He and his colleagues found that fathers experience different symptoms than mothers, such as irritability and anger. So, they developed the Paternal Postnatal Depression Scale, which includes questions on aggression, emotional numbness, and disinterest in activities fathers usually enjoy. The new scale has been validated in multiple languages and is now being used in research around the world, giving fathers a more accurate tool for identifying their own struggles.
Shifting the narrative
With more awareness and better screening tools, the narrative around paternal mental health is changing. Celebrities like Prince Harry and John Legend have opened up about their struggles with fatherhood and mental health, helping to destigmatize the issue. Researchers, clinicians, and policymakers are also pushing for more resources and support for fathers, recognizing that healthy dads lead to healthy families.
For Lewis-Carter, the turning point in his own journey came when he finally opened up to Chess about his struggles. She encouraged him to seek help, and he started therapy and joined a support group for fathers. Slowly, he began to feel better and more connected to his family.
Now, Lewis-Carter uses his platform to raise awareness about paternal PPD and mental health, sharing his story openly to let other fathers know they are not alone. He hopes that by speaking out, he can help break down the stigma and barriers that prevent dads from getting the support they need.
As the conversation around paternal mental health continues to grow, more dads like Lewis-Carter are finding the help and resources they need to navigate the challenges of fatherhood. With continued research, advocacy, and support, the future looks brighter for fathers struggling with their mental health.
And for Lewis-Carter, the journey is ongoing, but he is grateful for the progress he has made. “I’ve learned how to manage my emotions better and how to communicate more effectively,” he says. “I’m in a much better place now, and I’m excited for the future.”
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Fatherhood came as something of a shock to Mat Lewis-Carter. His partner, Chess, got pregnant unexpectedly and, despite the excitement, he struggled to adjust to the news. When his baby daughter arrived in July 2021, Lewis-Carter didn’t immediately feel a connection. He began to “spiral”, going on long runs to escape the house over the first year. He swallowed the pressing sadness, keen not to burden Chess, as his thoughts steadily darkened.
“I remember… not wanting to be here,” says Lewis-Carter, 37, who lives in London and works as a personal trainer and an influencer focused on men’s health. It was the first time in his life he had fantasised about his own death.
Around a year after his daughter’s birth, Lewis-Carter stumbled across a news article about postpartum depression (PPD) in fathers. “It was on like page three or four of Google,” he says. The term resonated deeply. “For me, it was this sense of, ‘ahh OK, I see’.” Before that, Lewis-Carter was among the 40 per cent of people who had never heard of PPD in dads.
PPD is roughly as prevalent among fathers as it is in mothers, and the two are closely correlated. Best estimates have put the number at around 8.4 per cent in dads, compared with 13 per cent in new mums. Though they may not experience the immense biological shift that mothers do during pregnancy and after birth, fathers are exposed to similar mental health triggers: a huge identity change, stress, lack of sleep and potentially witnessing birth trauma. But, until recently, fathers like Lewis-Carter received relatively little attention.
This is finally changing. A spate of studies published over the past couple of years created a turning point in paternal mental health, as researchers have discovered the extent of fathers’ suffering and lack of support, says Ishrat Husain, director for mental health at Canada’s University Health Network. Last year, researchers led by Kate Ellis-Davies, a senior lecturer at Swansea University, UK, analysed data from Wales to expose the deadly risks of PPD, finding that the rate of suicide in fathers with newborns is around seven times that of mothers.
Fathers’ mental health has also been found to carry wider family implications, including on children’s social-emotional development. This wake-up call is now helping spur ongoing support, from paternal PPD screening to better interventions. “We’re certainly seeing movement,” says Richard Fletcher at the University of Newcastle in Australia, who has researched fathers for over 20 years. “Politicians are saying, this is serious, fathers’ mental health.”
Checking in
No clinician ever asked how Lewis-Carter was doing after his baby arrived, nor did he seek a professional diagnosis. “Because everything was happening physically to [Chess]… I felt I wasn’t in a position to come forward and talk about how I was feeling,” he says.
This sense that fathers should focus on their family isn’t unusual. After all, early motherhood isn’t easy, and 41 per cent of new mothers who struggled with their mental health reported getting no support during and post-pregnancy in one 2023 UK survey. But resources for mums are steadily improving, and mental health screening for new mothers has been standard in Australia for the past 15 years and for roughly a decade in both the US and UK. Services remain years behind for fathers, with no routine screening or check-ups in place in most nations.
