When Fathers Begin to Falter: A Comprehensive Review on Paternal Perinatal Depression

Assessment of the validity and reliability of edinburgh postpartum depression scale in Turkish men

OBJECTIVES

Perinatal depression (PD) affects individuals during pregnancy and early parenthood, resembling major depression. Recent research highlights paternal perinatal depression (PPD) in fathers. PPD has adverse effects on fathers and their children. This study assesses the Turkish version of the Edinburgh Postnatal Depression Scale (EPDS) for Turkish fathers, aiming to provide a tool for PPD identification.

METHODS

This methodological study validates the EPDS for Turkish fathers and explores associations with demographic and psychosocial factors. The study involved 295 fathers with infants aged 2 weeks to 12 months. The EPDS, originally designed for perinatal depression and validated in Turkish women, was used. Fathers completed a participant information questionnaire, the EPDS, and the Beck Depression Inventory (BDI) during clinic visits. Data on sociodemographic factors, paternal roles, and pregnancy and postpartum support were collected. Mothers also completed the EPDS. Descriptive statistics, exploratory factor analysis, confirmatory factor analysis, and correlation tests were used.

RESULTS

The study included fathers with an average age of 30.5 years, mostly with a high school education or higher. The EPDS had a mean total score of 3.1. Factor analysis suggested a three-factor structure for the EPDS in Turkish fathers, including anhedonia, anxiety, and depression. Confirmatory factor analysis validated the three-factor structure, with acceptable model fit indices. Positive correlations were found between fathers' EPDS scores, maternal EPDS scores, and paternal BDI scores. The EPDS effectively discriminated between different levels of depression severity. Various factors, such as education level and lack of support during pregnancy and after childbirth, were associated with higher EPDS scores.

CONCLUSIONS

These findings emphasize the significance of assessing and addressing PPD in fathers, supporting the use of the EPDS as a valid tool in the Turkish context. The three-factor structure aligns with international research, highlighting the importance of a multi-dimensional approach to PPD assessment. Early intervention can mitigate PPD's impact on fathers, mothers, and children, benefiting mental health and well-being.

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.

An exploration of psychological and socio-cultural facets in perinatal distress of Pakistani couples: a triangulated qualitative study

The phenomenon of perinatal distress in terms of depression, anxiety, bipolar, and psychotic disorders is well-explored in the West but barely investigated in South Asia; particularly research evidence highlighting the cultural expression of couples' mental health with respect to Pakistan is rare. The purpose of this research is to focus on the exploration of psycho-socio-cultural expression of couples' perinatal distress and coping strategies used in the Pakistani context in relation to maternal and paternal mental health, with implications for the wellbeing of their unborn or born progeny. The research design focused on qualitative interpretative approaches. In data triangulation, reflexive thematic analysis and interpretative phenomenological analyses were applied on the verbatim of the semi-structured interviews conducted with the mental health professionals (n = 9) and the couples (n = 8), screened positive for perinatal distress. Four couples were screened out of 325 perinatal women visiting the gynaecological ward of Aziz Bhatti Shaheed Teaching Hospital, Gujrat. Edinburg Postnatal Depression Scale, Generalized Anxiety Disorder-7 and Washington Early Recognition Center Affectivity and Psychosis Screen are the standardized instruments considered to be used for screening perinatal distress among couples. The Urdu version of WERCAP Screen was developed by a standardized forward-backward translation procedure. The rest of the four couples were purposively selected from the psychiatric ward of the same hospital. The Simplified Negative and Positive Symptoms Interviews were administered to the couples after getting approval for the Urdu version form. All couples were probed with an indigenously developed Structured Clinical Interview Schedule for DSM Disorders based on DSM-5-TR. The triangulation carried out with reflexive thematic analysis and interpretative phenomenological analysis revealed cultural conception of perinatal distress as perceived by the mental health professionals and experienced by the couples during the antenatal and postnatal period of their lives. They were enlightened with a constructive view aimed at promoting transformational change in terms of their mental health care and coping. The implications suggested implementation of a psychotherapeutic intervention for reduction in the level of distress and subsequent enhancement of well-being in couples during the perinatal period.

Awe and Trepidation: The Role of Perinatal Care Providers in Black Fathers' Experiences of Childbirth in the U.S

Care provider communication with Black birthing families is impactful. This cross-sectional study asked 216 Black fathers to recall treatment by birthing care providers and tested variables contributing to birth satisfaction and fathering identity salience. Most fathers reported that care providers were respectful resulting in a positive birthing experience; however, 15% reported negative experiences with care providers. Perceived social support was shown to be a mediator between disrespect, mistreatment, inclusive communication, trust, and positive emotion with birth satisfaction and fathering identity salience. Care provider disrespect served as a "spoiler" of the birthing experience and subsequently diminished positive fathering identity salience. Analysis of open-ended comments showed that contrary to stereotypes about absent, disengaged Black fathers, fathers in this study were caring toward their newborns, present for them, and engaged in fathering. More work needs to be done with care provider communication to make every birth a positive and inclusive experience for Black fathers and their partners.

