Online mental health screening for rural fathers over the perinatal period.

Objective: To determine the feasibility of identifying distressed fathers in rural areas of NSW via a 'light touch' support program (SMS4dads).

Design: A retrospective observational study using self-reported distress and routinely captured help-seeking behaviour over a 14-month period (September 2020-December 2021) comparing rural and urban fathers.

Setting: Rural and urban Local Health Districts in NSW.

Participants: A total of 3261 expectant and new fathers enrolled in a text-based information and support service (SMS4dads).

Main Outcome Measures: Registrations, K10 score, program engagement, attrition, escalation and referral to online mental health services.

Results: Rural (13.3%) and urban (13.2%) enrolments were equivalent. Rural fathers had higher rates of distress than urban fathers (rural 19%; urban 16%) and were more likely to be smokers, consume alcohol at risky levels and report lower education levels. Rural fathers were more likely to exit the program early (HR = 1.32; 95% CI 1.08-1.62; p = 0.008); however, once adjusted for demographic factors aside from rurality, this increased likelihood was nonsignificant (HR = 1.10; 95% CI 0.88-1.38; p = 0.401). Although engagement with psychological support during the program was equivalent, a greater proportion of rural participants were escalated to online mental health support (7.7%) than urban participants (6.1%); however, this was nonsignificant (p = 0.222).

Conclusion: Digital platforms offering text-based parenting information in a 'light touch' format may be an effective way to screen rural fathers for mental distress and connect them to online support.