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. Men and women tend to have different symptoms of depression, and the EPDS seemed likely to miss “male-typed” signs such as irritability, substance use, withdrawal or risk-taking. “It’s not just feeling sad,” says Schöch: men more often seek escapism, working extreme hours or intensively doing sports just to get away.

Lewis-Carter’s postpartum running streak wasn’t simply a fitness craze, but a signal of distress. Even if he had been seen by a medical professional at the time, though, the EPDS may not have picked up on his symptoms.

In 2024, Schöch reviewed studies analysing the effectiveness of screening tools, including the EPDS, and uncovered clear shortcomings. There isn’t even consensus on what the EPDS diagnostic cut-off score should be for fathers. A lower score is generally advised, to account for the pressure on men to conceal their emotions, but there isn’t a consensus on how low. Cultural expectations vary, making the EPDS particularly unhelpful in hyper-patriarchal societies, the report noted, where there can be even greater pressure to be stoic. 

Schöch believes that over-reliance on the EPDS has probably contributed to the underdiagnosis of PPD in fathers. A 2025 study in Singapore backed this up, finding much lower detection in dads using the EPDS (around 5 per cent) compared with a male depression screening scale (about 14 per cent).

Tools focused on men, such as the Male Depression Risk Scale and Gotland Male Depression Scale, could offer better alternatives: a study last year of the efficacy of five tools explicitly designed for fathers showed promising results. But it will take time for these to have mass clinical uptake, says Fletcher.

In the meantime, researchers have started using standard depression scales instead of the EPDS. Groups like Dad Matters, a service run by UK charity Home Start, encourage doctors to use these alternatives and educate them on the best diagnostic practices. Physicians often just get screening tools from the internet and don’t have training, says Kieran Anders, who started offering peer support via Dad Matters after struggling as a new father himself.

Anders also encourages practitioners to ask dads specific questions, including “How are you sleeping?”, “How is your partner doing?” and “How was the birth for you?”. Wider questions about men’s social support systems can also offer early warning signs about those at risk, with low support having been linked with paternal PPD.

Transforming treatment

Improving screening isn’t the only focus area for new fathers who are struggling; specialist treatment is another gap. While traditional interventions for depression like medication and one-on-one therapy can be useful, men are less likely than women to seek treatment. Some see therapy as emasculating, and studies show it might be less effective for men than for women.

After Lewis-Carter became a father, he resisted the quiet, internal nagging that he might need professional help for months. He continued posting funny videos on social media, and, from the outside, seemed to be coping.

“The trouble is, the dads won’t go to therapy,” says Fletcher. “The dads don’t know that’s what you do. They don’t know what their symptoms mean. They don’t know who to trust.” Fathers make up just 3 per cent of callers to ForWhen, an Australian helpline for distressed parents with babies up to 1 year old, he says.

The lack of father-centric interventions prompted Husain and his colleagues to design the first-ever randomised controlled trial focused on treating dads with PPD. His psychosocial intervention studied guided activities for groups of fathers over a dozen hour-long sessions that covered parent-child play, parenting skills training including time and stress management, and cognitive behavioural therapy. The 2024 study tested more than 350 fathers, roughly half of whom had the intervention while the other half had “treatment as usual”, consisting mainly of antidepressants.

The results showed incredible promise, with those who took part in the new intervention experiencing a greater reduction in depressive symptoms, while children in the play group also showed more improvements in their social-emotional development scores and physical health. By framing the intervention as a “training program” rather than therapy, this approach could also help minimise stigma around mental health, says Husain.

Meanwhile, others are developing “guy-friendly” therapy. The Movember charity, for instance, is training practitioners in Australia on how to better treat men, including how to respond to anger and irritability as signs of depression. Practitioners are also taught how to validate and gently challenge those whose sense of masculine self-reliance leads them to feel that going to therapy is a sign of giving up. At the Center for Men’s Excellence in San Diego, California, psychologist Daniel Singley runs group sessions that similarly encourage fathers to reflect on the social norms that could be hurting them. He has found that this work can both improve men’s engagement with therapy and practitioners’ ability to help.

Ideally, fathers’ engagement with mental healthcare would begin before they fall into crisis. Lewis-Carter believes his entry to fatherhood could have been different if he had known about the warning signs, which could have potentially prevented his slide into depression. Now, several researchers are trialling tools that could do just that, hoping to stop PPD from developing in the first place, rather than relying on piecemeal treatment.