Paternal postnatal depression: prevalence and the associated demographic and maternal reproductive factors among Iranian fathers

BACKGROUND

Paternal postnatal depression (PPND) is a critical mental health issue that may harm family members' health and relationships. The Edinburgh Postpartum Depression Scale (EPDS) is the most common self-reported questionnaire for postnatal depression screening among mothers and fathers worldwide. However, identifying fathers with postnatal depression and determining the related factors have been neglected in some countries.

AIMS

The present study aimed to determine the prevalence of PPND and then to identify its predictive demographic and reproductive factors. Two cut-off points (10 and 12) for the EPDS were used to detect PPND.

METHODS

This cross-sectional study was conducted on 400 eligible fathers selected via multistage sampling. Data were collected using a demographic checklist and the EPDS.

RESULTS

None of the participants had previously been screened for PPND. The mean age of the participants was 35.53 ± 5.47 years, and most of them were self-employed and had university degrees. The prevalence of PPND was 24.5% and 16.3% using the EPDS cut-off scores 10 and 12, respectively. An unwanted pregnancy and an abortion history were the predictors of PPND at both EPDS cut-off scores, with gravidity and the number of abortions also being associated with PPND at the cut-off score of 10.

CONCLUSION

In line with the related literature, our results revealed a fairly high prevalence of PPND and its related factors. This indicates the need for a screening program for fathers during the postnatal period to detect and adequately manage PPND and prevent its adverse effects.

Effectiveness of online psychological interventions to prevent perinatal depression in fathers and non-birthing partners: A systematic review and meta-analysis of randomized controlled trials

Little is known about the effectiveness of online preventive interventions for paternal perinatal depression (PPD). This systematic review (SR) and meta-analysis (MA) of randomized controlled trials (RCTs) evaluated the effectiveness of online psychological interventions to prevent PPD in fathers and non-birthing partners. The PRISMA 2020 guidelines were followed. The search was conducted in eight electronic databases and other sources from inception to 12 May 2023. The pooled standardized mean difference (SMD) was computed using random-effect models. Seven RCTs were included in the SR and 6 were included in the MA, representing 1.042 fathers from five different countries. No trials focused on non-birthing partners were found. The pooled SMD was -0.258 [95 % confidence interval - 0.513 to -0.004; p < 0.047]. The heterogeneity was moderate (I2 = 51 %; 95%CI [0 % to 81 %]) and nonsignificant (p = 0.070). However, sensitivity analyses showed that the effectiveness was stable only when the fixed effect model and the Egger's g were used to estimate the pooled SMD. No publication bias was found. Only two RCTs had an overall low risk of bias assessed by using the Cochrane ROB 2.0 tool. The quality of evidence based on GRADE was very low. In conclusion, online psychological interventions may be effective for the prevention of PPD. More high-quality evidence is warranted.

Relationship between personality traits and postpartum depression in Pakistani fathers

The previous studies have found an association between Big Five personality traits and postpartum depression in women. The present study aimed to find out an association between Big Five personality traits and postpartum depression in a sample of Pakistani fathers. A total of 400 Pakistani fathers who had birth of a child in the past 1 month to 1 year period and had been living with their married partners were recruited purposively by using Google Form based survey from the major cities of Pakistan. The Urdu translated versions of Big Five Personality Inventory (BFI) and Edinburgh Postnatal Depression Scale (EPDS) were used as the main outcome measures to assess the relationship between personality traits and postpartum depression. The results found a significant negative and moderate association between Big Five personality traits and paternal postpartum depression except openness which had a weak association and neuroticism which had a positive and moderate association with PPPD (r(398) = .45). The multiple linear regression analysis found that Big Five personality traits significantly predicted paternal postpartum depression (F(5, 394) = 53.33, p = .001) except openness (B = .007, p = .98). The analysis of variance (ANOVA) found significant differences in paternal postpartum depression for age of father (F(2, 397) = 6.65, p = .001, ηp2 = .03), spouse age (F(2, 393) = 5.97, p = .003, ηp2 = .02), employment type (F(2, 395) = 9.69, p = .001, ηp2 = .04) and time spent at home (F(2, 397) = 6.23, p = .002, ηp2 = .03) while there were found no significant differences for education (F(2, 397) = 1.29, p = .27, ηp2 = .006), marital duration (F(2, 397) = 2.17, p = .11, ηp2 = .01), and birth number of recent child (F(2, 397) = 1.48, p = .22, ηp2 = .007). The study concluded that Big Five personality traits are significantly correlated with and predict paternal postpartum depression except openness which did not predict paternal postpartum depression. The occurrence of paternal postpartum depression varied significantly for age of father, age of spouse, type of employment and time spent at home.

