Abstract
Current literature lacks qualitative information derived from distressed fathers. The aim of this study was to explore distressed fathers’ experiences and needs in the early postpartum period. A descriptive qualitative study design was used. The study took place from October 2018 to December 2018 at the tertiary public hospital in Singapore. A purposive sample of 12 distressed Singaporean fathers were interviewed in this study. Audio recorded interviews were conducted face-to-face using a semistructured interview guide and thematic analysis was used to analyze the data. Six themes emerged from the thematic analysis: (a) facing the “real deal,” (b) everyday woes, (c) “losing excitement,” (d) “trying to be strong,” (e) “reality check,” and (f) supplementing help for fathers. This study highlights distressed father’s agony and the urgent need for health care professionals and family members to seek acceptability and understanding of fathers’ mental health difficulties in the early postpartum period.
Keywords
Introduction
Research has shown that fathers experience mental health difficulties in the postnatal period, including depression and anxiety (Giallo et al., 2013). These findings underscore the fact that postnatal mental health difficulties exist in not just mothers but fathers as well. Psychological distress is a broad term, and the origin of this concept has not been clearly articulated (Ridner, 2004). This study adopts the most widely accepted definition of psychological distress—a state of emotional suffering characterized by symptoms of depression and anxiety (Mirowsky & Ross, 2002). Psychological distress is a form of maladaptive coping to a stressful situation, and progression into the maladaptive state may result from prolonged exposure to stress or multiple stressful events. Stress may be common, but when it poses undesirable effects on everyday living, relationships, or health, it becomes psychological distress that calls for concern (Schneiderman et al., 2005). Fatherhood can be rewarding and meaningful (Levtov et al., 2015) yet complex and demanding. Fathers experience high stress levels while adjusting to the demands of early parenting and altered partner relationships, which usually peak during the first postnatal year and may persist across the early childhood period for some (Giallo et al., 2013). Factors associated with paternal psychological distress are multifarious, ranging from sleep deprivation (Darwin et al., 2017; Shorey et al., 2017) to altered marital relationships (Chung et al., 2011; Kerstis et al., 2016) to work–family conflicts (Cooklin et al., 2015). While subsequent fathers are expected to cope better, Darwin et al.’s (2017) study revealed that past experiences can still provoke anxiety as experiences are still equally “scary” when new challenges of divided attention and sibling rivalry arise. Detecting mental health difficulties in fathers can be difficult, especially when men in nature have poor help-seeking behaviors when it comes to mental health. Stigma against mental health has always been longstanding, a study found that depressed men were viewed more negatively than depressed women by society (Felder et al., 2017). Fathers also tend to underreport their mental health difficulties due to their innate stoical attitudes and perceived expectations of masculinity (Cole, 2013), especially so for Asian populations who value emotional self-control where they are expected to withhold feelings of pain and suffering (Kim et al., 2001) and deny any psychological problems to remain in the social norm (Kim & Omizo, 2003). In multicultural society like Singapore, there exist different religions such as Islam, Hinduism, and Christianity that promote patriarchy which influences the functioning of fatherhood (Yeung, 2013). Despite initiatives such as the “DADs for Life” movement in Singapore that promotes active fathering, fathers are still expected to be the breadwinner of the family while mothers, regardless of their employment status, continue to be the main caregiver for the children (Salway et al., 2009; Yeung, 2013). Dual-income families are also a common sight in Singapore, hence it is typical to receive help from extended families and domestic helpers to meet childcare demands (Yeung, 2013).
In the long term, besides engaging in unhealthy forms of stress relief such as excessive smoking and poor diet choices (Shorey et al., 2017), dysfunctional mental health can also affect parenting behaviors (Takehara et al., 2017) and relationships (Kerstis et al., 2016; Top et al., 2016). Moreover, children of fathers with persistent mental health difficulties are more likely to have emotional and behavioral problems later in life (Ramchandani et al., 2013). As fatherhood has long-term impacts on not only fathers but the entire family, it is important to understand the experiences and support needs of distressed fathers. However, literature examining the postnatal needs of fathers is scarce (Shorey et al., 2017, 2018) and its focus remained on presumably healthy fathers, overlooking the mental health of distressed fathers. The latest published qualitative study (Eddy et al., 2019), addressing the father’s mental health during the postpartum period, highlighted the need of exploring distressed fathers’ experiences through in-depth interviews. As such, this study aims to explore the needs and experiences of fathers with psychological distress in the early postpartum period so as to narrow the notable research gap in understanding the first-hand experiences of distressed fathers, the challenges they face and how best to address their psychological well-being.