Online self-guided psychological and education programmes, which have proven helpful for mothers, present an exciting opportunity. A 2024 systematic review of seven digital resources sent to fathers before the baby’s birth suggested they could help prevent dads’ depression, though more high-quality evidence is needed.

The most widely used programme, having reached 20,000 fathers in Australia over the past decade, is Fletcher’s SMS4dads. The free text message service repeatedly checks in on expectant and new dads, offering support until 24 weeks after the baby’s birth. Dads can text back how they feel on a scale of 1 to 10, and even those with medium scores are referred to helplines or advised to seek medical help.

“It’s the biggest fathers’ group in the world,” says Fletcher. Rigorous trials are still needed to assess whether the programme lowers the prevalence of PPD, but one study found that 83 per cent of users felt less isolated, while the majority said the messages helped their relationship with their partner and child.

A pilot of SMS4dads is now being rolled out in France and Spain, following similar efforts in Colombia and Kenya. Schöch is hoping Austria will create its own version, which he wants to study for depression outcomes. “This could really make a big change,” he says.

Researchers are also hoping to prevent more cases by unravelling the causes of paternal PPD, which is relatively understudied, while even less is known about how gay, bisexual and transgender fathers are affected. Research so far has found that unplanned pregnancy, marital problems, poverty and a history of depression all create risk, as does sleep deprivation and other life stresses, including minimal paternity leave.

​Biology likely also plays a role, as new fathers experience hormone shifts, such as lower testosterone, which is thought to lessen hostility in response to a crying baby, and higher oestrogen, which could drive doting parenting. Researchers are still trying to determine the link to PPD. One study suggests fathers with less testosterone have more depressive symptoms postpartum. Overly high testosterone levels in men creates other problems though, as the same research suggests this is linked to more depression in their partners.

The partner’s well-being is an important factor for dads too. In heterosexual couples, fathers are known to struggle if their partner’s mental health deteriorates, especially if the mother doesn’t have a prior history of depression. This was the breakthrough finding of a study published last year, based off an analysis of 15,257 father-mother pairs. It found there was an 81 per cent increase in PPD in fathers whose partners developed postpartum depression where she had no history of mental health concerns.

Fletcher says the findings match his own research. He noticed that dads whose partner had no previous mental health issues are often “blindsided” by their partner’s depression. They have a lot less understanding of how to cope and “why she couldn’t just pull herself out of it”, he says. These experiences reinforce the idea that the whole family’s mental health should be addressed postpartum.

Time for change

Even as scientists work to further advance understanding of paternal PPD, the research of the past two years has started shaping policy. NHS England recently announced the first ever Men’s Health Strategy, a 10-year plan to transform men’s health outcomes, including for perinatal mental health. In some parts of the UK, the NHS has started screening fathers if their partners have perinatal mental health problems and, last year, Australia created the first ministerial cabinet position to oversee men’s health.

“If you look back on the history of perinatal mental health research and policy with mothers, it wasn’t until it was shown [in the early 2000s] that suicide was one of the leading causes of mortality in women that you got this big shift,” says Ellis-Davies, who led the study on suicides in dads. That’s where we now are for paternal PPD, she says. Her discovery of the stark suicide rate in fathers is already helping to “kick open some doors”, including in shaping the Men’s Health Strategy, which she calls a “real game-changer”.

Pressure is building. The charity Fathers Reaching Out estimates that failure to support paternal mental health costs the UK billions of pounds a year, based on the economic impact of suicides, children’s behavioural issues and workplace productivity. “This is not a niche issue,” said Mark Williams, the charity’s founder.

This boom in research offers hope for dads like Lewis-Carter, who has since started a podcast for new fathers. His own recovery from PPD took time and a “lot of work”, he says, and he needed professional support. Eventually, around a year after his daughter’s birth, he sought out a therapist, who he credits with helping kick-start his recovery.

Today, Lewis-Carter loves being a dad to his “full-of-character” 4-year-old. But he wants other fathers to have access to help earlier. “When the dad is in a much stronger place, it’s better for everyone,” he says.

Need a listening ear? UK Samaritans: 116123; US 988 Suicide & Crisis Lifeline: 988; hotlines in other countries.