Perception of Paternal Postpartum Depression among Healthcare Professionals: A Qualitative Study

The pathway to parenthood constitutes a fundamental and transformative stage in every individual's life. While postpartum depression in mothers has been increasingly studied and acknowledged, paternal postpartum depression (PPD) has garnered only moderate research attention. This study aims to delve into the comprehension and knowledge of healthcare professionals who may encounter men suffering from postpartum depression. Within the framework of this qualitative research, we conducted six semi-structured interviews with various healthcare professionals. The data were subjected to interpretative phenomenological analysis, revealing the following themes: (1) the professionals' uncertainty in the face of paternal PPD; (2) the context and timing of healthcare professionals' involvement appeared unsuited for detecting paternal PPD; (3) the experiences of fathers were found not to be shared with healthcare professionals due to their inhibitions and avoidance reactions; (4) the social representation of the role of fathers influenced professionals in their considerations of this aspect. Strengthening the training and confidence of healthcare professionals in France would lead to an enhancement in the screening and management of paternal PPD. Additionally, the healthcare system should better organize postnatal support to enable caregivers to be more available during the peak of depression occurrence.

"What Can I Do to Not Have This Life"? A Qualitative Study of Paternal Postnatal Depression Experiences among Fathers in the United Kingdom

Understandings of paternal postnatal depression (PND) in fathers from the United Kingdom (UK) have received limited attention, particularly in view of changing dynamics of contemporary parenthood. To rectify this, eight UK fathers with PND took part in one-to-one interviews, with Interpretative Phenomenological Analysis used to understand their lived experiences. Our findings demonstrate that UK fathers with PND experienced extremely distressing emotions, including anger and misery, after their babies are born. Their working practices were highly relevant to their fatherhood, with working considered a key responsibility and a source of stress, but also a "legitimate" escape from the home. Fathers' relationships with their partners were experienced as less intimate and conflicted. Fathers often hid their feelings to protect their partners, but also reported their partners as being aware of their challenging and difficult emotions. Healthcare providers should be professionally curious about fathers' mental health and consider the assistance of mothers in identifying cases of paternal PND.

Feasibility and acceptability of an online mental health intervention for pregnant women and their partners: a mixed method study with a pilot randomized control trial

BACKGROUND

Untreated perinatal mood and anxiety disorders (PMAD) have short- and long-term health and social consequences; online cognitive behavioral therapy (CBT) interventions can reduce symptoms. Despite partner support being protective online interventions rarely target couples. This study builds on research on an existing CBT-based intervention, the Mothers and Babies Online Course (eMB), by testing its feasibility with prenatal couples.

METHODS

We conducted a pilot, randomized, controlled feasibility trial using a 1:1 parallel design. To be eligible, participant dyads were pregnant people (between 13-30 weeks gestation and with a score of 10 or greater on either the GAD-7 or PHQ-9 scale indicating elevated symptoms of anxiety or depression) and their cohabitating partners, living in Missouri, with access to the internet; both in the dyad consented to participate. Recruitment occurred via Facebook ads, flyers, and a snowball approach. The intervention group received eMB, and the control group received a list of community resources. We examined retention and adherence data extracted from eMB analytics and study databases. All participants were given depression and anxiety scales at baseline, 4 and 8 weeks to test preliminary efficacy; satisfaction and acceptability were measured at trial end (i.e., eight weeks) and via interview.

RESULTS

There were 441 people who responded to recruitment materials, 74 pregnant people were screened; 19 partners did not complete enrolment, and 25 dyads were ineligible. There were 15 dyads per group (N = 30) who enrolled; all completed the study. The survey response rate was 90% but partners required nearly twice the number of reminders. No participant completed all lessons. Mean depression and anxiety scores dropped over time for dyads in control (M = -1.99, -1.53) and intervention (M = -4.80, -1.99). Intervention pregnant people's anxiety significantly decreased (M = -4.05; 95% CI [0.82, 7.27]) at time two compared to control. Twelve pregnant people and four partners participated in post-intervention interviews and suggested improvements for eMB.

CONCLUSION

Online dyadic interventions can potentially reduce PMAD symptoms. However, to feasibly study eMB with couples, strategies to increase program adherence are necessary. Tailoring interventions to overtly include partners may be advantageous.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05867680, 19/05/2023.

Paternal peripartum depression: emerging issues and questions on prevention, diagnosis and treatment. A consensus report from the cost action Riseup-PPD

INTRODUCTION

Paternal peripartum depression (P-PPD) is a serious and understudied public health problem associated with impaired family functioning and child development. The lack of recognition of P-PPD may result in limited access to both information and professional help.

OBJECTIVE

The aim of the study was to review studies on paternal peripartum depression and to identify issues and questions where future research and theory formation are needed.

METHODS

A literature search for systematic reviews, meta-analyses and primary studies was conducted using PubMed, Web of Science, Embase, Scopus, Medline, PsychInfo and Informit databases. Key results within the retrieved articles were summarised and integrated to address the review objectives.

RESULTS

Based on the literature, the knowledge related to prevalence, screening, risk factorsunique to fathers, management strategies and outcomes of P-PPD is lacking. Currently, there is no consensual understanding of the definition of P-PPD and recommendations for dealing with P-PPD. Limited data were available regarding the barriers preventing fathers from accessing support systems.

CONCLUSION

Emerging issues that need to be addressed in future research include: P-PPD definition and pathogenetic pathways; prevention strategies and assessment tools; self-help seeking and engagement with interventions; the cost-effectiveness of P-PPD management; needs of health professionals; effect on child development, and public awareness. Future studies and clinical practice should account the complexities that may arise from the father's perceptions of health care services. Results from this review highlights the critical issues on how to plan, provide and resource health services, to meet the health needs of fathers.

