Summary: A new study shows that a group parenting intervention significantly reduces male postpartum depression (PPD) in fathers, with over 70% of participants experiencing full remission of symptoms. The program, “Learning Through Play Plus Dads,” also improved child development and strengthened relationships within families.
This groundbreaking approach addresses a previously underexplored area of male mental health, showing that fathers’ well-being is crucial to family dynamics and children’s emotional growth. The study suggests this model could be effective globally, offering new hope for addressing PPD in men.
Key Facts:
- Over 70% of fathers in the study experienced remission from PPD.
- The program improved child social and emotional development.
- Fathers reported reduced intimate partner violence after the intervention.
Source: CAMH
A new study from the Centre for Addiction and Mental Health (CAMH), in collaboration with leading researchers in Pakistan, has demonstrated the effectiveness of an integrated psychosocial intervention aimed at improving parenting skills and symptoms of depression.
The treatment was effective for male postpartum depression (PPD) in a cohort of Pakistani fathers, improving both paternal mental health and child development outcomes.
“Male mental health, and especially postpartum depression in fathers, remains a stigmatized and understudied area,” says Dr. Ishrat Husain, the study’s lead investigator and senior scientist at CAMH.
“Historically, the focus has rightfully been on maternal health during pregnancy and postpartum. However, we’re learning that men also experience substantial emotional challenges as they adapt to new parental roles and are in need of support.”
Globally, around 10 per cent of fathers are affected by PPD, and in societies like Pakistan, where more traditional gender roles dominate, depression rates are even higher, potentially as high as 23.5 per cent.
Published today in JAMA Psychiatry, the study A Group Parenting Intervention for Male Postpartum Depression: A Cluster Randomized Clinical Trial involved 357 fathers from low-income households in Pakistan.
Fathers were randomly assigned to receive either standard care or participate in the four-month Learning Through Play Plus Dads (LTP + Dads) program, a parenting and mental health initiative adapted from a similar program for Pakistani mothers.
Fathers in the LTP + Dads program were provided with calendars detailing child development stages and activities to encourage parent-child engagement. They also attended 12 group sessions led by community health workers and psychologists.
These sessions combined cognitive behavioural therapy to help manage depressive symptoms with life skills training in topics including time management and emotional regulation. Sessions took place weekly for the first two months, then bi-weekly.
The study’s findings reveal that the intervention not only led to a full remission of depressive symptoms in over 70 per cent of fathers with PPD over four months, but also had a positive impact on household dynamics and child social and emotional development.
Fathers who completed the program also showed improvements in well-being, and enhanced relationships with their children and partners. Children in these households also demonstrated improvements in social and emotional development.
These findings echo previous trials with mothers, reinforcing the idea that addressing mental health in both parents is key to positive family outcomes.
The personal stories shared by participants underscore the impact of the program: “I used to get aggressive with my family, including my children,” recounted one father who took part in the study.
“My child wasn’t close to me; he was attached to his mother. Now, I understand why. I used to think a young child couldn’t understand what was happening around him, but I was wrong. He can not only understand and feel, it also affects him.”
“Parenting plays a fundamental role in shaping a child’s personality and their ability to handle stress later in life,” adds Dr. Husain.
“We noticed that as a father’s depressive symptoms improved, social support for both the father and the family improved. This suggests that when people receive training and education about their mental health, they are more able and willing to seek support from their network of friends, family members, and colleagues.”
One of the study’s most interesting findings was a reduction in intimate partner violence. In the study, fathers receiving the intervention reported lower scores on a measure of perpetrated intimate partner violence at the end of the treatment period compared to those receiving treatment as usual.
“This data suggests that the LTP + Dads intervention may reduce the risk of such violence in Pakistani fathers experiencing PPD, leading to healthier family environments overall,” says Dr. Husain.
Dr. Husain believes that this model could have similar success in diverse settings, including Canada, where cultural and social pressures also create barriers to seeking mental health support for men.
“Similar patterns of male PPD likely occur in Canada, which we know is a melting pot of different cultures,” he explains.
