Method
Search Strategy and Selection Criteria
Quality Appraisal
Data Extraction and Analysis
Results
Included Studies
No | Author(s) year Country | Research aims/ outcomes considered | Sample (male particip ants only) | Woman’s postnatal mental health problem | Sample details (male participants only) | Sampling method | Data collection | Method of analysis |
---|---|---|---|---|---|---|---|---|
1 | Boddy et al. (2017) UK | To explore fathers experiences of early fatherhood and relationships during their partner’s MBU admission | 7 male partners of MBU patients | Postpartum psychosis | Aged 23-42 years (mean = 31); 5 White British, 1 Black/ African/Caribbean, 1 Mixed race; University degree, 1 postgraduate qualification, 1 A- Levels; employed, 1 unemployed; 5 Married/engaged, 1 cohabiting, 1 ‘other’; 6 first time father, 1 other children | Purposive sampling from two MBUs during partner’s admission | Semi-structured interviews (face- to-face at MBU) | IPA |
2 | Reid et al. (2017) UK | To explore how fathers felt supported during their partner’s and baby’s MBU admission. | 17 male partners of MBU patients | Data not collected | 20–64 years (mean = 38); No cultural or socioeconomic data available; 7 married, 9 cohabiting; 11 (out of 17) new fathers | Purposive sampling from one MBU during partner’s admission | Semi-structured interviews conducted (telephone or face-to-face at MBU) | Thematic analysis |
3 | Bell et al. (2016) Canada | To explore perceived barriers and facilitators to the use of mental health services | 30 male partners of women with elevated symptom s of depression (EPDS ≥ 12) in the postpartum period (1 week to 6 months) | Postnatal depression | Mean age 35 years; 13 had a university degree; 15 Canada-born; 13 married, 17 common law; 19 new parents. | Convenience sampling from a larger qualitative study (Feeley et al. 2016) | Semi-structured interviews (face- to-face at participants’ homes) Men interviewed separately from partner by a male interviewer | Inductive content analysis |
4 | Feeley et al. (2016) Canada | To explore the care preferences of women and their partners | 30 male partners of women with elevated symptom s of depression (EPDS ≥ 12) up to 12 months postpartum | Postnatal depression | Mean age 35 years (acceptors) and 34 years (decliners); 15 Canada-born; 13 university degree, 6 college/ vocational, 11 high school or less; 26 employed; 13 married, 17 common law; 19 first time fathers | Purposive sampling from obstetrical clinics and a perinatal mental health clinic of two tertiary care hospitals | Semi-structured interviews (face- to-face at participants’ homes) Men interviewed separately from partner by a male interviewer | Inductive content analysis |
5 | Henshaw et al. (2016) USA | To explore how women and their partners detect, evaluate, categorise and respond to maternal mood changes in the first postpartum year. | 11 male partners of women with postnatal depression (EPDS ≥ 10) | Postnatal depression | No separate data; All employed | Purposive sample | Semi-structured interviews (face- to-face at participants’ homes or alternative location) Men interviewed separately from partner | Qualitative analysis closely associated with grounded theory |
6 | Mizukoshi et al. (2016) Japan | To explore the experiences of husbands of women with mental health problems and the difficulties they face in the perinatal period | 7 husbands of women with postnatal depression (PDPI-R > 7.5) | Postnatal depression | Aged late 20s-early 30 s; No cultural, educational, or fatherhood details given; All married; All employed | Purposive sampling from obstetric clinical in 2 hospitals | Semi-structured interviews (face to face at the hospital or university) | Not specified |
7 | Habel et al. (2015) Canada | To explore perceptions of the causes of postnatal depression | 30 male partners of women with postnatal depression (EPDS ≥ 12) up to 12 months postpartum | Postnatal depression | Mean age 35 years; 15 Canadian-born; 15 French, 7 English, 8 other language spoken; 13 university degree, 5 college, 11 secondary education; 19 new fathers. | Convenience sampling from a larger qualitative study (Feeley et al. 2016) | Semi-structured interviews (face- to-face at participants’ homes) Men interviewed separately from partner by a male interviewer | Content analysis |
8 | Wyatt et al. (2015) UK | To explore how women and their partners make sense of the experience of postpartum psychosis and their relationship | 5 male partners of women with a diagnosis of postpartum psychosis (no time limit since onset) | Postpartum psychosis | No details available pertaining to men specifically | Purposive sampling from 3 perinatal mental health services and online via social media | Semi-structured interviews (face- to-face at participants’ homes or local buildings) Couples were interviewed together | IPA |