[Fathers, patients in mother and baby unit? Thinking about family-based approach in perinatal care]

BACKGROUND

The perinatal period is a psychic risk for fathers because of multiple overhauls. Fathers' place in perinatal medicine has evolved these last few years but continues to be poorly limited. These psychic difficulties are barely investigated and diagnosed in everyday medical practice. The prevalence of depressive episodes by new fathers was high in the most recent research studies. This thus is a public health problem with consequences on the family system both in the short and the long-term.

REVIEW

In the mother and baby unit, the father's psychiatric care is often secondary. But with societal modifications, there is the question of impact of separation between the father and the mother and the baby. With the family based approach, care by the father is indispensable for the care of the mother, baby, and the family's as a whole.

OBJECTIVE

In our mother and baby unit located in Paris, fathers were also hospitalized as patients. Therefore difficulties in the familial dynamic, between each member of the triad and mental health difficulties of fathers were able to be treated.

CONCLUSION

Following the hospitalization of a few triads with a positive evolution, a reflection process is now in progress.

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

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

[Fatherhood in the mother-baby unit: the experience of the Panda unit]

Mother-baby units offer a care environment that is conducive to better care for fathers. However, these units still need to evolve in terms of organization and attitude to care. The systematic use of pre- and postnatal interviews is an interesting approach to consider.

An App to Support Fathers' Mental Health and Well-Being: User-Centered Development Study

BACKGROUND

Numerous studies describe the popularity and usefulness of parenting programs. In particular, parenting programs are generally viewed as effective for supporting parents' mental well-being during key transition periods. However, the evidence base for fathers is limited owing to their lack of involvement in parenting programs and scarcity of tailored support.

OBJECTIVE

This paper aimed to describe the co-design process for a universal digital intervention for fathers (fatherli) and the outline of a logic model with its expected outcomes.

METHODS

Following established guidelines for co-designing and developing complex interventions, we conducted a nonsystematic review of the available literature to gather key information, developed market surveys to assess fathers' needs and interests, consulted with key stakeholders to obtain expert opinions, and engaged in a rapid iterative prototyping process with app developers. Each step was summarized, and the information was collated and integrated to inform a logic model and the features of the resulting intervention.

RESULTS

The steps in the co-design process confirmed a need for and interest in a digital intervention for fathers. In response to this finding, fatherli was developed, consisting of 5 key features: a discussion forum for anyone to post information about various topics (the forum), a socializing platform for fathers to create and engage with others in small groups about topics or points of shared interest (dad hub), a tool for fathers to find other fathers with shared interests or within the same geographic location (dad finder), a resource for fathers to access up-to-date information about topics that interest them (dad wiki), and a portal to book sessions with coaches who specialize in different topics (dad coaching space). The evidence-based logic model proposes that if fatherli is successfully implemented, important outcomes such as increased parental efficacy and mental health help-seeking behaviors may be observed.

CONCLUSIONS

We documented the co-design and development process of fatherli, which confirmed that it is possible to use input from end users and experts, integrated with theory and research evidence, to create suitable digital well-being interventions for fathers. In general, the key findings suggest that an app that facilitates connection, communication, and psychoeducation may appeal to fathers. Further studies will now focus on acceptability, feasibility, and effectiveness. Feedback gathered during pilot-testing will inform any further developments in the app to increase its applicability to fathers and its usability.

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

Objective

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

Methods

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

Results

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

Conclusion

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

An exploration of masculinity, social support and depression in new and experienced fathers

OBJECTIVE

This study aimed to explore the relationship between masculinity, perceived social support and depression symptomology in the postpartum period in new and experienced fathers.

DESIGN

Cross-sectional questionnaire study.

PARTICIPANTS

A total of 118 first- and second-time fathers (N = 48) of infants aged under 12-months, currently residing in the United Kingdom.

MEASUREMENTS AND FINDINGS

Questionnaires consisted of the Edinburgh Postnatal Depression Scale, the Conformity to Masculine Norms Inventory, and the Multidimensional Scale of Perceived Social Support. Data were analysed through inferential statistics.

KEY CONCLUSIONS

Masculine norms of self-reliance and primacy of work were positively related to depression symptomology in both father groups. Perceived social support was negatively related to depression symptomology. Further analyses revealed significant effects regarding partner health status and depression symptomology. No significant differences were found between presentation of first- and second-time fathers.

IMPLICATIONS FOR PRACTICE

Main findings support partners as a part of the family unit. Findings have implications for midwives in that an increased understanding of these factors in early fatherhood could improve family outcomes.