“Stigma, cultural beliefs, and the high demand for mental health services often prevent fathers from seeking the help they need. Programs like LTP + Dads could be transformative for men in their transition to parenthood by introducing accessible support and educational services that provide a safe space to process emotions.”
Funding: Funding for this study was provided by Grand Challenges Canada and conducted in close collaboration with Pakistan Institute of Living and Learning (PILL), the country’s largest non-governmental mental health research organization. Building on the success of the initial study, Dr. Husain and the team at PILL have received $2M in further funding to expand the program nationwide.
They are currently scaling the study to include nearly 4,000 fathers and their partners. This expansion means that soon, close to 8,000 parents experiencing depression will have received the Learning Through Play Plus intervention across Pakistan.
The team’s long-term goal is to make this program a routine part of mental health care in Pakistan. The ultimate goal is to apply this work to other populations, aiming to achieve similar outcomes for parents and their children globally.
About this paternal postpartum depression research news
Author: Hayley Chazan
Source: CAMH
Contact: Hayley Chazan – CAMH
Image: The image is credited to Neuroscience News
Original Research: Closed access.
“A Group Parenting Intervention for Male Postpartum Depression: A Cluster Randomized Clinical Trial” by Ishrat Husain et al. JAMA Psychiatry
Abstract
A Group Parenting Intervention for Male Postpartum Depression: A Cluster Randomized Clinical Trial
Importance
Male postpartum depression is prevalent across populations; however, there is limited evidence on strategies to address it, particularly in low-income settings.
Objective
To evaluate the effectiveness of Learning Through Play Plus Dads (LTP + Dads), a nonspecialist–delivered psychosocial intervention, in improving symptoms of male postpartum depression compared to treatment as usual.
Design, Setting, and Participants
This cluster randomized clinical trial was conducted in Karachi, Pakistan, between June 2018 and November 2019. Assessors were blind to treatment allocation. Participants were recruited from 2 large towns in the city of Karachi via basic health units.
Fathers aged 18 years and older with a DSM-5 diagnosis of major depressive episode and a child younger than 30 months were recruited. Of 1582 fathers approached, 1527 were screened and 357 were randomized in a 1:1 ratio to either the intervention or treatment as usual; 328 were included in the final analysis. Data were analyzed from April to June 2022.
Interventions
LTP + Dads is a manualized intervention combining parenting skills training, play therapy, and cognitive behavior therapy. The intervention was delivered by community health workers via 12 group sessions over 4 months.
Main Outcomes and Measures
The primary outcome was change in 17-item Hamilton Depression Rating Scale score at 4 months. Secondary outcomes included anxiety symptoms; parenting stress; intimate partner violence; functioning; quality of life; and child social, emotional, and physical health outcomes. Assessments were completed at baseline and 4 and 6 months postrandomization.
Results
Of the 357 fathers included (mean [SD] age, 31.44 [7.24] years), 171 were randomized to the intervention and 186 to treatment as usual.
Participants randomized to the intervention demonstrated significantly greater improvements in depression (group difference ratio [GDR], 0.66; 95% CI, 0.47 to 0.91; P < .001), anxiety (GDR, 0.62; 95% CI, 0.48 to 0.81; P < .001), parenting stress (GDR, −12.5; 95% CI, −19.1 to −6.0; P < .001), intimate partner violence (GDR, 0.89; 95% CI, 0.80 to 1.00; P = .05), disability (GDR, 0.77; 95% CI, 0.61 to 0.97; P = .03), and health-related quality of life (GDR, 12.7; 95% CI, 0.17 to 0.34; P < .001) at 4 months.
The difference in depression and parenting stress was sustained at 6 months. Children of fathers randomized to the parenting intervention had significantly greater improvements in social-emotional development scores (mean difference, −20.8; 95% CI, −28.8 to −12.9; P < .001) at 6 months.
Conclusions and Relevance
The psychosocial parenting intervention in this study has the potential to improve paternal mental health and child development in Pakistan. Further studies in other populations and with longer follow-up are warranted.
