The perceived influence of fathers' and non-gestational parents' experiences of postnatal depression on their relationship with their child and partner: a systematic review of qualitative studies and meta-synthesis.

INTRODUCTION: The role of the father/non-gestational parent has been found to be important in child development and wellbeing, but their mental health in the postnatal period is under-researched. Thus, this systematic review aimed to explore how postnatal depression was perceived to affect familial relationships.

METHODS: A systematic review of qualitative literature was conducted, and the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines were followed. Nine databases were searched for terms associated with fathers/non-gestational parents, postnatal depression, and qualitative and mixed method studies. Studies that met inclusion criteria were quality assessed using the Critical Appraisal Skills Program (CASP). Data were thematically synthesized.

RESULTS: Thirteen studies met the inclusion criteria. The methodological quality of all included papers was moderate to high. Following thematic synthesis, six themes and nine subthemes were identified, illustrated in a conceptual model. The main themes included 1) co-existing without connection, 2) withdrawing from others, 3) prior perceptions and expectations influencing view of self, 4) conditional connection with baby, 5) the dutiful parent, and 6) the role of partnership, validation and time for self-care as protective relationship factors.

CONCLUSIONS: Relationship dynamics often worsened between fathers or non-gestating mothers with postnatal depression and their partners after the baby's birth. Participants with postnatal depression who experienced relational conflict with partners often expressed a mismatch between their parenting ideals and their actions. Fathers and non-gestating mothers reported a loss of identity and feelings of resentment when they carried out caregiving tasks dutifully but without emotional connection. When fathers carried out tasks in this way, they tended to avoid spending time at home, reinforcing their separation from the mother and their baby and increasing feelings of jealousy toward the mother-infant dyad. Non-gestational mothers did not express using avoidance as a coping strategy, highlighting a difference in the way men and women cope with difficulties in the family. Participants appeared to express a high internal locus of control, internalizing blame for their baby's negative reactions (e.g., crying or difficult to settle) and interpreting these responses as evidence that the baby disliked them, leading them to conclude they were a bad parent.