Paternal Perinatal Experiences during the COVID-19 Pandemic: A Framework Analysis of the Reddit Forum Predaddit

During the COVID-19 pandemic, new parents were disproportionately affected by public health restrictions changing service accessibility and increasing stressors. However, minimal research has examined pandemic-related stressors and experiences of perinatal fathers in naturalistic anonymous settings. An important and novel way parents seek connection and information is through online forums, which increased during COVID-19. The current study qualitatively analyzed the experiences of perinatal fathers from September to December 2020 through the Framework Analytic Approach to identify unmet support needs during COVID-19 using the online forum predaddit on reddit. Five main themes in the thematic framework included forum use, COVID-19, psychosocial distress, family functioning, and child health and development, each with related subthemes. Findings highlight the utility of predaddit as a source of information for, and interactions of, fathers to inform mental health services. Overall, fathers used the forum to engage with other fathers during a time of social isolation and for support during the transition to parenthood. This manuscript highlights the unmet support needs of fathers during the perinatal period and the importance of including fathers in perinatal care, implementing routine perinatal mood screening for both parents, and developing programs to support fathers during this transition to promote family wellbeing.

A relational investigation of Israeli gay fathers' experiences of surrogacy, early parenthood, and mental health in the context of the COVID-19 pandemic

Perinatal distress affects approximately 10% of fathers, but little is known about how gay fathers experience the challenges surrounding childbirth and early parenting of a child. This study explored gay fathers' experiences of having a baby via transnational surrogacy, raising that baby as a gay parent, and the context of the COVID-19 pandemic. In-depth qualitative interviews were conducted with 15 Israeli men to understand their experiences of surrogacy and early parenthood, focusing on the impact on their mental health and the relational factors involved. Secondary narrative analysis revealed that fathers constructed surrogacy as a perilous quest that required strong intentionality to undertake. The first year of parenthood was conceptualised alternately as a joyful experience and/or one that challenged fathers' identities and mental health. A relational framework was applied to better conceptualise the fathers' narratives, revealing that actual connections-and the potentials for links-considerably shaped experiences of surrogacy, perinatal distress and recovery. Implications for research and policy are discussed.

Perinatal mental health counselling programme: A scoping review

OBJECTIVE

To map the evidence on a Perinatal Mental Health Counselling Programme, identifying its characteristics, participants, and outcomes.

METHODS

This review followed the guidelines of the Joanna Briggs Institute and PRISMA-ScR. Published and unpublished studies, from 2011 to 2021, written in English, Portuguese or Spanish were included.

RESULTS

Despite the high number of articles identified, only nine articles were included in the final analysis, mainly from Iran, Italy and one Portuguese study. All articles referred to community health care centres and hospitals. The sessions varied between 6 and 16 and lasted 30-90 min. The method used was either individual and/or group, with weekly or monthly sessions or whenever deemed necessary throughout the evaluation. Different techniques were found, but emotional management, problem-solving, relaxation and mindfulness techniques were highlighted. Participants are pregnant women, partners, or family members. All articles suggest a decrease in the levels of stress, anxiety, and depression after the counselling intervention.

CONCLUSION

Perinatal counselling programme have varied characteristics and mental health nurses are potential facilitators.

The Perinatal Assessment of Paternal Affectivity (PAPA): Italian validation of a new tool for the screening of perinatal depression and affective disorders in fathers

BACKGROUND

Questionnaires for the screening of paternal perinatal psychological distress are based on clinical manifestations expressed by women, showing limitations in capturing the wide array of signs and symptoms exhibited by men. The current study aimed to validate the Perinatal Assessment of Paternal Affectivity, a new self-report tool for the screening of paternal depressive and affective disorder.

METHOD

This study used a cross-sectional design with a 3-month test-retest, involving respectively 385 (T1) and a sub-sample of 111(T2) fathers. Confirmatory factor analysis (CFA) was performed to test structural validity and concurrent validity was assessed by Spearman correlations. We assessed reliability using McDonald's ω and ordinal alpha. Group differences in PAPA scores based on sociodemographic were also tested.

RESULTS

The CFA reported a one factor structure as the optimal solution. The PAPA also showed adequate reliability and internal consistency as well as acceptable test-retest indices. Concurrent validity was confirmed by significant correlations between PAPA total score and standardized test scores. Non-Italian fathers and fathers who experienced recent stressful life events reported higher PAPA scores.

LIMITATIONS

Our sample was not homogeneous in terms of nationality and most of the participants, were from Northern Italy. Some risk factors associated with paternal parental psychological distress (e.g., unplanned pregnancy) have not been considered.

CONCLUSION

This study provides initial evidence of validity and reliability of the PAPA as a brief and sensitive screening tool to detect signs and symptoms of paternal affective disorder during both prenatal and postnatal period.

Examining the Relationship between Paternal Mental Health and Informal Support Networks: Reflections on the Impact of the COVID-19 Pandemic

Paternal mental health remains an under-researched area in the UK. Consequently, father-focused formal and informal support provisions fail to address the complex emotional and psychological wellbeing needs of fathers. Drawing on data from twenty semi-structured interviews with fathers in the York area, this study seeks to better understand how access to and participation in informal support networks is influenced by gendered perceptions and the impact hegemonic perceptions of masculinity have on fathers' access to support prior and during the COVID-19 pandemic. The findings demonstrate that fathers internalise stereotypical masculine tropes, such as stoicism, which prevent them from actively seeking support. While fathers value informal support network, they generally struggle to engage in mental health talks. The COVID-19 lockdown exacerbated fathers' struggles to access informal support or prioritise their mental health. Fathers felt the pandemic presented a unique challenge that only people that became parents at the time understood. This meant that fathers could not rely on their parents or other parents who did not have similar experiences of the COVID-19 pandemic. This paper aims at challenging structural and cultural barriers that inhibit fathers' participation in informal support networks, and to promote more meaningful, supportive engagement with peer groups.

