How do fathers experience depression during the perinatal period? A qualitative systematic review

Objective: The objective of the review is to understand fathers’ experiences of depression in the perinatal period, including how they recognize their depression, the emotions they experience, the impact of depression on their relationships, and their help-seeking behaviors and support. Introduction: Whilst the prevalence of postnatal depression in men is now estimated to be just below that in women, no current care pathways exclusively for affected men exist in the United Kingdom. However, evidence demonstrates that paternal depression has severe consequences, affecting men’s relationships with their partners and infants, their parenting behaviors, and the well-being of their children. This demonstrates a need to focus on the paternal experience of depression during this stage of life. Therefore, this review focuses on these topics. Inclusion criteria: The review included qualitative studies that included biological fathers over the age of 18. The phenomena of interest was depression or mental distress in fathers, within the context of the perinatal period. All qualitative designs were included in the study with a focus on lived experiences of fathers. Methods: Searches for similar existing systematic reviews were carried out in March 2021 and no similar protocols or completed reviews were found. Seven databases were searched in April 2021: MEDLINE (EBSCO), CINAHL, PsycINFO, Scopus, ProQuest Sociology, ProQuest Dissertations and Thesis Global, and OpenGrey. Search limits included English language and Organization for Economic Co-operation and Development (OECD) countries. Two reviewers assessed methodological quality, with a third reviewer’s opinion being sought in the case of disagreement. A standardized extraction tool was used to extract data and synthesis was achieved. Confidence in the findings was subsequently assessed. Results: Nine papers were included after full text review, which were considered relevant to the research questions, and which focused on fathers’ experiences (n=138), although only two focused specifically on depression. The overall quality of the studies was moderate. Overall, 109 findings were collated into 22 categories producing six synthesized findings. These were: mental health literacy around paternal perinatal depression is poor amongst men; relationships are experienced as both comforting and distressing in the perinatal period; new fathers do experience depression, but this is avoided, normalized, or hidden; fathers feel judged about mental health difficulties and so are reluctant to disclose them; help-seeking in fathers is prevented by non-targeted support for dads; and all men have the potential to become depressed because fatherhood is challenging. Conclusions: The review found that fathers may experience depression and negative emotions around the time their child is born, including anger, irritability, and resentment of the child. Men found their relationship changes difficult, feeling that fatherhood did not seem real until the baby was born. There was a significant lack of father-focused support for men, who were aware of stigma and social expectations of them. Men were not keen to seek help for their feelings, in part due to prioritizing the needs of the mother (and child) as more important. There is a need for greater attention on paternal perinatal depression through research and practice.