Men's psychological transition to fatherhood: an analysis of the literature, 1989-2008

Arabic validation of the parental stress scale (PSS) in a population-based sample of Lebanese parents

BACKGROUND

Parental stress significantly impacts the well-being of families, and necessitates culturally sensitive tools for its assessment. The Parental Stress Scale, widely used in diverse cultural settings, lacks a validated Arabic version suitable for the Lebanese context, where unique sociopolitical and economic factors might influence parental stress differently. This study aimed to translate, culturally adapt, and validate the scale in Arabic among a Lebanese sample.

METHODS

Following the Snowball sampling method, participants (n = 502) were adult Lebanese parents who answered demographic questions and completed the Arabic version of the Parental Stress Scale and the Depression, Anxiety, and Stress Scale-8.

RESULTS

Confirmatory Factor Analysis showed a two-factor model of the Parental Stress Scale (CFI = 0.956). We found adequate composite reliability for both the 'Parental Stress' (ω = 0.91/α = 0.91) and 'Parental satisfaction' (ω = 0.94/α = 0.94) subscales. Convergent validity and concurrent validity were demonstrated through positive correlations with measures of depression, anxiety and stress. Our translation of the scale was shown to be invariant across sexes, with fathers scoring significantly higher than mothers.

CONCLUSION

Our validated Arabic version of the Parental Stress Scale offers a culturally sensitive instrument for assessing parental stress in Lebanon. This tool enables healthcare providers and researchers to identify stressors affecting Lebanese families, facilitating the development of targeted interventions to support parental mental health.

Longitudinal trajectories and associated risk factors of paternal mental illness in the nine years surrounding the transition to fatherhood

BACKGROUND

The arrival of one's first child is a known risk factor for mental illness, yet investigations on fathers' mental health are limited. We conducted a longitudinal investigation on paternal depression and anxiety in the nine years surrounding the transition to fatherhood.

METHODS

Using a national cohort of French men (CONSTANCES, n = 6299), we investigated the prevalence and associated risk factors of mental illness amongst first-time fathers. Responses to the Center for Epidemiological Studies Depression (CES-D) and 12-item General Health Questionnaire (GHQ-12) scales were used to identify clinically significant symptom scores. Self-declared mental illness was also reported by participants. Group-based modelling was used to identify latent trajectory groups for both measures.

RESULTS

Levels of self-declared anxiety (averaging 4.9 % pre-fatherhood, 7.8 % post) exceeded that of depression (1.9 % pre- fatherhood, 3.3 % post) or other disorders. However, rates of clinically significant symptom scores (17-27 %) were consistently higher. Participants' mental health appeared to worsen from two-years prior to their child's arrival and improve from two-years after. We identified three trajectory groups for fathers' self-declared mental illness: Low stable (90.3 %); Low risk with high temporary increase (5.6 %); and Consistent high risk (4.1 %). Risk factors associated with worsening mental health trajectories were unemployment, not living with one's partner, having had adverse childhood experiences and foregoing healthcare due to financial reasons.

LIMITATIONS

All measures of mental illness relied on participant self-reports and are thus subject to bias.

CONCLUSIONS

This study reveals an important period of heightened psychological vulnerability amongst first-time fathers, emphasising the need for increased and better adapted paternal mental health screening.

Depression is associated with unintended pregnancy among fathers during the first 3 years after childbirth

BACKGROUND

The aim of the present study is to estimate the prevalence of unintended pregnancy in fathers with children aged less than or equal to 36 months and evaluate whether unintended pregnancy is associated with depression after controlling for covariates.

METHODS

We used data from the Brazilian National Health Survey (PNS) of 2019, a cross-sectional study that comprised a representative sample of residents in private households in Brazil. For the analysis of this study, we selected 30,579 men (> 14 years old) who answered to the Selected Resident questionnaire of the PNS and reported having a biological child (son). Among these 4806 had a child with less than 4 years of age and were used in our analysis.

RESULTS

The prevalence of unintended pregnancy in this group of fathers with a child ≤ 3 years was 35.0 % (95 % CI 32.6-37.5). In the final adjusted model, the variables associated with depression were: PHQ-9 total score (OR: 1.07, 95 % CI 1.03-1.11, p ≤0.001), a higher father's age (OR 1.01, 95 % CI 1.01-1.02), a higher father's age at birth (OR: 0.92, 95 % CI 0.90-0.94), self-reported black (OR: 3.00, 95 % CI 1.94-4.66), brown (OR: 1.63, 95 % CI 1.25-2.13) or indigenous (OR: 0.22, 95 % CI 0.07-0.69) skin color, lower per capita family income >1 to 2 MW (OR: 1.54, 95 % CI 1.01-2.35), ½ to 1 MW (OR: 2.22, 95 % CI 1.46-3.38) and up to 1 MW (OR: 1.76, 95 % CI 1.19-2.59) and not participating in the partner's prenatal appointments (OR: 2.04, 95 % CI 1.55-2.68).

DISCUSSION

In our study, the prevalence of unplanned pregnancy among fathers of child less than 4 years of age is high, and it is associated with depression. Black and brown self-reported skin color, lower family income and higher father's age are associated with increased risk of unintended pregnancy.

Cumulative childhood interpersonal trauma and parental stress: The role of partner support

Parents who have experienced cumulative childhood interpersonal trauma (CCIT, i.e., an accumulation of different types of abuse) tend to experience higher parental stress following the birth of a child. As CCIT is associated with lower levels of partner support, which is linked to increased parental stress, partner support could explain the link between CCIT and parental stress. Yet, these variables have never been studied using a dyadic approach. This study examined the role of received and provided partner support in the association between CCIT and parental stress. A randomly selected sample of 1119 couples with infants completed online questionnaires assessing CCIT, partner support, and parental stress. An actor-partner interdependence model path analysis showed that both parents' CCIT were associated with increased paternal stress through fathers' lower received and provided support, and with increased maternal stress through mothers' received and provided support. Overall, the findings highlight the significance of examining the interdependence between both parents' experience and the role of partner support as a key factor explaining the link between CCIT and parental stress, thereby emphasizing its importance as an intervention target.

Lived Experiences of Migrant Fathers in the Perinatal Period: A Systematic Review and Analysis

The worldwide population of migrant families is on the rise, and there is growing acknowledgement of the significance of supporting parental mental health within these families. However, understanding of the experiences of migrant fathers during the perinatal period remains incomplete. The objective of this review is to provide an overview of existing research on perinatal migrant fathers' experiences in different cultures. Multiple searches were conducted in April 2023 for quantitative, qualitative, and mixed-methods studies across six electronic databases: Medline, CINAHL, Embase, PsycINFO, Web of Science, and Scopus. Fourteen eligible articles were identified, including nine qualitative studies, five quantitative studies, and no mixed-methods studies. The Mixed-methods Appraisal Tool was used to assess the quality of these studies. The quantitative findings were transformed into narrative summaries to be analysed thematically along with the qualitative data. Three themes were identified: (1) Cultural competence (dealing with cultural differences, needs related to original country); (2) Parenthood in a new country (challenges and adaptation to fatherhood, challenging traditional gender norms, lack of extended family and building new support networks, being the main supporter for the family); (3) Needs of the fathers and their personal difficulties. The findings of this review suggest a direction for future research in perinatal psychology. The review also provides insights into the need for social and community support for migrant fathers and how healthcare services can support this group during the perinatal period.