Paternal Perinatal Depression in Modern-Day Fatherhood

Postpartum depression in new mothers has become a widely recognized public health concern. Paternal perinatal depression (PPND) and the mental health of fathers in the perinatal period continues to receive significantly less public attention. Overall prevalence rates of up to 25% have been documented in first-time fathers. The presence of maternal depression, unsatisfactory couple relationships, and certain psychosocial and biological risk factors are associated with poor paternal bonding and increased depression risk. Depressed fathers experience excessive self-criticism, restlessness, irritability, and aggression rather than low mood. Depression in new fathers can lead to drug and alcohol abuse, food behavior disorders, and lack of impulse control. PPND leads to developmental delay, mental health disorders, and emotional or behavioral problems in the offspring. PPND may also adversely affect a child's ability to learn new information, with lasting intellectual and scholastic consequences. There currently are no official criteria to diagnose PPND, and neither are there validated screening tools available to fathers. A family-focused approach should be considered in place of the historically gender-focused mood assessment. Nontraditional interventions such as Internet communities, e-therapy, or group workshops are shown to combat a father's contextual understanding of therapy. Group therapy with integrated cognitive behavioral therapy can address masculine norms surrounding the parenting roles of fathers and can help cultivate support networks that are otherwise absent among new dads. PPND is ideally addressed by the adoption of a father-inclusive model of care that shifts the parenting paradigm and provides emotional and parenting support to men as they experience their new role as dad.

Paternal depression and attachment levels of first-time fathers in Turkey

PURPOSE

Paternal depression and inadequate attachment experienced in the postpartum period may be associated with future emotional and behavioural problems of children. This study aimed to investigate the paternal depression and attachment levels of first-time fathers.

DESIGN AND METHODS

The sample of this descriptive study consisted of 175 fathers with 3-6 months old babies whose wives applied to the polyclinic for check-up.

FINDINGS

When the cut-off point of the scale was evaluated at 13 and above in this study, the risk of depression was found to be 14.2%. The level of attachment decreases as fathers' risk of depression increases (p < 0.05).

PRACTICE IMPLICATIONS

There is a risk of depression in fathers in the postpartum period. The level of attachment decreases as fathers' risk of depression increases.

Paternal depression: "The silent pandemic"

Maternal mental health during and after pregnancy is a well researched entity. However, father's mental health during the same period and even while raising the children has not been given due consideration. Recent studies have tried to explore the prevalence, risk factors, symptoms and implications of paternal depression on the children, marriage and the whole family. In this short communication, we aim to bring to the fore the recommendations for prevention and management of paternal depression.

Risk for partners' depression and anxiety during pregnancy and up to one year postpartum: A longitudinal cohort study

INTRODUCTION

Families may benefit from increased focus on partner emotional well-being during pregnancy and the perinatal period. Our aim was to explore the risk for depression and anxiety during pregnancy and one year postpartum in relation to partners' self-reported health, sense of coherence, social support, and lifestyle factors.

METHODS

This is a longitudinal cohort study using three questionnaires that were answered twice during pregnancy and at one year postpartum. Participants (n=532) were recruited between April 2012 and September 2013, and follow-up was between April 2012 and March 2015, in Sweden.

RESULTS

In late pregnancy, 8.9% of the prospective partners were at high risk for depression and 8.3% one year postpartum. An increased risk for depression was found amongst those reporting 'fair or very poor' sexual satisfaction and those reporting 'fair or very poor' health during pregnancy and postpartum. High anxiety was reported by 10.8% during late pregnancy and 12.4% one year postpartum. Partners who were unemployed, had financial difficulties, and who scored low on a Sense of Coherence scale, showed significantly higher anxiety in late pregnancy and postpartum. Social support has a significant and positive impact concerning signs of depression and anxiety, both during pregnancy and postpartum.

CONCLUSIONS

More than 10% of partners in this study showed depressive symptoms and anxiety, indicating a problem in need of attention by stakeholders. Strengthening social support is of greatest importance. It is time for the introduction of family-focused care aimed at prevention of depression and anxiety, and maintenance of family well-being.

Predicting perinatal health outcomes using smartphone-based digital phenotyping and machine learning in a prospective Swedish cohort (Mom2B): study protocol

INTRODUCTION

Perinatal complications, such as perinatal depression and preterm birth, are major causes of morbidity and mortality for the mother and the child. Prediction of high risk can allow for early delivery of existing interventions for prevention. This ongoing study aims to use digital phenotyping data from the Mom2B smartphone application to develop models to predict women at high risk for mental and somatic complications.

