Fathers’ perinatal mental health: Impacts, interventions and supports

Background. Fathers’ perinatal mental health problems have far reaching implications not only for themselves, but also for their partner, their couple relationship, and their children. The primary objective of this thesis by publication was to generate evidence to inform the development of policy and intervention efforts to promote fathers’ mental health in the perinatal period. The aims of the research were four-fold: first, to determine the extent to which fathers’ experiences of mental health problems impact parenting and their children; second, to undertake a systematic review into interventions targeting fathers’ perinatal mental health; third, to explore fathers’ support needs in the perinatal period; and finally, to investigate midwives’ perceptions and experiences of working with fathers. Method. A multi-method approach was adopted across four studies. The first study used data from a longitudinal study of a nationally representative sample of Australian children and their families (N = 3,741 fathers) and explored mechanisms that link fathers’ postnatal distress to later child outcomes. Second, a systematic review of existing research detailing interventions targeting expectant and new fathers’ mental health was conducted. Third, fathers’ perceived support needs to accessing mental health and parenting support in the perinatal period were explored through qualitative interviews with fathers (N = 20). Finally, midwives’ perceptions and experiences of engaging fathers in the perinatal period were surveyed via a national online survey (N = 106) and qualitative interviews (N = 13). Results. In Study 1 (Chapter 6), results indicated that fathers’ postnatal distress and low parenting self-efficacy (PSE) were associated with higher levels of fathers’ parenting hostility and lower levels of parenting consistency when children were aged 4-5 years. In turn, this was associated with children’s emotional and behavioural difficulties when aged 8-9 years. Additionally, fathers’ levels of parenting warmth when children were aged 4-5 years was associated with fathers’ postnatal PSE and children’s prosocial outcomes when aged 8-9 years. In Study 2 (Chapter 7), the systematic literature review of interventions identified 11 studies, only five of which demonstrated significant intervention effects. The review highlighted the paucity of literature on interventions targeting fathers’ perinatal mental health and identified specific design issues related to outcome measures, timing of content delivery, and the mode of intervention delivery across the studies. Study 3 (Chapter 8) described a wide range of fathers’ experiences related to seeking support and several subthemes were identified within each broad area of inquiry: 1) support accessed; 2) support needs; 3) barriers to support; 4) facilitators of support; and 5) timing of support. Finally, online survey results in Study 4 (Chapter 9) indicated that the midwives considered engaging fathers to be a part of their professional role and that father-specific training is needed to develop their knowledge and skills in this area. Analysis of the interview data led to the identification of factors specific to midwives, the external workplace, and fathers that can impact a midwife’s ability to engage men in their services. Conclusion. Findings from this thesis extend our theoretical understanding of issues related to fathers’ perinatal mental health in three key areas; intergenerational health, the role of fathers’ PSE, and models of men’s help-seeking behaviour. Practical implications include intervention and support strategies to promote fathers’ perinatal mental health, and building capacity in the service system so perinatal health professionals can engage, support, and be more inclusive of fathers. Recommendations for future research focusing on fathers’ perinatal mental health include the exploration of diverse father groups, longitudinal research designs, enhanced intervention design and evaluation, and expanded professional training resources.