Dynamics of postnatal depressive symptoms in early parenthood

BACKGROUND

New mothers and fathers are at risk of developing postnatal depressive problems. To understand how postnatal depressive symptoms unfold over time, analyses at the within-person level are necessary. Inspecting postnatal depressive problems at the symptom level provides a novel perspective, ultimately offering insight into which symptoms contribute to the elevation of other symptoms over time.

METHODS

Panel graphical vector-autoregression (GVAR) models were applied to analyze the within-person temporal and contemporaneous relations between depressive symptoms across the postnatal period in new mothers and fathers (at T1; Nmothers = 869, Nfathers = 579). Depressive symptoms were assessed at 6-, 12-, and 18-months postpartum, using the Edinburgh Postnatal Depression Scale.

RESULTS

The results revealed that for mothers, sadness was a key symptom predicting symptom increases in multiple other depressive symptoms and itself (autoregressive effect) over time. Furthermore, anxiousness and feeling scared predicted each other across the postnatal period in mothers. For fathers, the most central predicting symptom in the overall network of symptoms was being anxious, while self-blame and being overwhelmed had strong self-maintaining roles in the fathers' symptomatology, indicating that these could be key features in fathers experiencing postnatal depressive problems. The pattern of symptoms that mothers and fathers experienced within the same time window (contemporaneous associations), shared many of the same characteristics compared to the temporal structure.

CONCLUSIONS

This study suggests that across the postnatal period, from 6- to 18-months postpartum, depressive symptoms in mothers and fathers contribute differently to the pattern of depressive problems, highlighting sadness as a key feature in maternal symptomatology and anxiousness components in paternal symptomatology.

The influence of antenatal imaging on prenatal bonding in uncomplicated pregnancies: a mixed methods analysis

BACKGROUND

Prenatal bonding describes the emotional connection expectant parents form to their unborn child. Research acknowledges the association between antenatal imaging and enhanced bonding, but the influencing factors are not well understood, particularly for fathers or when using advanced techniques like fetal magnetic resonance imaging (MRI). This study aimed to identify variables which may predict increased bonding after imaging.

METHODS

First-time expectant parents (mothers = 58, fathers = 18) completed a two-part questionnaire (QualtricsXM™) about their expectations and experiences of ultrasound (n = 64) or fetal MRI (n = 12) scans in uncomplicated pregnancies. A modified version of the Prenatal Attachment Inventory (PAI) was used to measure bonding. Qualitative data were collected through open-ended questions. Multivariate linear regression models were used to identify significant parent and imaging predictors for bonding. Qualitative content analysis of free-text responses was conducted to further understand the predictors' influences.

RESULTS

Bonding scores were significantly increased after imaging for mothers and fathers (p < 0.05). MRI-parents reported significantly higher bonding than ultrasound-parents (p = 0.02). In the first regression model of parent factors (adjusted R2 = 0.17, F = 2.88, p < 0.01), employment status (β = -0.38, p < 0.05) was a significant predictor for bonding post-imaging. The second model of imaging factors (adjusted R2 = 0.19, F = 3.85, p < 0.01) showed imaging modality (β = -0.53), imaging experience (β = 0.42) and parental excitement after the scan (β = 0.29) were significantly (p < 0.05) associated with increased bonding. Seventeen coded themes were generated from the qualitative content analysis, describing how scans offered reassurance about fetal wellbeing and the opportunity to connect with the baby through quality interactions with imaging professionals. A positive scan experience helped parents to feel excited about parenthood. Fetal MRI was considered a superior modality to ultrasound.

CONCLUSIONS

Antenatal imaging provides reassurance of fetal development which affirms parents' emotional investment in the pregnancy and supports the growing connection. Imaging professionals are uniquely positioned to provide parent-centred experiences which may enhance parental excitement and facilitate bonding.

Supporting the transition to parenthood: a systematic review of empirical studies on emotional and psychological interventions for first-time parents

OBJECTIVES

The transition to parenthood can evoke a range of concerns in parents, profoundly impacting their psychological well-being. The literature regarding the transition to parenthood focuses primarily on functional aspects of parenthood, generally overlooking the psychological well-being of parents.

METHOD

This comprehensive review synthesized studies describing emotional and psychological interventions during the transition to parenthood among participants between 2013 and 2022. A rigorous screening process, conducted by three of the authors, resulted in 18 studies that met the inclusion criteria.

RESULTS

This report provides detailed descriptions of these studies, including their characteristics, demographics, types of interventions, and main outcomes. The majority of interventions focused on mothers and mother-infant dyads, with fewer interventions targeting couples, and none addressing fathers or father-infant dyads.

CONCLUSIONS

The interventions examined were found to be effective in reducing symptoms such as depression, anxiety, and stress among mothers and had positive effects on infants' behaviors, mother-infant synchrony, and co-parenting.

PRACTICE IMPLICATIONS

This review stresses the necessity of interventions targeting the transition to parenthood, especially among fathers and marginalized populations, as well as serves to identify barriers faced by vulnerable and minority populations.

Going through it together: Dyadic associations between parents' birth experience, relationship satisfaction, and mental health

BACKGROUND

Previous research suggests that a negative birth experience is associated with symptoms of postpartum depression and anxiety in mothers and partners. However, this has mostly been investigated within the first year postpartum and research on the long-term effects is lacking. Additionally, the role of relationship satisfaction and the interdependence between parents have not been considered so far.

METHODS

Couples (N = 1992) completed questionnaires on their birth experience, relationship satisfaction, and symptoms of depression and anxiety at two months, 14 months, and two years after birth, respectively.

RESULTS

Actor-Partner Interdependence Mediation Models indicated no partner effects, but several significant actor and indirect effects. A more positive birth experience was associated with higher relationship satisfaction and less depression and anxiety symptoms for both parents. Higher relationship satisfaction was in turn associated with less depression (mothers and partners) and anxiety symptoms (mothers). The association between birth experience and depression symptoms was partially mediated by relationship satisfaction for mothers and partners, while the association between birth experience and anxiety symptoms was partially mediated by relationship satisfaction only for mothers.

LIMITATIONS

Due to the highly educated, very healthy sample with low levels of depression and anxiety as well as high relationship satisfaction, results cannot be generalized to less privileged parents. Moreover, all effects were very small.

CONCLUSIONS

Results highlight the importance of a positive birth experience for parents' relationship satisfaction and mental health. Negative birth experiences need to be avoided to prevent a negative impact on the whole family.

The role and effect of companions during childbirth in Oman

BACKGROUND

There is increasing evidence that a companionship is an important tool for improving the quality of care provided to pregnant women during the labour and delivery process. The literature review shows very limited studies assessing the role of companions during childbirth from the companion's point of view. Many published papers studied the role and satisfaction of pregnant women but not their companions. Therefore, this study aimed to assess the role and effect of companions during childbirth in Oman.

METHODS

This cross-sectional observational study was conducted at Sultan Qaboos University Hospital, Oman, between June 2022 and April 2023. Companions were interviewed face-to-face at a time convenient to them. A telephone interview was conducted with those who left the hospital early. The questionnaire comprised sociodemographic data and other sections, including the nature of the help provided by the supportive companion, their effects on the women who gave birth, and the timing of their presence during companionship.