Methods
Study Aim and Design
This study aimed to achieve a comprehensive understanding of distressed fathers’ experiences and support needs in the early postpartum period. A descriptive qualitative research design was used in this study as this design provides an opportunity for researchers to gain rich insights from the participants’ perspectives (Bradshaw et al., 2017).
Participants
Purposive sampling was used to identify psychologically distressed fathers, with the aim of yielding the most representative sample of the population (Lavrakas, 2008).
Recruitment took place at the delivery suite of a tertiary public hospital in Singapore from October 2018 to December 2018. Materials involved in the invitation included a participant information sheet, a consent form, and a background information sheet. Singaporean fathers who were 21 years old and above, who were literate in English and/or Chinese, and whose babies were born at ≥37 weeks of gestation were invited to participate in this study on the day of their children’s births. Since previous studies have shown that both first-time and experienced fathers undergo stressful transition to fatherhood (Shorey et al., 2018; Shorey & Ang, 2019), fathers were thus invited to participate irrespective of whether or not they are first-time or subsequent fathers.
Fathers who agreed to participate each received a screening questionnaire titled Kessler-6 (K6) via email to screen for their psychological distress levels one week after their children’s births. Only psychologically distressed fathers (scored ≥8 points on the K6 scale) were eligible to be interviewed. Eligible interviewees (n = 17) were each invited for a face-to-face interview within 30 days into the postnatal period.
Data Collection
Screening tool
The K6 was used as a screening tool for psychological distress in fathers in this study, based on the extent to which they have felt ‘nervous’, ‘hopeless’, ‘restless or fidgety’, ‘extremely sad’, ‘worthless’, and ‘everything was an effort’ in a given time frame. These six items were rated from 0 (none of the time) to 4 (all of the time) and summed up to give a maximum score of 24, with higher scores indicating greater psychological distress. Consistent with other studies, fathers who scored a cut-off point of 8 and above, which indicates significant psychological distress, were eligible to be interviewed (Giallo et al., 2013). Participants who scored below 8 points were informed that their participations in the study had ceased and they would not be involved in any interviews. K6 has a high internal reliability of 0.86 and is known for its brevity and strong psychometric properties (Kessler et al., 2010). K6 has also been validated in Asian population (Tiong et al., 2018) and even in a multiethnic population such as Singapore (Vaingankar et al., 2018).
Interviews
A semistructured interview guide was used to conduct individual face-to-face interviews, in which fathers were asked the same questions while retaining the flexibility to explore their responses in detail. The interview guide was developed based on Castillo-Montoya (2016)’s four-phase process—ensuring questions align with the study’s research questions, organizing and forming prompt questions to facilitate conversation, receiving feedback on the preliminary set of questions, then performing a pilot test. In this study, the interview guide was constructed by the first author (MK) and then reviewed by the last author (SS) who has extensive experience in conducting qualitative interviews. Some of the interview questions were “How have you been ever since your baby was born?” and “Is there anyone who knows you have been feeling this way?” A pilot test was conducted on one distressed father to confirm the comprehensibility and appropriateness of questions (Polit & Beck, 2014). The results of the pilot test were not included in the final data analysis. Of the 17 eligible participants, an eventual number of 12 fathers were interviewed due to withdrawals (n = 2) and inability to contact the fathers (n = 3). All 12 interviews were conducted by first author (MK), and they were all audio recorded and held in private rooms. The duration of the interviews lasted an average of 40 minutes. Data saturation was reached at the 10th participant. Another two participants were interviewed to confirm that no new data emerged.
Ethical Considerations
This study was approved by the Centralized Institutional Review Board [Reference No: 2018/2753]. The study team ensured that the conduct of this study complied with the ethical principles of research stated in the Belmont Report, which include respect for persons, beneficence, and justice. Participants were made aware that withdrawal from the study was allowed at any time without any form of penalty. They were also guaranteed confidentiality, whereby data obtained were anonymously coded and securely kept in a password-protected laptop.
