Baldwin Sharin, Malone Mary, Sandall Jane, Bick Debra
Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.
London North West University Healthcare NHS Trust, London, UK.
JBI Database System Rev Implement Rep. 2018 Nov;16(11):2118-2191. doi: 10.11124/JBISRIR-2017-003773.
The aim of this systematic review was to identify and synthesize the best available evidence on first time fathers' experiences and needs in relation to their mental health and wellbeing during their transition to fatherhood.
Men's mental health and wellbeing during their transition to fatherhood is an important public health issue that is currently under-researched from a qualitative perspective and poorly understood.
Resident first time fathers (biological and non-biological) of healthy babies born with no identified terminal or long-term conditions were included. The phenomena of interest were their experiences and needs in relation to mental health and wellbeing during their transition to fatherhood, from commencement of pregnancy until one year after birth. Studies based on qualitative data, including, but not limited to, designs within phenomenology, grounded theory, ethnography and action research were included.
A three-step search strategy was used. The search strategy explored published and unpublished qualitative studies from 1960 to September 2017. All included studies were assessed by two independent reviewers and any disagreements were resolved by consensus or with a third reviewer. The recommended Joanna Briggs Institute (JBI) approach to critical appraisal, study selection, data extraction and data synthesis was used.
Twenty-two studies met the eligibility criteria and were included in the review, which were then assessed to be of moderate to high quality (scores 5-10) based on the JBI Critical Appraisal Checklist for Qualitative Research. The studies were published between 1990 and 2017, and all used qualitative methodologies to accomplish the overall aim of investigating the experiences of expectant or new fathers. Nine studies were from the UK, three from Sweden, three from Australia, two from Canada, two from the USA, one from Japan, one from Taiwan and one from Singapore. The total number of first time fathers included in the studies was 351. One hundred and forty-four findings were extracted from the included studies. Of these, 142 supported findings were aggregated into 23 categories and seven synthesized findings: 1) New fatherhood identity, 2) Competing challenges of new fatherhood, 3) Negative feelings and fears, 4) Stress and coping, 5) Lack of support, 6) What new fathers want, and 7) Positive aspects of fatherhood.
Based on the synthesized findings, three main factors that affect first time fathers' mental health and wellbeing during their transition to fatherhood were identified: the formation of the fatherhood identity, competing challenges of the new fatherhood role and negative feelings and fears relating to it. The role restrictions and changes in lifestyle often resulted in feelings of stress, for which fathers used denial or escape activities, such as smoking, working longer hours or listening to music, as coping techniques. Fathers wanted more guidance and support around the preparation for fatherhood, and partner relationship changes. Barriers to accessing support included lack of tailored information resources and acknowledgment from health professionals. Better preparation for fatherhood, and support for couple relationships during the transition to parenthood could facilitate better experiences for new fathers, and contribute to better adjustments and mental wellbeing in new fathers.
本系统评价旨在识别并综合关于初为人父者在成为父亲的转变过程中，其心理健康和幸福方面的经历与需求的最佳现有证据。
男性在成为父亲的转变过程中的心理健康和幸福是一个重要的公共卫生问题，目前从定性角度的研究不足，且了解甚少。
纳入生育健康婴儿、未患明确终末期或长期疾病的常住初为人父者（亲生和非亲生）。感兴趣的现象是他们从怀孕开始到产后一年成为父亲的转变过程中，在心理健康和幸福方面的经历与需求。纳入基于定性数据的研究，包括但不限于现象学、扎根理论、民族志和行动研究等设计。
采用三步搜索策略。搜索策略探索了1960年至2017年9月发表和未发表的定性研究。所有纳入研究由两名独立评审员评估，任何分歧通过共识或由第三名评审员解决。采用推荐的乔安娜·布里格斯研究所（JBI）批判性评价、研究选择、数据提取和数据综合方法。
22项研究符合纳入标准并纳入本评价，根据JBI定性研究批判性评价清单，这些研究随后被评估为中等至高质量（得分5 - 10）。这些研究发表于1990年至2017年之间，均采用定性方法来实现调查准父亲或新父亲经历的总体目标。9项研究来自英国，3项来自瑞典，3项来自澳大利亚，2项来自加拿大，2项来自美国，1项来自日本，1项来自台湾，1项来自新加坡。研究中纳入的初为人父者总数为351人。从纳入研究中提取了144项结果。其中，142项支持性结果被汇总为23个类别和7个综合结果：1）新的父亲身份认同，2）新父亲身份的多重挑战，3）负面情绪和恐惧，4）压力与应对，5）缺乏支持，6）新父亲的需求，7）父亲身份的积极方面。
基于综合结果，确定了影响初为人父者在成为父亲的转变过程中心理健康和幸福的三个主要因素：父亲身份认同的形成、新父亲角色的多重挑战以及与之相关的负面情绪和恐惧。角色限制和生活方式的改变常常导致压力感，父亲们采用否认或逃避活动，如吸烟、长时间工作或听音乐等作为应对技巧。父亲们希望在为成为父亲做准备以及伴侣关系变化方面获得更多指导和支持。获得支持的障碍包括缺乏量身定制的信息资源以及卫生专业人员的认可。更好地为成为父亲做准备，并在向父母角色转变过程中支持夫妻关系，可为新父亲带来更好体验，并有助于他们更好地调整和保持心理健康。
