Fathers matter: Supporting new dads during the transition to parenthood

Deborah Da Costa, PhD, Associate Professor at the Department of Medicine, McGill University, Scientist at McGill University Health Centre, details promoting and supporting new dads during the transition to parenthood

Approximately one in ten fathers experience mental health difficulties during their partner’s pregnancy and/or the postpartum period. ^(1-3) Fathers’ mental health difficulties adversely impact parenting, maternal mental health, and couple functioning.

A recent systematic review and meta- analysis of 16 observational studies showed that paternal depression was associated with an increased risk of depression in offspring, underscoring the intergenerational transmission of mental health problems. ⁽⁴⁾ Fathers’ mental health during this life stage is an important public health issue, but it continues to be under-researched, under-recognized, and under-treated.

Supporting new dads: Risk factors for perinatal depression in fathers

Risk factors for perinatal depression in fathers include:

• A history of depression.
• Having a partner with depression.
• Low social support.
• Poor adjustment in the couple relationship.
• Poor sleep quality.
• Higher parenting stress.

Elevated depressive symptoms during the partner’s pregnancy have been shown to be among the most significant predictors of depression in men in the postnatal period, highlighting the need for better support for expectant fathers during the antenatal period. Scalable, evidence-based strategies to prevent depression in men during the transition to parenthood are needed.

Interventions targeting fathers’ perinatal mental health

Qualitative studies in North America and internationally report that fathers feel marginalized by health professionals during the perinatal period, with limited or no access to information from the fathers’ perspective on pregnancy, birth, childcare, relationship changes, mental health, and balancing work and family responsibilities. There is a paucity of research in the area of interventions designed and delivered directly for fathers to target their mental health during this teachable moment. Interventions designed to reduce the risk of postpartum mental health difficulties in fathers must be informed by how men cope and seek help.

Studies consistently show that compared to women, men are less likely to seek psychiatric services and psychotherapy for emotional difficulties. Stigma, greater severity of symptoms, and stronger adherence to traditional Western masculine norms are associated with a lower likelihood of mental health help-seeking in men.

Much research on mental health help-seeking in men has been conducted in the general population. In a sample of expectant and new fathers from three Canadian provinces, we found barriers to mental help-seeking included lack of time, lack of resources, financial costs, and feeling that one should be able to do it alone. ⁽⁵⁾

To address these practical, access, and attitudinal barriers, developing innovative approaches to prevent and treat emotional difficulties in men tailored to this life stage is essential.

Digital interventions to promote fathers’ mental health

To disseminate interventions designed to enhance, prevent, and treat mental health, the internet has enormous appeal. It is anonymous, highly accessible, far-reaching (rural areas), sustainable, and allows for a high level of tailored and interactive content at a lower cost than traditional face-to-face modes.

For the majority of people globally, the internet has come to play a pivotal role in work, education, and personal domains. In the last decade, substantial evidence from studies with diverse populations across the lifespan indicates that online psychosocial programs can effectively treat and prevent mental health problems.

More recently, there have been numerous calls for the need to develop and evaluate father-focused digitally delivered interventions to optimize fathers’ mental health and other paternal outcomes. This mode of delivery has been found to be a preferred source of support for fathers with young children. ⁽⁶⁾

A growing number of studies find that most expectant and new fathers access the internet as a source of information about their partner’s pregnancy and parenting, but are often dissatisfied by the lack of tailored father-friendly content. ^(5,7)

Development and evaluation of a father-friendly digital intervention in the Canadian context

With initial funds from Movember, we used a multi-step process to develop a prototype bilingual digitally delivered program called HealthyDads with accurate information on topics related to mental health, parenting, and health behaviors, along with strategies to optimize each. The content of our intervention was guided by what expectant and new fathers representing three Canadian provinces told us they wanted. ⁽⁵⁾

The content and approach of the learning modules incorporate aspects of current fatherhood and fathering practices within the constructions and understandings of masculinity, and differences in how men experience depression and accept help.

As language around mental health and its treatments can itself be viewed as a barrier to engaging men, we have taken steps to ensure that the language in the program is positive and father-friendly. We use a solution/action-based approach, which has been shown to be helpful when working with men.

While securing funds for research on men’s mental health can be a challenge, we have recently obtained additional funding from the Canadian Institutes of Health Research to refine and enhance the program with additional features to optimize user engagement, which remains a challenge in the field of digitally delivered mental health and behavior change interventions. Once the enhanced version is completed, our program will be evaluated with expectant fathers across Canada to determine uptake, engagement, user satisfaction ratings, and user experiences.

Conclusion: Fathers matter

Supporting new dads and their mental health during the transition to parenthood has largely been a neglected area of research, with minimal public health attention. Yet fathers’ mental health can be at risk during this life transition, with important negative impacts on the family, including both parents and offspring. An approach to proactively promote fathers’ mental health during the partner’s pregnancy with a highly accessible, far-reaching digital modality may have the potential to positively impact parental, child, and family outcomes.

References

1. Paulson JF, Bazemore SD. Prenatal and postpartum depression in fathers and its association with maternal depression: a meta-analysis. J Am Med Assoc. 2010;303(19):1961-9.
2. Cameron EE, Sedov ID, Tomfohr-Madsen LM. Prevalence of paternal depression in pregnancy and the postpartum: An updated meta-analysis. J Affect Disord. 2016;206: 189-203.
3. Rao W-W, Zhu X-M, Zong Q-Q, Zhang Q, Hall BJ, Ungvari GS, et al. Prevalence of prenatal and postpartum depression in fathers: A comprehensive meta-analysis of observational surveys. J Affect Disord. 2020;263:491-9.
4. Dachew B, Ayano G, Duko B, Lawrence B, Betts K, Alati R. Paternal Depression and Risk of Depression Among Offspring: A Systematic Review and Meta-Analysis. JAMA. 2023;6(8):e2329159.
5. Da Costa D, Zelkowitz P, Letourneau N, Howlett A, Dennis CL, Russell B, et al. HealthyDads.ca: What do men want in a website designed to promote emotional wellness and healthy behaviors during the transition to parenthood?
   J Med Internet Res. 2017;19(10):e325.
6. Giallo R, Dunning M, Gent A. Attitudinal barriers to help-seeking and preferences for mental health support among Australian fathers. J Reprod Infant Psychol. 2017;35(3):236-47.
7. Oscarsson MG, Medin E, Holmström I, Lendahls L. Using the internet as source of information during pregnancy-a descriptive cross-sectional study among fathers-to-be in Sweden. Midwifery. 2018;62:146-50.

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