Data Analysis
All interviews were transcribed verbatim within two days of each session. Nonverbal cues were bracketed in the transcripts to allow for full immersion into the data (Moser & Korstjens, 2017). The two researchers then read through the transcripts multiple times to familiarize themselves with the information. A thematic analysis was used to analyze data, whereby transcribed data were coded line by line and organized in a table according to similar concept before proceeding with defining and naming the themes and subthemes (Braun & Clarke, 2006). As proposed by Braun and Clarke (2006), two researchers (MK and SS) conducted the thematic analysis independently, then came together to discuss any discrepancies that existed until a consensus was reached.
Study Bias
The researchers involved in this study were solely motivated by their passion in studying paternal issues. There were no factors such as personal experience of fathering or depression that could influence the results of this study.
Study Rigor
The rigor of this qualitative study depends on its credibility, dependability, confirmability, and transferability. Credibility was upheld during data transcription, whereby audio recordings were replayed multiple times to ensure that emergent themes were true representations of fathers’ perceptions (Houghton et al., 2013). Dependability was achieved with the use of a semistructured interview guide that ensured that every participant was asked the same questions so that the topic did not deviate (Houghton et al., 2013). Confirmability was established through an analyst triangulation involving two research members in the data analysis (Houghton et al., 2013). Transferability was maintained through the use of purposeful sampling of the participants and clear articulations of the study’s contextual information (Pandey & Patnaik, 2014).
Results
The 12 interviewed fathers were Singaporeans who were aged between 29 and 39 years old, involving six Chinese, five Malays, and one Indian (Table 1). At the time of their interviews, seven had already started work while five others were still on paternity leaves. Six main themes and 20 subthemes emerged from the thematic analysis of the fathers’ accounts (Table 2).
Sociodemographic Data of Fathers.
Themes and Subthemes.
Theme 1: Facing the “Real Deal”
The fathers’ accounts of postnatal experiences began from the time they met the “real deal,” which refers to their babies. Both positive and negative encounters were reported.
Mixed feelings
Most fathers expressed positive feelings toward their babies’ arrivals. Some cried tears of joy, while some had feelings of uncertainty. P01 shared, “Emotional, yeah. I look at my kid, and I just cry for no reason. I mean, I’m just proud, because that’s my son” and P09 shared “Honestly, I didn’t feel anything during the nine months of pregnancy. . . It’s only until the day comes, then that’s the real deal. . . I wasn’t feeling prepared.”
Hospital experiences
Hospital encounters were deemed important to 40% (n = 5) of fathers. Negative experiences were related to the attitudes displayed by health care professionals. “The nurse just pushed the baby in, then walked off just like that. Never even guide me on how to carry the baby, never educate anything” (P06). Good experiences of support given by hospital staff were also mentioned. P06 shared, “Because you need to know that you are in a safe pair of hands, for the baby. I think that’s the key. . . It helps when you meet such (a) good nurse around. . . Thankful, ah, thankful.”
Theme 2: Everyday Woes
In this theme, fathers recounted everyday struggles while adjusting to the addition of a new family member.
Stressful transition period
While all fathers complained of sleep disturbances due to crying infants, they felt incompetent regarding their caregiving efforts. “Angry at myself. Sometimes, (you) feel useless because you want to do something, but, at the same time, your brain is just in a big mess” (P01).
Baby’s postbirth condition
Child’s health, especially jaundice, was the biggest stressor brought up by 40% (n = 5) of fathers. Every follow-up visit was very stressful, and measuring jaundice levels was described as “waiting for 4D number,” which is akin to waiting to see the winning numbers of the lottery in the local context. P12 shared, “Her jaundice didn’t come down, so (we) have to go back every day, so it’s kinda worrying.”
Confinement nanny “will not be around forever.”
Almost half of the interviewed fathers engaged postnatal support services from confinement nannies. While some fathers made use of the short one-month period to acquire as much knowledge as possible, like what P03 shared, “Yesterday, I just tried to shower my son. . . under the supervision of the nanny,” some took it for granted. The employment of a confinement nanny can be seen as a procrastination or temporary escape from roles and responsibilities. Quoted from P05, “I have the nanny to take care of everything. . . so I [don’t] need to worry much, la.” These fathers expressed worries pertaining to returning to life without confinement nannies, having to struggle between work and procrastinated role transitions.
