to improve their sleep quality and competence in emotion regulation.

"We're in the background": Facilitators and barriers to fathers' engagement and participation in a health intervention during the early parenting period

ISSUES ADDRESSED

Little is known about the barriers and facilitators associated with engaging fathers in interventions targeting their physical and mental health. The current research therefore aimed to explore fathers' perceived barriers and facilitators to engagement and participation in a health intervention delivered during the early parenting period.

METHODS

Eleven fathers of young children (0-4 years) were interviewed about their perceptions and experiences of facilitators and barriers to engaging and participating in an intervention (Working Out Dads) to target their mental and physical health. Interviews were recorded and transcribed. Transcripts were analysed using thematic analysis.

RESULTS

Fathers identified a number of program-related and father-related facilitators and barriers which impacted their engagement and participation. Program-related facilitators included: accessibility of the program; father advocacy of the program; group fitness/exercise component; and having a father-specific program. Facilitating factors related to fathers included: making social connections; learning how to be a better dad/partner; and partner support and encouragement to attend. Program-related barriers included: travel; lack of awareness; and gender roles. While father-related barriers included: being time poor; sacrifices to family; and apprehension.

CONCLUSIONS

The current findings identified many areas that facilitate, encourage and motivate men to participate in interventions which support their mental and physical health during the early parenting period.

RELEVANCE

Generating evidence on barriers and facilitators to health interventions is important to improving the current intervention along with informing the development of engaging and targeted health interventions for fathers in early parenthood.

A pilot evaluation of 'Working Out Dads': promoting father mental health and parental self-efficacy

AIM

Approximately one in 10 fathers experience mental health difficulties in the early years of parenting, yet there is a dearth of evidence-based interventions to promote fathers' mental health at this time. Therefore, the aims of this study were: (1) to obtain preliminary data on the short-term changes in mental health symptoms and parenting self-efficacy for fathers of young children (aged 0-4 years) participating in Working Out Dads (WOD) and (2) to explore fathers' experiences of participation in WOD.

METHOD

The sample consisted of 57 fathers who had at least one child aged between 0 and 4 years. Participants completed pre- and post- measures to assess the severity of depressive, anxiety and stress symptoms and parenting self-efficacy. A brief survey of fathers' experiences in WOD was also completed.

RESULTS

There was a significant reduction in fathers' reports of depressive and stress symptoms from pre- to post-intervention, and no significant change in anxiety symptoms. Parenting self-efficacy significantly increased from pre- to post-intervention. All changes were associated with moderate to large effect sizes. Fathers indicated that they were satisfied with the programme and that they were more confident in managing the stress of parenting and in their overall role as a father.

CONCLUSIONS

This is the first study to evaluate WOD and provides promising preliminary evidence for its short-term effects on fathers' mental health and parenting self-efficacy. Pilot results are positive and are a critical first step, informing the design of a more robust evaluation in the future.

Parental Self-Efficacy: A Concept Analysis Related to Teen Parenting and Implications for School Nurses

Levels of parental self-efficacy are correlated with both positive and negative care delivery and developmental outcomes for parents and their infants. School nurses are in a unique position to facilitate parenting self-efficacy in teen parents. Using the concept analysis framework of Walker and Avant, parental self-efficacy is analyzed and elucidated to distinguish the concept's defining attributes, antecedents, consequences, and empirical referents. The operational definition of parental self-efficacy arising from this concept review is an individual's belief that he or she is capable of integrating and executing the knowledge and skills necessary to parent their infant. Model, borderline, related, and contrary cases are presented, along with implications for school nursing practice. School nurses are ideally situated to assist teen parents with parental self-efficacy realization tasks.

The Spanish version of the Fatigue Assessment Scale: reliability and validity assessment in postpartum women

Background

Fatigue is the most widely reported symptom by women during pregnancy, labour, the postpartum period, and early parenting. The objective was to translate the Fatigue Assessment Scale (FAS) into Spanish and assess its psychometric properties.

