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• To understand the importance of recognising postnatal depression in fathers
• To identify fathers’ barriers to, and motivators for, seeking support for postnatal depression
• To consider how healthcare services could better support fathers experiencing postnatal depression
Background Many men tend to avoid seeking support for mental health issues and little is known about help-seeking among fathers who experience postnatal depression.
Aim To explore fathers’ help-seeking for postnatal depression, including barriers and motivators, and their experiences of informal support from partners and formal support from healthcare professionals.
Method Data were obtained through individual semi-structured interviews with eight fathers who self-identified as having experienced postnatal depression. Data were analysed using interpretative phenomenological analysis.
Findings Five themes emerged from the data analysis: not recognising postnatal depression; fatherhood expectations restricting postnatal depression disclosure; disappointment at the medicalised response to help-seeking; health visitors as a feared profession which excludes fathers; needing communication, validation and a safe space to talk.
Conclusion Some fathers need professional support for their mental health after the birth of their child. Nurses and health visitors should routinely ask fathers about their mental well-being, validate their feelings and encourage them to discuss their mental health issues with a healthcare professional.
Primary Health Care. doi: 10.7748/phc.2023.e1810
Peer reviewThis article has been subject to external double-blind peer review and checked for plagiarism using automated software
Correspondence Conflict of interestNone declared
Davenport C, Swami V (2023) Exploring fathers’ experiences of seeking support for postnatal depression. Primary Health Care. doi: 10.7748/phc.2023.e1810
AcknowledgementsThe authors would like to thank Dr Craig Owen and Dr John Lambie for their assistance with this research
Published online: 16 November 2023
Men are often less forthcoming than women regarding their health concerns, especially when it comes to emotional and psychological issues (Addis and Mahalik 2003, Courtenay 2011, Liddon et al 2018), and often seek support only to restore or preserve aspects of their identity as men (O’Brien et al 2005). In fatherhood, men’s identity extends to encompass expectations of them as providers and protectors (Crespi and Ruspini 2015, Caperton et al 2020, Ewald et al 2020).
Research has suggested that fathers tend to seek support only in cases of severe mental health issues or when in a crisis (Seidler et al 2016, Darwin et al 2017, Baldwin et al 2019). Unmet mental health needs in fathers can have significant consequences for the fathers themselves – for example, in terms of increased risk of suicide – and for the family unit. Paternal mental ill-health is associated with an increased risk of maternal mental ill-health (Paulson and Bazemore 2010, Thiel et al 2020) and with behavioural issues in children at later stages of their development (Ramchandani et al 2008).
Given these consequences, it is important that healthcare services encourage fathers to seek support when they experience mental health issues and that fathers receive adequate support to manage and overcome these issues. Nurses, particularly those working in public health, community and primary care settings, are well placed to support men during their transition and adaptation to fatherhood.
Postnatal depression is a type of depression that parents may experience after the birth of a child, with symptoms lasting longer than two weeks and starting at any time in the first year from two weeks after the birth (NHS 2022). It is less recognised in fathers than in mothers (Swami et al 2020) and the National Institute for Health and Care Excellence (2020) guideline on antenatal and postnatal mental health prioritises mothers. Mothers’ experiences of depression in the postnatal period are well understood, with clear guidance for their recognition and treatment (Royal College of Psychiatrists 2018), but this is not the case for fathers, partly because it is often assumed that postnatal depression does not occur in fathers or is less severe in fathers than in mothers (Bruno et al 2020). Williams (2020) highlighted this inequality between mothers and fathers in the provision of support for postnatal depression.
Furthermore, the help-seeking behaviours and support needs of fathers experiencing mental health issues, including postnatal depression, are not fully understood, which limits the ability of healthcare professionals and services to assess and support fathers. Our understanding of the ways fathers think about help-seeking and how they approach healthcare professionals for support during the postnatal period needs to be enhanced.
The authors of this article conducted a study guided by the following research question: ‘What motivates fathers with postnatal depression to seek support for their condition and what are their experiences of informal and formal support?’. This article reports and discusses the study findings.
To explore fathers’ help-seeking for postnatal depression, including barriers and motivators, and their experiences of informal support from partners and formal support from healthcare professionals.
