Perinatal fathers’ perspectives on paternal perinatal depression: A qualitative study

Objective

Paternal perinatal depression refers to depressive symptoms experienced by fathers during their partner’s pregnancy or within the first year following childbirth. It affects approximately 10% of fathers worldwide¹ and impacts the entire family. Indeed, paternal perinatal depression is associated with increased risk of maternal perinatal depression and adverse childhood parental attachment.² Paternal perinatal depression remains underrecognized, potentially due to a lack of awareness among fathers.^1,2 This study aimed to understand perinatal fathers’ perspectives on paternal perinatal depression’s prevalence and symptoms.

Study Design

English-speaking participants were recruited during their partner’s prenatal clinic appointment at a tertiary care center. Consenting participants completed a virtual, individual, semi-structured interview, which was audio-recorded, transcribed, and coded by at least two authors for consensus. Codes were applied to data in NVivo and analyzed to identify participant perspectives on paternal perinatal depression. This study was IRB approved by Women & Infant’s Hospital’s IRB (#2041949).

Results

22 interviews were conducted from August 8, 2024 to March 20, 2026. Participants were racially and ethnically diverse, the majority were first-time fathers (55%), and half had either public health insurance (41%) or no health insurance (9%) (Table 1). Awareness of the risk of paternal perinatal depression was low among participants. Several themes emerged that framed this lack of awareness (Table 2). In general, many participants noted that feeling excluded in the perinatal experience resulted in a lack of both awareness about paternal perinatal depression and preparedness for the transition to fatherhood. As one participant stated,

Table 1:

Sociodemographic characteristics of study participants

Characteristic	Value N=22
Race *
Black	7 (32%)
American Indian or Alaska Native	1 (3%)
Asian	1 (3%)
White	10 (45%)
No response to race	3 (14%)
Ethnicity *
Hispanic	6 (28%)
First-time Father	12 (55%)
Insurance
Private	11 (50%)
Public (Medicaid)	9 (41%)
None	3 (9%)

All data listed as n (%) unless otherwise noted

^*Race and ethnicity were self-reported

Table 2:

Themes and representative quotes

Themes	Representative Quotes
Lack of awareness about paternal perinatal depression	“It’s funny ‘cause when you just said postpartum depression earlier for men, I never had heard of that.”
	– Experienced father, Hispanic, Private insurance
	“I thought postpartum depression was that classical Eeyore type depression. I didn’t realize it can show up as anger or need for control… Postpartum anger is something I was not ready for.”
	– First-time father, White, Private insurance
	“A lot of people are worried about the mother having postpartum depression. Nobody seems to really worry about the father and what’s going on in their head or in their life, or what changes they’ve had to overcome [to get ready for parenthood].”
	– Experienced father, Hispanic, Private insurance
Abrupt role transition to fatherhood	“I don’t think anyone’s ever really prepared for [parenthood]… I’m gonna be as prepared as I can be, but I think that there’s gonna be a lot of learn-as-you-go.”
	– First-time father, Black, Private insurance
	“I don’t have experience being there for a child and being supportive with the child. Because of that there’s a little bit of unknown there which is making me less confident.”
	– First-time father, Black, Private insurance
	“Part of me is ready, but at the same time part of me was also trying to prepare myself for something I couldn’t prepare myself for because I’ve never been in this situation.”
	– First-time father, Black and Hispanic, Public insurance
Expectations of masculinity in parenthood	“The need for a support system… I never thought of that. It literally didn’t even dawn on me that a male support system would be something I would want or need.”
	– First-time father, White, Private insurance
	“I don’t see a lotta things that are for fathers… I see a lotta things for women ‘cause if we could be honest: for men, we just gotta deal with it and figure it out. I think this is a good idea so men could look for help without askin’ for help… ‘cause us men don’t really like askin’ for help. We’ll just try to figure it out on our own.”
	– First-time father, Hispanic, Private insurance
	“Fathers don’t wanna feel like they need support. They wanna feel like they’re doing a good job.”
	– Experienced father, White, Public insurance
Altered relationship to birthing partner	“I think that was the biggest thing, how to work together in support of the baby, and how do we balance stuff between us? It’s not always going to be 50–50 naturally. It’s hard to get that split perfectly.”
	– Experienced father, White, Private insurance
	“ I know that you can lose yourself when you have a new child, because everything becomes about the child, and then everything that's not about the child is about the mother.”
	– Experienced father, Hispanic, Private insurance

“Everything seems to be focused on the mother [even when] there are two parents involved. Obviously, the mother goes through the first nine months… but once the baby’s there, assuming the father’s involved, they’re 50 percent in there…. Their health and well-being should be involved as well.”

- Experienced father, Hispanic, Private insurance

Another common source of tension during the transition to fatherhood was that participants needed additional guidance regarding newborn care, but they felt compelled to appear confident and self-reliant to their partners:

[During OB appointments and my child’s birth,] I was just the guy in the room, waiting for some kind of attention, or to do something, or be told what to do… [Newborn care] is a tough subject because men, they wanna be the strong provider. [If they’re not,] they’ll suffer in silence.”

- Experienced father, White, Public insurance

Indeed, pervasive within the interviews was the awareness that their experience of fatherhood—and their lack of awareness of paternal perinatal depression—was due to societal expectations of masculinity:

“The idea of a man having postpartum depression… societally, nowadays, it’s like, ‘Why would a man have postpartum depression?’ A lot of men hide their feelings, and they tend to not care about mental health … or emotions being good things. It tends to cause a lot of ridicule.”

- Experienced father, White, Private insurance

Finally, participants described substantial changes in their relationship to their partner following childbirth, with the infant’s needs becoming central:

“It was a big change… from just keeping yourself and your partner in mind and now, your whole focus goes to caring for [your child]… it was a big change.”

- Experienced father, Black, Private insurance

Conclusion

Among 22 diverse perinatal fathers, most participants were unaware of paternal perinatal depression and, when informed, their perceptions were shaped by feeling excluded during prenatal care, unprepared for infant care, pressure to conform to traditionally masculine roles, and changes in relationship dynamics. These findings align with previous qualitative studies that explored fathers’ perspectives on barriers to seeking perinatal mental health support³ and mother’s perspectives on the importance of delivering perinatal mental health programs to both parents⁴. More research is needed to understand how to best incorporate fathers during perinatal obstetric and mental health care to help them feel prepared for fatherhood and recognize paternal perinatal depression should symptoms develop. This effort is paramount to mitigate the increased risk of maternal perinatal depression and adverse childhood attachment outcomes associated with paternal perinatal depression.^1,2

Study strengths include the racial/ethnic and economic diversity of the study population, which was sufficiently sampled per qualitative research methodologic principles⁵. A major limitation was that participants were recruited from one obstetric clinic, limiting generalizability and introducing the risk of selection bias, as men who did not attend their partner’s in-person prenatal care visits may have different perspectives. In summary, fathers describe a social and medical landscape that minimizes their role in the perinatal period and reduces their ability to recognize themselves as at risk of perinatal depression during the transition to parenthood.