Early signs can be overlooked. Fathers are less likely to be diagnosed during pregnancy, but face increased mental health risks months later.
Study: Psychiatric disorders in Swedish fathers before, during and after their partner’s pregnancy. Image credit: Monkey Business Images/Shutterstock.com
In recent research, JAMA network open investigated the pattern of occurrence of fathers’ mental illness before, during, and after their partner’s pregnancy.
The overlooked burden of mental illness among new fathers
Parental mental health shapes family functioning and child development across multiple domains, but paternal mental illness has received considerably less research attention than maternal mental illness. This disparity persists despite evidence that paternal perinatal mental illness increases the risk of adverse outcomes for both partners and children. Fathers typically face complex barriers to care, including stigma and delayed clinical recognition, which leaves family-level influences unaddressed.
Becoming a father comes with both rewards and challenges. Although many men experience strong emotional bonds, the perinatal period can also bring strained relationships, reduced communication with partners, and disrupted sleep due to new caregiving demands. These pressures combine to make it difficult to track fathers’ mental health, and unlike the more established support systems available for mothers in many healthcare settings, timely screening remains difficult without clearly defined high-risk periods.
Existing data indicate that the prevalence of mental disorders among fathers increases in the first 6 months postpartum compared to the general male population. However, prevalence estimates alone cannot identify when new episodes will appear, posing major challenges for clinical resource allocation and mechanistic understanding.
Assessing paternal psychiatric risk throughout the perinatal period
This national cohort study used linked national register data to investigate the incidence of clinically diagnosed paternal mental disorders among fathers whose children were born in Sweden between January 1, 2003 and December 31, 2021. Births were identified from the Medical Birth Register (MBR), which records 98% of all births in Sweden. Wrong or duplicate records were excluded.
Fathers were followed up to 1 year before pregnancy (or date of entry or 1 January 2003, whichever was later) until first psychiatric diagnosis, 1 year postpartum, emigration, death, or 31 December 2022, but approximately one-quarter of births did not have a full 1-year preconception observation period. Psychiatric diagnoses were identified using data from the National Patient Registry (NPR), which covers national inpatient care since 1973 and specialty outpatient care since 2001, thereby capturing all mental health symptoms and diagnoses made in specialty care rather than primary care encounters.
The primary outcome assessed in this study was psychiatric illness. Secondary outcomes included depression, anxiety, stress-related disorders, alcohol, tobacco, and substance use disorders, bipolar disorder, psychosis, and attention-deficit/hyperactivity disorder (ADHD).
Annual incidence rates (IRs) for all mental illnesses and disease-specific mental illnesses were estimated over three time periods from 2003 to 2021, standardized by age at birth, and further calculated at weekly intervals across the perinatal timeline.
Incidence of paternal mental disorders peaks in the late postpartum period
The study cohort consisted of 1,096,198 fathers and 1,915,722 live births. Approximately 77% of the fathers were born in Sweden, and 61.2% of the cohort resided in central Sweden. The majority lived with a partner, and 46.1% of the cohort had 10 to 12 years of education. The average age of the fathers at the time of birth was 33.8 years, and half were first-time fathers.
IR for all mental illnesses increased consistently throughout all perinatal periods from 2003 to 2013 and then decreased until 2021. This pattern also held true for depression, anxiety, stress-related disorders, alcohol use disorders, and drug use disorders. Tobacco use disorder and bipolar disorder increased gradually before stabilizing, while psychosis remained stable and ADHD continued to increase throughout the study period, albeit at a slower rate after 2013.
The IR for paternal mental disorders was lower during pregnancy and the early postpartum period than in the week before pregnancy, reaching a low point of approximately 4 per 1000 person-years in the third trimester and recovering to pre-pregnancy levels by the end of the year. Depression and stress-related disorders slightly exceeded fertility by the end of the puerperal year, whereas smoking disorders, ADHD, bipolar disorder, and psychosis remained largely stable throughout.
Relative to the corresponding number of pre-pregnancy weeks, the IRR for paternal mental illness increased slightly during the first trimester, decreased through the second trimester, and then recovered to pre-pregnancy levels by the late postnatal period, even though the absolute incidence during pregnancy remained lower than during the entire pre-pregnancy period. Depression and stress-related disorders showed the steepest increase postpartum, with IRRs exceeding pre-pregnancy levels by more than 30% in the last few weeks of the first year. Tobacco use disorder, ADHD, bipolar disorder, and psychosis did not show significant deviations across the board.
Sensitivity analyzes restricted by psychiatric history, geographic region, completeness of preconception follow-up, and birth order yielded consistent results, with slightly higher IRRs in analyzes restricted to Stockholm County, where primary care data supplement specialist records.
Fathers with lower educational attainment had significantly higher IRRs for mental disorders across all perinatal periods, but the relative pattern of IRRs was similar across educational strata. Year of birth, country of birth, and number of children did not significantly influence incidence or proportion.
conclusion
This Swedish national cohort study found that the incidence of paternal psychiatric disorders was lower during pregnancy and the early postpartum period compared with before pregnancy, and returned to baseline by the late postpartum period.
Depression and stress-related disorders increased most markedly in the late postpartum period, suggesting that the transition to fatherhood may be associated with delayed psychiatric risks or may reflect delayed detection associated with reduced help-seeking and awareness in the perinatal period.
The authors also note that, in contrast to mothers, fathers do not show early postnatal peaks in disorders such as depression and psychosis, highlighting that gender-specific temporal patterns are clear. These findings may partially reflect underdetection due to decreased help-seeking among fathers. Taken together, these findings highlight the need for targeted paternal mental health monitoring throughout the postpartum year.
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