This qualitative study was conducted between January 2021 and July 2021 as part of a PhD study by the first author (CD) under the supervision of the second author (VS) at Anglia Ruskin University, England. It is based on a constructivist paradigm, which means that participants were considered in their cultural, individual and psychological dimensions (Pilarska 2021) such as their home and work environments and their father and partner roles.
The study was advertised on social media with the help of advocates and charities in the field of fathers’ mental health, on the university intranet, through a press release and through a local radio interview. Potential participants were invited to contact the first author.
Interested participants were recruited if they self-identified as having experienced postnatal depression, since postnatal is not routinely screened for or diagnosed. To be included in the study, participants had to be the biological father of the child and have been living with the child’s mother at the time of the birth. This ensured a level of homogeneity in the sample, enabling participants’ experiences to be described in depth (Palinkas et al 2015) and collectively.
Eight fathers participated in the study, a sample size that is consistent with previous qualitative research in fathers with postnatal depression (Schuppan et al 2019, Pedersen et al 2021) and is considered sufficient to produce an adequate volume of data in interview-based studies (Vasileiou et al 2018).
Data were collected through individual semi-structured interviews, which took place online using teleconferencing software. This was due to restrictions arising from the coronavirus disease 2019 (COVID-19) pandemic but had the advantage of enabling fathers to take part from anywhere in the UK and at a convenient time for them (Archibald et al 2019). The interview schedule was designed to help participants describe their personal experiences of help-seeking and support for postnatal depression while enabling the researchers to answer the research question. The interviews lasted between 27 minutes and 114 minutes. They were conducted, audio-recorded and transcribed manually by the first author.
• Fathers need education on postnatal depression so they can recognise when they need to seek support
• Men who struggle to adapt to fatherhood may benefit from a space where they can talk without fear of judgement
• It is important to include fathers in healthcare interactions and reassure them that seeking support for postnatal depression will benefit the whole family
• Nurses and health visitors need to be transparent about their safeguarding role so that fathers do not fear that their child could be taken away if they disclose feelings of depression
• Training on how to identify and support fathers who experience postnatal depression could be beneficial for nurses and health visitors
Interpretative phenomenological analysis was chosen as the conceptual framework for data analysis. It involves ‘exploring, describing, interpreting and situating the means by which our participants make sense of their experiences’ (Smith et al 2009). It is particularly suited to emotional or challenging topics (Smith and Osborn 2015).
The first author examined the interview transcripts in detail, extracting and coding quotes from different participants expressing similar ideas. The codes were examined individually, then grouped based on similarity of meaning. Narrative accounts were written for each participant, facilitating the first author’s familiarisation with, and interpretation of, the data. The first author considered the similarities and differences between the individual accounts to make claims about participants’ experiences overall.
The first author, a female registered health visitor, kept a reflexive diary during transcription and data analysis to minimise researcher bias and ensure rigour (Johnson et al 2020). To ensure that gendered preconceptions did not influence the analysis, the data coding was checked and validated by the second author, a male professor of psychology, who examined the first author’s interpretations of the data to check whether they were representative of participants’ experiences.
Ethical approval was sought and granted by Anglia Ruskin University’s ethics panel. Approval from a research ethics committee was not required since participants were not recruited through healthcare settings.
After contacting the first author, potential participants were sent a participant information sheet. If they decided to take part they were asked to provide written consent by email. Before their interview they were asked to reiterate their consent verbally and given the opportunity to ask questions. They were assured that they would be free to interrupt the interview and withdraw from the study at any time without consequences. To check that participants were not experiencing or receiving care for severe depression and therefore safeguard them, they were asked to complete the Patient Health Questionnaire-9 (Kroenke et al 2001).
Confidentiality was protected throughout the study. The transcripts were anonymised and identifying details, such as names of people and places, were removed before data analysis. Participants were given pseudonyms and their identity was known only to the first author. When writing up the findings, further characteristics that could enable others to identify participants were omitted. The study was conducted alongside a study into fathers’ lived experiences of postnatal depression (Davenport and Swami 2023). The participants were the same in both studies but the chosen pseudonyms are different to ensure details about participants cannot be linked between the two studies.
Participants were aged between 27 years and 41 years. Six out of eight were first-time fathers. All identified as white British except one who identified as Asian. The ages of children ranged from under one year to primary school age. Five participants had approached and/or received care from their GP. Five participants had sought and/or received formal support from other healthcare professionals.
