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Reviewed research
Authors Giallo R, D’Esposito F, Cooklin A, et al.
Review Date June 2014
Citation Soc Psychiatry Psychiatr Epidemiol 2013; 48(4): 563-573
Background
The first year after having a baby is a period where some fathers may be at risk of experiencing mental health difficulties. Research suggests that 10% of fathers experience depression and 10-17% experience anxiety. Poor mental health among fathers is known to adversely affect their children’s well-being and development, and their relationship with their partner. Little research has focused on assessing the factors associated with poor mental health in fathers during the postnatal period. Such research has predominantly used small samples from clinical settings creating issues for generalisability. Further, there has been a focus on depression when men are known to underreport depressive symptoms and may experience mental health difficulties in ways that are not captured by self-report depression measures.
Aim
The current study aimed to examine a broad range of individual, infant and contextual factors, and their association with mental health difficulties experienced by men in the first year after the birth of their baby.
Methods
This paper used secondary analysis of data generated from the first wave of a population-based study (the Longitudinal Study of Australian Children) that aims to follow the development of Australian children and families. The sample for this paper comprised biological fathers who lived with their infant child aged 1 year or younger at the time of data collection, and for whom mental health data were available. Data collection included face-to-face interviews with the primary care giver, self-complete questionnaires with both primary and secondary carers, and data obtained from the Australian Bureau of Statistics. The main outcome was fathers’ mental health as measured by the self-complete Kessler-6 (K6) scale; a global measure of psychological distress in the last four weeks. Multivariate logistic regression was used to examine the associations between potential risk factors and fathers’ mental health. Each factor was first examined in a bivariate logistic regression; factors significantly associated with mental health were then entered into the final multivariable model.
Results
The final sample consisted of 3,219 men. Compared to those who were excluded due to incomplete mental health data, those included were more likely to have completed high school, speak English at home, to have high prestige jobs, higher incomes, and lower socio-economic disadvantage. Overall, 10% of fathers were classified as experiencing poor mental health. Bivariate analyses revealed no evidence of an association between fathers’ mental health and geographical remoteness, neighbourhood disadvantage, occupational prestige, number of children living in house, and having more than one child. Infant characteristics of gender, age, conception method, birth timing/weight, and temperament were also not associated with mental health. Multivariate analysis revealed that fathers’ poor mental health was associated with low parental self-efficacy (i.e., confidence in parenting ability) and the contextual factors of having low relationship quality, poor maternal mental health, low job quality, and having a partner in a more prestigious occupation.
Conclusion
Contextual factors pertaining to the fathers’ employment and the couple relationship were found to be the strongest predictors of poor mental health. Job quality (i.e., paid family friendly leave, flexible hours, job control, and job security) was the factor most strongly associated with poor mental health; those with the lowest job quality were five times more likely to experience poor mental health than those with the highest job quality. The findings of this paper have implications for policy and clinical practice. Improving fathers’ access to high quality employment conditions and entitlements may improve the mental health outcomes for fathers and their families. These findings may also assist clinicians to identify fathers at risk of mental health difficulties. Clinical assessment should consider employment and job quality, quality of the couple relationship, confidence in their parenting role, and perceptions regarding their relative contributions to the family. Such factors are also potential targets for intervention and support to improve postnatal father wellbeing; fathers may benefit from information on negotiating work-life balance and managing changes in the couple relationship.
Points to Note
- Both men and women are susceptible to experiencing mental health difficulties in the postnatal period.
- Fathers’ mental health difficulties in the postnatal period can have adverse effects on their children’s well-being and development, and the couple relationship.
- Strengths of this study include the consideration of a broad range of potential risk factors, use of a global mental health scale (as opposed to depression only), and use of a population sample (rather than a clinical sample).
- Limitations of this study include the use of self-report measures (vulnerable to response bias), no assessment of mental health history in secondary care providers (of which most were men), exclusion of men not in a relationship, and no acknowledgement of men in same-sex relationships. Further, the measure used to assess mental health addresses only the previous four weeks and not the whole postnatal period.
- This study is based on cross-sectional data and as such causality cannot be inferred. It is likely that the associations found represent a complex interplay of biological, social and cultural factors.
- The findings of this study demonstrate the importance of contextual factors (e.g., job quality, couple relationship quality) to fathers’ mental health beyond that of socio-demographic (e.g., age, socioeconomic status) and infant characteristics (e.g., temperament, sleep problems).
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