Fathers' experience of depression during the perinatal period: a qualitative systematic review

Objective: The objective of this review was 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 perinatal 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. Inclusion criteria: This review included qualitative studies that included biological fathers over the age of 18 years. The phenomenon 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 existing systematic reviews were carried out in March 2021 and no similar protocols or completed reviews were identified. Seven databases were searched in August 2021: MEDLINE, CINAHL, PsycINFO, Scopus, ProQuest Sociology, ProQuest Dissertations and Thesis Global, and OpenGrey. Search limits included English language and Organisation for Economic Co-operation and Development (OECD) countries. Two reviewers assessed methodological quality. A standardized data extraction tool was used to extract and synthesize data. Confidence in the findings was subsequently assessed. Results: Nine studies were included after full-text review that were considered relevant to the research questions and that 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 among men; relationships are experienced as both comforting and distressing in the perinatal period; fathers in the perinatal period 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 fathers; and all men have the potential to struggle 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 eager 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. Systematic review registration number: PROSPERO CRD42021245894