Trying their best to keep the balance
60% (n = 7) of fathers experienced familial tensions, involving parents and in-laws that stemmed from unaccommodating behaviors, such as noncompliance to proper hand hygiene before handling the babies and posing financial stress on fathers. P05 shared, “My mother in-law keeps on. . . err. . . stressing me about money-related stuff. . . like the maternity dress she asked me to buy. . . Now, baby related stuff.” Conflicting views and advices from elder relatives added to fathers’ frustrations. P03 shared, “Our family relatives came by to visit us, (and they) gave us a lot of advice. But you know, these uncles and aunties. . . sometimes, their advices can be outdated, or just (a) grandma’s tale.” And P02 shared, “So, for me, as a son in-law. . . I feel very restricted to have a say. I don’t want to argue.” Some fathers constantly prioritized their wives’ mental well-being and always compromised to please their wives. Quoted from P10, “I’m trying to avoid my wife being depressed. I’m trying to be on the fence for that. Just to not make her upset, I stop gaming and stop going out. . .”
Parenting rivalry with siblings and/or friends
Interestingly, some fathers felt pressured by parenting competitions. P12 shared, “Her (my wife’s) siblings have kids as well, and … their kids are put in those expensive. . . early childhood. . . schools……That pressures my wife to want to make our kids attend the same classes. Because they attended, our kids have to attend too.”
Theme 3: “Losing Excitement”
As everyday stress haunted fathers, fathers showed maladaptive coping, both mentally and physically.
Rocky relationship with wife
30% (n = 4) of fathers reported having more arguments and misunderstandings with their spouses than before, mainly related to infant care. “Then, sometimes, we will feel annoyed with each other and say things like, “Why are you so slow?” (P03).
Negative lifestyle changes
As expected, all fathers experienced sleep disturbances. Appetite losses and increased alcohol intakes were also reported. P12 shared, “I think, recently, I also lost, er. . . lost appetite? Don’t really feel like eating as much anymore? And maybe, ya. . . now, I drink more often. . . definitely more frequent.” Fathers who forewent their paternity leaves and started work soon after their children’s births worked excessively to earn more money to make ends meet. P08 shared, “So, the only thing I can do is work and put in more hours to get more money so that the baby has everything.”
Unusual mood swings
Increased irritability was also reported by 30% (n = 4) of fathers, and they reacted vigorously to vent out their stress. Quoted from P04, “Probably because of the stress I’m currently facing, I tend to blame my teammates a little bit more, then I shouted at them and lost my temper.” Some fathers seemed to experience anhedonia as they reported that they lost feelings of excitement in previously enjoyable activities. Quoted from P12, “When I go car shopping, I’m not as excited as I used to be. . .It’s eating you up. Ah, you just lose that excitement. I’m, like, doing things, but sort of just doing (them) for the sake of doing.”
Minimal involvement in caregiving duties
Few fathers admitted being minimally engaged in caregiving duties for their children as they did not “feel like it” or felt “too lethargic” to help out. P12 shared, “I don’t really do anything. I have changed about 10 diapers in total? And fed about five times? Okay, definitely less than 10. Never showered them.”
Theme 4: “Trying to Be Strong”
Fathers of different ethnicities showed varying coping strategies. Chinese fathers would turn to their wives, Malay fathers would confide in their parents, and the Indian father would seek help from friends, but all of them often preferred to manage their problems alone. Maintaining the stoical characteristic of men. Crying was regarded as a sign of weakness, and 75% (n = 9) of fathers masked their sentimental feelings to avoid worrying their spouses. P06 shared, “I did cry, only in the shower once. Because that’s probably a good way to rant out… I guess the wife needs a support right. You can’t. . . I don’t think you should be showing any signs of weakness.”
Doing solo activities to relieve stress
All fathers engaged in individual stress-relieving activities ranging from watching movies to exercising as forms of distraction and release. Quoted from P01, “Sometimes, it will be better to be on my own. Maybe just sit somewhere relaxing to gather all my thoughts.” And P05 shared, “When I’m driving, sometimes I just shout in the car. . .”