METHODS AND ANALYSIS

All Swedish-speaking women over 18 years, who are either pregnant or within 3 months postpartum are eligible to participate by downloading the Mom2B smartphone app. We aim to recruit at least 5000 participants with completed outcome measures. Throughout the pregnancy and within the first year postpartum, both active and passive data are collected via the app in an effort to establish a participant's digital phenotype. Active data collection consists of surveys related to participant background information, mental and physical health, lifestyle, and social circumstances, as well as voice recordings. Participants' general smartphone activity, geographical movement patterns, social media activity and cognitive patterns can be estimated through passive data collection from smartphone sensors and activity logs. The outcomes will be measured using surveys, such as the Edinburgh Postnatal Depression Scale, and through linkage to national registers, from where information on registered clinical diagnoses and received care, including prescribed medication, can be obtained. Advanced machine learning and deep learning techniques will be applied to these multimodal data in order to develop accurate algorithms for the prediction of perinatal depression and preterm birth. In this way, earlier intervention may be possible.

ETHICS AND DISSEMINATION

Ethical approval has been obtained from the Swedish Ethical Review Authority (dnr: 2019/01170, with amendments), and the project fully fulfils the General Data Protection Regulation (GDPR) requirements. All participants provide consent to participate and can withdraw their participation at any time. Results from this project will be disseminated in international peer-reviewed journals and presented in relevant conferences.

In her shoes: Partner reflective functioning promotes family-level resilience to maternal depression

Parental depression has significant implications for family functioning, yet much of the literature does not consider family-level dynamics in investigating individual, parenting and child outcomes. In the current study we apply a new index of couple-level support, partner reflective functioning (RF), or the romantic partner's ability to consider how the partner's mental states can guide behavior, to study familial resiliency in the face of prenatal parental depression among first-time parents. We investigate how partner RF buffers the association between prenatal parental depression and outcomes of postnatal parental depression, parenting style, and child effortful control. Maternal and paternal depression were measured in 91 primiparous couples during the sixth month of pregnancy and parental depression, partner RF, parental RF at 6 months postnatally. Outcomes of parental depression, permissive parenting, and children's effortful control were assessed 24 months postnatally. Results indicate that average and high levels of paternal partner (not parental) RF attenuate risk for maternal postnatal depression, maternal permissive parenting, and deficits in child effortful control. Implications are discussed from a family systems approach.

Prenatal intervention program for Japanese first-time fathers to adapt to the paternal role: a mixed methods study

This study aimed to develop a prenatal intervention program focused on the formation of paternal identity for adapting to paternal role. The intervention program allowed participants to create a postpartum schedule using a uniquely developed paternity portfolio. Pre and post-intervention effects were evaluated using a convergent design of mixed methods. This intervention effect was quantitatively evaluated between the two groups. To qualitatively examine the intervention's effects, participants were interviewed for effective prenatal education, and their paternal role behaviors were identified by the intervention. Details of actual postpartum paternal role behavior and effective prenatal education were collected. Obtained data were inductively analyzed and compared with those in the proposed prenatal intervention program. There were 10 pairs in the intervention group and 31 pairs in the control group. Intergroup comparison of evaluation data showed no significant difference. However, qualitative results clarified the effective nursing intervention, confirming the achievement of intervention goals by all participants. Intervention expressions were adjusted based on the results, and a revised prenatal intervention program was developed. This article is protected by copyright. All rights reserved.

Depressive symptoms in men immediately after birth

OBJECTIVE

Depression is the second leading cause of morbidity worldwide. This study aimed to assess the prevalence and associated risk factors of paternal postpartum depressive symptoms (PPD).

METHODS

In a cross-sectional study, via a stratified random and convenience sampling method 591 couples who were referred to Mazandaran primary health centers between 2 and 8 weeks postpartum were recruited from March to October 2017. Couples were screened for depressive symptoms using Edinburgh Postnatal Depression Scale (EPDS). Fathers provided information on socio-demographic characteristics, life events, neonatal stressor, perceived stress (Perceived Stress Scale), social support (Multidimensional Scale of Perceived Social Support), and general health status using General Health Questionnaire (GHQ-12) as well. Data was analyzed using multiple logistic regression.

RESULTS

Overall, 93 fathers (15.7%) and 188 mothers (31.8%) reported depressive symptoms above the cut-off EPDS score of 12. In the multiple logistic regression model, older age, maternal depressive symptoms, higher GHQ-12 scores and increased recent life events were related to paternal PPD. A significant inverse association was found between number of children and paternal PPD.

CONCLUSION

Depressive symptoms especially in first-time fathers following the birth of a child are not uncommon. Creating opportunities for men to access special health care services, parental education to help adapting to parenthood, screening programs, and psychiatric/psychosocial interventions to decrease suffering of depression for both depressed parents are recommended.

Hormones and neuroplasticity: A lifetime of adaptive responses

Major life transitions often co-occur with significant fluctuations in hormones that modulate the central nervous system. These hormones enact neuroplastic mechanisms that prepare an organism to respond to novel environmental conditions and/or previously unencountered cognitive, emotional, and/or behavioral demands. In this review, we will explore several examples of how hormones mediate neuroplastic changes in order to produce adaptive responses, particularly during transitions in life stages. First, we will explore hormonal influences on social recognition in both males and females as they transition to sexual maturity. Next, we will probe the role of hormones in mediating the transitions to motherhood and fatherhood, respectively. Finally, we will survey the long-term impact of reproductive experience on neuroplasticity in females, including potential protective effects and risk factors associated with reproductive experience in mid-life and beyond. Ultimately, a more complete understanding of how hormones influence neuroplasticity throughout the lifespan, beyond development, is necessary for understanding how individuals respond to life changes in adaptive ways.

