Parenthood arrived as a considerable surprise for Mat Lewis-Carter. His partner, Chess, became pregnant unexpectedly. While excitement was present, he found adjusting to this news challenging. Upon the arrival of his baby daughter in July 2021, Lewis-Carter did not immediately experience a profound connection. He began to feel overwhelmed, resorting to extended runs to leave the house during the baby’s first year. He suppressed his rising sadness, determined not to burden Chess, as his thoughts grew increasingly bleak.
“I recall… not wanting to be here,” states Lewis-Carter, a 37-year-old London resident who works as a personal trainer and an influencer focusing on men’s health. This marked the first instance in his life where he entertained thoughts of his own death.
Discovery Amidst the Digital Noise
Approximately one year after his daughter’s birth, Lewis-Carter encountered a news article detailing postpartum depression (PPD) in fathers. “It was on, like, page three or four of Google,” he recalls. The terminology resonated deeply. “For me, it was this realization, ‘ahh OK, I see’.” Prior to this, Lewis-Carter was among the 40 percent of individuals who had never heard of paternal PPD.
PPD affects fathers with roughly the same prevalence as mothers, and the two conditions are closely linked. Current estimates suggest approximately 8.4 percent of fathers experience PPD, compared to 13 percent of new mothers. Although fathers may not undergo the significant biological changes that mothers do during pregnancy and after childbirth, they are susceptible to similar mental health triggers: a profound identity shift, stress, sleep deprivation, and the potential for witnessing birth trauma. However, until recently, fathers like Lewis-Carter received comparatively little attention.
A Turning Point in Research and Recognition
This neglect is finally beginning to change. A series of studies published over the past couple of years has marked a turning point in paternal mental health. Researchers have begun to uncover the extent of fathers’ suffering and their lack of support, according to 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, analyzed data from Wales. Their findings exposed the severe risks associated with PPD, revealing that the suicide rate among fathers with newborns is approximately seven times that of mothers.
Paternal mental health has also been shown to have broader implications for the family, including children’s social-emotional development. This growing awareness is now driving ongoing support initiatives, from paternal PPD screening to enhanced interventions. “We’re certainly seeing movement,” notes Richard Fletcher from the University of Newcastle in Australia, who has researched fathers for over two decades. “Politicians are acknowledging, this is serious, fathers’ mental health.”
The Silent Struggle in Clinical Settings
No clinician inquired about Lewis-Carter’s well-being following his baby’s arrival, 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 explains. This sentiment that fathers should prioritize their family’s needs is not uncommon. Indeed, early motherhood presents its own set of challenges; a UK survey in 2023 found that 41 percent of new mothers experiencing mental health difficulties reported receiving no support during or after their pregnancy. Support systems for mothers, however, are steadily improving, with mental health screening for new mothers being standard in Australia for the past 15 years and in the US and UK for roughly a decade.
Services for fathers lag significantly behind, with most nations lacking routine screening or check-ups. Freedom of information requests conducted between 2019 and 2020 by Ellis-Davies and her colleagues at Swansea University revealed that only 20 percent of NHS England trusts offered specialist resources for paternal perinatal mental health. Furthermore, a report published last year by the Australian government indicated that just over a third of first-time fathers face barriers in accessing healthcare services, citing issues such as physician unavailability or extended waiting times. It is therefore unsurprising that the 2022 World Health Organization perinatal health guide noted that partners of those who have given birth often feel they are not entitled to support.
Limitations of Existing Diagnostic Tools
Even when clinicians do consider fathers’ mental health, their diagnostic process often begins with a tool designed for postpartum mothers. The primary global method for detecting paternal PPD is the Edinburgh Postnatal Depression Scale (EPDS). This scale comprises 10 questions primarily focused on sadness and crying. Philipp Schöch, a psychiatry researcher at the University of Innsbruck in Austria, found this approach to be inappropriate. Men and women tend to exhibit different depression symptoms, and the EPDS is likely to miss “male-typed” indicators such as irritability, substance misuse, social withdrawal, or risk-taking behaviors. “It’s not just feeling sad,” Schöch observes, noting that men more frequently seek outlets for escapism, engaging in excessive work hours or intense sports as a means of avoidance.