Methods

Instrumental Design. The FAS was translated into Spanish (FAS-e) using forward and back translation. A convenience sample was constituted with 870 postpartum women recruited at discharge from 17 public hospitals in Eastern Spain. Data was obtained from clinical records and self-administered questionnaires at discharge. Internal consistency, factor structure, comparisons between known groups and correlations with other variables were assessed.

Results

Cronbach’s alpha coefficient was .80. Findings on the dimensionality of the FAS-e scale indicated that it was sufficiently unidimensional. FAS-e scores were higher among women who had undergone caesarean births (p < .05), had a higher level of postpartum pain (p < .01), experienced difficulties during breastfeeding (p < .01) and had lower levels of self-efficacy for breastfeeding (p < .01).

Conclusions

An equivalent Spanish version of the FAS was obtained with good reliability and validity properties. FAS-e is an appropriate tool to measure postpartum fatigue.

Bio-ecological factors associated with the psychological distress of fathers of children with autism spectrum disorder: A population-based study of Australian families

Using a bio-ecological framework, the aim of this study was to examine factors associated with psychological distress experienced by fathers of children with autism spectrum disorder from a nationally representative sample of Australian children and their families. Individual (e.g. age and self-efficacy), interpersonal (e.g. partner distress, couple relationship, child behaviour and social support) and social environmental factors (e.g. job quality and financial hardship) were explored as potential predictors of fathers’ distress. Data were drawn from the Longitudinal Study of Australian Children, where 159 fathers of children with autism spectrum disorder were identified. As comparison, 6578 fathers of children without developmental disabilities were identified. Multiple regression analyses showed that experiencing depression within the past year, job quality (e.g. autonomy and access to parental leave) and social support were significant predictors for fathers of children with autism spectrum disorder. The importance of supporting the well-being of fathers of children with autism spectrum disorder is discussed.

Relationships between parental sleep quality, fatigue, cognitions about infant sleep, and parental depression pre and post-intervention for infant behavioral sleep problems

Background

Maternal and paternal depression has been associated with infants’ behavioral sleep problems. Behavioral sleep interventions, which alter parental cognitions about infant sleep, have improved infant sleep problems. This study reports relationships between parental depression, fatigue, sleep quality, and cognitions about infant sleep pre and post-intervention for a behavioral sleep problem.

Methods

This secondary analysis of data from Canadian parents (n = 455), with healthy infants aged 6-to-8-months exposed to a behavioral sleep intervention, examined baseline data and follow-up data from 18 or 24 weeks post intervention (group teaching or printed material) exposure. Parents reported on sleep quality, fatigue, depression, and cognitions about infant sleep. Data were analyzed using Pearson’s r and stepwise regression analysis.

Results

Parents’ fatigue, sleep quality, sleep cognitions, and depression scores were correlated at baseline and follow-up. At baseline, sleep quality (b = .52, 95% CI .19–.85), fatigue (b = .48, 95% CI .33–.63), doubt about managing infant sleep (b = .44, 95% CI .19–.69), and anger about infant sleep (b = .69, 95% CI .44–.94) were associated with mothers’ depression. At baseline, fathers’ depression related to sleep quality (b = .42, 95% CI .01–.83), fatigue (b = .47, 95% CI .32–.63), and doubt about managing infant sleep (b = .50, 95% CI .24–.76). At follow-up, mothers’ depression was associated with sleep quality (b = .76, 95% CI .41–1.12), fatigue (b = .25, 95% CI .14–.37), doubt about managing infant sleep (b = .44, 95% CI .16–.73), sleep anger (b = .31, 95% CI .02–.59), and setting sleep limits (b = −.22, 95% CI -.41-[−.03]). At follow-up, fathers’ depression related to sleep quality (b = .84, 95% CI .46–1.22), fatigue (b = .31, 95% CI .17–.45), sleep doubt (b = .34, 95% CI .05–.62), and setting sleep limits (b = .25, 95% CI .01–.49).

Conclusions

Mothers’ and fathers’ cognitions about infant sleep demonstrate complex relationships with their depression scores. While mothers’ setting sleep limit scores are associated with decreased depression scores, fathers’ setting limits scores are associated with increased depression scores. Parental doubts about managing infant sleep and difficulties with setting sleep limits require attention in interventions.