RESULTS

A total of 214 companions were included in this study with the mean age of 42.54 years. The most common relationship to the pregnant women was mothers (35.7%), followed by husbands (30.5%). The majority of companions provided support during admission (62.6%), in the immediate post-partum ward (56.5%) and during delivery (54.2%), while a minority helped from admission to discharge (22.4%). The most common type of support provided was encouraging words (89.7%) followed by transferring things (43.9%), massage (37.4%) and touch (33.6%). The majority of companions (96.7%) reported that their support helped very much, and the pregnant women felt better and calmer.

CONCLUSIONS

Labouring women felt better and calmer because of the presence of companions. Companions preferred to be present in the postpartum and during labour and delivery. The majority of companions support their labouring women by encouraging wards. Companions love and encourage others to support their labouring women during their critical times.

[Fathers' negative experience of childbirth is associated with an increased risk of paternal postpartum depression]

OBJECTIVES

The aim of this study was to investigate the influence of the childbirth experience by primiparous fathers living in France on their level of postnatal depression, parental self-efficacy, and postnatal sense of security.

METHODS

Two hundred and fifty men answered sociodemographic questions and filled up the Edinburg Postnatal Depression Scale (EPDS), the First-Time Father Questionnaire (FTFQ), the Parent Expectations Survey (PES) and the Parents' Postnatal Sense of Security Instrument (PPSSi).

RESULTS

A negative birth experience was associated with a higher rate of postnatal depressive symptoms (P<.001) and a lower level of postnatal security (P<.001). However, no relationship was found between childbirth experience and sense of parental efficacy (P=0.09).

CONCLUSIONS

Similar to mothers, the way fathers experience the birth of their partner can have consequences for the way they go through the postpartum period. In order to prevent possible depressive affects that may impact the relationship with their child, and to strengthen their sense of security when returning home, it is important to provide fathers with appropriate support throughout the perinatal period.

"Connection, community and convenience": A case study of a Facebook group for fathers navigating parenthood

ISSUES ADDRESSED

Fathers remain less likely to participate in parenting interventions which can limit their ability to receive support and build their parenting capacity. The advent of social media has engendered novel opportunities for fathers to connect with, and support, one another in the form of online peer support. Growth of these online communities exemplifies the demand from fathers to relate to other fathers who are navigating parenthood. However, the benefits of membership to these communities remain unclear. This study evaluated the perceived benefits of members of an online father-to-father, community-created and moderated Facebook group designed for Australian fathers in both rural and metropolitan regions.

METHODS

One-hundred and forty-five Australian fathers (aged 23-72 years) who were members of the same online fathering community completed an online survey where they qualitatively described their experiences as members of this community.

RESULTS

Content analysis of open-ended survey questions revealed that fathers identified a series of unique and important personal and familial benefits, which were largely attributed to their ability to connect with fellow fathers. Specifically, the opportunity to have convenient access to a safe space for fathers to connect was highly valued, providing fathers with opportunities to support, discuss and normalise parenting experiences.

CONCLUSIONS

Online father-to-father connection is a highly valued resource for fathers who are navigating parenthood. SO WHAT?: Online, community-led groups for fathers contribute to perceptions of genuineness and ownership by its members and provide a unique opportunity to connect and seek support for parenting.

"Crying on the Bus": First Time Fathers' Experiences of Distress on Their Return to Work

There is increasing research interest in the experiences of new fathers taking paternity leave, but less insight into men's experiences of returning to work after the birth of their first baby. For many men in the UK context, this could take place immediately after the birth or after one or two weeks of paternity leave. This paper utilizes data from a UK-based study whilst also drawing on international literature and policy contexts. A constructivist grounded theory method was adopted to generate theory from the data gathered. Twelve new fathers shared their experiences in this study by participating in audio-recorded, semi-structured interviews. This paper focuses on fathers' experiences of negotiating the workplace as part of an overall theoretical framework related to broader transitions to fatherhood and sheds light on the distress, guilt and psychological challenges that the participants experienced when they initially returned to work. Whether fathers did or did not explicitly describe distress at this time, they all described a change in their worker identity, which for some participants led to uncertainty in the workplace. Men returning to work at this time in the postnatal period are vulnerable to experiencing distress. Flexibility and support in the workplace could be protective of their mental health. Finally, policy and practice developments are offered to support men's transitions to fatherhood in the workplace context.

Screening for Partner Postpartum Depression: A Systematic Review

BACKGROUND

Postpartum depression is a significant mental health condition affecting an estimated 7% to 20% of women, with higher rates among individuals with increased risk factors. Most research on postpartum depression has focused on mothers, with less recognition of the mental health changes experienced by their partners. Research suggests almost 20% of partners may experience postpartum depression, yet our understanding is limited. An enhanced understanding of postpartum depression in a birthing person's partner is critical, given the mental and physical health sequelae associated with depression.

PURPOSE

The purpose of this review was to systematically examine the current tools available to assess partner postpartum depression.

METHODS

We conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies were identified using selected key terms in PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and Ovid MEDLINE. Studies were included if they assessed partner depressive symptoms and identified the specified use of a tool or screening measure.

RESULTS

Seventeen studies met inclusion criteria. Seven different measures were used to assess postpartum depression. The Edinburgh Postnatal Depression Scale (EPDS) was used in 16 out of the 17 studies for depression assessment.

CLINICAL IMPLICATIONS

Routine screening of partners for postpartum depression should be recommended as part of standard care. Nurses are critical liaisons for assessing risk and connecting relevant and timely resources to birthing people and their partners. Identifying the available screening tools may help to avoid adverse clinical outcomes associated with increased symptom severity and burden.

The experience of being a partner to a childbearing woman whose pregnancy is complicated by pre-eclampsia: A Swedish qualitative study

BACKGROUND

Pre-eclampsia affects 3-5% of all pregnant women and is among the leading causes of maternal morbidity and mortality as well as iatrogenic preterm birth worldwide. Little is known about the experience of partners of women whose pregnancy is complicated by pre-eclampsia.

AIM

To describe partners' experience of having a spouse whose pregnancy was complicated by pre-eclampsia.

METHODS

A qualitative study with in-depth interviews. Eight partners of women whose pregnancy was complicated by pre-eclampsia were interviewed and data were analysed using content analysis.

FINDINGS

Partners found themselves in an unfamiliar and unexpected situation. They experienced an information gap in which they tried to make sense of the situation by interpreting subtle signs. The situation left them feeling emotionally stretched, feeling like an outsider while trying to provide support for their extended family. The partners experienced a split focus after the baby was born, prioritising the baby while worrying about their spouse. Post-partum, they expressed needing time to process and heal after childbirth. A need for professional support was highlighted and concerns about a future pregnancy were voiced.

CONCLUSION

Having a spouse who is diagnosed with pre-eclampsia is challenging and overwhelming. Our findings imply a need to develop a model of care for women with pre-eclampsia that includes their partner, i.e., the other parent.