Indeed, only 20 per cent of NHS England trusts, which provide NHS services including hospitals and ambulances, have specialist resources for paternal perinatal mental health, according to freedom of information requests made between 2019 and 2020 by Ellis-Davies and her colleagues at Swansea University. And a report published last year by the Australian government showed just over a third of first-time fathers face barriers – such as no physicians available or extensive wait times – in accessing health services. Little surprise that the 2022 World Health Organization perinatal health guide reported that partners of those who have given birth often feel they have no right to support.
Even when physicians pay attention to dads’ mental health, their diagnostic journey often starts with a tool created for postpartum mothers. The main method for detecting paternal PPD globally is the Edinburgh Postnatal Depression Scale (EPDS) – 10 questions that ask predominantly about sadness and crying.
This seemed inappropriate to Philipp Schöch, a psychiatry researcher at the University of Innsbruck in Austria. He and his colleagues found that fathers experience different symptoms than mothers, such as irritability and anger. So, they developed the Paternal Postnatal Depression Scale, which includes questions on aggression, emotional numbness, and disinterest in activities fathers usually enjoy. The new scale has been validated in multiple languages and is now being used in research around the world, giving fathers a more accurate tool for identifying their own struggles.
Shifting the narrative
With more awareness and better screening tools, the narrative around paternal mental health is changing. Celebrities like Prince Harry and John Legend have opened up about their struggles with fatherhood and mental health, helping to destigmatize the issue. Researchers, clinicians, and policymakers are also pushing for more resources and support for fathers, recognizing that healthy dads lead to healthy families.
For Lewis-Carter, the turning point in his own journey came when he finally opened up to Chess about his struggles. She encouraged him to seek help, and he started therapy and joined a support group for fathers. Slowly, he began to feel better and more connected to his family.
Now, Lewis-Carter uses his platform to raise awareness about paternal PPD and mental health, sharing his story openly to let other fathers know they are not alone. He hopes that by speaking out, he can help break down the stigma and barriers that prevent dads from getting the support they need.
As the conversation around paternal mental health continues to grow, more dads like Lewis-Carter are finding the help and resources they need to navigate the challenges of fatherhood. With continued research, advocacy, and support, the future looks brighter for fathers struggling with their mental health.
And for Lewis-Carter, the journey is ongoing, but he is grateful for the progress he has made. “I’ve learned how to manage my emotions better and how to communicate more effectively,” he says. “I’m in a much better place now, and I’m excited for the future.” Depression is a serious mental health issue that can affect anyone, regardless of gender. However, research has shown that men and women tend to exhibit different symptoms of depression. Men, in particular, may display signs such as irritability, substance use, withdrawal, or risk-taking, which are often overlooked by traditional screening tools like the EPDS (Edinburgh Postnatal Depression Scale).
One man, Lewis-Carter, experienced postpartum depression but his symptoms were not recognized at the time. His coping mechanism of running excessively was actually a cry for help. Unfortunately, the EPDS may not have been sensitive enough to pick up on his distress.
In a review conducted in 2024, it was found that existing screening tools, including the EPDS, have clear shortcomings when it comes to diagnosing depression in fathers. There is no consensus on the appropriate cut-off score for fathers, and cultural expectations can further complicate the diagnosis process. This has likely led to an underdiagnosis of paternal postpartum depression.
To address these gaps in screening and diagnosis, researchers are exploring alternative tools specifically designed for men, such as the Male Depression Risk Scale and Gotland Male Depression Scale. These tools have shown promise in detecting depression in fathers more effectively than the EPDS.
In addition to improving screening methods, it is crucial to enhance the availability of specialized treatment for fathers struggling with depression. Traditional interventions like medication and therapy may not be as effective for men, who are less likely to seek help due to stigma and societal expectations of masculinity.
One innovative approach is a psychosocial intervention designed for fathers with postpartum depression. This intervention involves guided activities in group settings, focusing on parenting skills training, time and stress management, and cognitive behavioral therapy. The results of a 2024 study on this intervention were promising, showing a significant reduction in depressive symptoms among participants.
