A longitudinal study of paternal mental health problems from the antenatal to the postpartum period: riskfactors, relationship with maternal factors and impact of gender roleand traditionalism-modernity

Abstract

There is emerging evidence of the significance of paternal mental health problems as well as its influence on spouses and children. However, current research attention mainly focuses on paternal postpartum depression. The present study aims at determining the prevalence of paternal mental health problems, identifying risk factors and the relationship among various risk factors across different stages of pregnancy and the postpartum period. In particular, it attempts to examine the significance of gender role and traditionalism-modernity as personality traits for paternal mental health problems in the perinatal period as well as fill the current gap in knowledge on the impact of paternal mental health problems on paternal-fetal attachment.

Given the relative lack of data in the existing literature, the present study involved two phases of investigation combining qualitative and quantitative approaches to provide a more systematic understanding on the nature of paternal mental health problems. In phase 1, a qualitative study was conducted on 31 expectant fathers as the hypothesis-generating ground work. Subsequently, a total of 622 expectant couples were recruited and followed up in a large-scale survey in Phase 2. Expectant couples were recruited from regional antenatal clinics in Tsan Yuk Hospital and Queen Mary Hospital. In the quantitative component, the expectant couples were assessed using standardized and validated psychological instruments on 3 time points including early pregnancy, late pregnancy and six week postpartum.

The results showed that a significant proportion of expectant fathers manifested anxiety, and depressive symptoms, high level of perceived stress, psychosomatic symptoms, fatigue and tobacco consumption during the perinatal period. Different demographic risk factors for the outcome variables varied across different time points. Psychosocial risk factors were consistently associated with outcome variables in different time points. Maternal depression and anxiety were not only predictors of paternal psychological distress but also the predictor of higher level of paternal psychosomatic symptoms and fatigue severity. Gender role and Traditionalism-modernity were found to be significant moderators for paternal mental health problems. Undifferentiated, masculine fathers and fathers who adhere to traditional values were at higher risk of mental health problems during the transition of fatherhood. A mixed effect model analysis showed that paternal anxiety, depression and psychosomatic symptoms changes over time and was higher during the antenatal period. The relationships between paternal and maternal anxiety and depressive symptoms were significant across different time points even after controlling for confounding factors and the correlations were found to be strongest at six weeks postpartum. Findings also showed that paternal mental health problems had a detrimental effect on paternal-fetal bonding from antenatal to postpartum period.

The present study points to the need for greater research and clinical attention to paternal mental health problems given that paternal mental health problems is a highly prevalent problem with changing course and is related to maternal well-being and paternal-fetal attachment. The present findings contributes to theoretical basis of the relationships of personality traits, risk factors and mental health problems and have implications for the design of effective identification, prevention, and interventions of these clinical problems.