Paternal pregnancy-related anxiety: Systematic review of men's concerns and experiences during their partners' pregnancies

BACKGROUND

Up to 25 % of expectant parents experience anxiety symptoms. Pregnancy-related anxiety is characterised by concerns and worries specific to pregnancy, childbirth, and the transition to parenthood. While pregnancy-related anxiety is well-researched in women, the exact nature of this construct in men is unclear. The purpose of the current review was to examine men's concerns, worries, and fears during pregnancy and gain an understanding of their experiences during pregnancy.

METHODS

An integrative review design was adopted, using thematic content analysis to synthesise findings from quantitative and qualitative studies. Quality appraisal of the quantitative studies used the AXIS appraisal tool. The Critical Appraisal Skills Program (CASP) checklist was used for the qualitative studies.

RESULTS

A comprehensive search of nine databases led to inclusion of 14 quantitative and 41 qualitative studies. Ten dimensions of paternal pregnancy-related anxiety were identified: childbirth concerns, attitudes towards childbirth, baby concerns, acceptance of pregnancy, partner concerns, relationship concerns, worry about self, transition to parenthood, attitudes towards health care professionals, and practical and financial concerns. The pregnancy transition was characterised by mixed emotions and conflicted experiences for fathers.

LIMITATIONS

Generalizability of review findings was limited by poor reporting of demographic information by many included studies, exclusion of studies not published in English, and focus on heterosexual relationships.

CONCLUSIONS

Expectant fathers may experience anxiety symptoms characterised by excessive worry across multiple domains of pregnancy-related concerns. Clinicians play an important role in identifying and supporting fathers with pregnancy-related anxiety and addressing the sense of exclusion often experienced by them.

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.

Association of adolescent and young adult depression and anxiety with perinatal mental health in fathers: Findings from an Australian longitudinal study

The current study examined associations between preconception diagnoses of major depressive disorder (MDD) and anxiety disorders in adolescence and young adulthood and perinatal depression and anxiety symptoms in early fatherhood. In an Australian community cohort study of health and development, earlier history of MDD and anxiety disorders (extending back to adolescence) were assessed retrospectively in the third trimester of pregnancy via the Composite International Diagnostic Interview. Paternal perinatal depression and anxiety were then assessed prospectively over three timepoints (third trimester of pregnancy, 8 weeks and 12 months postpartum), using established cut-points on the Edinburgh Postnatal Depression Scale and the Depression Anxiety Stress Scales (anxiety subscale). Mixed-effects regression models examined risk associations between preconception diagnoses of MDD and anxiety disorders, and perinatal depression and anxiety symptoms at each timepoint, adjusting for socio-demographic factors and concurrent maternal mental health difficulties. The odds of clinically concerning levels of paternal perinatal depression and anxiety were 6-fold and 4-fold higher, respectively, in men with a preconception history of MDD. The odds of perinatal depression were 3-fold higher in men with a preconception history of an anxiety disorder. Less evidence was found for an association between preconception diagnoses of an anxiety disorder and perinatal anxiety in fathers. Interventions aimed at improving mental health in men during adolescence and young adulthood may promote continued psychological health in men during early fatherhood.

How to support fathers of preterm infants in early parenthood - An integrative review

PROBLEM

Preterm birth is a stressful event. Paternal experiences of having a preterm infant indicate a need for tailored support. However, it is unclear which interventions work best. This review presents the evidence on existing healthcare interventions to support fathers of preterm infants in early parenthood, how effective they are and paternal experiences with the interventions.

ELIGIBILITY CRITERIA

The integrative review process of Whittemore and Knafl was used to guide the study. A structured and comprehensive literature search was conducted in PubMed (MEDLINE), Embase, CINAHL, PsycInfo, Cochrane, Scopus, Web of Science, SweMed+, and Proquest Dissertation & Thesis Global.

SAMPLE

A total of 18 qualitative and quantitative studies were included in the review. The Mixed Methods Appraisal Tool was used to assess quality.

RESULTS

Three overall themes were identified in the analysis: 1) Skin-to-skin contact supported interaction between infant and father, 2) information impacted paternal experiences of stress, anxiety, and development of fatherhood, 3) fathers' relationships with the nurses oscillated between conflict and assistance.

CONCLUSIONS

Our findings show that targeted interventions could support father-infant interaction and reduce stress among fathers of preterm infants.

IMPLICATIONS

Fathers of preterm infants rely on nurses to support their engagement in early parenthood, while nurses facilitate the interventions that engage the fathers. It is also essential to develop a culture within the neonatal intensive care unit that encourages the presence of fathers and enhances educational nursing strategies for supporting fathers of preterm infants during early parenthood.

Opinions of Non-English Speaking Fathers in the Antenatal and Delivery Room

This study investigated the demographic differences, newborn outcomes, and psychological experiences of English speaking (ES) and non-English speaking (NES) fathers in antenatal and delivery rooms. One thousand fathers completed antenatal and delivery questionnaires. Thirty-three percent of NES fathers were smokers, compared to 26% of ES fathers. NES fathers also reported significantly lower elective cesarean surgery rates. However, intrauterine growth restriction was significantly higher amongst the NES newborn cohort. Further, nursery admission of newborns born to NES fathers was more than double that of ES fathers. NES fathers self-reported more psychological symptoms after delivery than ES fathers (31% vs 19%). This study highlights the dual need for more research into NES perinatal experiences and change in pregnancy management for NES families.

Fathers' anxiety levels during early postpartum: A comparison study between first-time and multi-child fathers

BACKGROUND

The postnatal period is considered the most challenging period in the adjustment to fatherhood. This study aimed to assess anxiety levels among fathers during this period.

METHODS

A comparative study assessing the anxiety levels of first-time and multi-child fathers before the mother and child returned home (0-7 days after birth) was conducted. We used the French validation of the State-Trait Anxiety Inventory (STAI).

RESULTS

Among 235 fathers who were met at the maternity ward, 182 (77 %) responded to the questionnaire. For most fathers in both groups, anxiety levels were low or very low for trait anxiety (166/182, 91.21 %) and state anxiety (177/182, 97.25 %). Levels of state anxiety were statistically higher for first-time fathers compared to multi-child fathers but were mainly at a low or very low level (70/83 [84 %] versus 71/99 [71 %], respectively, p = 0.029). The multiple linear regression showed that "feeling prepared at birth time" was the only significantly (p < 0.001) associated factor with state anxiety among first-time fathers only.

LIMITATIONS

The validity and reliability of the STAI have been widely proven for the general population but not specifically for men during the postpartum period.

CONCLUSIONS

Most fathers had low to very low anxiety levels during the early postpartum period, suggesting that developing new specific support interventions is not needed during early postnatal care. Further research focusing on when the family is back home is warranted.

Paternal prevalence and risk factors for comorbid depression and anxiety across the first 2 years postpartum: A nationwide Canadian cohort study

OBJECTIVE

To determine the prevalence of comorbid depression and anxiety symptoms in fathers and investigate the predictors for comorbidity during the first- and second-year following birth.

METHODS

In a longitudinal Canadian study, couples were recruited within 3 weeks of childbirth. Fathers completed a survey after the birth of their child followed by questionnaires at 3, 6, 9, 12, 18, and 24 months postpartum on paternal depression and anxiety symptoms and potential risk factors. Sequential logistic regression was used for analysis.

