Unmasking Fatherhood: An Interpretative Phenomenological Analysis Exploring Mental Health Experiences Among Fathers...

To explore how fathers in Singapore experience, interpret, and cope with the emotional and mental health demands of raising an autistic child, and how stigma and support contexts influence coping and help-seeking.

Qualitative.

Interpretative phenomenological analysis guided this qualitative study. Purposive sampling recruited 17 fathers (aged 31-55 years) of autistic children under 18 years living in Singapore, with confirmed DSM-5 diagnoses by trained developmental behavioural paediatricians. The sample was multi-ethnic (Chinese n = 9; Malay n = 5; Indian n = 1; Other n = 2), broadly reflecting the national distribution. Most fathers held university-level education and were in full-time employment. Fathers completed one-to-one in-depth semi-structured interviews from September to October 2025.

Three themes were identified: (1) Fatherhood disrupted: Grief and the spectre of an unscripted future; (2) Holding it together: functioning as a moral metric and the quiet toll of self-reliance; (3) Guarded disclosure: navigating stigma, masculinity and the search for safe spaces.

These findings highlight that fathers' mental health experiences and help-seeking are shaped by identity-level processes that current services have not adequately addressed. Cultural stigma surrounding autism and masculine role expectations influence how fathers interpret and respond to psychological distress by encouraging functional self-monitoring and discouraging emotional disclosure, thereby delaying help-seeking and under-recognition of clinically relevant distress in fathers. The study reveals a significant need to understand paternal experiences in greater depth before designing interventions, and points to the importance of father-inclusive support structures that recognise the intersection of disability-related stigma with culturally specific masculine identity standards. Further research is needed to examine the longer-term trajectories of paternal coping and the potential consequences of sustained reliance on functional self-monitoring as the primary indicator of wellbeing.

Nurses and allied health professionals should recognise fathers of autistic children as distinct, underserved recipients of mental health support whose experiences are shaped by identity-level processes rather than symptom recognition alone. Practice should explicitly invite fathers into psychoeducation, coaching and care-planning conversations rather than defaulting to mothers as the sole service interface. Engagement strategies should use functional, role-sustaining language that aligns with how fathers conceptualise their own wellbeing, while remaining alert to the risk that such framing may inadvertently reinforce avoidance of emotional processing. Service pathways should integrate autism-specific peer-based entry points with clearly signposted escalation routes to professional mental health care. Culturally attuned practice should acknowledge the compounded effects of courtesy stigma, affiliate stigma and Confucian-influenced masculine norms, so that help-seeking can be framed as an expression of paternal duty rather than an admission of failure. Nurses are often the first and most sustained professional contact for these families; they are well placed to lead a two-step engagement pathway: first using capability-oriented language to lower the threshold to contact, then, within a trusting relationship, introducing emotion- and identity-level reflection and clear escalation to specialist care. Embedding father-inclusive, gender-sensitive and culturally safe competencies in nurse education and advanced practice would help nurses detect paternal need that symptom-based screening alone is likely to miss.

What problems did the study address? Fathers of autistic children are disproportionately vulnerable to mental health difficulties yet remain peripheral to autism caregiving research and services. This is particularly the case in Asian contexts, where culturally specific masculine norms and disability-related stigma shape paternal help-seeking in under-examined ways. This study addressed how fathers in Singapore experience, interpret and cope with the mental health demands of raising an autistic child, and how stigma and support contexts influence their coping and help-seeking. What were the main findings? Fathers described their child's autism diagnosis as a turning point that disrupted expected fatherhood trajectories and required them to reconstruct what it meant to be a competent and caring father. They conceptualised mental health through functional capacity and moral duty rather than through emotional distress language, and they navigated compounded help-seeking barriers arising from the intersection of courtesy stigma, affiliate stigma and Confucian-influenced masculine norms. Autism-specific, peer-based, activity-embedded support emerged as the most acceptable form of help, while professional mental health services were positioned as a last resort. Where and on whom will the research have an impact? The findings will inform nurses, mental health clinicians, paediatric and early intervention professionals and policymakers designing father-inclusive autism caregiving services in Singapore and comparable multi-ethnic Asian contexts. The study will also extend the global autism caregiving evidence base by contributing an underrepresented Southeast Asian paternal perspective that foregrounds identity, masculinity and cultural stigma as central to paternal mental health.

COREQ guideline.

This study did not include patient or public involvement in its design, conduct or reporting.