Theme 5: “Reality Check”
Fathers felt restricted in certain ways to better their lives, largely due to stressful living conditions, life events, and inadequate policies.
Keeping up with the stressful demands in the Singapore society
50% (n = 6) of fathers foresaw the future to be “bleak” as they spoke of the need for close to half a million dollars to safely raise their children up to tertiary education in Singapore. P12 shared, “Singapore is a very stressful place. . . Although they say you don’t need tertiary education right now, it’s going to be a skill-based economy, but, come on, there will still be scholars taking up CEO roles. . . You don’t want your kid to be, like, a construction worker, what” (P12).
Childcare concerns
As dual-working parents are common in Singaporean families, fathers anticipated engaging infant care and childcare services when both parents were back to work. However, the associated cost and quality concerns were raised across all fathers. P04 shared, “If we send our boy to infant care, what is the quality of the care, the ratio of instructors versus babies?” Additionally, fathers felt traces of guilt that both themselves and their wives would not be able to perform full-time caregiving duties and thus worried about their children’s upbringings. Quoted from P05, “Sometimes, I just think about. . . how my son is gonna be like in the future. . . Both me and my wife won’t be bringing [him] up closely as we both are working parents.”
Simultaneous life events
Apart from childbirth, some fathers (30%; n = 4) dealt with multiple important events at close proximity. Events such as marriage, housing relocation, and work hurdles were mentioned. P04 shared, “I mean, running a startup without any newborn kid is already a stressful thing, so when both stressful events come into my life, it is quite challenging.”
Insufficient government support
While paternity leaves were valued by all fathers, most thought it was not long enough. P06 shared, “This paternity leave probably is the best thing that has ever happened. I think I haven’t taken two weeks leave for maybe years? And to begin with, even if I will still be focused on work. . .I think this time around, it is really a good break because, in the sense. . . they need my full attention. . . Ya, so (it) is very useful. . . but (I) wish it was longer.” Self-employed fathers returned to work almost immediately after their children’s births. In view of their unstable incomes, they could not afford to leave work as much as they wanted to. P04 shared, “There is no paternity leave for self-employed persons. So. . . should there be any scheme that can help this group of people?” One father, who married a foreign spouse, encountered immense financial difficulties with regard to restricted property rights. Quoted from P08, “One month (‘s rent). . . I’m paying almost three quarters of my salary. So, that is a very huge burden, la../ I can’t buy an HDB (government-subsidized housing) because my wife is a foreigner. . .”
Theme 6: Supplementing Help for Fathers
Fathers gave practical suggestions that encompassed educational and social support to improve fatherhood.
Enhance e-learning among internet-savvy fathers
Only 30% (n = 4) of the fathers attended antenatal classes. The internet had been every father’s primary source of informational support. However, local sources providing credible information were scarce. P08 shared, “If they (local hospitals) have their own YouTube channel(s) and share videos on babies, ya, (these) definitely will help. Because, now, the videos I see (are) all American and (from) other countries. . . (I’m) not sure (if they are) applicable to our culture or outdated or not.”
Support groups for fathers
Of all fathers, none had knowledge of any existing support system in place for fathers in Singapore. Mutual support groups were a common desire. Virtual social support was also suggested. P06 shared, “Father support group, ah, like (a) WhatsApp group chat for fathers (whose children’s births are) of the same month, ah. . .Quite useful, eh, to be honest.”
Discussion
Fatherhood is a life-changing event, and postpartum experiences are unique to every father. This study finds that hospital encounters are important to fathers as hospitals are where postnatal experiences begin. Supported by previous findings, the qualities of hospital staff, such as being caring and competent, were important not just for women (Gaboury et al., 2017) but also for men (Ellberg et al., 2010). It is pertinent to build secure and supportive hospital environments through positive staff attitudes to help fathers feel confident and optimistic about their new life transitions and begin their postpartum journeys on a good note (Gaboury et al., 2017).