Furthermore, efforts are underway to develop more “guy-friendly” therapy options for men, including training practitioners to better understand and respond to male-specific symptoms of depression. By addressing issues of masculinity and stigma, these interventions aim to make mental healthcare more accessible and effective for fathers.
Ultimately, early detection, tailored screening tools, and specialized treatment programs are essential in addressing paternal postpartum depression. By recognizing and addressing the unique needs of men experiencing depression, we can improve outcomes for fathers and their families. Lewis-Carter’s journey into fatherhood was not an easy one. He struggled with postpartum depression (PPD), a condition that is often overlooked in men. Reflecting on his experience, he believes that if he had been aware of the warning signs, he could have taken steps to prevent his slide into depression. This realization has sparked a movement among researchers to develop tools and programs that can help prevent PPD in fathers.
One such tool gaining traction is online self-guided psychological and education programs. These programs have been successful in supporting mothers, and now researchers are exploring their potential in helping fathers. A recent systematic review of digital resources sent to fathers before their baby’s birth showed promising results in preventing PPD, although more high-quality evidence is needed to fully assess their impact.
One of the most widely used programs is SMS4dads, a free text message service that provides support to expectant and new fathers. This program, which has reached 20,000 fathers in Australia, allows dads to express how they feel and receive guidance and referrals to helplines or medical help if needed. While rigorous trials are still underway to determine the program’s effectiveness in lowering the prevalence of PPD, initial studies have shown that users feel less isolated and report improved relationships with their partners and children.
The success of SMS4dads has led to pilot programs being rolled out in other countries, including France and Spain. Researchers are hopeful that these programs could make a significant impact in preventing PPD among fathers. In addition to developing support programs, researchers are also delving into the causes of paternal PPD, which remains relatively understudied. Factors such as unplanned pregnancy, marital problems, poverty, and a history of depression have been identified as risk factors, along with sleep deprivation and minimal paternity leave.
Biology also plays a role in paternal PPD, as hormone shifts in new fathers can impact their mental health. Lower testosterone levels have been linked to more depressive symptoms postpartum, while higher estrogen levels may influence parenting behavior. Understanding these biological factors could help in developing targeted interventions to support fathers’ mental health.
Furthermore, research has shown that a partner’s well-being is crucial for fathers, especially in heterosexual couples. Fathers are more likely to experience PPD if their partner develops postpartum depression, particularly if she has no prior history of mental health concerns. This finding underscores the importance of addressing the mental health of the entire family postpartum.
As the scientific community continues to advance its understanding of paternal PPD, policymakers are starting to take notice. Initiatives like the Men’s Health Strategy in the UK and increased screening for paternal mental health problems are steps in the right direction. The focus on fathers’ mental health is gaining momentum, with organizations like Fathers Reaching Out advocating for better support and awareness.
For fathers like Lewis-Carter, the growing body of research offers hope for a brighter future. His journey through PPD was challenging, but with professional support and determination, he was able to overcome it. Today, he cherishes his role as a father to his 4-year-old daughter and has even started a podcast to support other new fathers. His story is a testament to the resilience of fathers facing mental health challenges and the importance of early intervention and support. “When the dad is in a much stronger place, it’s better for everyone,” he says. This statement holds a lot of truth when it comes to the well-being of a family. A father plays a crucial role in the family dynamic, and when he is in a good place mentally and emotionally, it has a positive impact on the entire family.
Having a strong and stable father figure in the family can provide a sense of security and support for everyone. When a father is struggling with his own mental health, it can create tension and stress within the family unit. This can have a ripple effect on the children and the other parent, leading to a breakdown in communication and relationships.
It is important for fathers to prioritize their mental health and seek help when needed. By taking care of themselves, they are better able to support and care for their family. This can mean seeking therapy, practicing self-care, or reaching out to support groups for help.
In some cases, fathers may struggle with thoughts of suicide or crisis. It is important for them to know that help is available. Resources such as the UK Samaritans or the US 988 Suicide & Crisis Lifeline can provide a listening ear and support for those in need. There are also hotlines available in other countries for individuals who are struggling with their mental health.
Ultimately, when a father is in a much stronger place, it benefits not only himself but his entire family. By prioritizing mental health and seeking help when needed, fathers can create a positive and supportive environment for their loved ones. It is important to remember that it is okay to ask for help and that there are resources available for those who are struggling.