Five themes emerged from the analysis of data, representing different aspects of participants’ experiences:
• Not recognising postnatal depression.
• Fatherhood expectations restricting postnatal depression disclosure.
• Disappointment at the medicalised response to help-seeking.
• Health visitors as a feared profession which excludes fathers.
• Needing communication, validation and a safe space to talk.
At the time, participants did not recognise or understand that they were experiencing postnatal depression and were reluctant to share their experiences with others. Initially, participants considered their symptoms of postnatal depression to be ‘normal’ and to reflect the tiredness of new parenthood. However, participants described reaching a point when they realised they were experiencing a serious mental health issue or distress:
‘I wasn’t enjoying it. That’s when it just… I’d gone from not enjoying it to wishing it’d never happened and that was the catalyst that was the real point of yeah, that’s pretty bad to feel like that, that’s when it was the worst.’ (Victor)
Coping strategies that participants would have used before becoming fathers, such as reading or exercising, often became unfeasible after the birth of the child. As a result, they resorted to managing their distress through self-reliance and avoidance:
‘Dealing with it as best as I could individually.’ (Xander)
‘Ride it out, you know it’ll get better.’ (Samuel)
Coping with postnatal depression was described in terms of surviving; for example, Zack described how he would just try to get through one day at a time. However, these strategies did not help participants with their feelings of depression. Participants avoided discussing their feelings – Richard tended to bottle them up, William would never have thought about discussing them and Paul thought that doing so would make him feel uncomfortable.
Participants’ internalised perceptions of the social expectations of fatherhood restricted the sharing of their experiences. Participants all described feeling inadequate in their parenting role; for example, Richard expressed the feeling that his children had not got the best of him. These feelings also arose from participants’ perception of having to play a certain role in the family unit, notably as the breadwinner:
‘Dad can’t ask for help, you’re supposed to be the pillar of the family, you’re supposed to be the breadwinner.’ (Zack)
For most participants, the idea of being asked about their depression was exposing and something that they sought to avoid:
‘You found outlets and ways of avoiding having those conversations with people.’ (Xander)
Participants also described a need to minimise or avoid disclosing their symptoms because they perceived their partner’s needs as greater than their own:
‘Seeing what she went through to give birth to him, you know, a bit of mental anguish on my part didn’t really seem particularly worthy of attention.’ (Samuel)
‘If I feel like this, then God knows what his mum feels like, so it would always be to downplay what was going on.’ (Paul)
Despite participants’ attempts to protect their partner by avoiding disclosure, partners recognised that participants were experiencing postnatal depression. Some participants eventually spoke to their partners about their depression but rarely fully disclosed their experiences to them:
‘The less she knew, the less she’d worry.’ (Thomas)
Partners also strongly influenced participants’ formal help-seeking, encouraging them to see their GP.
Five participants were immediately offered antidepressants when they visited their GP. They were all disappointed by this and initially refused treatment. They considered antidepressants inappropriate, with concerns that treatment would change their personality or that they were being offered antidepressants because of a lack of other types of support. Some participants stated they would have preferred, or had expected, to be offered talking therapy:
‘They just kept saying right, antidepressants, or whatever it is, just surrounding as an umbrella but they weren’t targeting the problem.’ (Richard)
‘I was worrying that taking the pills would sort of take the edge off that and make me a different person altogether.’ (William)
‘[The GP] said, “To be honest I don’t think there’s that much out there for depressed dads, nothing I’m aware of anyway”.’ (Samuel)
‘I went in with the expectation that I was probably going to be referred to a counsellor.’ (Paul)
Five participants eventually received talking therapy.