Lewis-Carter’s postpartum running routine was not merely a physical pursuit but a manifestation of distress. Even if he had consulted a medical professional at the time, the EPDS might not have identified his symptoms. In 2024, Schöch reviewed studies assessing the effectiveness of screening tools, including the EPDS, and identified significant deficiencies. There is even a lack of consensus regarding the appropriate EPDS diagnostic cut-off score for fathers. A lower score is generally recommended to account for the societal pressure on men to conceal their emotions, yet there is no established agreement on how low it should be. Cultural expectations vary, rendering the EPDS particularly ineffective in highly patriarchal societies where the pressure to maintain stoicism can be even greater, as the report highlighted.
Schöch posits that an overreliance on the EPDS has likely contributed to the underdiagnosis of PPD in fathers. A 2025 study conducted in Singapore supported this finding, revealing considerably lower detection rates in dads using the EPDS (approximately 5 percent) compared to a dedicated male depression screening scale (around 14 percent). Tools tailored for men, such as the Male Depression Risk Scale and the Gotland Male Depression Scale, could offer superior alternatives. Last year, a study examining the efficacy of five tools specifically designed for fathers yielded promising results. However, widespread clinical adoption will require time, according to Fletcher.
In the interim, researchers have begun employing standard depression scales in lieu of the EPDS. Organizations like Dad Matters, a service provided by the UK charity Home Start, actively encourage healthcare professionals to utilize these alternative scales and educate them on best diagnostic practices. Kieran Anders, who initiated peer support through Dad Matters after experiencing difficulties as a new father himself, states that physicians often obtain screening tools from the internet without receiving formal training.
Anders also advises practitioners to ask fathers specific questions, such as “How are you sleeping?”, “How is your partner doing?”, and “How was the birth for you?”. Broader inquiries regarding men’s social support networks can also serve as early warning indicators for those at risk, as a lack of social support has been linked to paternal PPD.
Transforming Treatment and Support
Improving screening is not the sole focus for addressing paternal mental health challenges; specialized treatment also presents a notable gap. While conventional depression interventions such as medication and individual therapy can be beneficial, men are less inclined than women to seek professional help. Some perceive therapy as emasculating, and studies suggest it may be less effective for men compared to women.
Following his daughter’s birth, Lewis-Carter resisted the persistent internal urge for professional assistance for several months. He continued to post humorous videos on social media, projecting an image of coping well from the outside. “The trouble is, the dads won’t go to therapy,” Fletcher observes. “The dads don’t know that’s what you do. They don’t understand what their symptoms signify. They don’t know who to trust.” Fathers constitute a mere 3 percent of callers to ForWhen, an Australian helpline for distressed parents with infants up to one year old, he states.
The scarcity of father-specific interventions prompted Husain and his colleagues to design the inaugural randomized controlled trial focused on treating fathers with PPD. His psychosocial intervention involved guided group activities for fathers over twelve one-hour sessions. These sessions covered parent-child play, parenting skills training, including time and stress management, and cognitive behavioral therapy. The 2024 study involved over 350 fathers, with approximately half receiving the intervention and the other half undergoing “treatment as usual,” primarily consisting of antidepressant medication.
The results demonstrated considerable promise. Participants in the new intervention experienced a greater reduction in depressive symptoms. Moreover, children in the play group showed enhanced social-emotional development scores and improved physical health. By framing the intervention as a “training program” rather than therapy, this approach could also help mitigate the stigma surrounding mental health, according to Husain. Concurrently, other initiatives are developing “guy-friendly” therapy approaches. For instance, the Movember charity is training practitioners in Australia on how to better treat men, including how to interpret anger and irritability as indicators of depression. Practitioners are also educated on validating and gently challenging those whose sense of masculine self-reliance leads them to view seeking therapy as a sign of weakness. At the Center for Men’s Excellence in San Diego, California, psychologist Daniel Singley leads group sessions that similarly encourage fathers to reflect on societal norms that may be detrimental to their well-being. He has found that this work can improve both men’s engagement with therapy and practitioners’ ability to provide effective assistance.
Proactive Measures for Prevention
Ideally, fathers’ engagement with mental healthcare would commence before they reach a crisis point. Lewis-Carter believes he might have experienced his entry into fatherhood differently if he had been aware of the warning signs, potentially preventing his descent into depression. Currently, several researchers are testing tools designed to achieve precisely this, aiming to prevent PPD from developing in the first place rather than relying solely on reactive treatment.