RESULTS

Of the 3217 enrolled fathers, 2544 (79.08%) provided data for at least one time point during the first year postpartum and 2442 (75.29%) in the second year. Overall, 569 fathers (22.4%) had comorbid depression and anxiety symptoms at some point during the first year postpartum (2.2% at baseline to 8.9% at 6 months), and 323 fathers (13.2%) had comorbidity at some point during their second year postpartum (8.1% at 18 months and 8.6% at 24 months). Strongest risk factors associated with paternal comorbidity were poor or fair perceived health at 4 weeks postpartum, depression before pregnancy, anxiety in the current pregnancy, significant adverse childhood experiences, positive ADHD screen, and victim of intimate partner violence.

CONCLUSION

High rates of comorbidity among fathers in the first 2 years postpartum demonstrate the importance of perinatal mental health management at a family level. The identification of important modifiable comorbidity risk factors highlights areas for further research and the development of interventions to support paternal mental health to optimize child and family outcomes.

Prevalence and associated factors of paternal stress, anxiety, and depression symptoms in the early postnatal period

BACKGROUND

The changes experienced during the transition to first-time or subsequent fatherhood are mainly positive; however, fathers can also experience adverse mental health outcomes such as stress, anxiety, and depression. The aim of this study was to investigate the prevalence and associated factors of paternal stress, anxiety, and depression symptoms in the early postnatal period.

METHODS

A quantitative, descriptive correlational design was used. Data were collected using a self-administered questionnaire comprising of the Perceived Stress Scale, the State-Trait Anxiety Inventory, and the Edinburgh Postnatal Depression Scale.

RESULTS

A total of 336 fathers were included in the study. The prevalence rates were 41.1% (n = 138) for moderate/high stress symptoms, 20.8% (n = 70) for state anxiety symptoms, 25.9% (n = 87) for trait anxiety symptoms, and 13.4% (n = 45) for depression symptoms. In the multivariable analysis, several factors were associated with increased stress, anxiety, and depression symptoms including being a subsequent father (p = 0.009), not living in a house (p = 0.009), having a history of adverse mental health (p = 0.008), and having a partner with a history of anxiety (p = 0.040).

CONCLUSION

The findings suggest that fathers are at risk of adverse mental health in the early postnatal period which is a pivotal time for fathers in terms of bonding with their infant and redefining their relationship with their partner.

Placing myself in a new normalized life: The process of becoming a first-time father. A grounded theory study

Becoming a first-time father is an important transition period in men's lives that is frequently accompanied by joy and happiness. Engaging fathers has a broader impact on family and community and on fathers' own well-being. This study explores the process of men becoming first-time fathers and the experiences and challenges involved. Seventeen interviews with men in different stages of pregnancy, childbirth, and the postpartum period were conducted. Through a grounded theory design, a novel four-stage theoretical model emerged that represents the journey to first-time fatherhood. These stages are beginning the journey, fatherhood in limbo, facing reality, and settling down. Participants suggested that achieving a new normality was the final stage where they finally felt located with a sense of mastery in their journey to fatherhood. The novel theoretical approach of addressing the process of men's transition allowed more complete access to their perspectives. Men's needs are different at every phase of the transition to fatherhood, and the use of these findings can help care providers in caring for every man according to the stage he is facing.

The roots of paternal depression: Experienced and nonexperienced trauma or Folie a Deux?

The transition to fatherhood may be challenged with anxiety and trepidation. A high prevalence has been found for paternal depression and it is reactive to maternal depression. This review aims to address potential sources of paternal depression, which may have adverse consequences on child development. We describe through three hypotheses how fathers may be at risk of depression during the transition to fatherhood: (1) psychological (interacting with ecological systems); (2) brain functional∖structural changes; and (3) (epi)genomic. We propose that paternal stressful experiences during the transition to fatherhood may be the source for paternal depression through direct stressful paternal experiences or via (potential, currently debated) nonexperienced (by the father) epigenomic transgenerational transmission. On the other hand, we suggest that resilient fathers may undergo a transient dysphoric period affected by identifying with the newborn's vulnerability as well as with the mother's postpartum vulnerability resulting in "paternity blues." In accordance with recent views on paternal "heightened sensitivity" toward the infant, we propose that the identification of both parents with the vulnerability of the newborn creates a sensitive period of Folie a Deux (shared madness) which may be a healthy transient, albeit a quasi-pathological period, recruited by the orienting response of the newborn for survival.

Fathers' Involvement in Early Childcare is Associated with Amygdala Resting-State Connectivity

Becoming a parent requires new skills and frequent task switching during daily childcare. Little is known about the paternal brain during the transition to fatherhood. The present study examined intrinsic neuronal network connectivity in a group of first-time expectant and new fathers (total N = 131) using amygdala seed-based resting-state functional connectivity analysis. Furthermore, we examined the association between paternal involvement (i.e. hours spent in childcare and real-time push notifications on smartphone) and connectivity within the parental brain network in new fathers. There were no significant differences in functional connectivity between expectant and new fathers. However, results show that in new fathers, time spent in childcare was positively related to amygdala connectivity with the supramarginal gyrus, postcentral gyrus and the superior parietal lobule—all regions within the cognition/mentalizing network that have been associated with empathy and social cognition. Our results suggest that fathers’ time investment in childcare is related to connectivity networks in the parental brain.

Father-child bonding and mental health in gay fathers using cross-border surrogacy during the COVID-19 pandemic

RESEARCH QUESTION

What are the psychological implications of the COVID-19 pandemic for father-child bonding and mental health among Italian gay fathers pursuing surrogacy in the USA or Canada?

DESIGN

Between 20 March and 29 July 2020, this cross-sectional case-control study collected data on father-child bonding quality, depression, anxiety and somatization in 30 Italian gay fathers (n=15 families) who were having or successfully had a child through cross-border surrogacy during the COVID-19 pandemic. These fathers were compared with a sociodemographically similar group of 50 Italian gay fathers (n=25 families) who had children through cross-border surrogacy prior to the pandemic.

RESULTS

Although father-child bonding quality and the mental health symptoms of fathers scored below the clinical cut-off points in both groups, fathers who had or were having a child during the COVID-19 pandemic reported poorer father-child bonding (estimate 3.04, SE 1.47, P=0.044) and more depressive (estimate -1.47, SE 0.49, P=0.005), anxious (estimate -1.96, SE 0.55, P<0.001) and somatic symptoms (estimate -2.48, SE 0.52, P<0.001).

CONCLUSIONS

The findings call for the development of international guidelines for cross-border surrogacy and underline the need for tailored and ongoing psychological and legal support for intended gay fathers to ease their strain and anxiety related to having a child through cross-border surrogacy during the COVID-19 pandemic.

The effect of counseling on fathers' stress and anxiety during pregnancy: a randomized controlled clinical trial

BACKGROUND

Pregnancy is a challenging period for mothers and fathers. This study aimed to investigate the effect of counseling on stress and anxiety levels of fathers.

METHODS

This randomized controlled trial was conducted on 102 spouses of pregnant women in Ardabil, Iran. The participants were randomly assigned to intervention and control groups. The intervention group attended four 60-min counseling sessions at weekly intervals. The perceived stress and anxiety questionnaires were completed before and 4 weeks after the intervention.