9 | Beestin et al. (2014) UK | To explore how postnatal depression affects fathering, what men perceive as good fathering in this context, and the ways in which men adapt | 14 men who perceive d the mother of their children to have experienced postnatal depression (no time limit since onset) | Postnatal depression | Aged 25-50 years (Mean = 33.9); 12 White British, 2 African- Caribbean; All employed; 8 partnership/ cohabiting, 5 married, 1 separated; 5 had only experienced fatherhood with their partner having postnatal depression, 9 had experienced fatherhood without this | Purposive sampling from support groups and an outreach worker, and snowball sampling | Narrative interviews (face- to-face at participants’ homes, places of work or on university premises) | IPA |
10 | Marrs et al. (2014) UK | To explore what impact a MBU admission had on father’s role and relationship with his family | 8 male partners of MBU patients | Data not collected/ reported but all women were admitted to MBU | Aged 28-51 years (Mean = 37.5, SD = 8.14); White British (n = 7), Black African (n = 1); Employed (n = 7), Self-employed (2); All married; 5 first time fathers, 3 had older children | Purposive sampling from two perinatal mental health units | Individual interviews (example questions given, no details about setting for interviews or interviewer) | Grounded theory |
11 | Doucet et al. (2012) Canada | To explore the support needs, preferences, accessibility to resources, and barriers to support | 8 male partners of women with postpartum psychosis (met criteria of by physician within the past 10 years) | Postpartum psychosis | Mean age 36.25 years (SD = 6.65); All White (Canada, n = 7, USA, n = 1), All English first language; 7 employed (full- time, n = 6, part- time, n = 1), 1 unemployed; 7 university degree, 1 partial university; 6 married, 2 common-law | Purposive sampling from community and hospital agencies that provide services for mothers with postpartum psychosis | Semi-structured interviews (over the telephone or face-to-face in a mutually agreed- upon setting) Men interviewed separately from partner | Inductive thematic analysis |
12 | Letourneau et al. (2012) Canada | To explore men’s perspectives on their support needs and preferences for coping with their partners postnatal depression | 40 male partners of women who experienced postnatal depression within the past 10 years | Postnatal depression | Aged 23-46 years; Canada-born (n = 36), immigrants (n = 4; USA, UK, Denmark); First language English (n = 38), French (n = 2); Employed (full- time, n = 32, part- time, n = 2, Self- employed, n = 2), Unemployed (n = 1), paternity leave (n = 1), student (n = 2); Technical school (n = 11), university (n = 14), graduate programme (n = 10); Married (n = 39), divorced (n = 1); No fatherhood details | Convenience sampling (Phase 1) from a variety of sources including professionals, support groups, social networking site, online adverts and media releases (n = 37) Purposive sampling (Phase 2) of articulate interviewees from Phase 1 (n = 6) and additional participants for a ‘fresh perspective (n = 3) | Phase 1: Semi- structured interviews(telephone) Phase 2: Semi- structured interviews (telephone) with a report of findings and intervention options from Phase 1 provided prior to interview | Thematic content analysis |
13 | Engqvist and Nilsson (2011) Sweden | To explore men’s experience of having a partner with a postpartum psychiatric disorder | 11 men whose partner has a postpartum psychiatric disorder (as reported by the men) | Key words searched: postpartum or postnatal disorder, postpartum or postnatal psychosis, postpartum depression | Data not collected | Internet search engine search for written narratives using key words and inclusion criteria | Written narratives identified through internet search engine search | Not specified |
14 | Letourneau et al. (2011) Canada | To explore how men perceive and receive support when their partners have postnatal depression. | 11 men whose partners have postnatal depression (reported symptom s during their last pregnancy and were no longer than 24 months post- partum) | Postnatal depression | Aged 29-44 (Mean = 37); All Canada-born; All English first language; All employed full-time; Technical school (n = 3), college/university degree (n = 3) graduate programme (n = 3); Married (n = 10), Single (n = 1); 6 first-time fathers and 2 child died within first year | Convenience sampling from community agencies, self- nomination or service provider nomination | Semi-structured interviews (telephone) | Thematic content analysis |