Paternal mental health following perceived traumatic childbirth

OBJECTIVE

the objective behind the current study was to explore the experiences and perceptions of fathers after childbirth trauma, an area of minimal research. This is part two of a two-part series conducted in 2014 researching the mental health of fathers after experiencing a perceived traumatic childbirth.

DESIGN

qualitative methodology using semi-structured interviews and reporting of qualitative questions administered in part one's online survey (Inglis, 2014).

SETTING

interviews conducted face-to-face at an Australian University or on Skype.

PARTICIPANTS

sixty-nine responded to the online qualitative questions and of these seven were interviewed.

MEASUREMENTS

thematic analysis of verbal and written qualitative responses.

FINDINGS

thematic analysis of qualitative survey data and interviews found a global theme 'standing on the sideline' which encompassed two major themes of witnessing trauma: unknown territory, and the aftermath: dealing with it, and respective subthemes.

KEY CONCLUSIONS

according to the perceptions and experiences of the fathers, there was a significant lack of communication between birthing teams and fathers, and fathers experienced a sense of marginalisation before, during, and after the traumatic childbirth. The findings of this study suggest that these factors contributed to the perception of trauma in the current sample. Whilst many fathers reported the negative impact of the traumatic birth on themselves and their relationships, some reported post-traumatic growth from the experience and others identified friends and family as a valuable source of support.

IMPLICATIONS FOR PRACTICE

improved communication between midwifery staff and fathers before, during and after childbirth may reduce the rates of paternal postpartum mental health difficulties and experiences of trauma.

WHEN MUM IS STRESSED, IS DAD JUST AS STRESSED? PREDICTORS OF PATERNAL STRESS IN THE FIRST SIX MONTHS OF HAVING A BABY

The primary aim of this study was to examine predictors of paternal stress within the first 6 months of having a baby in a normative Australian sample, and to compare paternal and maternal stress. In total, 54 fathers and 71 mothers completed self-report measures of postnatal depressive symptoms, parenting stress, efficacy, responsiveness, attachment, and family and social support. Paired sample t test revealed a significant relationship within couples in their level of parenting stress. Fathers reported lower levels of postnatal depression, responsiveness, and attachment than did mothers. Fathers rated their level of social support to be higher than did mothers. Regression analyses indicated that responsiveness and efficacy significantly predicted paternal stress whereas responsiveness and attachment predicted maternal stress when history of psychological diagnosis and financial stability were controlled for. Results have implications for early preventive parenting programs.

Risk factors associated with the mental health of fathers of children with an intellectual disability in Australia

BACKGROUND

Raising a child with a disability places considerable demands and stress on parents, which can contribute to mental health difficulties. Research has primarily focused on mothers' mental health, and our understanding of the effects on fathers remains limited. The factors that place fathers at increased risk of mental health difficulties are also poorly understood. This study aimed to redress these gaps by reporting on the mental health of a large sample of fathers of children with an intellectual disability (ID) (aged 3-15 years), comparing this to published Australian norms and mothers of children with ID. The second aim of the study was to explore risk factors associated with fathers' mental health.

METHOD

The data for this study come from 315 Australian fathers of children (aged 3-15 years) with ID, who participated in the large-scale evaluation of the Signposts for building better behaviour programme. Fathers completed a range of self-report questionnaires at baseline including the Depression Anxiety Stress Scale (DASS).

RESULTS

Fathers in the present sample reported significantly more symptoms of depression and stress than the Australian normative data, with approximately 6-8% reporting symptoms in the severe to extremely severe range. The strongest predictors of fathers' mental health difficulties were children's behaviour problems, daily stress arising from fathers' own needs and children's care needs, and low parenting satisfaction. Socio-economic factors did not predict mental health difficulties.

CONCLUSION

This study is among one of the first to report the mental health of fathers of children with a disability in Australia. Findings highlight that some fathers of children with ID are at heightened risk of experiencing mental health difficulties, underscoring the importance of the provision of information and interventions to promote their mental health.