RESULTS

The mean scores of state anxiety in the intervention group decreased significantly 4 weeks after the intervention compared with the control group (MD: -2.4; 95%CI: - 4.7 to - 0.2; p = 0.030). Four weeks after the intervention, no significant difference was found between the two groups in terms of trait anxiety (p = 0.472) and perceived stress (p = 0.635).

CONCLUSIONS

The findings indicate that counseling reduced state anxiety in expectant fathers; therefore, this intervention is recommended to be used to reduce fathers' anxiety.

TRIAL REGISTRATION

IRCT2017042910324N38 . Registered 25 June 2017.

Parents' Experiences of Receiving Professional Support Through Extended Home Visits During Pregnancy and Early Childhood-A Phenomenographic Study

Background: While becoming a parent can be challenging for all, it can particularly be challenging for those parents and children who are in a vulnerable situation—e.g., in families whose members have problems related to health, relationships, or socioeconomic status. It is essential for health care professionals to identify the more vulnerable families at an early stage. Home visits are one cost-effective way of identifying and supporting such families. This study describes the parental experiences of an intervention that involves professional support in the form of extended home visits. The aim of the study is to describe the parents' understanding of their experiences of receiving professional support through extended home visits both during pregnancy and the first 15 months of their child's life.

Methods/Design: A phenomenographic approach was used. Semi-structured interviews were conducted with 12 parents who had received the intervention. The interviews were analyzed using the seven-step phenomenography model described by Sjöström and Dahlgren.

Results: The following three descriptive categories emerged from the analysis: (1) conceptions concerning the meaning of the physical environment, (2) conceptions concerning extended home visits promoting feelings of self-confidence in the parental role, and (3) conceptions concerning extended home visits promoting parental participation and relations.

Conclusion and Clinical Implications: Extended home visits as a form of professional support appear to promote parental self-confidence in parenting ability, giving parents a feeling of security that facilitates conversation with professionals. Children and their entire families had natural roles during home visits, which allowed the children to behave more characteristically. Furthermore, the home visits were understood to facilitate social support through social activities at the child health center as well as integration into Swedish society for migrant parents. Professional support should be adjusted to the unique individual needs of parents, which demands a variety of supportive interventions—for example, reorganizing one or two of the regular clinical visits currently being scheduled as home visits instead.

The Experiences of First-Time Fathers in Perinatal Services: Present but Invisible

Fathers in the UK are becoming more involved in the care of their infants and children. A constructivist grounded theory approach was adopted to explore men’s transition to fatherhood. This paper reports on one of the sub-categories derived from the data. First-time fathers with a child under two were recruited predominantly via social media. Audio-recorded semi-structured interviews were undertaken with an opening question asking men to tell their story of becoming a father. Interviews were transcribed and analysed using constructivist grounded theory methods. This paper reports one core aspect of the research findings which has particular relevance for healthcare professionals. The men in this study were highly appreciative of the care their partner and baby received but consistently reported a lack of father-specific support throughout their journey to fatherhood. This ranged from generally poor communication with healthcare professionals to being ignored and side-lined in maternity settings where they continued to be treated as visitors before, during and after the birth of their baby. Despite similar findings being reported over the last 30 to 40 years and policy directives emphasising the importance of working with fathers, change within healthcare services remains slow. Currently, fathers’ needs are not being adequately met by perinatal services.

Predictive and Incremental Validity of Parental Representations During Pregnancy on Child Attachment

Parental pre-natal representations predict the interactive patterns that parents will put in place after childbirth. Early interactions defined by high parental emotional availability (EA) influence the development of security in children. To date, research on the predictive role of parental pre-natal representations on child attachment is still poor. Moreover, investigations on pre-natal representations have mainly focused on mothers. This study aimed at: investigating the criterion validity of the Interview of Maternal Representations During Pregnancy-Revised (IRMAG-R) and of the Interview of Paternal Representations During Pregnancy (IRPAG), using EA, parental attachment, and child attachment toward both parents, as criteria; testing the incremental validity of the IRMAG-R and IRPAG in the prediction of child attachment, controlling for other covariates, such as depressive and anxious levels during pregnancy, EA, and parental attachment; evaluating the possible mediation role of EA on the relationship between parental representations during pregnancy and child attachment. Fifty couples of primiparous parents were recruited during pregnancy, when the IRMAG-R and IRPAG were administered to mothers and fathers. At 6–9 months after childbirth, the mother–child and father–child interactions were coded by means of the EA Scales (EAS). At 14–18 after childbirth, the Adult Attachment Interview (AAI) was administered to parents, and the Strange Situation Procedure (SSP) was carried out to assess children's attachment toward mothers and fathers, respectively. The results showed significant correlations between parental pre-natal representations and EA, parental attachment and child attachment. As regards the prediction of child attachment, the IRMAG-R/IRPAG categories showed: a significant and large unique contribution for maternal representations; a close to be significant contribution for paternal representations (with a higher effect size for mothers than fathers). Moreover, while the indirect effect of pre-natal representations in the prediction of child attachment was not significant for mothers, it was instead significant for fathers. The results of this study confirmed the criterion validity of the IRMAG-R and IRPAG, and supported the incremental validity of the IRMAG-R and IRPAG in the prediction of children's attachment categories. Finally, the mediation models revealed that EA did not mediate the relationship between maternal pre-natal representations and child attachment, while it totally mediated the relationship between paternal pre-natal representations and child attachment.

Spouse's participation in perinatal care: a qualitative study

Background

Pregnancy is one of the most important periods of any woman’s life, wherein the support of her relatives, especially her spouse, enables her to tolerate the difficulties with good memories. However, in Iran, there are very few studies on the participation of spouses in the perinatal period. Therefore, the present study aimed to explain the concept of spouse participation in perinatal care.

Methods

This is a qualitative study that was carried out in 2018 on spouse participation in perinatal care in Qom, Iran. Purposive sampling from pregnant or postpartum women, spouses, midwifery care providers, and key informants was performed according to study inclusion criteria. Semi-structured in-depth interviews were carried out until the data saturation was met. Also, the data analysis was performed based on a conventional content analysis approach according to Graneheim & Lundman steps using MAXQDA software (v.10). Five Guba and Lincoln criteria were applied to ensure the trustworthiness of data.

Results

Fifty-three final codes were classified into 18 sub-categories, 7 categories, and 3 themes including empathy (emotional and cognitive understanding), accountability (supporting, position management, compassion), and consequences (help improvement of family function, improvement of maternal-neonatal health).

Conclusions

Based on the findings of this study, the concept of men’s participation in this period has been defined as a set of empathic and responsive behaviors that can lead to improvement of the family function and mother and baby health.

Association of smoking behavior among Chinese expectant fathers and smoking abstinence after their partner becomes pregnant: a cross-sectional study

Background

Exposure to secondhand smoke (SHS) during pregnancy can cause pregnancy complications and adverse birth outcomes. About 40% of Chinese expectant fathers are smokers and they rarely attempt to quit smoking. There is a paucity of effective smoking cessation services targeting this population. In this study, we assessed the smoking behavior of Chinese expectant fathers and examined its association with smoking abstinence after their partner became pregnant, which is an essential prerequisite for designing effective smoking cessation interventions.