15 | Muchena (2007) UK | To explore the experience of MBU admission, understand their reactions, coping strategies, stressors, needs and expectations of the fathering role | 8 male partners of MBU patients | Postpartum psychosis and postnatal depression | No details | Purposive sampling from a MBU. Stratified sampling: Potential participants were grouped by 1) their partner’s diagnosis and 2) whether they were inpatient/ post-discharge then randomly selected from these groups | Semi-structured interviews (face- to-face, no details of location) | Thematic analysis |
16 | Nicholls and Ayers (2007) UK | To explore the experience and perceived impact of traumatic birth and postnatal PTSD. | 6 men whose partner has childbirth-related post- traumatic stress disorder (met DSM-IV diagnosti c criteria within the first year) | Childbirth -related post- traumatic stress disorder | No separate age, cultural or socioeconomic details for men reported; All married; 5 first-time parents, 1 second child | Purposive sampling via internet advertisements and self-help organisations. | Semi-structured interviews (face- to-face at participants homes) Men were interviewed separately to partner | Inductive thematic analysis |
17 | Davy et al. (2006) Australia | To explore experiences of a group treatment programme for male partners | 13 male partners of women with postnatal depression (diagnosed in the first year postpartum) | Postnatal depression | Mean age = 29.8 years (SD = 5.4) No cultural, socioeconomic or marital details for men reported Mean children per family = 2 (SD = 1.0) | Two treatment groups (n = 5, n-8) recruited from local community through self- referral or health- professional referral (specific recruitment details not reported)- focus groups conducted at the end of the treatment | Focus group interviews- two groups (face-to- face at health service conducted in second half of final treatment group session) | Phenomenological approach (themes generated) |
18 | Everingham et al. 2006 Australia | To explore the way in which couple’s talked about PND and the discrepancies between men and women’s understanding, and the ways in which the diagnostic process had helped/hindered the couples communication | 6 male partners of women with postnatal depressio n (EPDS or clinical assessme nt, up to 15 months postpartu m) | Postnatal depression | Average age 35 years; All cohabiting; No specific cultural, socioeconomic, marital or fatherhood details reported | Purposive sampling by early childhood health professionals | Semi-structured interviews (face- to-face at participants homes) Men interviewed separately from partner by a male interviewer | Framework analysis |
19 | Webster (2002) UK | Men’s perceptions of the effect of PND | 8 male partners of women with postnatal depression (identified by health visitor) | Postnatal depression | All cohabiting; No specific age, cultural, socioeconomic, marital or fatherhood details for men reported | Purposive sampling via health visitor | Semi-structured interviews (setting not detailed) Couples were interviewed together | Not specified (themes identified) |
20 | Meighan et al. (1999) USA | To explore the lived experiences and impact of PND on men | 8 male partners of women with postnatal depression | Postnatal depression | No specific age, cultural, socioeconomic, marital or fatherhood details reported for men. | Convenience sampling from previous study (Wood et al. 1997) and purposive sampling through health care professionals and snowballing sampling | (Limited details) Interviews (face- to-face in participants homes) Most women were present in the home but did not participate in interview process | Existential phenomenology |
Paper | Clear research aims | Appropriate methodology used | Appropriate design used | Appropriate recruitment strategy | Appropriate data collection | Relationship between researcher and participants considered | Ethical issues considered | Rigorous data analysis | Clear statement of findings | Valuable research | Total score (T = 10) |
---|---|---|---|---|---|---|---|---|---|---|---|
Boddy et al. (2017) | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | 10 |
Reid et al. (2017) | Yes | Yes | Can’t tell | Yes | Yes | Yes | Yes | Yes | Yes | Yes | 9.5 |
Bell et al. (2016) | Yes | Yes | Can’t tell | Yes | Yes | Can’t tell | Yes | Yes | Yes | Yes | 9 |
Feeley et al. (2016) | Yes | Yes | Yes | Yes | Yes | Can’t tell | Yes | Yes | Yes | Yes | 9.5 |
Henshaw et al. (2016) | Yes | Yes | Yes | Yes | Yes | Can’t tell | Yes | Yes | Yes | Yes | 9.5 |
Mizukoshi et al. (2016) | Yes | Yes | No | Yes | Yes | Can’t tell | Yes | Yes | Yes | Yes | 8.5 |
Habel et al. (2015) | Yes | Yes | Can’t tell | Yes | Yes | Can’t tell | Yes | Yes | Yes | Yes | 9 |
Wyatt et al. (2015) | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | 10 |
Beestin et al. (2014) | Yes | Yes | Yes | Can’t tell | Yes | Can’t tell | Can’t tell | Yes | Yes | Yes | 8.5 |
Marrs et al. (2014) | Yes | Yes | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | 9 |
Doucet et al. (2012) | Yes | Yes | No | Can’t tell | Yes | Yes | Yes | Can’t tell | Yes | Yes | 8 |