Life after childbirth was described as “totally different” and stressful, whereby fathers experienced abundant parental stress and sleep deprivation from crying infants and unstable infant health, which were commonly reported in literature (Edhborg et al., 2016; Shorey et al., 2018). For fathers who started work immediately after childbirth, fatigue resulting from sleep deprivation was needless to say (Mellor & St. John, 2011). The prevalence of fatigue in fathers was reportedly 65% at six weeks and 75% at 12 weeks compared with 20% to 30% in the general working population (Mellor & St. John, 2011). Even though no investigation was done six weeks’ prior, this study suggests that fatigue could have already sparked as early as the first two weeks according to the fathers’ accounts. Even though fatigue and lack of sleep are expectedly common experiences for new fathers, policymakers should not overlook these phenomena in view of the possibility that fatigue may affect concentration and decision-making abilities (Sadeghniiat-Haghighi & Yazdi, 2015), both at work and at home. Moreover, fathers who undergo a myriad of stressful life events such as experiencing work hurdles, housing relocation, or the loss of a loved one in close proximity are more prone to depressive symptoms (Cooklin et al., 2015; Eddy et al, 2019; Top et al., 2016). The hectic lifestyle after childbirth lands fathers in a state of psychological disequilibrium where they do not have the time to emotionally recuperate from one life event to another. Therefore, incentives such as paternity leaves should be made mandatory for both governments and self-employed fathers.
In today’s competitive society such as in Singapore, a competitive culture seems to exist, even in the context of parenting—which led us to a novel finding of fathers’ distress. Fathers and their wives were pressured to follow what their siblings or friends did for their children, such as enrolling them into expensive early childhood learning programs. Competitive parenting may be a norm in some societies, but it is somehow amplified in Singapore, owing to the kiasu (an attitude arising from the fear of losing) culture in this rat-race society (Sandhu, 2018). Furthermore, because fathers are expected to be the main material support in Asian families (Salway et al., 2009), the high living costs in Singapore pose overwhelming economic pressures on fathers. To meet the economic demands of Singapore, dual-income families are a common sight. When both parents return to work after their parental leaves, they are unable to commit full-time caregiving duties, hence leading to conflicts of interest and, eventually, more arguments. Deteriorated partner relationships after children’s births have been common issues reported by fathers internationally (Darwin et al., 2017; Edhborg et al., 2016). Epidemiological studies have warned that a poor marital relationship has a great potential for depressive symptoms to thrive in both parents, which consequently affects children’s emotional and conduct problems through hostile parenting (Giallo et al., 2013). It is therefore important to pay attention to marital relationship qualities after childbirth to prevent negative family outcomes (Cummings et al., 2005).
The demand for instrumental support through postnatal services delivered by confinement nannies has been reportedly on the rise, largely due to the shrinking family size in Singapore and the innate desire to give the best to their children (Sim, 2018). The duties of confinement nannies (generally older ladies) include caring for both the mother and the baby, meal planning, and housekeeping, all of which are valuable tangible help crucial in the postnatal period (Ong et al., 2014). Demographically, confinement nannies are usually engaged by Chinese families, whereas providers of confinement care in Malay and Indian families are usually family members, such as mothers and mothers-in-law, or none at all.
While added support from family members may be a blessing, tensions may arise due to differences in beliefs, as echoed in Chung et al.’s (2011) findings. While Chung and colleagues’ (2011) study involved only the Chinese population, this present study adds that intergenerational conflicts exist in Malay and Indian families as well. Discrepancies in values and attitudes toward traditional confinement care practices are bound to exist intergenerationally due to changing societal values. Thus, it is important to reconsider the validity of traditional cultural beliefs on contemporary parents today.
Findings revealed that different ethnic groups displayed varying preferences for informal support. It was observed that wives were the primary support for Chinese fathers, friends for the Indian fathers, and Malay fathers preferred to seek help from their parents, as supported by the fact that Malay families in Singapore place a great emphasis on family and Malay fathers usually get abundant support from parents, siblings, and extended family members (Tan, 2012). To the best of our knowledge, fathers’ help-seeking behaviors have been understudied (Isacco et al., 2015), and future research is needed to explore this area of interest because ethnic differences in help-seeking behaviors exist (Magaard et al., 2017).
