Risk Factors Associated with Mental Health Problems in Expectant and New Fathers: A Critical Literature Review

Background: Current research indicates that expectant and new fathers with mental health problems can be less attentive and nurturing toward their children and their partner. These behaviours can negatively affect child wellbeing and development, spousal relations, and family functioning. Yet relatively little is known about paternal mental health risks. Methods: To identify risk factors associated with paternal mental health problems, prenatal and postnatal, a critical literature review was undertaken of observational studies published in English-language academic journals between 2012 and 2017. CINAHL, Education Source, MEDLINE, and PsycINFO were searched; 552 studies were initially identified and screened; 52 were assessed in detail; and 12 met inclusion criteria.Findings: Methodologically, the quality of the 12 included studies varied and included both cross-sectional and longitudinal approaches, as well as a randomized controlled trial, in samples ranging in size and representativeness. Potential risk factors associated with paternal prenatal mental health problems included adverse childhood experiences and childbirth fear. A number of potential risk factors emerged from the literature assessing paternal postnatal mental health problems, including: low relationship quality; employment and income concerns; and, past and current mental health problems. Discussion: As noted by other authors, more prospective longitudinal studies are needed to better identify risk and protective factors associated with paternal prenatal and postnatal mental health. Additionally, previous authors have noted that a shared understanding of how to evaluate risk factors is needed to advance research such as this. Methodologically, strategies are also needed to reduce attrition among study participants in longitudinal studies and in randomized controlled trials, especially among men with mental health problems, a problem noted in several of the studies reviewed here. Future studies would also benefit from larger, randomly selected, and more representative sample populations.There may nevertheless be policy and practice implications, based on the literature to date. For example, interventions such as asking about relationship quality in maternal mental health screening could help to identify male partners who may be experiencing mental health challenges. Based on the quality of the data, it is premature to recommend more extensive policy and practice interventions until more research is conducted.Conclusions: The policy, practice and research communities, as well as Canadians in general, need to better understand and address paternal mental health – an underappreciated public health problem which can greatly affect child and family wellbeing.