Letourneau et al. (2012) | Yes | Yes | No | Yes | Yes | Can’t tell | Yes | Yes | Yes | Yes | 8.5 |
Engqvist and Nilsson (2011) | Yes | Yes | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | 9 |
Letourneau et al. (2011) | Yes | Yes | Yes | Yes | Yes | Can’t tell | Can’t tell | Yes | Yes | Can’t tell | 8.5 |
Muchena (2007) | Yes | Yes | Can’t tell | Yes | Yes | Can’t tell | Yes | Can’t tell | Yes | Yes | 8.5 |
Nicholls and Ayers (2007) | Yes | Yes | Can’t tell | Yes | Yes | No | Yes | Can’t tell | Yes | Yes | 8 |
Davey et al. (2006) | Yes | Yes | Yes | Yes | Yes | Can’t tell | Yes | Yes | Can’t tell | Can’t tell | 8.5 |
Everingham et al. 2006 | Yes | Yes | Yes | Yes | Yes | Can’t tell | Yes | Can’t tell | Yes | Yes | 9 |
Webster (2002) | Yes | Yes | Yes | Yes | Yes | No | Can’t tell | Yes | Can’t tell | Yes | 8 |
Meighan et al. (1999) | Yes | Yes | Yes | Can’t tell | Yes | No | Can’t tell | Yes | Yes | Yes | 8 |
Qualitative Results
Main theme: being a father
Parenting together
I was under a lot of pressure as well… I’m literally the one left holding the baby and obviously, I was expecting her to do everything. (Wyatt et al. 2015)
You do the smallest thing and, ‘oh no, you’re doing it wrong’. Let her got on with it. Ok, it might not be your way but if each of your people and us have different ways of doing it, it doesn’t mean we’re wrong it just means it’s different. (Boddy et al. 2017)
Transition to fatherhood
Obviously you have the double whammy. One, you have a partner who is quite poorly. Two, you loose some of the most important weeks of your life with your baby. (Reid et al. 2017)
She was in a really bad situation, so I said I have to do this for her and….show her how good I am, to look after the children and I want to see her…recover…She’s happy now because, I could be asked to be that person for that time. (Boddy et al. 2017)
Father-baby-bond
[H]e won’t go nowhere without his dad, and vice versa you know what I mean? […] I love spending time with him, I love doing, so for that reason alone and er with what I get back off him now er you know cuddles and wanting to come with his dad and the smiles and you know we’re just happy with each other. (Beestin et al. 2014)
Then there’s the issue of not being able to spend time with your baby…you only see him for a couple of hours a day. It’s as if you’re only a temporary father. (Reid et al. 2017)
Impact on the family
The first four weeks in particular every night he cried. Things like that, as a father, when your wife, his mother is taken, when she is not in the environment he is used to, as in your home. Dealing with that was quite hard. (Marrs et al. 2014)
I know I did try to direct a lot of attention and love to [the baby] because I felt maybe [my wife] wasn’t providing that so I was trying to bridge a bit of a gap. (Nicholls and Ayers, 2007)
Main theme: being a partner
Uncertainty
The hardest part of it all is the drastic change in mood. /…/When she praises me I take it with a grain of salt because I know that it can turn on a dime. (Engqvist and Nilsson 2011)
I think throughout the experience I had more or less the feeling of like I wasn’t able to help her just because I wasn’t- I couldn’t- I didn’t really understand why she couldn’t sleep so and didn’t understand how bad her anxiety was… and then you’re worried about your partner as well, that can be quite stressful. (Letourneau et al. 2011)
Breakdown and loss
I’m at a loss to know what to do, we argue over and over about the same things, again and again…I spend time listening, talking about options over and over again. Finally, I get to sleep and think it’s all resolved, and then a few days later she bring it up again and says we didn’t finish discussing such and such. (Davey et al. 2006)
I felt so lost and confused I didn’t know what to do. It was like a stranger had come and replaced my warm and loving best friend with a woman with dead eyes and a cold heart. (Engqvist and Nilsson 2011)
Growing stronger
For me it was almost natural to think that it’s our problem, not your problem…one attitude is, it’s your problem, solve it, and another one is, the problem is yours, but we have to sort it together, we have to be together in the process. (Nicholls and Ayers 2007)
We were obviously very close and open with each other but I do think possibly we’d be more open with each other now just ‘cause of what’s happened. (Wyatt et al. 2015)
Attributing the cause of the problems
(She) is such an anxious person, when there’s change. She’s not real big on change. So that’s probably the biggest change in her whole life. (Everingham et al. 2006)
Let’s say that I think that modern society asks too much… Before, a woman was staying at home and taking care of the kids. Now, a woman is a professional, a mother, a lover… So it is heavy in terms of demands. (Habel et al. 2015)