Methods

We conducted a cross-sectional survey in the obstetrics and gynecology clinic of three tertiary hospitals in China. Expectant fathers who smoked at least one cigarette per day for 1 month within the past 12 months were invited to participate in this study. The participants were asked to complete a structured questionnaire that assessed their smoking behaviors before and after their partner became pregnant.

Results

From December 2017 to March 2018, we recruited a total of 466 eligible expectant fathers, among whom 323 (69.3%) were identified as current smokers and 143 (30.7%) were ex-smokers. Using lasso regression, 19 features were selected from among 27 independent variables. The results of the selected multivariable logistic regression model showed that knowledge about the health hazards of smoking among smokers (odds ratio (OR) 1.39; 95% confidence interval (CI) 1.24 to 1.58; p < 0.001), knowledge about the health hazards of SHS to pregnant women (OR 1.46; 95% CI 1.09 to 1.97; p < 0.001), knowledge about harm to the fetus and newborn (OR 1.58; 95% CI 1.25 to 2.03; p < 0.001), and being a first-time expectant father (OR 2.08; 95% CI 1.02 to 3.85; p = 0.046) were significantly positively associated with smoking abstinence among expectant fathers after their partner became pregnant. Significantly negative associations were found for severe dysfunctionality in terms of family support (OR 0.48; 95% CI 0.24 to 0.95; p = 0.036) and smoking only outside the home (OR 0.81; 95% CI 0.26 to 0.98; p < 0.001).

Conclusions

In this study, we identified several factors associated with smoking abstinence among expectant fathers after their partner became pregnant. These findings can guide the development of effective interventions targeting expectant fathers, to help them quit smoking.

Antecedents of fathers' perception of child behavior at child age 12 months

This study investigates whether fathers' adverse childhood experiences (ACE) and attachment style reported during pregnancy predict fathers' perception of child behavior assessed 12 months postpartum, expressed by the Parenting Stress Index (PSI), Child Domain. Prospective fathers (N = 835) were recruited to "The Little in Norway (LiN) study" (Moe & Smith) at nine well-baby clinics in Norway, with data collection composed of five time points during pregnancy and two time points postpartum (6 and 12 months). The main analyses included linear regression, path-analysis modeling, and intraclass correlation based on mixed effects modeling. First, linear regression analyses showed that neither fathers' ACE nor attachment style significantly predicted perceived child behavior postpartum directly. Furthermore, path analyses showed that ACE and less secure attachment style (especially avoidant attachment) measured early in pregnancy strongly predicted negatively perceived child behavior, mediated by fathers' mental health symptoms during pregnancy and partner disharmony postpartum. Second, intraclass correlation analyses showed that fathers' perceived child behavior showed substantial stability between 6 and 12 months postpartum. Family interventions beginning in pregnancy may be most beneficial given that fathers' early experiences and perceptions of attachment in pregnancy were associated with later partner disharmony and stress.

Transformation of attitude through brief psychoeducation program for the husbands of women with postpartum psychiatric disorders

According to existing literature on Perinatal Psychiatric Services, husbands have not often been involved in the treatment of their spouses with Perinatal Psychiatric disorders, especially in India, despite the advantages as an adjunctive form of therapy. The current study aimed at evaluating the effectiveness of brief psychoeducation on the attitude of husbands of women with postpartum psychiatric disorder through a biopsychosocial based informative and supportive model of intervention. A 3 session based Brief Psychoeducation Program (BPP) was developed for the targeted population and its effectiveness was evaluated through quasi-experimental research design. Using Community Attitude towards Mentally Ill Scale (CAMI) assessment of the outcome variable was done at 3 levels i.e., Pre (baseline), Post (immediately after the intervention) and Follow-up post (1 month after the intervention). A total of 21 participants were recruited meeting the study criteria. Friedmans test and descriptive statistics were used to analyze the data. Results indicated the transformation in the attitude of the participants in all the 4 domains of the scale from pre-intervention to post-intervention phase. The study has a strong implication for mental health professionals in this area at both clinical (medical and psychiatry settings) and nonclinical settings.

Hindering resilience in the transition to parenthood: a thematic analysis of parents' perspectives

OBJECTIVE

Investigate parents' recollections of resilience hindering experiences in the first year of parenthood.

BACKGROUND

The transition to parenthood is a significant period of change in the lifespan. Understanding the factors which undermine resilience during this process will help illuminate resilience theory and provision of perinatal support.

METHODS

We conducted a thematic analysis of in-depth interviews with 10 parents (including four fathers) and examined factors hindering resilience as a global theme within a broader thematic network.

RESULTS

We identified two organising themes; context which related to external experiences and relationships and appraisals which related to parents' internal attributions and experiences. We refined these organising themes into 24 specific resilience hindering factors including ambivalence about parenthood, fear of judgement, compromised self-care and relationship change. We also collated parents' suggested changes to structural supports such as providing a comprehensive overview of services available to new parents, having credible resources online, engaging fathers directly in perinatal care and a greater focus on postnatal support such as prioritising continuity of care and making longer hospital stays available.

CONCLUSION

Our work illuminates parents' own thoughts about factors hindering resilience in the transition to parenthood and provides direct recommendations from consumers about improvements to provision of support throughout this critical period.

Parenting Outcomes and Predictors of Parenting Satisfaction in the Early Postpartum Period

This study examined the relationships among parenting self-efficacy (PSE), social support, postnatal depression (PND), and predictors of parenting satisfaction in the early postpartum period using a cross-sectional exploratory quantitative design. The hypothetical model was tested among interrelated concepts of outcome variables among 250 parents (125 couples). The structural equation model revealed an adequate fit between the hypothesized model and the data. PSE and spousal support were found to be predictors of parenting satisfaction. PSE was also found to be a predictor of social support. PND was not found to be a predictor of parenting satisfaction. None of the obstetric and demographic factors predicted parenting satisfaction. This is the first study that tested interrelations among crucial parenting outcome variables among fathers and mothers in the early postpartum period. It is important to assess interrelated parenting outcomes among both parents so that support can be provided to ultimately influence parenting satisfaction.

Improving Perinatal Care Through Theory Application

Theories from various perspectives can increase nurses' understanding of maternal behaviors throughout the developmental process of pregnancy and postpartum. The purpose of this article is to present relevant theories that maternity nurses will likely find useful, and to demonstrate their applicability through an unfolding exemplar case. Nurses can provide improved and more sensitive care when guided by psychosocial theories such as Rubin's tasks of pregnancy, prenatal attachment, pregnancy as a liminal phase, and the grief work in postpartum as proposed by Mercer. Use of relevant theories can promote holistic nursing care, increase critical thinking, and improve nursing responsiveness to unique family situations such as pregnancy after loss and premature birth.

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.