In terms of government support, modest efforts have been invested in addressing paternal needs. To date, the duration of paternity leaves is two weeks in Singapore, with other Asian policies alike (Page, 2017). The importance of paternity leaves has not been as valued Asian countries compared with Scandinavian countries, where paternity leave policies can go up to 90 days (Johansson et al., 2016) while fathers in this study yearned for longer paternity leaves, the benefits of extended paternity leaves remain a question. Despite long paternity leaves, Swedish fathers are still subject to postpartum depressive symptoms (Kerstis et al., 2016), which may indicate that apart from paternity leave, there exist many other significant factors that contribute to their psychological distress. However, fatherpreneurs, men who are dads and entrepreneurs at the same time (Agarwal, 2018), have caught our attention with regard to the lack of paternity benefits. In view of the high volatility of business in the competitive market today, fatherpreneurs cannot afford to have paternity leaves. Juggling both parenting and entrepreneurship can be overwhelming round-the-clock pursuits as fathers face abrupt situations such as work hurdles or sick children (Chan, 2016). Policymakers should thus keep fatherpreneurs, or even the self-employed in general, in mind when implementing paternity schemes to help this growing number of fathers better manage role transitions.
In terms of learning and support needs, fathers gave their suggestions. Most of them did not attend antenatal classes and this may have affected their parenting preparedness and increased their distress levels. Contemporary fathers today are tech-savvy, and the internet has been their main informational support.
However, the reliability of online information has always been a concern (Darwin et al., 2017; Shorey et al., 2017, 2018). There is a common desire for local health care organizations to launch their own informational channels to supply information relevant to local cultures and practices. Fathers also showed preferences of videos over written information, which correspond Shorey et al.’s (2017) findings. Research has also shown that videos yielded better learning outcomes for different types of learners (Lee & Tsai, 2018). However, preferences of videos contradict Darwin et al.’s (2017) findings, in which written information was more appreciated. Policymakers thus need to consider the needs and preferences of their target population when revamping their informational infrastructures. Additionally, the paucity of father support groups remains an issue today (Darwin et al., 2017; Edhborg et al., 2016; Shorey et al., 2017, 2018). However, some fathers may not feel comfortable presenting themselves physically in view of social stigma; hence, virtual support groups were also proposed by fathers, which had been proven to not only lessen perceived stigma on mental health but also reduce depressive symptoms over time (Breuer & Barker, 2015).
Limitations
One prominent limitation of this study is the lack of a structured psychiatric diagnosis that is in accordance with the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria. However, the researchers felt that interviewing fathers when they had already been diagnosed with mental health conditions may be too late to capture the true sources of distress that plagued fathers at the very early stages of the postnatal period. Another limitation is that majority of the study’s participants were first-time fathers, hence the research outcome may not speak on behalf of experienced fathers. Last but not least, since only English-speaking and Chinese-speaking fathers were invited to participate in this study, the findings may not be fully representative of the entire father population in a multiracial society such as Singapore.
Future Research and Implications
Future researchers who embark on paternal mental health studies should conduct mixed-method studies to enhance the hierarchy of evidence and the triangulation of findings. A future local research is also needed to examine the prevalence of paternal mental health difficulties in Singapore to gain a better picture of the depth and severity of this phenomenon. In addition, future studies should also consider including more experienced fathers to examine their fatherhood experiences. This study recognizes the fact that paternal psychological distress exists in the early postnatal stage, hence health care professionals and family members have to be more empathetic and sensitive to paternal struggles and support needs. Interventions surrounding paternal support needs such as informational support should be carried out in future studies so as to shape better fatherhood experiences for future fathers.
Conclusion
The findings in this study translated distressed fathers’ voices into literature and add to the limited evidence on the study’s phenomenon of interest. This study’s findings strongly relate to health care professionals, as well as family members of fathers, to seek acceptability and understanding of fathers’ mental health difficulties in the postpartum period so that help can be rendered to fathers effectively during this critical period of life transition.
Health care professionals are vital in creating supportive human environments that are sensitive to paternal needs. When delivering postnatal education to mothers, health care professionals should involve and empower fathers. Routine assessments of paternal mental health can also be done together with maternal follow-ups. Local health care organizations should look into revamping their informational support infrastructures to keep up with modern-day learning needs and preferences.
Footnotes
Acknowledgements
The authors are thankful to all the fathers who participated for their time and contribution to the study. The authors would also like to thank the National University Health System, Medical Publications Support Unit, for assistance in the language editing of this manuscript.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