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.

Subthreshold psychiatric symptoms as potential predictors of postpartum depression

The authors' purpose in the present study is to examine the role of subthreshold mental disorders as predictors of Postpartum Depression (PPD). 110 pregnancy women were evaluated as follow: the General 5-Spectrum Measure at 26 weeks of gestation; the Edinburgh Postnatal Depression Scale at 3/6 months after delivery. Only 4.5% of the sample developed PPD at 3/6 months after delivery. Agoraphobia/panic, depressed mood, social anxiety and eating problems relate positively to PPD at 3/6 months. Early identification of symptoms that could indicate the development of future mood problems in the mother is of crucial importance for mental health and prevention.

"When I got the news": Aboriginal fathers in the Kimberley region yarning about their experience of the antenatal period

ISSUE ADDRESSED

Paternal involvement during the antenatal period is recognised as a positive contributor to a child's health and developmental outcomes. Little is known about Aboriginal Australian men's experiences and perceptions during their partner's antenatal period.

METHODS

A qualitative yarning methodology was used to explore the experiences of ten Aboriginal Australian fathers during their partner's antenatal period, in a remote Northern Australian town.

RESULTS

The study found the participants valued supporting their partners through pregnancy, making positive changes to their lifestyles, and having access to information on pregnancy. Participants described experiencing multiple stressors during the antenatal period that impacted on their social and emotional wellbeing. This is despite the range of protective factors identified by them. Participants had diverse experiences with health care providers during the antenatal period.

CONCLUSIONS

This study demonstrated that these Aboriginal men valued engagement with antenatal care (ANC) services and highlighted strategies to improve Aboriginal paternal involvement with ANC services. SO WHAT?: Enhancing ANC to be inclusive of fathers, through a local co-design process, could strengthen and support Aboriginal families to achieve improved health and wellbeing outcomes across the family system.

Screening for Early Signs of Paternal Perinatal Affective Disorder in Expectant Fathers: A Cluster Analysis Approach

Previous studies documented gender-related differences in the expression of Perinatal Affective Disorders. However, little attention has been paid to screening the male population during the perinatal period. This study was based on three aims: (1) to investigate the mental health of expectant fathers based on their levels of depression, anxiety, addiction, anger attacks/hostility, and somatization, identifying psychological profiles; (2) to analyze the association between these profiles and the individual variable of perceived stress; (3) and to examine the association between these profiles and the couple’s variable of marital adjustment. A total of 350 Italian expectant fathers in the last trimester of pregnancy were asked to fill in questionnaires concerning perceived stress, dyadic adjustment, psychiatric symptomatology, and depression. Three different clusters were found: “psychologically healthy men” (68%) with low levels of symptoms on all the scales; “men at risk of externalized behavioral problems” (17.1%), characterized by one or more addictive or risky behaviors and moderate levels of scales scores; and “men experiencing psychological distress” (14.9%), with the highest scores on all the scales. A significant association emerged among the perceived stress, marital adjustment, and cluster membership. These results highlight the importance of screening fathers in perinatal health services, which are still predominantly mother-centered, and underscore the necessity to create tailored and personalized interventions.

Rubrofusarin Attenuates Chronic Restraint Stress-Induced Depressive Symptoms

The aim of this study was to examine whether rubrofusarin, an active ingredient of the Cassia species, has an antidepressive effect in chronic restraint stress (CRS) mouse model. Although acute treatment using rubrofusarin failed, chronic treatment using rubrofusarin ameliorated CRS-induced depressive symptoms. Rubrofusarin treatment significantly reduced the number of Fluoro-Jade B-positive cells and caspase-3 activation within the hippocampus of CRS-treated mice. Moreover, rubrofusarin treatment significantly increased the number of newborn neurons in the hippocampus of CRS-treated mice. CRS induced activation of glycogen synthase kinase-3β and regulated development and DNA damage responses, and reductions in the extracellular-signal-regulated kinase pathway activity were also reversed by rubrofusarin treatment. Microglial activation and inflammasome markers, including nod-like receptor family pyrin domain containing 3 and adaptor protein apoptosis-associated speck-like protein containing CARD, which were induced by CRS, were ameliorated by rubrofusarin. Synaptic plasticity dysfunction within the hippocampus was also rescued by rubrofusarin treatment. Within in vitro experiments, rubrofusarin blocked corticosterone-induced long-term potentiation impairments. These were blocked by LY294002, which is an Akt inhibitor. Finally, we found that the antidepressant effects of rubrofusarin were blocked by an intracerebroventricular injection of LY294002. These results suggest that rubrofusarin ameliorated CRS-induced depressive symptoms through PI3K/Akt signaling.