Main theme: experiencing negative emotions
Stress and depression
When you have had no sleep, you are pulling your hair out and you have bags under your eyes and you think, why have I bothered, why are we having a family, I don’t want to feel like this…is that depression? Could be, I don’t know. (Webster 2002)
I needed emotional support. I felt I was becoming depressed. It was everything, the long days at the hospital. I saw things that I never saw before and that affected me. I kept thinking, when is she going to snap out of it? Why is this happening? I thought having a baby was going to be the best thing to happen. (Doucet et al. 2012)
Helplessness
I thought her suicide would be an answer, then I felt guilty for [having] those feelings. (Meighan et al. 1999)
I also had no idea how to get help. Nothing in my life has come close to causing as much worry, desperation, anger, frustration, despair, and fear as dealing with PPD. (Engqvist and Nilsson 2011)
Shock and confusion
I couldn’t understand it, really, but I had nothing to compare it with, so I just thought oh, is it just hormones and things after having the baby and it’ll settle down. But maybe somewhere in the back of my mind I knew something wasn’t quite right. (Boddy et al. 2017)
At first, I was just scared…I didn’t know what it was and she didn’t know what it was. (Meighan et al. 1999)
Anxiety
In terms of anxiety, certainly some anxiety because we would actually just walk around the house on eggshells wondering if (wife) is going to have one of these episodes and what is the effect going to be on her and on our little guy. (Letourneau et al. 2011)
It was really scary, especially I think going home at night and things. Like just lying awake and then, I dunno, obviously I hadn’t been sleeping well as well so the thoughts that [partner] was speaking to the psychologist, I was getting the same kind of thoughts. Not wanting to kill myself but just that I couldn’t concentrate on anything. I couldn’t relax because my mind was racing… (Marrs et al. 2014)
Main theme: the ways in which men cope
Practical coping
I called her [the doctor] and she explained to me what was happening, how these kinds of things can happen. She talked me through what I needed to do. (Engqvist and Nilsson 2011)
I think at the time probably what I would…my overriding kind of emotion would have been relief that finally she was in a place where people understood what was going on. (Marrs et al. 2014)
Avoidant coping
This is the second time my wife has had PND. It’s been really hard. I have avoided going home at times. (Davey et al. 2006)
Switching off my feelings… to make like your own, kind of like your own postnatal depression pills. (Beestin et al. 2014)
Social coping
My partner has been extremely loving and supportive towards me through this whole process. (Reid et al. 2017)
Help from the parents was so big that I could sleep completely through the night. I understood that it was hard to become a parent and thanked my parents. We were at a loss when the baby cried. Nothing could be done by us, and we felt powerless. (Mizukoshi et al. 2016)
Main theme: where support is needed
Personal barriers
I didn’t know what I was looking for. I didn’t recognise there was as much of a problem as there actually was. (Letourneau et al. 2011)
I wish I was able to send an SOS out to bring us casseroles or to help around the house. I couldn’t do that because I have difficulty asking for support. It’s a guy thing. (Doucet et al. 2012)
Support network barriers
She said, ‘I will be fine, it will pass.’ (Bell et al. 2016)
Extended family should be afforded some educational sessions on what’s going on…they would like to help but if they don’t understand what is going on, what’s the point? (Letourneau et al. 2012)
Professionals approach to care
They [health care professionals] focus a lot on the newborn. Services focus on the baby’s health, not on the mother’s health and definitely not on the father’s health. (Bell et al. 2016)
Erm nobody had ever really explained to me I don’t think the real purpose of her being in the unit. I don’t think anybody ever really sat me down and said, you know ‘this is what we are hoping to do. Not just keep your wife and daughter together’. Erm it felt a bit strange at times. It almost felt like you were going down to visit somebody in hospital. (Marrs et al. 2014)
Possible solutions
I needed advice on how to handle the illness and what to say. Also, information on the early signs of relapse to watch for and if it was to the point that I needed to get help. (Doucet et al. 2012)
I think taking about it is better than just pretending it hasn’t happened…My partner is quite willing…to say to people, ‘look, this is what happened afterwards’…what people need to look out for…I’m a great believer in that people need to shout about things to get people to listen. (Boddy et al. 2017)