Men's experience of first fatherhood discovery: a descriptive study based on free hierarchical evocation by associative networks

Objective and Background: Men's experiences of first-fatherhood discovery differ widely with various circumstances; they were examined according to the intended/unintended occurrence of partner's pregnancy.Methods: An Associative Network study targeted 44 first-time fathers and analysed their reactions to a stimulus-sentence 'In the first days after pregnancy announcement … 'Results: Word-associations formed 19 themes and 5 metathemes. The main metathemes were Emotional (30%), Cognitive (27%) and Relational (23%). Negative emotions were more frequent in unintended vs. intended pregnancies. Subthemes Chock, Feeling of unreality, Emotion control, Guilt, Denial, or Regret prevailed in unintended pregnancies. The major theme in all pregnancies was Personal advancement but subthemes Physical and psychological preparation and Responsibility prevailed in intended pregnancies vs. Acceptation and Personal progress in unintended pregnancies. Themes Relationships (with partner and others) were more frequently mentioned in unintended pregnancies vs. theme Logistics in intended pregnancies. Overall, the participants expressed opposed conflicting emotions but a desire for real involvement in pregnancy, birth, and child-raising.Conclusion: The participants proved interested and concerned. Fathers's presence and support should be solicited, accounted for, and valued by mothers-to-be and health professionals in all pregnancies. Involving fathers since pregnancy is essential for mental equilibrium, child-parent attachment, child and parent development, and family relationships.

Vasopressin and parental expressed emotion in the transition to fatherhood

In the last decades, parenting researchers increasingly focused on the role of fathers in child development. However, it is still largely unknown which factors contribute to fathers' beliefs about their child, which may be crucial in the transition to fatherhood. In the current randomized within-subject experiment, the effect of nasal administration of vasopressin (AVP) on both Five Minute Speech Sample-based (FMSS) expressed emotion and emotional content or prosody was explored in 25 prospectivefathers. Moreover, we explored how the transition to fatherhood affected these FMSS-based parameters, using prenatal and early postnatal measurements. Analyses revealed that FMSS-based expressed emotion and emotional content were correlated, but not affected by prenatal AVP administration. However,child's birth was associated with an increase in positivity and a decrease in emotional prosody, suggesting that the child's birth is more influential with regard to paternal thoughts and feelings than prenatal AVP administration.

Manifestation and Associated Factors of Pregnancy-Related Worries in Expectant Fathers

Background: During the last decades, fathers have increasingly participated in prenatal care, birth preparation classes, and childbirth. However, comparably little is known about the prenatal emotional well-being of fathers, particularly content and extent of broader paternal concerns that may arise during pregnancy beyond those focusing on childbirth. Thus, the aims of this study were to investigate the manifestation of paternal pregnancy-related worries in a population-based sample and to identify relevant associated factors. Materials and Methods: As part of a longitudinal pregnancy cohort at the University Medical Center Hamburg-Eppendorf, Germany, N = 129 expectant fathers were assessed once during pregnancy. Pregnancy-related worries centering around medical procedures, childbirth, health of the baby, as well as socioeconomic aspects were assessed with the Cambridge Worry Scale (CWS). Additionally, paternal socioeconomic background and maternal obstetrical history, symptoms of generalized anxiety and depression, and level of hostility were investigated, as well as perceived social support. The cross-sectional data were analyzed based on multiple regression analyses. Results: The level of reported worries was overall low. Some fathers reported major worries for individual aspects like the health of a significant other (10.9%) and the baby (10.1%), as well as the current financial (6.2%) and employment situation (8.5%). Pregnancy-related worries were negatively associated with household income and positively associated with anxious and depressive symptoms and low perceived social support. Associations varied for specific pregnancy-related worries. Limitations: Due to the cross-sectional data examined in this study, a causal interpretation of the results is not possible. The sample was rather homogeneous regarding its socioeconomic background. More research needs to be done in larger, more heterogeneous samples. Conclusion: Though overall worries were rather low in this sample, specific major worries could be identified. Hence, addressing those fathers reporting major worries regarding specific aspects already in prenatal care might support their psychosocial adjustment. Fathers with little income, those with elevated levels of general anxious and depressive symptoms, and those with less social support reported higher pregnancy-related worries. Our results indicate the relevance of concerns beyond health- and birth-related aspects that could be relevant for fathers. Measurements developed specifically for expectant fathers are needed to properly capture their perspective already during pregnancy.

Parenting stress and its correlates in an infant mental health unit: a cross-sectional study

Background: An infant's development is closely linked to the relationship they have with their parents. Parenting stress, affective disorder, and an upbringing with substance-abusing parents can affect parenting quality and increase the risk of children developing behavioral, mental and social problems. The overall aim of the study was to investigate how parents of children attending an outpatient Infant Mental Health (IMH) unit rate their own psychological health and parenting stress, and to explore predictors of parenting stress.Methods: The sample comprised 197 parents, 129 mothers and 68 fathers, referred with their infant/toddler to an outpatient IMH unit for interplay treatment. On admission, the parents completed self-report questionnaires concerning their own mental health problems and parenting stress.Results: The mothers reported significantly more psychiatric symptoms and parenting stress than the fathers. Fathers with substance-abusing parents had often experienced divorce in the family of origin, had a low level of education, and had often experienced trauma. Depression was a predictor for parenting stress for both mothers and fathers.Conclusion: The parents' situation was strained, presenting a variety of psychiatric symptoms and high levels of parenting stress, making assessment of parental health before starting treatment important. The mothers' situations were more serious compared with the fathers', and for both parents depression was a significant predictor for parenting stress. To increase the chances of a positive treatment outcome for the child, both parents should be included in the treatment.

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.

Couples' prenatal bonding to the fetus and the association with one's own and partner's emotional well-being and adult romantic attachment style

OBJECTIVE

Developing an emotional bond to the fetus is a highly relevant task for both parents. However, research on the influence of emotional well-being and relationship dynamics on parental-fetal bonding is limited, especially regarding the paternal experience. Additionally, the roles of prenatal anxiety and hostility in parental bonding need further investigation. The aim of this study was to investigate the importance of one's own anxiety and hostility, adult romantic attachment style and one's partner's anxiety and hostility for parental-fetal bonding quality and intensity.

DESIGN

Data were assessed cross-sectionally and analyzed using linear regression models.

SETTING

The study took place at the University Medical Center Hamburg-Eppendorf, Germany.

PARTICIPANTS

Ninety-three pregnant women and their partners (total n = 186).

MEASUREMENTS AND FINDINGS

Participants completed questionnaires in mid to late pregnancy. For mothers, higher levels of hostility and attachment-related avoidance were associated with lower bonding quality. Unexpectedly, higher levels of partner hostility were associated with higher bonding quality. Fathers with higher attachment-related avoidance reported lower bonding intensity. Neither maternal bonding intensity nor paternal bonding quality was associated with the predictor variables.

KEY CONCLUSION

Prenatal bonding is individually influenced by emotional well-being and romantic attachment styles, with different effects in mothers and fathers.

IMPLICATIONS FOR PRACTICE

Potential negative emotional states and couple dynamics in the peripartum period should be addressed in prenatal care. Birth preparation classes might be an ideal context to generally inform parents about these topics. Distressed parents might benefit from interdisciplinary support focusing on perinatal mental health and parental-fetal bonding.

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.

Reproductive justice and support for young fathers

The current article addresses the interests and contributions of fathers to child development and well-being within a reproductive and social justice framework. We present an overview of research on the role of fathers in the lives of children from the prenatal period through early childhood, with an emphasis on fathers as partners and caregivers in promoting the reproductive health and safety of women and the healthy development of young children. We explore especially the challenges of young, at-risk fathers as well as system and practice opportunities that support their contributions as partners and parents. Our goal of the article is to extend the discourse on reproductive and social justice to include the shared responsibility of all parents and facilitate circumstances whereby children experience the support needed to become nurturing caregivers for the next generation.