Online self-guided psychological and educational programs, which have proven effective for mothers, present an exciting avenue. A 2024 systematic review of seven digital resources provided to fathers before their baby’s birth suggested they could help prevent paternal depression, though further high-quality evidence is required. The most widely adopted program, having reached 20,000 fathers in Australia over the past decade, is Fletcher’s SMS4dads. This free text message service provides regular check-ins for expectant and new fathers, offering support for up to 24 weeks after the baby’s birth. Dads can text back their feelings on a scale of 1 to 10, and even those with moderate scores are directed to helplines or advised to seek medical attention.
“It’s the biggest fathers’ group in the world,” Fletcher remarks. While rigorous trials are still necessary to assess if the program effectively reduces the prevalence of PPD, one study found that 83 percent of users reported feeling less isolated, and the majority stated that the messages improved their relationships with their partner and child. A pilot of SMS4dads is currently being implemented in France and Spain, following similar initiatives in Colombia and Kenya. Schöch hopes Austria will develop its own version, which he intends to study for depression outcomes. “This could really make a big change,” he states.
Unraveling Causes and Addressing Diverse Needs
Researchers are also striving to prevent more cases by understanding the underlying causes of paternal PPD, an area that remains relatively understudied. Even less is understood about how gay, bisexual, and transgender fathers are affected. Existing research indicates that unplanned pregnancy, marital difficulties, poverty, and a prior history of depression can increase risk, as do sleep deprivation and other life stressors, including limited paternity leave. Biology likely plays a role as well, with new fathers experiencing hormonal shifts such as decreased testosterone, which is thought to reduce aggression in response to a crying infant, and increased estrogen, which may promote nurturing parenting behaviors. Researchers are still working to establish a definitive link to PPD.
One study suggests that fathers with lower testosterone levels exhibit more postpartum depressive symptoms. Conversely, excessively high testosterone levels in men can lead to other issues, as the same research indicates this is associated with increased depression in their partners. The well-being of a partner is a significant factor for fathers as well. In heterosexual couples, fathers often struggle if their partner’s mental health deteriorates, particularly if the mother has no prior history of depression. This was a pivotal finding of a study published last year, which analyzed data from 15,257 father-mother pairs. It revealed an 81 percent increase in PPD among fathers whose partners developed postpartum depression without a prior history of mental health concerns.
Fletcher notes that these findings align with his own research. He has observed that fathers whose partners have no prior mental health issues are often “blindsided” by their partner’s depression. They possess less understanding of how to cope and “why she couldn’t just pull herself out of it,” he explains. These experiences underscore the importance of addressing the entire family’s mental health postpartum.
Policy Shifts and Societal Recognition
Even as scientists continue to advance the understanding of paternal PPD, the research conducted over the past two years has begun to influence policy. NHS England recently unveiled its first Men’s Health Strategy, a 10-year plan aimed at improving men’s health outcomes, including perinatal mental health. In certain regions of the UK, the NHS has initiated screening for fathers whose partners experience perinatal mental health problems. Last year, Australia established its first ministerial cabinet position to oversee men’s health.
“If you look back at the history of perinatal mental health research and policy concerning mothers, it wasn’t until it was demonstrated [in the early 2000s] that suicide was one of the leading causes of mortality in women that you saw this significant shift,” states Ellis-Davies, who led the study on suicide rates among fathers. She believes this is the critical juncture now reached for paternal PPD, asserting that her discovery of the stark suicide rate in fathers is already helping to “kick open some doors,” including shaping the Men’s Health Strategy, which she describes as a “real game-changer.”
The pressure to act is mounting. The charity Fathers Reaching Out estimates that the failure to support paternal mental health costs the UK billions of pounds annually, based on the economic impact of suicides, children’s behavioral issues, and workplace productivity losses. “This is not a niche issue,” emphasized Mark Williams, the charity’s founder.
Hope for Fathers and Future Generations
This surge in research offers hope for fathers like Lewis-Carter, who has since launched a podcast for new fathers. His personal recovery from PPD was a lengthy process requiring “a lot of work,” acknowledging that he eventually needed professional support. Approximately one year after his daughter’s birth, he sought out a therapist, whom he credits with initiating his recovery. Today, Lewis-Carter cherishes being a father to his “full-of-character” four-year-old daughter. However, he advocates for earlier access to help for other fathers. “When the dad is in a much stronger place, it’s better for everyone,” he states.
Need a listening ear? UK Samaritans: 116123; US 988 Suicide & Crisis Lifeline: 988; hotlines in other countries.