Five participants took antidepressants, often as a result of pressure from their partner, who had expected medicines to be the mainstay of treatment offered by the GP:
‘My wife was very much expecting me to get medicated immediately… She was also disappointed that I didn’t stick with the medication.’ (Xander)
In terms of the care provided by their GP, four participants found it helpful to be diagnosed with postnatal depression or depression. For example, Samuel found that the diagnosis helped him to explain and accept his symptoms:
‘He’d given me that label… not that it was a label I wanted to proudly display, but I guess it just helps you internalise, accept it… I was relieved it was official.’ (Samuel)
Participants recalled health visitors coming to their home but thought that they were there to support mothers, not fathers. Participants felt excluded and some of their interactions with health visitors were negative:
‘I didn’t know they were there to help me as well.’ (Zack)
‘The moment [my partner] said she was starting to buckle, a whole system seemed to leap into place, the health visitor was coming round… but even they never spoke to me, no one ever spoke to me.’ (William)
‘[The health visitor] was just not inclusive of dad and didn’t really value or listen to my opinion.’ (Richard)
‘I remember twice they came on Saturday, because I was there, and both times I was asked to leave the room.’ (Paul)
Participants commonly linked health visitors with safeguarding practices and feared that disclosing that they were experiencing symptoms of depression would create a risk of the child being removed from the family:
‘If I did say I was struggling, then it becomes a very different issue and then what happens? Like, is she going to ring social services and is she going to take my child away?’ (Xander)
‘You don’t know, if you turn round to this person [and tell them] look, we’re struggling… if it’s gonna trigger anything.’ (Victor)
When seeking support from healthcare professionals, participants tended to minimise their distress. One participant used physical pain as the reason to consult his GP. Xander communicated that he needed help but used humour to do so:
‘It was in a jokey way that I said it, it was like “I wish someone would ask me that question, ha ha ha!”.’ (Xander)
Disclosing their symptoms of depression to healthcare professionals made participants feel vulnerable and the environment in which it would happen became significant:
‘I guess I just wasn’t quite sure what to expect so the idea of being quite open and vulnerable to someone I’ve not met, on a regular basis, especially when I was struggling enough about things emotionally anyway, it was quite difficult to comprehend that.’ (Thomas)
Most participants wanted to share how they felt but needed a safe space to do so. For participants, feeling safe to disclose their symptoms meant feeling included and listened to, knowing what would happen, not being rushed and being afforded a private space away from their partner.
Talking therapy was viewed as offering safety and increased participants’ awareness and understanding of the mental health issues they were experiencing:
‘It made me more aware that there was something wrong.’ (William)
‘I felt that I understood that it was to do with my relationship with [my son].’ (Paul)
Limitations of talking therapy included lengthy waiting times, a limited number of sessions and a lack of availability – which led some participants to use private services.
The findings of this study indicate that fathers who experience postnatal depression tend not to share their feelings, often find that they cannot rely on previous coping strategies and may use self-reliance and avoidance instead. Applied to practice, this suggests that it could be beneficial to ask fathers about their daily life experiences and changes in their routine. Schuppan et al (2019) showed that fathers find direct screening for mental health issues in the perinatal period useful, so approaching the subject of their mental health directly with them could encourage them to seek support for postnatal depression.
In this study, fathers did not initially recognise their experiences as postnatal depression and did not consider postnatal depression as something that could affect them – a finding supporting those of Pedersen et al (2021). The findings of this study also support Eddy et al’s (2019) observation that men who experience postnatal depression tend to use typically masculine coping mechanisms, while the finding that some participants believed things would simply get better with time reflects Edhborg et al’s (2016) work. Education on postnatal depression delivered by nurses and health visitors could increase fathers’ awareness and knowledge of the condition and assist them to recognise when they need to seek support. Such education would need to be delivered sensitively, considering that gendered norms such as self-reliance are associated with a greater severity of depression in men (Iwamoto et al 2018).
One barrier to participants disclosing their feelings to their partner was that they felt their role was to support their partner. Darwin et al (2017) noted that many men avoid disclosing the extent of their mental health issues to their partner to protect them; Schuppan et al (2019) found that men consider help-seeking for mental health issues as a personal responsibility; and Ghaleiha et al (2022) observed that men are reluctant to seek their partner’s support during pregnancy and postnatally. When engaging with fathers, nurses and health visitors need to be aware that fathers may consider their partner’s needs to be more important than theirs and reassure them that seeking support is beneficial for their partner and child as well as for themselves.
Some men feel dissatisfied with their relationship with their partner following the birth of a child. In Davenport and Swami (2023), some fathers described their relationship with their partner as distanced, strained or non-existent. Discussing the couple’s relationship during pregnancy could help fathers prepare for change. Asking fathers about their relationship with their partner could be a useful way of assessing their feelings about fatherhood generally and give them an opportunity to discuss their mental health.
