Why do health visitors screen mothers and not fathers for depression in the postnatal period?

Abstract

Traditionally, health visitors have focused on maternal wellbeing and child health, which explains why paternal postnatal depression (PND) has been comparatively unrecognised by this group of health professionals. This small study sought to identify why health visitors carry out PND screening using a tool such as the Edinburgh Postnatal Depression Scale and provide emotional support for mothers and not fathers, despite literature highlighting the need for both mothers and fathers with poor mental health to be signposted to mental health services and offered emotional support. The majority of participants in this study identified that they do not routinely consider fathers' emotional health, and believe that their role as a health visitor should continue to be child- and mother-focused, despite knowing that paternal mental health consistently correlates with child health and wellbeing ( Fatherhood Institute, 2012 ).

Perspectives on supporting fathers affected by postnatal depression and a history of violence

“…However, Walker et al, (2015) contends that individuals with minimal violence and psychopathology will benefit from basic intervention. Health Visitors already deliver psychologically informed sessions to mothers; these are shown to be clinically effective at six and 12 months postnatally when compared with usual care (Whitelock, 2016). It may be possible to deliver similar sessions to fathers, thereby reducing the risk of IPV.…”

“…Educating and skilling Health Visitors to assess women's wellbeing and identify symptoms of postnatal depression has been effective in mothers gaining timely and appropriate support (Morrell, 2009). However, screening fathers for PPPD is not routinely undertaken because of an assumed focus on mother and child (Whitelock, 2016). Should a Home Visitor identify a father in need of support they are likely to be concerned over the limited number supportive interventions available for fathers with depression and anxiety (O'Brien et al, 2016).…”

“…Health visitors routinely perform psychosocial assessments of new mothers and fathers within the context of Family Centred Care (FCC) (Brook, 2015). Although FCC is inclusive of fathers, health visitors may focus primarily on mothers because they lack the knowledge and confidence to explore men's issues in the perinatal period (Whitelock, 2016). Unrecognised and unresolved issues held by fathers may ultimately have negative health consequences for mother and child (Garfield, 2015).…”

Evidence from a systematic review on first-time fathers' mental health and wellbeing needs

“…Depression in fathers has been associated with higher levels of emotional and behavioural problems in children at around three years of age, particularly in boys (Ramchandani et al 2005). In a later study, Ramchandani et al (2008) While the importance of addressing maternal mental health needs are more widely recognised, with routine mental health screening and assessment offered to women during and after pregnancy, men continue to report feeling marginalised and unacknowledged by health professionals during the perinatal period, and report a lack of appropriate information on pregnancy, birth, child care, and balancing work and family responsibilities (Palsson et al, 2017;Whitelock, 2016;Dheensa et al, 2013;Williams et al, 2011;Backstrom and Hertfelt Wahn, 2009). This paper considers the findings of a recent systematic review on first time fathers' mental health and wellbeing needs, and discusses the practice implications for health visiting services.…”

Mental health of first time fathers – it's time to put evidence into practice

“…13 Despite increasing evidence of perinatal consequences for men's mental health, fathers continue to report being marginalized by the maternity and early years services. 14,15 The UK National Institute for Health and Care Excellence guidelines on antenatal and postnatal mental health recommend routine mental health assessment of pregnant and postnatal women; however, no mention is made of the mental health and wellbeing of fathers and no practice recommendations relevant to father's mental health needs are included in the guidance. 16 That awareness of maternal mental health needs is being addressed by the relevant UK services is commendable; however, men's mental health needs continue to be neglected, despite them also having to deal with the roles, responsibilities and challenges of new parenthood.…”