Around 10 years ago, there was little discussion around the incidence of postnatal depression. Statistics by Cox et al (1987) demonstrated that at least 1 in 10 mothers suffered from it and this was later increased to 1 in 7 by Wisner et al (2013).
Several scientific and social mitigating factors converged to alert the public that the occurrence of anxiety and depression during pregnancy needed to be carefully considered because of the significant circumstances which might impact on the mother and infant. What followed was greater focus and concentration on the mother's mental health.
Although it may be argued there is not always equity within the perinatal mental health services across the UK, there has been a substantial improvement in the access for mothers. This, however, is not the case for fathers. There has been a growth of interest in fathers' mental health but this does not appear to have the same momentum as that for mothers. The statistics for fathers experiencing depression is around 1 in 10.
With escalating mental health problems, fathers are almost 50 times more likely to pose a suicide risk than at any other time in their lives (Quevedo et al, 2010). One systematic review found the prevalence rates for an anxiety disorder, ranged between 4.1%–16.0% during the antenatal period and 2.4%–18.0% during the postnatal period (Leach et al, 2016). It is slowly being recognised that the transition to fatherhood can be both challenging and life changing.
The societal influences and expectations are for fathers to be more involved with their infant than their forebears, and to be acquaint with the foibles of child-rearing, which does not come naturally for some. The unique experience of becoming a father may be a stressful time as it has physical demands on sleep patterns and the ensuing fatigue, and also psychological demands on self-esteem and motivation. For the most part, fathers manage, but if they do experience difficulty coping this may be compounded by a poor relationship or dissatisfaction with their partner, and financial or employment problems (Giallo et al, 2013).
The impact of the father witnessing a traumatic delivery are now well documented, with the emphasis on the despair and vulnerability of the father following the observation of the mother and his child being subjected to extreme stress during the birth. This can lead to post-traumatic stress disorder and reliving the scenes of the ordeal (Bradley and Slade, 2011; Stramrood et al, 2013). There is considerable evidence suggesting that the mother's mental health has a significant impact on the father's and in some instances, can exacerbate his poor mental state (Paulson and Bazemore, 2010; Vismara et al, 2016; Gutierrez-Galve et al, 2019). Whereas there is often sufficient support for the mother, the needs of the father can often be ignored or marginalised (Stein, 2018).
Suicide is the biggest killer in men under 50 in the UK and global rates near 600 000 male suicides per year (World Health Organization, 2016). We need to include fathers in policy and pathway of care to support all parents for their mental health which has far better outcomes for the whole family.