When participants in this study eventually sought help, they did so because they felt unable to fulfil their perceived role as fathers and because their partner encouraged them to consult their GP. Pedersen et al (2021) noted that men often need their partner’s support to seek help for health issues. Men’s partners often appear to be their strongest source of support in that respect, with men in rural settings relying on their partners when seeking health information (Hiebert et al 2016) and spouses acting as brokers of men’s health promotion and help-seeking behaviours (Gast and Peak 2011). Applied to practice, this suggests that it could be useful to involve partners when discussing fathers’ mental health issues with them and when planning care.
Participants’ help-seeking was triggered when they realised that they were experiencing a mental health crisis or severe symptoms of depression, which is consistent with the findings of Darwin et al (2017) and Baldwin et al (2019). Nurses and health visitors need to be aware that if a father asks for help, his mental health issues are likely to be severe and have existed for a long time.
The fathers in this study reported they were rarely asked about their well-being and mental health when their partners were screened. Overall, health visitors were perceived as being there for the mother and the child and participants felt they were not involved, describing themselves as being ‘stood there’, ‘sat there’ or ‘watching’ – which supports findings by Mayers et al (2020). Beyond feeling excluded, participants also feared health visitors because they were assumed to have the power to take the child away from the family in case of parental mental health issues – which supports findings by Pedersen et al (2021) and Davenport et al (2022).
Fathers’ preferred healthcare professional to approach regarding their mental health is the GP (Baldwin et al 2019), whereas they typically fear the consequences of approaching the health visitor or family nurse (Pedersen et al 2021). This shows that nurses and health visitors need to demonstrate professional curiosity and routinely enquire about fathers’ well-being. It is crucial that healthcare professionals ensure fathers are included during appointments, even when the focus is on the mother and the child, and are transparent and reassuring about their professional role, including their role in safeguarding.
When they sought help, participants minimised the severity of their depression, which suggests a perceived stigma around mental health issues. Stigma around mental health is a barrier to fathers’ help-seeking (Pedersen et al 2021). Rominov et al (2018) noted that fathers sometimes use non-mental health issues, such as sleep difficulties or infant colic, as the reason for seeking support. This was the case for one participant in this study, who used physical pain as the reason to see his GP.
Another participant described using humour to express his mental health needs. Men tend to use humour to talk about health issues they are embarrassed about (Branney et al 2014) or to avoid talking about their health issues (O’Brien et al 2005). Nurses and health visitors need to be aware that when men joke about their mental health, they may well be seeking support but in a manner that protects their self-image, avoids stigmatisation and acknowledges that their partner’s needs are more important than theirs. To encourage fathers to talk about their mental health, it is important to validate their feelings and help them feel emotionally safe. While some men use humour as a tool when talking to others about their mental health, the responses of healthcare professionals must be professional and caring.
Overall, participants in this study were disappointed by the medicalised approach adopted by their GP – that is, being offered antidepressants as the primary treatment option – whereas they felt they needed a safe space to talk and wanted access to talking therapy. This conflicted with some partners’ views that GP care and antidepressants were the optimal form of support. When attempting to support men with postnatal depression, nurses and health visitors should consider how gendered perspectives on help-seeking can influence treatment preferences and how discordant partner preferences can affect the relationship.
The richness of data and the depth of analysis enabled the authors to highlight the nuances and complexity of fathers’ help-seeking for postnatal depression. However, the lack of diversity in the sample limits the findings’ application to other contexts of fatherhood, such as non-biological fatherhood, racialised minority fatherhood or gay, bisexual or transgender fatherhood. Because of the recruitment methods, people who do not use social media, lack digital skills or lack access to the internet could have been excluded from participating. Another potential limitation arose from the fact that the interviewer was a female health visitor, which potentially limited the extent to which participants disclosed their experiences.
This small qualitative study offers new insight into fathers’ help-seeking for postnatal depression. It identified that fathers often did not initially recognise they had postnatal depression and thought their symptoms were a normal part of parenthood. Some fathers need professional support for their mental health after the birth of their child. To be able to discuss their mental health issues with a healthcare professional they need emotional safety, privacy and reassurance that help-seeking will benefit the whole family. Nurses and health visitors should routinely ask fathers about their mental well-being, validate their feelings and encourage them to discuss their mental health issues, even when the focus of the visit is the mother and the child.
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